Cultural Competence

January 25th 2016

Our understanding of what a health care practitioner encounters in a clinical setting can
easily be undermined. If anything, we may have thought about extreme cases such as a patient
having a life-threating condition or a red flag, or how to communicate with patients who are
unaware of the philosophy of Chiropractic. However we may not have consider the
ethical/race/religious challenges we will face in practice. With different race/ethnicity/religion
can come barriers towards a patients understanding and/or acceptance of care Chiropractors
provide. To myself, I may not have an issue receiving a manipulation from a female Chiropractor
of a different race. However, there is a possibility this might not be an unacceptable act to some
races or ethnicities, or perhaps it conflicts with the individuals religious beliefs. This is not just
limited to technique treatments, but many other clinical situations as well. For example; South
Asians are three five times more likely to develop type two diabetes compared to the general
population, and having higher cardiovascular related disease from their large obesity rates.1 The
execution of exercise in the South Asian lifestyle is not a habitual way of life 2. Neither is there a
sufficient amount of protein in their diets 3. Considering Chiropractic care is very much
conceptualized around prevention of illness and disease, exercise and referrals to dietitians is
something that can be heavily prescribed to obese patients. For a lack of better words,
prescribing exercise and diet to South Asians may be a harder crowd to appeal too. Another issue
that may be encountered with this culture is a lack of confidentiality. South Asians have a
tendency to be accompanied by family members during face time with a professional, even if this
professional is a doctor. There exists a very real possibility of the information discussed with the
patient can be sensitive or/ or server, and may not be in the interest of the patient for family to be
present in that disclosure. Its also been observed in a study that South Asian countries may not
be fully attentive to informed consent forms, which can be a latent issue down the road with unwillful treatment. Regardless, a consent form should be discussed in full detail with a patient
regardless of race, ethnicity, or culture. 4 But this allows us to conceptualize the kind of situations
one can encounter with different demographics.
In the eyes of the patients, male Chiropractors may be portrayed as more qualified for the
physical demands of the profession. A persona still lingers between the two genders which males
are perceived to be more suitable for the physical performance of the job, and females approach
with a gentler nature of care and are more suitable for maternal and young patients. Women
Chiropractors actual are up to par with the manipulations produced in clinic to that of their male
competitors.5 Which allows for the female Chiropractic community to receive some recognition
for their physical capabilities. Still, the female community comes across a disadvantage it seems.
According to stats, female physicians have a lower employment rate and lower career success
compared to that of male physicians. Female practitioners seem to be more-likely to search for
part-time work, and apply a lot of their time to managing a family. This can carry over to giving
the male community a sense of leadership in the practice. However, while male practitioners
associate themselves heavily into Chiropractic, they may receive less fulfillment over time in
other aspects of social life, leisure activities, and overall satisfaction.6

Outside of gender, race, ethnicity and religion, there also exists sexual orientation of a
patient. Gays, lesbians, transsexuals, or bisexuals are significant portion of the population.
Knowing the patients sexual orientations and gender identities is something very important for a
health-care practitioner to be aware of. These can be associated with mental illnesses, suicide
rates, cancers, and sexually transmitted diseases to name a few. Efforts to promote the discussion
on sexual orientation between patient and doctor should be made as it poses as a valuable asset to
ensure the most is being to the patients care.7

References

1. Ghutarora, A. SAPNA and the Region of Peel Initiate Successful Dialogue around
Healthier Environments for Canadian South Asians. 2013. Retrieved from
http://mysapna.org/sapna-and-the-region-of-peel-initiate-successful-dialogue-aroundhealthier-environments-for-canadian-south-asians/
2. Palo Alto Medical Foundation Sutter Health: Fitness. 2015
3. Asian Nation. Asian Cuisine and Foods. 2015. Retrieved from http://www.asiannation.org/asian-food.shtml
4. Kallivayalil, R. Chadda, R. The International Journal of Person Centered Medicine.
Culture, Ethics and Medicine in South Asia. 1:1, 2015.
5. Forand D, Drover J, Suleman Z, Symons B, Herzog W. The forces applied by
6. female and male chiropractors during thoracic spinal manipulation. J Manipulative
Physiol Ther. 2004 Jan;27(1):49-56.
7. Buddeberg-Fischer, B. Stamm, M. Buddeberg, C. Bauer, G. Hammig, O.
Knecht, M. Klaghofer, R. BMC Health Services Research. The impact of
gender and parenthood on physicians' careers - professional and
personal situation seven years after graduation. 10:40. 2010.
DOI: 10.1186/1472-6963-10-40