…acute renal failure after being treated by her voodoo priest with kerosene-soaked sugar cubes for a cold; the patient believes that the medical problems she is experiencing are caused by evil spirits.
In addition, representatives of certain ethnic groups may not respond to treatment in the same way that other groups may. Some drugs used to treat tuberculosis such as Isoniazide, for instance, may not work as well in black patients as in whites. Such differences might be caused by what are called genetic polymorphisms. And in the treatment of hypertension, certain medications which focus on blocking the neurohormonal axis such as angiotensin converting enzyme inhibitors and beta-blockers may not reduce blood pressure to goal levels as readily in African Americans as in Caucasians when those medicines are used as monotherapy.
Some Chinese patients may have an exaggerated response to the beta-blocker propranolol, to which they may exhibit an unusual sensitivity. There are many other examples of differences which can affect clinical outcomes between different groups.
The main thing is that doctors must realize that the patient must first be assessed according to the cultural, racial, ethnic, and other special characteristics that he or she brings to the clinical setting. It has to be understood that “one size does not fit all”, and that treatment has to be tailored for the individual, or personalized.
Once the practitioner has been properly educated about the principles of cultural competence, he should then concentrate on learning the methods of approaching the patient. The most important facet on which to concentrate is effective communication, both non-verbal and verbal.
Non-verbal communication refers to elements such as looking the patient in the eye, and expressing an attitude of welcome and genuine interest in the patient’s problem. As Sir William Osler said, “it is more important to consider what sort of patient has a disease, rather than what sort of disease the patient has”. Just the knowledge