Culturally Competent, Pursuing Deeper Human Understanding with Scientific Rigor

What does culturally competent healthcare mean to you? Medical students across Maricopa County competed in the 2021 MCMS Medical Student Essay Contest. The winner was Mayo Clinic, Alix School of Medicine's Stephen O'Neill, MS-II.

Science is the art of asking questions, and centuries of questions have been asked with the sole purpose of helping providers better understand the patients before them. Posing grand questions about the nature of existence allows us to describe the nature of the individual in new ways we had not previously thought of. For example, there was a time when we knew nothing of genetics or the social determinants of health, but now we regularly describe patients in the context of nucleotide polymorphisms or their social environment. So, when you consider your patient—plainly draped in a poorly patterned gown, shifting uncomfortably on exam table paper—consider that Nobel Prizes have been awarded on behalf of elucidating the mysteries of that individual. In academia it is understood that the more we learn about an individual, the better we can treat them. Cultural competence is an application of that academic truth: the more we understand an individual, the better we can care for them. It not only makes the patient-provider relationship more meaningful, but it improves our ability to understand the intricacies of our patient.

To say that cultural competence is a preformed understanding of someone’s ethnic background or geographical location is too limiting. Culture is complex and protean and may even be difficult for an individual to define about themselves, so we should not assume a person’s culture is limited to our understanding of it. Cultural competence exists through a desire to learn about others by giving them the opportunity to be understood as they understand themselves to be. It is a practice that requires humble questioning and space. In fact, cultural competence largely exists in the space between asking a question and receiving an answer. It is here that patient and provider take account of each other; the patient will decide if they can truly share themselves with the provider, and the provider will decide if they are truly willing to listen. If we do not show genuine interest in learning from our patient, we risk treating a façade. How, then, will we say we have improved someone’s quality of life if we have no sense of what gives their life meaning?

Defining Cultural Competence

Healthcare providers will appreciate that within the confines of the exam room they may be interacting with the most private aspects of a person’s life, but we should be careful not to conflate this with the idea that we are automatically interacting with the most important aspects of a person’s life. A physical exam is a deeply personal interaction, but a personal interaction alone will not divulge the intricacies of a patient’s humanity. This is why it is necessary to define cultural competence as a conscious process and not a trait. It is the process of asking, listening, and learning. The exam room merely provides the opportunity for meaningful interaction but does not confer it; it is up to the provider to ensure the encounter is made meaningful by learning about the culture that defines their patient.

The Key to Cultural Competence

The opportunity to interact with patients in this intimate manner is a well-respected privilege. Each interaction offers the chance to learn a great deal about humanity, but applying cultural competence allows us to learn about humanity in ways more central to our being than the subatomic forces that stitch together our miles of DNA. This is why we use the word “sacred” to describe the patientprovider relationship. It is sacred because if we approach it with humility and cultural competence, we have the ability to learn profound truths about people and the world we inhabit.

…It is necessary to define cultural competence as a conscious process and not a trait. It is the process of asking, listening, and learning.

Ultimately, cultural competence should be just like science: ask questions because you are inspired to do so. A humble awe of the natural world has always driven science forward, and the complexity of an individual should stir no less wonder. There will always be more to learn about the world around us and those in it, so we should use all of our faculties to do so. The key to cultural competence is that we approach learning about others with the same dedication that we have used to unearth the mysteries of our biology, because, at the end of the day, novel discoveries in either realm have the same result: a better understanding of the human in the gown, on the exam table, in front of us. ■

BY STEPHEN O’NEILL, MS-II, MAYO CLINIC — ALIX SCHOOL OF MEDICINE