Cultural gap may affect care

While doctors acknowledge that communicating clearly with patients is a key factor in clinical decision-making, many resident physicians report being unprepared to adequately communicate with people who are culturally different from themselves.

Residents -- up-and-coming doctors who treat tens of thousands of patients in the nation’s teaching hospitals -- say they are not being adequately trained to cope with the increasingly diverse populations requiring medical treatment. They acknowledge needing better training to understand the cultural, ethnic, racial and religious differences encountered.

“In terms of successfully providing cross-cultural care, the weight is on the medical establishment” to provide the training, said Dr. Joel Weissman, an associate professor of healthcare policy at Massachusetts General Hospital in Boston.

He conducted a national survey of more than 2,000 resident physicians in their last year of training to assess opinions about healthcare delivery to patients who may not speak English, may be socioculturally different from the doctor, or may have religious practices that are foreign to the treating physician.

One in four doctors responding to the survey said they felt ill prepared to cope with patients who held health beliefs at odds with Western medicine or who were recent immigrants. Another 20% said they were not well versed in addressing patients whose religious beliefs affected their care. The survey found about half the doctors had little or no training in providing culturally competent care, including understanding how to address patients from different cultures, identify patient mistrust and understand religious and cultural customs.

Reporting in the Sept. 7 issue of the Journal of the American Medical Assn., Weissman said residents generally support the importance of cross-cultural care, but he added there appears to be no meaningful education and mentoring in this area.