Abstract: Cultural competence requires sensitivity to the diverse ethnic, religious, and cultural expectations of patients in our health care system. In the increasingly multicultural world of the city hospital, patients will benefit from increased cultural competency on the part of health care providers. This study interviews Japanese, Korean, and Indian immigrants to the United States, showing that these individuals hold vastly different expectations concerning: 1) when to seek medical assistance; 2) the role of the doctor in the community; 3) the role of the patient and the patient's family in conversations with the medical specialist; 4) the roles of doctors versus nurses; 5) issues of privacy and disclosure to patient and family; 6) organ donation; and 7) end-of-life care. The paper concludes with immigrants' views on what would make their medical experience in the United States more comfortable, and, hence, potentially more beneficial to their mental and physical health. Key Words: Cultural Competence, Japanese, Indian, Korean, Patient Care
As the population of the United States grows more diverse, the need for culturally sensitive care also grows. As one article attests (Flores, 2000), presently 31 million patients speak different primary languages than their health care providers. Numerous studies already have explored the attendant need for culturally sensitive care theoretically (Harwood, 1981; Kleinman, 1978a; Salimbene, 1999) and curricularly (Caudell, 1996; Flores, 2000; Palmer, 1997; Zweifler & Gonzalez, 1998). While some authors argue that health care providers must become adept interviewers of their patients, so that they may gauge each patient's needs appropriately (Elwyn, 1997; Jones, Bond, & Cason, 1998; Pachter, 1994), others emphasize the importance of general education about, and awareness of, cultural differences (Bartol & Richardson, 1998; Salimbene, 1999; Sullivan, 1989). Although some studies explored the attitudes of specific populations toward issues of health, illness and medical care (Beine, Fullerton, Palinkas, & Anders, 1995; Kleinman, 1978b; Salimbene, 2001), these remain the exception rather than the rule. Far more common are theoretical studies that end with a call for substantive education and qualitative research (Navon, 1999).
This article seeks to answer that call through a careful examination of the cultural attitudes of patients from Japan, Korea, and India, all of whom utilize the health care system in the United States. As immigrants, these three patient populations share certain characteristics in common, such as feelings of uncertainty and trepidation when encountering an unfamiliar medical system; feelings of frustration when they are unable to communicate their symptoms effectively in English; and feelings of anger when they believe they are being viewed with suspicion and distrust by predominantly Anglo hospital staffs. Nevertheless, because Japanese, Korean, and Indian societies each articulate different cultural meta-narratives regarding illness and healing, individuals from these countries hold divergent patient expectations. Further, conversations with immigrants from these three Asian countries highlight the extent to which medical care in the United States, especially at the end-of-life, has become divorced from the kinds of spiritual rituals and narratives that traditionally have framed life cycle transitions such as birth and death. The challenge of providing sensitive health care to persons coming from cultures steeped in spirituality offers doctors, nurses, and hospital staffs in the U.S. the opportunity to learn more about diverse cultural worldviews as they seek to ease suffering and promote healing among their patients.
This study utilized in-depth ethnographic interviews. In-depth interviews involving both patients themselves (Beine et al., 1995; Coulter, 2001; Mackinnon, Gien, & Durst, 1996) and health care providers (Blendon, 2001; Kirkham, 1998) have been used by several other studies that seek to understand the attitudes of specific populations to particular issues associated with health, illness and medical care. …