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Beyond Cultural Competence: The Family Medicine Educator as “Cultural Broker”

Beyond Cultural Competence: The Family Medicine Educator as “Cultural Broker”. Elizabeth Lee-Rey, MD Nereida Correa, MD Hispanic Center of Excellence Albert Einstein College of Medicine Margi Gold, MD Department of Family Medicine and Community Health, Montefiore Medical Center

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Beyond Cultural Competence: The Family Medicine Educator as “Cultural Broker”

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  1. Beyond Cultural Competence:The Family Medicine Educator as “Cultural Broker”

  2. Elizabeth Lee-Rey, MD Nereida Correa, MD Hispanic Center of Excellence Albert Einstein College of Medicine Margi Gold, MD Department of Family Medicine and Community Health, Montefiore Medical Center Bronx, New York

  3. Objectives • To discuss the competencies that are needed to be an effective “cultural broker” • To highlight the role for physician advocacy in navigating various social and health care systems that impact on patient health and well being.

  4. Cultural Competence • At the level of individual provider- Defined as “ a set of academic and interpersonal skills that allow individuals to increase their understanding and appreciation of cultural differences and similarities within, among, and between groups.”

  5. What is Cultural Competence to a successful cross-cultural encounter? • Awareness of diversity • Respect for these differences • Empathy • Curiosity

  6. Does Cultural Competence go far enough?

  7. What is Cultural Brokering to a successful cross-cultural encounter? • Understanding and incorporating the needs and perspective of cultural diversity while understanding forces that impact health-their linkages and their interactions.

  8. What does it mean to be a cultural broker? • Go beyond Cultural Competency 101 • Accept often other needs feel more immediate then health care • Acknowledge need for navigating various social and health care systems • Acknowledge systems are seen as difficult and adversarial • Advocate for patients when systems are unfriendly or complicated

  9. Questions to consider • Does cultural competence limit us to a paternalistic view of non-dominant cultures? • Is cultural competence enough to bridge the gap between physician-patient and health-wellness in individual and community? • Is there a role for the family physician in helping patients to define and develop skills to navigate systems?

  10. Case 1 • GW brings in 6 year old nephew whom she has legal guardianship for prescription for Ritalin. School has advised that child can not return unless he is on medication. GW who is a recent immigrant wants nephew in school. At home GW also has terminally ill mother.

  11. How would you deal with situation?

  12. Cultural Competence 101 would consider: • From another country • No control over situation • Education is important • Stressful living conditions • No social support • Literacy/Language Barriers

  13. A Cultural Broker could ask: • Do you know your options? • Do you understand what is being requested? • Do you know how to make an appointment to see you nephew’s teacher? • Can you help him with his homework?

  14. Case 2 • AB is pregnant and wants a medical abortion. AB has sent her own paperwork home for fear of INS but submits relative’s documentation. AB is currently employed under this assumed identity.

  15. Cultural Competence 101 would go as far as… • Immigrant fears • Access to free clinic • Nonjudgmental care

  16. A Cultural Broker could ask: • Do you know that identity fraud can put you and friend in jail? • Are you aware that no documentation can get you deported? • How do you plan on getting health care?

  17. Case 3 • RP presents to a community health center with c/o of vaginal bleeding. She is undocumented and evaluation and workup determine that she will need aggressive management and therapy for uterine cancer with metastatic spread. Access to outpatient pain medication is proven difficult.

  18. Cultural competency 101 would go as far as: • Empathy • Foreign born • Identify social supports • Referral for concrete social services

  19. A Cultural Broker could ask: • Do you know how to obtain your green card? • Do you want the embassy to intervene on your behalf? • What will you need to get through? • Do you have enough food and clothing?

  20. Questions to consider • Can we be cultural brokers within the scope of our practice? • Can we be competent physicians without being cultural brokers? • How does this impact on individual and on community health and wellness?

  21. Conclusions • Accept responsibility – we make a difference not only in patient lives, but also in the health and well being of our community

  22. “It is much more important to know what sort of a patient has a disease, than what sort of disease a patient has.” -William Osler

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