Family practitioners have recognized the importance of cultural competence in health care for many years. "The American Academy of Family Physicians is committed to ensuring high quality of care and patient safety by promoting access for limited English proficient (LEP) patients, cultural proficiency, expanded health workforce diversity, and reduced health disparities in the provision of medical care to our nation's LEP and racial/ethnic medically-underserved populations. Cultural proficiency is a necessary component for patient safety and adherence. All persons, regardless of race, ethnicity, or primary language deserve access to high quality health services." (AAFP Position Paper 2008)
The AAFP is not alone, however. Knowledge and skills of cultural competence are recognized as an essential element of quality medical care for America's diverse population by medical professions (AAFP and American Medical Association), accrediting bodies (Centers for Medicare and Medicaid Services and Joint Commission), organizations that set requirements for medical education (Association of American Medical Colleges and Liaison Committee on Medical Education), and at least five state medical licensure boards.
The US Government embraces and requires culturally competent medical care. In December 2000, the Department of Health and Human Services endorsed the National Standards for Culturally and Linguistically Appropriate Services (CLAS) as a way to achieve the national Healthy People 2010 goal to eliminate health disparities. Indeed, Title VI of the 1964 Civil Rights Act guarantees equal access to federally funded services, regardless of people's gender, age, race, ethnicity, religion, or national origin, including people of limited English proficiency.
Multiple reports illustrate how quality care for a diverse American population requires a primary care system that is culturally competent and patient-centered. The Institute of Medicine's (IOM) 2001 report "Crossing the Quality Chasm" documented the failures of the American medical system and asserted that the system must become equitable and patient-centered, as well as safe, timely, efficient, and effective. The following year, the IOM released Unequal Treatment, a powerful critique of how health care providers' prejudices, biases, and stereotyping contribute to unequal treatment of racial and ethnic minorities.
Given these requirements and mandates for culturally competent quality care, this chapter addresses three topics. Why is cultural competence important? What about culture is important in medicine? And how can physicians provide culturally competent care in clinical settings?
American Academy of Family Physicians. Principles for Improving Cultural Competency and Care to Minority and Medically-Underserved Communities (AAFP Position Paper). 2008. Available at: http://www.aafp.org/online/en/home/policy/policies/p/princculturproficcare.html. Retrieved May 25, 2009.
Institute of Medicine: Crossing the Quality Chasm: A New Health System for the 21St Century. Committee on Quality of Health Care in America. National Academies Press. 2001.
Smedley BD et al: Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Institute of Medicine, Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. 2002.
US Department of Health and Human Services: National Standards on Culturally and Linguistically Appropriate Services in Health Care. ...