Reading Between the Lines: Unveiling Cultural Understanding to Build Trust in Patient Care
Last year, my mom was diagnosed with Stage 4 ameloblastic carcinoma, an exceedingly rare form of cancer. This diagnosis instilled profound fear in my immigrant parents, who harbored a deep-seated distrust of medical institutions due to their past experiences with inadequate health care in their home country.
In their eyes, a medical diagnosis as intimidating as “cancer” meant: “death.” Witnessing my mom’s apprehension during countless doctor visits and engaging in meaningful dialogues with her emphasized the paramount importance of fostering genuine human connections between health care providers and patients. This experience provided me with invaluable insights into effective methods of building trust, prompting me to reflect on my own interactions with patients. I aspire to share and expand upon these lessons throughout my career as a physician.
My mom’s diagnostic odyssey was characterized by many misdiagnoses, with doctors attributing her symptoms to the stresses of a working mother. Eventually, her worsening symptoms prompted them to label her condition as periodontal disease, despite her gums being perfectly healthy. Through our conversations, I observed the impact of cultural nuances on patient care, as my mom, feeling dismissed by doctors she once trusted, internalized her pain, and suffered in silence as women typically do in South Asian culture.
While she was eventually diagnosed with ameloblastic carcinoma, she explained that her lack of faith and cultural biases had influenced her conservative decision for only the surgical removal of cancer, denying other treatments. Witnessing the harmful manifestations in my mom’s physical and psychological health, I encouraged her to seek doctors that prioritize active listening and cultural competency.
Rather than leading patients astray with false assurances and misinformation that can be compounded by past traumas and unreliable sources online, I explained the value of physicians acknowledging the limits of medical information. My contrasting suggestion was to accept the radiation and reconstruction treatments. This dialogue with my mother, who was battling uncertainty as a rare condition patient, not only fostered trust but also empowered her to actively participate in her own care, following through with the appropriate treatments from doctors who could understand her story.
From this experience, I learned that nurturing patients’ trust requires viewing them as individuals with unique stories, fears, and aspirations, rather than as mere cases to be solved. Furthermore, the quality of patient-provider relationships relies on doctors’ promotion of cultural competence and health equity.1
I recall a particularly poignant, different encounter during my time as part of a medical team in Haiti. Amidst the backdrop of poverty and limited access to health care, I witnessed the profound impact of bonding with patients to provide comfort.
One instance stands out vividly. I encountered a patient named Marie, a middle-aged woman, who was seeking relief from chronic back pain. Her pain was not just physical but also emotional, stemming from years of laborious work carrying heavy baskets on her head for long distances, without access to proper medical care. As I examined her, I recognized the fear in her eyes, mirroring the same emotions I had seen in my own family during my mother’s illness. As she shared her daily struggles, I could sense her apprehension towards my broken Creole, which was similar to the interactions I witnessed with my parents.
However, I couldn’t help but empathize with her plight. Living and working alongside the community allowed me to experience their daily struggles firsthand. Having set up camp in an isolated mountain village, I pulled water from a well, slept on the floor in homes without electricity, and adapted to the local conditions. I understood the unspoken reality of how Marie’s cultural environment exacerbated her condition. These implicit experiences allowed me to ease Marie’s doubts about whether a foreigner could understand her pain.
As I continued my verbal and non-verbal engagement with Marie and her community, a sense of camaraderie began to form. Her shift in perspective regarding my cultural competence allowed me to no longer be an outsider but instead an ally working to address her health care needs. My conversations with Marie became more meaningful, considering not just her physical symptoms but also the underlying social determinants affecting her well-being.
By attentively acknowledging patients’ cultural environments through open conversations, physicians’ bonds with patients can flourish, transcending language and cultural barriers and uniting us in a shared commitment to patient well-being.2
I learned building trust with patients is not confined to the walls of a hospital or clinic. It is a universal language of compassion and empathy that transcends surface-level dialogues to a deeper understanding of our patients’ diverse backgrounds.
Nitya Devisetti is a medical student at Rutgers New Jersey Medical School (in the Combined BS/MD Program) in Newark, NJ. She is passionate about promoting accessible health care to underserved populations. Pursuing this passion, she has interned at the Penn Injury Science Center and Centers for Disease Control and Prevention (CDC) where she did research on the social determinants of health. Recently, Nitya won $20,000 in a business plan competition, detailing her business idea for affordable health care inspired by the current state of the health care system and recent Price Transparency Laws. In her free time, Nitya likes to experiment with nail art, cook plant-based meals, and exercise with her dog, Cookie.
References
- Saha S, Beach MC, Cooper LA. Patient Centeredness, Cultural Competence and Healthcare Quality. Journal of the National Medical Association. 2018;100(11):1275-1285. doi:https://doi.org/10.1016/s0027-9684(15)31505-4
- Stubbe DE. Practicing Cultural Competence and Cultural Humility in the Care of Diverse Patients. Focus. 2020;18(1):49-51. doi:https://doi.org/10.1176/appi.focus.20190041