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Docs: Cultural divide hampers care

BY DELTHIA RICKS
STAFF WRITER

September 7, 2005

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 health care 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 health care 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 of the doctors responding to the survey said they felt ill-prepared to cope with patients who had held health beliefs at odds with Western medicine or who were recent immigrants. Another 20 percent 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 during their residency 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 today's Journal of the American Medical Association, 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.

In the report, he and his colleagues write: "Our study is the first, to our knowledge, to obtain a national estimate of the readiness of new physicians to deliver high-quality care to culturally diverse populations."

Partially underwritten by a grant from the Commonwealth Fund in Manhattan, the research suggests cross-cultural education should be as much a part of training as the clinical principles of medicine. The fund is a nonprofit group whose mission is improving the quality of care for low-income and uninsured people and members of minority groups by supporting research spotlighting critical issues.

Anne Beal, senior program officer at the fund, said with the growing number of diagnoses for diabetes, hypertension and congestive heart failure among vast segments of the population, it's important that physicians fully communicate with patients. Such medical conditions, she added, require an ongoing relationship between doctor and patient.