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Viewpoint: Culture and Care: Bridging the Patient-Physician Divide

Hasnain, Memoona MD

doi: 10.1097/01.EEM.0000411488.84145.c1

The global community and United States are increasingly becoming more heterogeneous, but a combination of patient, provider, and health system factors still contribute to barriers in providing quality care, resulting in health disparities. Providers' lack of understanding and failure to accommodate patients' needs based on their religious and cultural beliefs significantly contributes to these disparities.

Patients don't come to health care providers solely as clinical manifestations of disease; they bring with them their sociocultural background, including religion and culture that profoundly influence health-related attitudes, beliefs, and practices. When those religious and cultural needs are not understood, acknowledged, or accommodated, that ultimately translates into suboptimal care and an increased burden on the health care system. Understanding these needs and how they affect patients' health attitudes, beliefs, and practices becomes an important priority in reducing health disparities.

Muslims, the second largest religious group in the world, are spread geographically across the globe, and a significant number live in the United States: they are the fastest growing religious group in the country. Persons of this faith remain an enigma for health care providers, and regardless of their country of origin and ethnic and cultural diversity, they have a common religious thread that affects the entire spectrum of their health beliefs and practices.

Muslim women need same-gender providers, have dietary restrictions and special needs during fasting, and have personal hygiene issues related to daily prayers. Little empirical research examines the role of religion and culture on Muslim women's health. Although some research has examined female Muslim patients' perspectives about barriers to effective care, the provider's perspective largely remains unexplored.

The few studies that have looked at Muslim women's perceptions of the barriers they face in receiving quality care indicate that religious and cultural beliefs, such as the value placed on modesty, and the lack of providers' accommodation of these beliefs contribute to Muslim women's reluctance to seek health care. The manner and degree to which Islamic beliefs and customs can influence health care utilization by immigrant Muslim women also has been noted, highlighting the need for patient education. A study my colleagues and I recently published in the Journal of Women's Health critically examined provider and patient perceptions about barriers to and recommendations for providing high-quality, culturally appropriate, patient-centered care to Muslim women in the United States. (2011;20[1]:73.)

A majority (83.3%) of responding providers reported encountering challenges while providing care to Muslim women. A majority (93.8%) of responding patients reported that their health care provider did not understand their religious or cultural needs. Key challenges include the providers' lack of understanding of patients' religious and cultural beliefs; language-related patient-provider barriers; patients' modesty needs; patients' lack of understanding of disease processes and the health care system; and patients' lack of trust and suspicion about the health care system, and providers; and system-related barriers.

Providers and patients recommend provider education about basic religious and cultural beliefs of Muslim patients and facilitation of a collaborative patient-provider relationship, addressing language-related communication barriers, and patient education on disease processes and preventive health care.

The findings of this study shed light on the difficulties faced by Muslim women and health care providers, and help with understanding some of the dilemmas faced by each. This study points particularly to the importance of cultural competence and patient-centered care, which are frequently ignored in the design and delivery of health care services and in patient-physician communication, particularly for underserved and minority patients.

Improving the quality of care requires a flexible and collaborative care model that respects and accommodates the needs of patients, provides opportunities for training providers and educating patients, and makes necessary adjustments in the health care system. Certainly there are times when patients' needs cannot be accommodated, but providers can at least listen, reassure, and help patients understand why that is.

The Institute of Medicine's report, Crossing the Quality Chasm, A New Health System for the 21stCentury, details problems in the current U.S. health care system, and prescribes a roadmap for change. The report notes a serious quality chasm that exists between currently available health care in the United States and the health care patients could have. The gap is attributed in part to patients having to adapt to the customs and practices of health care organizations and professionals, rather than receiving services being designed to address patients' needs and preferences.

Patients and physicians share a common goal of improving the patient's health. Why should there be a divide between them? They can be on the same side to close the quality chasm.

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Dr. Hasnain

Dr. Hasnain

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