"Any document claiming to describe what Canadian patients are like would horrify me. (And what could it say? That we are boring, white, conservative??)

What about American patients? How would you describe them in a training or cultural competence textbook? If you feel that Americans are too diverse to characterize in such descriptions, be aware that the same is true of Mexicans, Chinese, Africans, Canadians... (Read more)

As a cultural competence trainer for about 12 years (and trainer-of-trainers), I must express my deep sadness to see expressed here on the list such a divergence of views about a basic issue when the facts are well known. There are, in fact, national standards for cultural competence instructors that explicitly address this issue of whether or not to describe groups of people on the basis of perceived shared characteristics. These standards take the strong position that a "recipe" approach to listing cultural and clinical descriptions of groups should be rigorously avoided. The standards can be found in Gilbert, J. (ed) (2003). */Principles and Recommended Standards for Cultural Competence Trainings of Health Care Professionals/*. Los Angeles, CA: California Endowment.

To quote from another source: "Interviews with service providers identified a need for professional training, but available training materials adopted a "cookery book" approach with lists of cultural norms, and descriptions of cultural differences. This approach, in which the special features of "the Asian family" or "the Afro-Caribbean child" are explored, with rigid notions of culture, has done little to challenge racist stereotypes. It also allows professionals to ignore their own prejudices and leads to pigeonholing, stereotyping, and "victim blaming." (Webb, E. and Sergison, M. (2003). Evaluation of cultural competence and antiracism training in child health services. Archives of Disease in Childhood. 88:291-294.

On a more personal note, I've heard several complaints from individuals in specific ethnic or racial minorities who felt stereotyped when hearing broad descriptions about their group in cultural competence trainings. In one case, during the coffee break of a workshop that I gave in June 2006, one white gentleman approached me to give an enthusiastic review of a well-known trainer and author in the field who speaks about specific ethnic groups. Five minutes later, a Latina participant (who had not heard this conversation) spontaneously ranted against the same author and told me that, while listening to the author speak about Latinos, she felt insulted as well as stereotyped.

I think there are a number of authors and educators who feel that they know how to handle with sensitivity, in writing or in classrooms, descriptions of specific ethnic groups. Many of us strongly question that assumption and feel that these descriptions, however well intentioned, are based on opinions and overgeneralizations, not demographic facts. Such descriptions are also potentially dangerous because health care providers who hear or read them may make decisions based on the descriptions and not the beliefs or practices of the individual, unique patient facing them.

Culturally competent health care is not about cultural lists. At its roots, it is about patient-centered care and asking the right questions. Which is great for ALL of us. (Even Canadians!)

Marjory

P.S. Two weeks ago at a federally-sponsored cultural competence training, an African American police detective came up to me at coffee break asking me if cultural competence training endorsed these types of cultural lists about African Americans. He then admitted that some widespread assumptions about the kind of food he likes irk him (he doesn't like watermelon etc). Even more troubling for him was the common idea among providers that he is somehow an expert on what African Americans think.