2015 Hector P. Garcia M.C. Cultural Competence Award
Third-year medical student Jorge Roman was named the winner of the 2015 Hector P. García M.D. Cultural Competence Award during a luncheon Sept. 18.
Roman’s essay, which touched on the importance of empathy and appreciating cultural diff erences while practicing medicine, was selected from a record number of submissions for this year’s competition. The double-blinded essays were reviewed and ranked by representatives from the four schools.
The program, which is sponsored by the Office of the President and the Hispanic Center of Excellence, recognizes a student who “demonstrates commitments to providing quality health care to all by incorporating cultural competence in his or her service to others.”
Roman said he considers García a role model for the ways he served his community and patients throughout his life, and that service inspired his essay.
“The process of writing this essay helped remind me of a saying that ‘the pre-clinical years are the pre-cynical years,’” Roman said. “Empathy can sometimes be lost over time and some forget why they started medicine in the first place. It’s always good to come back and remember what my values are, what I believe in and what I want to do with my career. Anyone can go and write a prescription. It’s something else to care for another human being.”
UTMB President Dr. David Callender said that García was a pioneer in the many ways that he cared for his patients and that UTMB is proud to celebrate his legacy as a distinguished alumnus.
“Dr. García believed that everyone had a right to an education and no one should be denied access to health care for any reason, especially ethnicity or socioeconomic status,” Callender said.
Also during the luncheon, García’s family and the memorial foundation that bears his name announced the establishment of an endowed scholarship within UTMB’s School of Medicine. Dr. Juliet V. García, director of the University of Texas Americas Institute, was the keynote speaker at this year’s luncheon.
Hector P. Garcia M.D. 2015 Cultural Competence Winning Essay
by Jorge Roman
Culture can be described as a collection of a person’s knowledge, beliefs, and behaviors. Culture involves many elements such as language, customs, values, and thoughts that are often tied to geographic, ethnic, racial, religious, or social groups. For the health care provider it is important to realize that culture has strong influences on health, disease, and health care delivery. To be culturally competent a person needs to be aware of his/her own world views as well as those of the patient. Cultural competence involves having the ability to obtain information about a person’s culture and applying that knowledge to improve patient care; while at the same time avoiding stereotyping and misuse of knowledge.
A major problem with the idea of cultural competency is that it suggests that culture can be reduced to a learned technical skill that clinicians can be trained in to develop an expertise. Culture is often made synonymous with other things such as nationality, language, or ethnicity and this can lead to the formation of stereotypes. I have heard many patients being referred to as the “Mexican patient” or the “Chinese patient”. These labels lead to assumptions that people of certain groups have a defined core set of beliefs and values about illness owing to fixed ethnic traits. This type of labeling leads to stereotypes such as “all Mexicans believe this,” or “the Chinese believe that,” Cultural competency then becomes a set of “do’s and don’ts” that define how to treat a patient of a certain ethnic background. The task we are thus faced with as clinicians is being able to understand a person’s “culture” in the face of illness in order to deliver the best care possible. The French philosopher Emmanuel Levinas believed that the earliest step that we must take when faced with human suffering is acknowledgement. Acknowledgement of a person as an individual and not as representative of a group. Issues of the individual take precedence over epidemiological and cultural ones.
Culture is not something that is fixed but something that changes in response to multiple variables that ultimately affect all aspects of experience for an individual. Culture is melded by a person’s political, economic, religious, and biological conditions and as such becomes a process for us that changes the way we experience. Morals, beliefs, ideas, and emotions change and grow with each individual throughout their lifetime. Culture is different even within the same ethnic or social group due to differences in things such as socioeconomic status, personality, age, and religion. A person’s individual and collective identity is shaped by an innumerable number of factors. So then how do we as health care providers take into account a person’s cultural identity when providing care given the remarkable variability and differences within and between different groups of people?
