Everyone Smiles in the Same Language

“Salam.” It is the only Arabic word I know, but it was enough to put a smile on my patient’s face every morning when I entered her room. My patient had recently immigrated from Egypt at the age of 75 and spoke only Arabic. I used a translator to communicate with her, but I always greeted her with salam when I entered her hospital room. Can you imagine being in a foreign country and trying to navigate the health care system in a language you do not understand? Can you imagine having a medical provider who is unable to appreciate or consider your beliefs and values about health care? These are just some of the challenges that plague patient–physician relationships in our minority population. Who is responsible for closing these gaps in patient care, and what are we doing as a fraternity to improve the cultural competence of physicians?

As health care providers, it is crucial that we understand the impact of a patient's sociocultural background on their health beliefs and behaviors. According to a study in Annals of Internal Medicine, ensuring quality health care for all requires a deep understanding of the unique needs that come with today's multicultural society. Carrillo and colleagues encourage us to strive to provide culturally competent care to all patients (1).

I practice medicine in Miami, the global gateway to the world. Forty-two percent of patients are natives, 52% were born outside the United States, 23% speak English, 70% speak Spanish, and 4% speak Haitian Creole (2). The unique challenges of such a patient population include language, diverse cultural beliefs, mistrust, and illiteracy (2). Health care disparities exist because these barriers affect our patients' behavior in seeking care, their health care outcomes, and the quality of care they receive (3). For this reason, cross-cultural education initiatives and diversity in employee populations are taking center stage in a variety of institutions, including health care. Culturally competent physicians are one of health care's greatest assets in addressing disparities and inequities in health care. Health care institutions use many cross-cultural models to promote cultural awareness, competence, safety, humility, and intelligence in patient care (4). The effectiveness of these modules is often questioned because staff training strategies focus on easily accessible didactics and handouts rather than retention and understanding of information.

Doris Abrishami believes that lectures and training are important tools but are not sufficient to teach cultural competence in patient care (5). I believe that in areas where the workforce is very similar to the patient population, this can be used to promote cultural competence in patient care through an eye-to-eye interactive learning experience. In other words, we can learn these cultural differences from our colleagues through interactive, structured activities for cross-cultural exchange. Many meta-analyses and systematic reviews have found that it is difficult to objectively measure the outcomes of initiatives aimed at bridging health disparities and inequities through cultural competence. But there is strength in diversity that can be harnessed through a culture of mutual understanding and respect.

Salam, the only Arabic word I know, helped me establish rapport with my patient. With a single word, I showed empathy and a desire to understand her feelings and ideas. Our morning communications went smoothly and I was able to build an effective relationship with her. Sometimes it's the little things. Being fluent in Arabic would have been ideal, but learning a morning greeting was a start in the right direction, and my patient appreciated it. After all, everyone smiles in the same language.

Correction: An earlier version of this story incorrectly reported the patient being from Iran. The patient is from Egypt and spoke Arabic. The post was corrected on 1 November 2023.

Reference

1. Carrillo JE, Green AR, Betancourt JR. Cross-cultural primary care: a patient-based approach. Ann Intern Med. 1999;130:829-34. [PMID: 10366373]
2. Miami, FL. Data USA. Accessed at https://datausa.io/profile/geo/miami-fl on 11 October 2023.
3. Juckett G. Caring for Latino patients. Am Fam Physician. 2013;87:48-54. [PMID: 23317025]
4. Shepherd SM, Willis-Esqueda C, Newton D, et al. The challenge of cultural competence in the workplace: perspectives of healthcare providers. BMC Health Serv Res. 2019;19:135. [PMID: 30808355] doi:10.1186/s12913-019-3959-7
5. Abrishami D. The need for cultural competency in health care. Radiol Technol. 2018;89:441-448. [PMID: 29793905]