Incorporating empathy, cultural competence in medicine

Oct 19, 2016, 10:11 AM by Stephen Hadley
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Second-year medical student Ali Mahmoud was named the winner of the 2016 Hector P. Garcia M.D. Cultural Competence Award during a luncheon Sept. 16.

This year’s event marked the 20th year anniversary of the essay contest and awards ceremony. The program, sponsored by the Office of the President and the Hispanic Center of Excellence under the direction of Dr. Norma Pérez, recognizes a student “who demonstrates commitments to providing quality health care to all by incorporating cultural competence in his or her service to others.”

The award is named in honor of Dr. Garcia, who graduated from the UTMB School of Medicine in 1940, and became well known throughout Texas and the U.S. as a trailblazer in the fight for civil rights for Mexican-Americans in Texas. Dr.Garcia’s efforts contributed greatly to improving access to health care for minorities and ending segregation in Texas hospitals.

“As someone who comes from a religious and ethnic minority in this country, improving life for minorities in whatever way I can has been something I’ve been passionate about from a very young age,” said Mahmoud. “My mentors have guided me in the direction of learning about other cultures and backgrounds and that’s where I find purpose. This work has allowed me to integrate my desires as a physician and my passions as a human being and a minority.”
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Mahmoud’s essay relayed the importance of cultural competency in a clinical atmosphere, where patient interactions are becoming ever shorter. This year’s event also introduced an abstract/poster contest that was won by third-year medical student Paige Hoyer.

During the luncheon, Rebecca Saavedra, vice president for Strategic Management, was honored for initiating the event and maintaining Dr. Hector P. Garcia’s enduring legacy at UTMB.

The luncheon, attended by members of Dr. Hector P. Garcia’s family, also featured a keynote speech by Dr. Eduardo Sanchez, chief medical officer for Prevention for the American Heart Association, which focused on the importance of cultural competency, diversity in medical schools and health care for Hispanics in Texas.

Winning Essay by Ali Mahmoud:

Cultural competence is a skill that takes years to develop but is truly manifested in a few, sacred moments. It's a skill that is most relevant with patients of a particular racial, ethnic, religious, or sexual minority, and in today's clinical atmosphere of shorter patient interactions, being prepared to act properly around patients of different backgrounds is essential to being a competent physician. The uniquely beautiful quality about cultural competence is that it cannot be rushed or faked. It is not something that can be picked up by simply reading a textbook. A mentality of tolerance coupled with dedicated time spent learning about another culture, language, or way of life is the only way for a physician to exhibit true cultural competence. Without adequate work, a physician will not have the ability to truly connect with patients from minority backgrounds in a way that is meaningful to them.

As someone who came from a religious and ethnic minority that has had a history of being marginalized in this country, I was drawn to the idea of activism and tolerance at a very young age. I have been active in volunteering within my local community since my early years in high school through attending interfaith events and raising awareness on issues of discrimination. This inspired me to pursue a degree in sociology in college, as well as start a minority social fraternity that was the first of its kind. These activities did not only allow me to build pride in my religion and heritage, but it allowed me to understand and appreciate the struggles of other backgrounds in my community as well. Social justice and tolerance could not be monopolized by any particular group. The more I worked with my community and learned about others, the more I realized that the problems of my community were often part of a larger systemic issue in our country. Our community's problems were simply a different form of the same problem that other communities were facing. The true solution was in working with other community activists, understanding their struggles, and figuring out how we could work together to make our common home a better place for everyone.

Upon being accepted to medical school, I decided that it was time to take what I learned working within my own community and use that knowledge and experience in my career by exhibiting cultural competence toward other backgrounds. Since beginning medical school a year ago, I have not only been involved with student organizations of my own background and others, but have pursued the Bilingual Health Track, interacted with the Hispanic Center of Excellence, volunteered at St. Vincent's clinic, was named Mr. UTMB by the American Medical Women's Association at UTMB, and attended the Building the Next Generation of Academic Physicians (BNGAP) American Medicine Career Development Regional Conference that was geared toward helping minorities pursue academic medicine. These experience have not only enriched my understandings of other cultures but have revealed the use of cultural competence. This has empowered to me to learn more about other people so that I can be the best physician within my capabilities.

One instance was particularly revelatory. I was with my attending physician on a preceptorship over the summer. We were seeing an elderly Hispanic woman who had diabetes. She could not speak English. She had peripheral neuropathy, and my physician checked her feet for any ulcerations. After checking her feet, he began to tell her grandson, who was serving as her translator, about all of the maintenance and precautions that his grandmother needed to take to avoid further complications with her feet. He mentioned that if she wasn't careful, she could be at risk for amputation in the future. The grandson turned to his grandmother, and uttered "Just make sure to check your feet" in Spanish. He had been on his phone while the physician was speaking and was not paying close attention to what he was saying. Knowing that I spoke Spanish, my attending physician looked at me, urging me to intervene. We both knew that the grandson had not done an adequate job at translating.

Everything I had learned about Hispanic culture, cultural competence, and Spanish rushed through my head. It was time for me to act. I took a deep breath, and translated what the attending physician had wanted to say to the best of my ability. The grandmother listened attentively. I asked her if she understood what I said, and she nodded. I asked her if she had any questions, and she said that she did not. I then turned to her grandson and told him in Spanish that his grandmother's condition is serious and that she depends on him. I told him that without his help, we cannot help his grandmother. He was a part of the healthcare team, and his grandmother needed him. To my surprise, the young boy agreed with what I was saying and gave his grandmother a hug. The value of family was something that was deeply instilled in him already; he just needed a reminder. His grandmother looked at me with approval and smiled.

Those moments meant the world to me. While it may not have been a textbook situation of how translation in a clinic should happen, it was a reflection of that reality and a wonderful learning experience. I learned that day that being competent with other cultures was not only important for improving the delivery of healthcare but for building trust in patients and their families. Building trust for physicians is just another way of breaking down the barriers to healthcare. When the barriers are being broken down for members of a minority population, true equality and tolerance are that much more accessible for them. It takes years for physicians to build true cultural competence that is expressed in only a few moments, but those moments can be the most powerful and meaningful moments in one's career.

It's the through these small instances that we can cumulatively help the situation of entire peoples. Physicians who are culturally competent are more than just healthcare workers. They are advocates of social justice.