MCC role objectives
- Initiate an interview with the patient by greeting with respect, attending to comfort and to the need for an interpreter if applicable, orienting to the interview, and consulting with the patient to establish the reason for the visit (1.1)
- When appropriate, facilitate collaboration among families and patients, while maintaining patient wishes as the priority, ensuring confidentiality, and respecting patient autonomy (1.5)
- Gather information about the patient’s concerns, beliefs, expectations, and illness experience (2.3)
- Identify the personal and cultural context of the patient, and the manner in which it may influence the patient’s choices (3.2)
- Provide information using clear language appropriate to the patient’s understanding, checking for understanding, and clarifying if necessary (3.3)
- Negotiate between patient and family, respecting patient wishes as primary (2.3.1)
- Recognize that attitudes to confidentiality may vary (Aboriginal peoples, minors) (2.3.3)
- Incorporates the patient’s experience and context into problem identification and management
Entrustable professional activities
- Lead and work within interprofessional health-care teams (8)
- Collaborate with patients, families and members of the interdisciplinary team (9)
- Establishes and maintains proficiency in clinical knowledge, skills and attitudes appropriate to Internal Medicine (2)
- Seeks appropriate consultation from other health professionals, recognizing the limits of one’s own expertise (5)
- Accurately elicits and synthesizes relevant information and perspectives of patients and families, colleagues and other professionals accurately (9)
- Conveys relevant information and explanations accurately to patients and families, colleagues and other professionals (10)
- Develops a common understanding on issues, problems and plans with patients, families and other professionals to develop a shared plan of care(12)
- Demonstrates a commitment to their patients, profession and society through ethical practice (19)
- Demonstrates knowledge of and applies the professional, legal and ethical codes for physicians (21)
Cultural diversity in Canada
Canada is one of the most culturally diverse societies in the world. Working in any of the health care professions almost anywhere in the country, physicians will interact with patients or other health care workers from the following backgrounds:
- Indigenous peoples of Canada
- Canadian-born, of western European heritage
- Canadian-born, second or third generation from non-western cultures, with or without a knowledge of their heritage language and culture
- Immigrants who have lived in Canada for many years, who have retained little of their heritage language and culture
- Immigrants who have lived in Canada for many years, who have retained most of their heritage culture, including language, integrating little into Canadian society
- Recent immigrants, unilingual, with little or no experience of other cultures
- Recent immigrants who have a wide variety of intercultural experience and who may speak several languages
- Canadian training programs have recognized the necessity of educating learners — and teachers — in the knowledge, skills and attitudes of cross-cultural communication.
- Cultural sensitivity and communication skills are two of the main themes of the MCC role objectives.
- If, as many feel, physicians should approach every patient encounter as potentially cross-cultural, what skills and knowledge do they need? What attitudes are needed for good cross-cultural communication?
- Many physicians and their training programs believe that the major task in developing greater cultural sensitivity is simply learning more about other cultures (Lingard, et al). Such a “cultural cookbook” approach is clearly impossible and trying it could also lead to cultural stereotyping.
- Others might feel that, simply by having lived in or immigrated to another culture, they have acquired cultural competence or sensitivity. This is not necessarily true.
The increasing awareness of cultural issues in health care has profoundly influenced the field of bioethics, another of the main themes in the MCC role objectives. The standard western, principle-based approach taught in medical schools is being challenged. For instance, the feminist movement has changed the way we think about the care of patients, especially in gendered and reproductive issues. Further, the globalization of society, especially in health care, has resulted in the need to approach bioethics from a cross-cultural perspective. This raises many problems and issues. If my values differ from those of my patient, how should I act? Must I accept the behaviour of another culture toward certain groups in society, such as women, if I find that behaviour unethical from my cultural perspective? Do I act according to accepted Canadian standards toward a patient who clearly prefers his or her own cultural norms?
In this case and the “Reflective exercises” that arise from it, we will examine three aspects of culture, bioethics and the interaction of the two:
- Self-awareness and self-reflection about one’s own culture, both personal and medical — this is the attitude part
- The skills involved in cross-cultural communication
- The Canadian medical culture and how it may differ from your previous experience — this is the knowledge part
Although intended primarily for graduates of non-Canadian medical schools, Canadian-trained physicians who want to improve their cross-cultural skills can also benefit from this information.
There are two “Self-assessment” quizzes and one “Reflective exercise.” They are designed to help you assess your knowledge, skills and attitudes about cultural issues in the medical domain and, as such, there are no right or wrong answers.
Reflective exercise 1
Read “Becoming interculturally competent” by Milton J. Bennett.
In this article, Bennett describes six stages of “intercultural sensitivity.” It is generally accepted that the acquisition of such skill is necessary in order to function as a professional in a cross-cultural environment. After reading the article, do the following exercises. Think about the level of intercultural sensitivity that is exhibited in each scenario. Where do you think your level would be if you were involved in a similar situation? What level do you think is needed by a physician in Canada?