Cultural Competence

RNZCGP cultural competence guidelines released

The RNZCGP Cultural Competence document was released at the College’s annual conference in Rotorua in July 2007. The aim of this document is to provide a framework and guidelines to assist general practitioners (GPs) to create and/or maintain culturally competent practices in New Zealand.

It is important to define just what we mean by culture and cultural competency. Definitions of culture are often confused by using terminology such as race and ethnicity. but a basic definition of culture reveals a far broader understanding.

One definition of culture is:

The totality of socially transmitted behaviour patterns, arts, beliefs, institutions, and all other products of human work and thought. These patterns, traits, and products considered as the expression of a particular period, class, community, or population and can be expressed in intellectual and artistic activity and in the works produced by the culture or cultural group.

Culture is essentially a convenient way of describing the ways members of a group understand each other and communicate that understanding. More often than not, the nuances of meaning are generated by behaviour rather than words, and much of the interaction between members is determined by shared values operating at an unconscious or taken for granted level. Many groups have their own distinctive culture: the elderly, the poor, professional groups, gangs, the army.

In terms of New Zealand’s population, there are many cultures. to be aware of and they are not necessarily based on one’s ethnicity, race, nationality or religion. Commonly recognised New Zealand cultures include (but not exclusively):

• Mäori
• New Zealand/European
• Pacific Peoples (e.g. those from the islands of Polynesia, Melanesia and Micronesia)
• Asian (e.g. Chinese, Malaysian, Thai, Korean etc.)
• European
• Other immigrant populations (e.g. Somali, Russian etc.)
• Catholic
• Jewish
• Arabic
• Gay/Homosexual and Transgender
• Teenagers/Elderly.

All of these cultures can have differing approaches to accessing, understanding and accepting health care, hence the need for health practitioners to develop cultural competence in the provision of health care.
It is also the case that patients can belong to multiple cultures simultaneously. As health practitioners, the key is to ascertain those cultural affiliations by routinely asking about a patient’s ethnicity, religion, hobbies, profession, and other aspects of their life through a thorough social history.

In this way, you can recognise and respect the potential effects each culture may have on a patient. For example, if a 15-year-old Mäori boy is brought in with an injured leg, his concern about the length of his recovery may have to do with his position on his school’s cricket team, planned attendance with his whänau at a headstone unveiling (hura kohatu), a desire not to miss his first date with a cute classmate, or his duties at the family’s marae. Some of these concerns are general to 15-year-old boys, others are specific to Mäori adolescents. By recognising that any of these may play a role, you will be better prepared to inquire about his concerns as well as allaying them and/or working out the treatment plan that is most acceptable to everyone involved.

Interpreting what is meant by cultural competence is complicated by the fact that even the government legislation has avoided providing a clear definition for the term used in the Health Practitioner’s Competence Assurance Act. Again, we will establish a broad understanding that cultural competence is:
· an awareness of cultural diversity and the ability to function effectively, and respectfully, when working with and treating people of different cultural backgrounds.

A culturally competent doctor will acknowledge:

• That New Zealand has a culturally diverse population
• That a doctor’s culture and belief systems influence his or her interactions with patients and accepts this may impact on the doctor-patient relationship
• That a positive patient outcome is achieved when a doctor and patient have mutual respect and understanding.

[Taken from the introduction to the report]