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In this MD Newsline exclusive interview, internist/HIV specialist Dr. Pete Thomas and resident physician/public health professional Dr. Janelle Hadley sit down to discuss cultural competence and how to provide culturally competent care.

Dr. Pete Thomas:

What is cultural competency and what role does it play in your practice? How do doctors gauge and earn a patient’s trust?

Dr. Janelle Hadley:

“For me, cultural competency is being aware of your patient population. What are things that your patient population faces every day? How do they get to the doctor? Are they working? Are they stay-at-home parents? What are some of the things that they’re dealing with in their communities? Right?

We were talking about Flint, Michigan. Water is a big thing in their community. If you’re a physician who works in Flint, you should understand what does the patient population look like regarding gender and ethnicity. What are things that they are facing day-to-day? Also, the history there. Right? I think it’s important to understand mentally where patients are coming from.

Is there a trust dynamic that there’s an issue between healthcare providers and patients? Right? If you don’t understand the history, then you don’t understand sometimes people’s actions and why they do or don’t do certain things. If they’re not compliant with their medication, it’s not just because, ‘oh, they don’t listen.’ Right? Is there a trust issue there? Is there an issue where they can’t access their medications because of finances? Things like that. Those are parts of what cultural competency means to me.

I think you have to really be a skilled physician to gauge and earn a patient’s trust. And what do I mean? I don’t think that skill is dependent on time or whether or not you’ve been practicing for twenty years or five years. I think it’s more of a feeling and being invested in the patient. You can go into the room and have a conversation with a patient, but if you don’t feel that there is honesty or trust—you feel that.

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If you go into the room and you’re just there for numbers or time, then you won’t understand that there are people who are not opening up to you, and it’s not just because it’s a time thing. Right? It’s a feeling—’does this patient fully trust me?’ Or, is this patient just there because they want to get a medication and go. I think for me and my patients, trust is something that’s established over time.”

 

Dr. Janelle Hadley:

Is there something that providers can do to increase their cultural competency so that they’re not a barrier, coming between a patient and the care that they need?

Dr. Pete Thomas:

“So first, let me say, I think there’s nothing like having a diverse workforce. I mean, I’ve said that three times. Imma say it again another three times. You can give these workshops, and I agree with giving cultural competency workshops, but there’s nothing like working next to someone that is transgender, that is a cisgender Black woman or an Asian American male. The more diverse you are, the more you can have real conversations.

And it’s not conversations about medicine and how to treat this case or that case. It’s conversations about your humanity. So then, when the trans woman walks in, you don’t have a foreign relationship with them. It’s organic. You work with this person. You just had lunch with this person. Yes, it’s wasn’t actually that person, but it was someone who looked like them. So I think the more diverse the workforce is, the better feeling the patients will have that they are genuinely respected and cared about.

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The other thing that could happen is workshops. There’s nothing like having a trans organization come in, give a workshop, and share their experience. There’s nothing like having a cultural competency workshop. They don’t take the place of having health diversity. I’m talking, not an ‘either or’ but an ‘and.’

Now the other thing that I think really needs to happen is medical staff having open conversations and sharing their experiences among themselves about these issues. So you’d be surprised when you hear Black women talk about not feeling heard when they go to their providers. And you think, ‘Wow, that’s Dr. so-and-so. Well, how can she not be heard?’

When people look at me, they don’t think that I’m a physician. So, having that conversation and recognizing that as a man, there’s certain privileges that I take advantage of that I don’t even know. That people will assume that I’m a doctor and I don’t have on a stethoscope. I just have on my coat. Now, being an African American male physician, that’s a little bit different, but in general, there are challenges around how we as providers relate to our patients.

And I think that the more we can have honest conversations among each other—and that means some uncomfortable conversations that we might need to have with our colleagues to say, ‘yes, I get pulled over by the police for no reason.’ And they need to hear that because then they can say, ‘that’s never happened to me. What do you mean you got pulled over? What’d you do?’ ‘Nothing. I was just driving home.’

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And they can’t believe it. And they get livid. And they get upset. And I’m like, ‘but that’s my existence.’ So I think the more we can have honest conversations like that—the more we can have trans people come in and talk about their experiences, have our LGBT brothers and sisters come in and talk about their experiences—the better, whether you agree with them or not.

When you’re in healthcare, your job is to take care of patients. So anything that gets in the way of that becomes a barrier. Our patients already have enough barriers. A healthcare setting is the one place where they should be able to come to and not feel judged.

And I think that we are getting to the point where that’s happening, but we have to normalize it more. I have seen that there’s certain places where people still feel violated and vulnerable. It’s nothing overt. It’s always covert. It’s always, you know, ‘go have a seat over here, and we’ll figure out what to do with you.’ Right? It’s not said, but it’s implied.

Many times it’s a matter of exposure. It’s emergency rooms. It’s urgent care centers. It’s some primary care centers where they’re not used to seeing a diverse population. And I just think we need to start having honest conversations, have more trainings, and of course, hire more diverse staff.”

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