Cultural competence in pediatric radiology: Hispanic culture
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COMMENTARY
Cultural competence in pediatric radiology: Hispanic culture Nicholas Heitkamp 1 & Richard B. Gunderman 1 Received: 20 July 2020 / Revised: 20 July 2020 / Accepted: 1 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
A Spanish-speaking woman was receiving prenatal care for the delivery of her fifth child. Through an interpreter, her obstetrician asked whether she would like to undergo a tubal ligation after the birth, so that she would not need to worry about contraception in the future. She replied that she would, and informed consent for the procedure was documented. Several months later, the baby delivered and the sterilization performed uneventfully, the patient returned for a routine postnatal care. As the visit was drawing to a close, she turned to the obstetrician and asked, “So doctor, how soon will I be able to become pregnant again?” In the immortal words of the screenplay of 1967’s Cool Hand Luke, what we have here and in countless similar situations in contemporary health care is “a failure to communicate” [1]. In one sense, the woman received first-rate care — both her delivery and tubal ligation were technically exemplary. But the patient and physician were separated by a gap in understanding — each heard the other’s words but did not really understand what the other intended. Good medical care hinges on mutual understanding between patient and physician, and when the two come from different cultures, extra effort is often needed to ensure such understanding is achieved. It is vital that all physicians, including pediatric radiologists, understand at the least the fundamental features of other cultures commonly represented in their patient populations. At this point in American history, nowhere is that cultural understanding more urgently needed than in the care of Hispanic patients. Hispanics and Latinos now make up the secondlargest ethnic group in the United States, numbering 60.6 million people [2]. By 2050, their number is expected to increase
* Richard B. Gunderman [email protected] 1
Department of Radiology, Indiana University, 702 North Barnhill Drive, Room 1053, Indianapolis, IN 46202, USA
to 106 million [3]. On average, they are much younger, less formally educated, and far more likely to be immigrants than the average American [4]. Both the Association of American Medical Colleges (AAMC) and the Accreditation Council for Graduate Medical Education (ACGME) mandate education in cultural competence. The AAMC states that “The faculty and students must demonstrate an understanding of the manner in which people of diverse cultures and belief systems perceive health and illness and respond to various symptoms, diseases, and treatments” [5]. The ACGME specifies that residents should be able “to communicate effectively with patients, families, and the public across a broad range of cultural backgrounds” [6]. Despite such mandates, however, there is work to be done. To begin with, it is important to recognize that culturally competent care is not guaranteed sim
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