It's been said that the crucial differences, which distinguish human societies and human beings, are not biological, they are cultural. And perhaps, nowhere is that more true than in the United States -- one of the most ethnically diverse countries in the world, representing varied racial, ethnic and cultural groups. In this challenging healthcare environment, how do you communicate effectively to ensure your patients receive the best care?

The 2000 U.S. census figures provide an interesting fact: We are a nation of many colors. Once a nation where whites were the uncontested majority, whites now make up around two-thirds of the total U.S. population. In some cities and large metropolitan areas, whites are the minority. In the last five years, Asian, Pacific Islander and Hispanic communities grew by 18 percent each, the African-American community grew by 3 percent and the Caucasian community grew by just 2 percent (Butler, 2001).

Culture is a term used by social scientists to describe a way of life. Every human society has a culture, which is a manmade part of the environment. It represents our ideas, values, symbols, traditions, institutions and technology. We learn our cultural characteristics through socializing and interacting with our cultural, religious or ethnic group.

Culture is not always obvious and does not need to equate ethnicity or religion. Culture creates and can limit human choices; therefore, cultural diversity has very strong implications for educators and healthcare workers. Multiculturalism is a political or social philosophy that promotes cultural diversity (Fain, 2002). Through education of different cultures we can understand and appreciate them better.

We must be culturally sensitive when interacting with students, patients, co-workers and their families. We must look at our own cultural background and understand how our biases affect our interactions with others. Cultural sensitivity shows an appreciation of human diversity and hopefully assures the appropriate and individualized respect everyone deserves.   

Our values, which originate from our cultural group, are instilled upon us as children. This may be very different from the current cultural group we live in. "Different living is not living in different places, but creating in the mind a map" (Spender, 1933). Cultural values are things we hold important; just as each individual holds certain values, each culture promotes different ones.

For example, the American culture values independence. In contrast, Asian and Latin cultures and many others value family interdependence and prefer to have family members care for each other.

As Hispanic healthcare professionals, we encounter various cultural and ethnic groups that are very different from ours. In the American culture, men and women are viewed as equals. In Hispanic cultures, males are dominant. For example, female patients who need to make decisions about their healthcare will wait for their husband or a male family member to determine what's best. Healthcare providers should not disturb such signs of male dominance nor misunderstand the male's role because it's a normal practice for many cultures.

As healthcare providers, we should not necessarily treat patients in the same manner that we want to be treated. The Golden Rule of "do unto others" does not apply across cultures. Instead, treat patients as they want to be treated. Culture determines the rule of polite and caring behavior. We should not be offended if patients fail to look us in the eye or fail to ask questions about the treatment or procedure to be performed. This may be due to the patient's culturally prescribed way of showing respect for our knowledge and position.

Although we sometimes have distorted and limited views of other people's culture and history, we must find ways to achieve cultural competency. To learn about a culture, awareness must be raised: What language do they speak? What do people in the society wear? Which foods do they eat? How and where do they live? How do they govern themselves? How do they judge right from wrong?

Awareness can be achieved through knowledge and attitude. Knowing about different cultures, beliefs, values and traditions is essential. While no one can be expected to know everything about every culture, we should learn the common patterns of the populations we typically encounter. However, we must keep in mind the fact that there are variations both within each group and among individuals.

Through attitude we can understand that people's ways of doing things may be a little different, but equally valid. It is essential to realize that cultural beliefs and traditions are adaptable to different environmental circumstances and have developed because they led to the survival of its members. We must try to view people as interesting rather than different. If we understand the beliefs and values of different cultures, we can become better human beings and healthcare practitioners.

The difference between human beings makes the world an interesting place in which to live. But when people concentrate on these differences, they often fail to appreciate how similar all human beings are. Most of the distinction people make between themselves and others have more do with culture than with biology (Swedlund, 2002).

In an attempt to understand and identify patients with multicultural needs, the Culture Connection Continuous Quality Improvement Team at South Miami Hospital developed the Culture Tool that can be used in didactic and clinical settings. The tool describes culture and language, belief practices, nutritional preferences, communication awareness and patient care/handling of death for different ethnic groups to promote equal and fair medical treatment for all. Click here to download the table (72 KB PDF).

As educators and healthcare professionals we must continually nourish awareness and understanding of the cultural needs and differences of our students, patients and customers. Ultimately, our goal is to achieve cultural competency.

— Jorge A. Casanas, MEd, RT(R)(CV)(QM), is an imaging services supervisor at South Miami Hospital and an adjunct faculty member for Miami-Dade College Medical Center Campus. Helena M. Coello, MEd, RT(R), is the quality data and systems coordinator at South Miami Hospital. Both are instructors at Baptist Health South Florida.