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Multicultural Medicine and Health Disparities
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- Cultural Competency: Current Practice;
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Multicultural Medicine and Health Disparities
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However, patients from other countries or cultures may be accustomed to different processes. In certain countries in Latin America, for example, patients are expected to walk in to a clinic or practice, take a number, and wait for the provider, instead of being scheduled for a specific time. Likewise, patients may favor using emergency services for non-emergent complaints rather than accessing a primary care provider. Some patients may use the emergency department as a medical home because of perceived advantages in accessibility, availability of ancillary laboratory and radiology services, and even availability of interpretive services.
Pediatricians should clarify the scheduling process in their practices. The expression of pain and the health-seeking behavior centered on the relief of pain varies from culture to culture. For example, in some cultures it is considered honorable and desirable to stoically tolerate pain, while these same behavior expectations are not shared by other cultures.
While there are culturally associated variations in patients' expression of pain, physicians' analgesic prescribing responses to patients of different cultures also may vary. Although some research studies have demonstrated that physicians may prescribe less analgesia to ethnic and racial minority populations, there is evidence to suggest that the disparity has lessened over time.
It is increasingly recognized that some patients from the United States or other countries use alternative or traditional practices, medicines, or healers. Families may use these options prior to, in combination with, or after seeking medical care from the pediatrician. In some cultures, the concept of a "folk illness" is embraced and there is a strong belief in a definite constellation of symptoms and treatments associated with the folk illness. Pediatricians should respect patients' health beliefs that may not be consistent with a biomedical model of disease etiology.
Many traditional practices used to treat these and other folk illnesses may be entirely benign, while others have been associated with adverse health outcomes. Folk medicines such as greta and azarcon, often used by Mexican Americans, may contain elevated lead levels and have been associated with lead poisoning in children. However, in some minority populations, this public health campaign has not been as effective. African American mothers, for example, are more likely to share beds with their infants and place them in a prone position to sleep, both risk factors for SIDS.
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Co-sleeping is considered a culturally acceptable, if not desirable practice, in some communities. Additionally, in large families with few resources, co-sleeping can be viewed as a necessity rather than an option. Identifying these factors can help to ensure positive health outcomes.
Differences in religion, for example, may exist. This allows for a much more thorough and accurate history and exam, she adds. It also helps answer questions such as why a patient may not take a certain medication or follow through with treatment recommendations. In general, understanding cultural context can enhance the overall clinical picture and help providers render more informed care.
Cultural competency also enhances communication and understanding. More thoughtful questions and communication can also help patients feel more connected to their physicians. This, in turn, can lead to better patient engagement, compliance with medical treatment, and outcomes. According to kevinmd.
The Office of Minority Health also provides a blueprint that practices can use to operationalize these principles.