# A story about clinical cultural competency



## wanderingmedic (Feb 22, 2016)

Preface: I have not talked about it much on these forums, but I am studying sociocultural anthropology at a major research university in the US. My work analyzes the ways immigrants perceive American biomedicine, and how American medical providers can provide good care to immigrant populations. I decided to post this story about a patient that I cared for several years ago. I hope you find it interesting, and that it makes you consider the cultural elements at play when we interact with people who seem different from us. This piece is part of a larger paper I wrote a few years ago. 

If you're willing, I would love to hear about your experiences caring for patients from other cultures. Have you learned any "tricks" in caring for people who seem very different? 

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I smiled as I walked into the patient’s room. The cool weather had left me in cheery spirits, and I was looking forward to finishing up my last call of the night so I could go home and enjoy the rest of my evening. My partner and I had received a request to transfer a pediatric patient on a ventilator to the Children’s Hospital for specialized intensive care. What I did not realize is that this call would shift the paradigm through which I saw many of my patients, but not in the way I practice clinical medicine.

As I rounded the corner into the room, I saw everything I expected. The patient was sedated and on a ventilator with multiple medications running into his IVs. What took me by surprise was an older woman, the patient’s mother, standing in the corner of the room. She was fully veiled – something I had never seen in person before. I could only see her eyes through narrow slits cut in her head covering - nothing else. I had been advised about these “veiled” people before. In cultural sensitivity training I was told how easy it was for young men to cause offense and get sued. The resounding message from these trainings was “don’t look, don’t talk, don’t touch.” But I could not help but to interact with this mysterious woman. She had a look in her eyes that was somewhere between confused, and terrified, and I felt sorry for her. I quickly introduced myself and did my best to overcome the awkward silence that filled the room. A smile and a touch to the patient’s shoulder as I began my assessment helped to cut the tension. The nurse gave report, and stated that the veiled woman had not spoken since she arrived at the hospital. As I listened to the nurse, my eyes glanced back to the veiled woman. I began to gently talk the woman through what we were doing, not even knowing if she understood what I was saying. But I realized that as I talked to the veiled woman, the veil that defined her to me began to fade away, and the more I interacted with her sick son, the more I saw a mother who cared for her child. The more I saw beyond the veil that seemed to separate us. The more we became connected.

The transport was about thirty minutes to the children’s hospital. On the road my partner (who was driving) rocked out to the song “Highway to Hell” in the cab. The veiled mother sat beside him in the passenger seat. It was an ironic convergence of cultures; me, and my caucasian blue-collar partner interacting with a family that had alien cultural practices, and notions of propriety. The transport itself was uneventful, and every so often I would see the dark brown eyes of the veiled mother peering into the rearview mirror at me. I would smile and gently nod - trying to reassure her that her child was okay. 

When we arrived the children's hospital I helped situate the patient in bed, and rechecked the patient's ventilator settings and medications. Just as I was about to slip out of the room, the veiled woman outstretched her hand. Her eyes were watering as I outstretched my hand in return. She took my hand and shook it. Then, she wrapped her arms around me in a hug, whispering into my ear “thank you.” I was blown away. The last thing I expected was for the veiled woman to interact with me on such a personal level. All of my assumptions about our differences faded away as I realized we had much in common. In that moment I could not help but to reach back in response to a mother’s simple act of kindness to me. I cannot imagine what it would be like to be a mother, and see your child clinging to life; dependent on a ventilator. But the concern of a loving mother is something much greater than cultural boundaries. Both the mother and I broke from the expectations set forth for us: I did not act “by the book” because I became emotionally involved in the care of a patient, and the mother reached out and broke her silence. We formed a connection. But, our connection was ambivalent because of the conflicting forces at play that seemed to unite, and push us apart simultaneously. It is these connections that allow us to adapt to new environments and cultures, while also maintaining our own unique identity.


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## johnrsemt (Mar 14, 2016)

I always talk calmly to the family in the room, either at the hospital or at home (or scene)  even if they don't understand the words, they understand the tone.  Keeping the family calm is important (not always possible though).    I always ask if they have any questions, and I explain what we are doing as we do it, or before if possible.   I am careful to watch how the family and patient reacts to what I am saying, and keep it basic, unless they ask more detailed questions, and the answers don't bother them.
Most families want to know what is going on and like to be kept informed
It helps them and helps us look more professional.    

I had a pt we took to a small ED with the fire dept and then a few hours later I transported to a larger hospital ICU with the private service I worked for:  At the ICU the mother told the nurse that she was happy to see me again, because she understood everything that I did for her daughter, because I explained it to her.  She also said the nurses and doctor would not volunteer anything and any question she asked they either answered yes or no, or gave 1-2 word answers.    During the transport I read the chart and explained what was done at the hospital, and why they did what they did or gave the medications that they gave.
  The nurse at the ICU pulled me out into the hospital and told me to stop talking so much to the patients family because "Then they always expect it from the nursing staff"  I found out later that the mother heard that comment and complained about the nurse.

I would want to know things


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