It was a typical night like any other on the Labor and Delivery service during my OB/GYN clerkship. The first thing we do as medical students is go introduce ourselves to all of the patients under our care. On this particular night I walk into the first room and say the usual “Hi my name is …I’m a medical student and I’m part of the team taking care of you tonight.” The patient responded with “Hablas espanol?” This was nothing out of the ordinary as our patient population includes many people who only speak Spanish. I told her “Yo hablo espanol” and continued with my interview. I continued to go back and check in on her throughout the night. Just like all the other patients we were taking care of I would go back in and inform the patients and families about what was going on and made sure they were doing okay. It was later that night, a few hours after she delivered, that she told me how nice it was to have someone who spoke Spanish taking care of her and her family. There is something distinct that happens when you’re able to talk to a person in their native tongue versus through a translator. Emotional content, expressions, and information are gathered in such a way that you are able to get a better sense of how the patient is feeling. It can help people feel more comfortable with one another, especially during times of stress or sickness. I was able to connect with her through our shared language and this made her healthcare experience better. In this experience lies the foundation of what I believe it means to be culturally competent; the ability for two people to understand one another despite differences in where they are from and how they grew up. But does a person need to speak Spanish in order to connect with someone who only speaks Spanish? How else do we overcome obstacles like a language barrier or customs in order to achieve cultural competency?
Because I can speak Spanish I was given the opportunity to work at Shriners Hospital for Children during my psychiatry clerkship. Many of the patients and families who come to Shriners for treatment are from Mexico or other South American countries and speak only Spanish. It was during my time at Shriners that I experienced what I believe lies at the core of cultural competency, empathy. The capacity to feel and understand what another person is experiencing within the other person’s frame of reference. The patients brought in for treatment suffer from terrible injuries and many times suffer a great deal of loss and emotional trauma. Day in and day out patients struggle with pain, anxiety, and fear while they travel along the road to recovery. During my time at Shriners I have learned that human emotions are universal across all cultures, continents, and ages. A mother’s love for her child is something so universally understood by people that it transcends any obstacles or hurdles that may present when a child needs help. It becomes much easier to connect with another person when you share a common goal.
Inequality makes people sick. As the United States becomes more diverse, there is increasing evidence that demonstrates the impact of sociocultural factors on healthcare. It is well known that economic, political, and social structures are major determinants of our health. Sociocultural differences between healthcare providers and patients influence communication between one another and thus clinical decision making. Communication between patient and physician is directly linked to overall quality of care. To this day, minority groups experience higher rates of disease, death, and poor health outcomes. Latinos have higher rates of obesity and diabetes. African-Americans die of cancer and AIDS at higher rates than whites. African-Americans and Latinos seen in emergency departments have higher pain scores but receive less pain medications. Cultural competency is vital to reducing health disparities. Health care that is respectful and responsive to the needs of diverse patients is what we as health care providers should strive for.
Cultural differences inherently create obstacles that must be overcome to provide people with the best care possible. Cultural competency in medicine began as an attempt to teach healthcare providers about population groups, their cultural norms, and expecially cultural peculiarities regarding healthcare. By now every nurse and doctor in teh United States is aware of Jehovah's witnesses and their beliefs with regards to blood products. But the meaning of cultural competency and its impact on medicine has evolved since its inception. What started out as a generalization of groups of people, has become something more centered on treating the individual and patient centered care. Cultural competency has become something that strives to improve healthcare by individualizing, rather than standardizing, health care interactions. I think Dr. Garcia was a pioneer in this movement and he made this an essential part of how he practiced medicine.
I come from a background very similar to Dr. Garcia. My parents were Mexican immigrants who came to Texas to better their lives. The footprint a person leaves on society is their legacy and surely Dr. Garcia has left us a legacy of compassion. He was a person who went above and beyond his duties as a physician for not only the care of his patients, but for the wellbeing of humanity as a whole. He is a reminder of the oath I took when I started this journey.
"...I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug." --Hippocratic Oath
I believe what Dr. Garcia envisioned when he fought against Mexican-American discrimination was a world where people were treated with the saem quality and standard of care regardless of their circumstances. Cultural competency is what Dr. Garcia embodied when he acknowledged, understood, and respected his patient's individual values, beliefs, and behaviors in the clinical setting as well as outside the healthcare field. He was an admirable example of how a person can use a position of leadership to advocate for others. I am grateful to have people like Dr. Garcia to look up to.