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Cultural safety


Respect for patients and families

Respecting difference and diversity


  • Achieving the ability to accept others' points of view and to adapt your attitude without judgment requires continual conscious effort.
  • A patient's lack of adherence to treatment plans may have roots in cultural diversity.
Two men greeting each other respectfullyMulticulturalism is enshrined in Canada's constitution. The Canadian Charter of Rights and Freedoms guarantees individual rights and freedoms to all Canadians and stipulates that those rights must be interpreted in the context of cultural diversity. Provincial/territorial human rights codes similarly prohibit discrimination.

Courts and regulatory bodies expect physicians to respect patient wishes about the care they receive. Patient-centred care helps strengthen the doctor-patient relationship because:

  • It considers a patient's values, beliefs, and wishes in the formulation of a treatment plan.
  • It requires that physicians understand how a patient's socio-cultural background affects beliefs and behaviours.

Being able to accept others' points of view and to adapt one's attitude without judgment is a journey.

As illustrated in the diagram below, cultural self-awareness is the cornerstone upon which new knowledge and skills can be built, giving rise to a culturally safe practice.

Model of self awareness, knowledge and skills

You can learn to provide patient-centred care by being culturally curious.

  • Polite and genuine interest in someone's cultural background opens the door to discussion and understanding.


Taking steps to understand the socio-cultural basis for a patient's behaviour is like receiving a present — you won't know what it contains until you unwrap it.

Click on the "gift box" in the image below to learn about the different levels of cultural understanding a physician can exhibit.
Use the left or right arrow keys to read about the different levels of cultural understanding a physician can exhibit.

  • Cultural awareness
    Cultural awareness is observing and being conscious of similarities and contrasts between cultural groups, and understanding the way in which culture may affect people's approach to health, illness, and healing.
  • Cultural sensitivity
    Cultural sensitivity is being aware of (and understanding) the characteristic values and perceptions of your own culture and the way in which this may shape your approach to patients from other cultures.
  • Cultural competence
    Cultural competence refers to the attitudes, knowledge, and skills necessary to become an effective healthcare provider for patients of diverse backgrounds. Competence requires a blend of knowledge, conviction, and a capacity for action.
  • Cultural safety
    Cultural safety goes beyond cultural sensitivity to understanding the inherent power imbalance and possible institutional discriminations against people of different origins. It implies that the care provider has reflected on her own identity and the perceptions of them that others from different cultures may hold. Culturally safe practice implies the ability to keep these differing perspectives in mind when providing treatment to the patient.
  • Culturally competent
    Physicians cannot realistically be "culturally competent" with regards to every possible patient background, although they can approach their patients in a way that demonstrates they are interested in discussing cultural issues that affect their health and to reasonably accommodate their patients' values in formulating a treatment plan.

(Source: Association of Faculties of Medicine of Canada. AFMC Primer on Population Health, chapter 3: Cultural Competence and Communication.)

Case: Asking a mother to remove her veil
Eyes only visible

Background

A plastic surgeon is seeing a child about a fingertip injury. The patient's mother is veiled so that only her eyes are visible. The surgeon asks the mother to remove her veil so he can see who he is speaking with.

The mother takes great offence to this request and complains to the regulatory authority (College) that the plastic surgeon had tried to frighten her and had made inappropriate comments.

Outcome

The College requires the plastic surgeon to undertake sensitivity training.
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