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    Creating culturally competent patient care

    Doctors and staff must understand the forces at work outside of the exam room

    In the 4th century B.C., Hippocrates understood that illness has—in addition to its biomedical context—an environmental, social, and behavioral context.1 Today, we understand that access to vision and eye care can be influenced by a variety of non-biomedical factors, including health literacy, language, race and ethnicity, patient perceptions, trust, and cultural values and beliefs.2 Both patients and optometrists are more likely today to bring to the clinical encounter a complex cross-cultural array of attitudes, customs, preferences, assumptions, expectations, practices, and fears that help decode experiences, form perspectives, influence decisions, and drive behavior.


    The importance of understanding culture

    Having an understanding of cultural norms can help identify and mitigate many of the cultural barriers that negatively impact quality and perpetuate disparities in health and health care, especially among racial and ethnic populations who frequently are at increased risk for certain ocular morbidities like glaucoma and diabetic retinopathy. With the racial and ethnic population in the U.S. expected to increase from 37 percent to 57 percent by the year 2060, the need for cultural competency as a component of quality health care becomes more compelling each day.3 Former U.S. Surgeon General Antonia Novello commented at the recent annual meeting of the American Public Health Association that, “prevention cannot work unless you understand the culture of the people.”4

    Related: Tips for serving Latino patients

    Each of us represents a blend of cultures that are conditioned by the collective and diverse experiences of our age, race, ethnicity, gender, sexual orientation, education, religion, socioeconomic status, geographic residence, and even our occupation or profession. Cultural diversity can introduce an unexpected dimension into the traditional biomedical paradigm of ophthalmic care. Conflicts can arise and interpersonal relationships can suffer when cultural-based dynamics clash. Such conflicts in health care can adversely affect communication, understanding, compliance, satisfaction, and ultimately the opportunity to achieve the most optimal health outcomes.

    Next: Accepting the cultural realities of your practice 

    Edwin C. Marshall, OD, MS, MPH, FAAO
    Dr. Edwin C. Marshall is professor emeritus of optometry and public health at Indiana University. Prior to his retirement in 2013, he ...


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