Clinicians appear to benefit from the information we gather during patient assessments, and broaden their views of the social and cultural contexts of patient care, but do they then explore these factors on their own with future patients? In the face of chronic time constraints, and their appreciation of the opportunity to discuss cases with us, they may be more inclined to call the CCS the next time they encounter difficulties due to social and cultural differences, rather than attempt a clinical ethnography interview on their own.
In order to change practices, it may be necessary to directly link the CCS experience with more purposive teaching, as in the London model described above. The retrospective, descriptive analysis of our cultural consultation service was based on written records of the consultation requests intake forms and patient assessment reports.
We regularly discussed cases with our expanded CCS team in order to bring in other perspectives, but different interpretations and recommendations might have been generated by other consultants.
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In addition, our intake forms and reports were not always complete and certain patient data were missing. Despite these limitations, we feel that these data allowed us to see some general trends with respect to the issues and situations that pose challenges for clinicians, and to identify the kinds of support and information that may help them to care more effectively for socially culturally diverse patients.
MDD and PH designed the evaluation study. SI and SV conducted the evaluation interviews with clinicians, retrieved the information from the consultation reports, created the data base of coded consultations, and conducted the descriptive statistical and qualitative analyses.
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PH and MDD drafted the manuscript, and all authors contributed to and approved the final version of the manuscript. Consent forms were signed by clinicians at the beginning of the evaluation interviews. Not applicable. For the three case vignettes provided, we have removed identifying information to protect patient anonymity. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Sophie Inglin, Email: moc. Sarah Vilpert, Email: hc. Patricia Hudelson, Email: hc. National Center for Biotechnology Information , U. Published online Jan Author information Article notes Copyright and License information Disclaimer.
Corresponding author. Received Nov 14; Accepted Dec Associated Data Data Availability Statement The data analyzed during the current study is available from the corresponding author on reasonable request. Methods We analyzed cultural consultation requests in order to identify key patient, provider and consultation characteristics, as well as the cross cultural communication challenges that motivate health care professionals to request a cultural consultation.
Results Requests for cultural consultations tended to involve patient care situations with complex social, cultural and medical issues. Conclusions A cultural consultation service such as ours can contribute to institutional cultural competence by drawing attention to the challenges of caring for diverse patient populations, identifying the training needs of clinicians and gaps in resource provision, and providing hands-on experience with clinical ethnographic interviewing.
Keywords: Cultural consultation, Clinical ethnography, Cultural formulation, Intercultural communication. Background Providing health care across social, cultural and linguistic differences is challenging and may lead to health care disparities and lower levels of care [ 1 ]. The cultural consultation In we created a cultural consultation service CCS to provide direct support to HUG clinicians who encountered cross-cultural communication difficulties [ 35 ].
Table 1 Modified cultural formulation guide used in cultural assessments. Open in a separate window. Methods We reviewed all requests and all CC patient assessment reports from March to December Table 2 Key characteristics of cultural consultation case requests. Table 3 Evaluation questionnaire for clinicians requesting a cultural consultation. Question Type of answer How satisfied were you with the CC? Open-ended question Do you have any other comments you would like to add?
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Open-ended question. Table 6 Categories of requests made by the referring clinicians to the Cultural consultation service CCS.
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Table 7 Examples of cultural consultation requests. Brief clinical description Requests made by the referring clinician A. Young recent immigrant female patient, illiterate and with very basic French language ability who was recently diagnosed with sarcoidosis. The patient complains of drug side effects despite low-dose treatment , massive weight gain and chronic pain.
The patient is depressed and hides her illness from her family and community. Treated unsuccessfully with antibiotics and a drain, she is now refusing all treatments and wants to leave the hospital. When her doctor explained that this would lead to serious consequences for her health, the patient and her mother became angry, stating that only God could predict the future.
Her physician would like help in overcoming this conflict so that he can treat the patient efficiently. He also presented with anxiety and obsessive-compulsive disorder OCD with no improvement despite medical treatment and psychotherapy. Also they were puzzled by the cultural aspects of his obsessive thoughts karmic interpretation of misfortune and were uncertain how to help the patient. Table 9 Examples of key issues identified during patient cultural assessment and main recommendations issued.
Brief case description Issues identified during cultural assessment Main recommendations A. Young recent immigrant female patient treated for sarcoidosis with major side effects, isolated and depressed. The patient was somewhat reluctant to talk openly in front of her sister for fear she would tell others, and the sister did not effectively translate all that was said.
In addition, she was physically unable to fulfill the important role of oldest daughter, which caused tensions at home.
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Female visible minority patient in her late twenties, hospitalized for an acute abdominal infection refusing care. Communication with her doctors and nurses was in English, but neither the patient nor many of her health care providers spoke it fluently. He firmly believed traditional medicine from his homeland could help him, as it had done so in the past. Table 10 Recommendations made by the Cultural consultation. The CC untied a knot… The CC helped create a trusting relationship between the patient and the medical team that was beneficial to further treatment.
What clinicians appreciated about the CCS The CC gave me tools that I can apply to similar situations in the future. Discussion Requests for cultural consultations are relatively few in number but tend to involve patient care situations with complex social, cultural and medical issues. Limitations The most important limitation of our evaluation is that we are unable to say whether contact with the CCS has led to more or better clinical ethnographic interviewing on the part of clinicians.
Acknowledgments None. Availability of data and materials The data analyzed during the current study is available from the corresponding author on reasonable request. Notes Ethics approval and consent to participate Ethical approval was obtained from the Geneva University Hospital Research and Ethics Committee for the evaluation.
Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Footnotes 1 During the first years of the CCS, a small number of assessments were conducted by a migrant care nurse specialist. References 1. Unequal treatment: confronting racial and ethnic disparities in health care: Institute of Medicine; Culture, language, and the doctor-patient relationship.
Fam Med. The challenges of cross-cultural healthcare--diversity, ethics, and the medical encounter. Bioethics Forum. Providing medical care for undocumented migrants in Denmark: what are the challenges for health professionals? Good practice in health care for migrants: views and experiences of care professionals in 16 European countries. BMC Public Health. Dowdy KG.
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The culturally sensitive medical interview. Qureshi B. There will be days when the most important ministry we do is square our shoulders to some hurting person, uncross our arms, lean forward, make eye contact, and hear their pain all the way to the bottom. Says Dunn,. Sometimes releasing these emotions is all that is needed to solve the problem.
The speaker may neither want nor expect us to say anything in response. Sometimes good listening only listens, and ministers best by keeping quiet, but typically good listening readies us to minister words of grace to precisely the place where the other is in need.
Our inability to listen well to others may be symptomatic of a chatty spirit that is droning out the voice of God. Bonhoeffer warns,. He who can no longer listen to his brother will soon be no longer listening to God either; he will be doing nothing but prattle in the presence of God too. This is the beginning of the death of the spiritual life.