Cross-Cultural Assessment and Management in Primary Care

Caring for the Amish: What Every Anesthesiologist Should Know

The Amish are a relatively isolated group with cultural and religious customs that differ significantly from the mainstream American population. Functioning as tight-knit communities with strong conservative Christian beliefs, the Amish maintain a culture based on intentional separateness from the outside world. Key aspects of Amish life include distinct clothing and behaviors, a unique language, an agrarian lifestyle, limited formal education, nonviolence/nonaggression, and a general lack of modern technology, as exemplified by the use of the traditional horse-and-buggy. The Amish have distinct health care practices, beliefs, and goals, and because of differing genetics and lifestyle, also have a distinct constellation of health and disease characteristics. This article reviews the core beliefs, community and lifestyle, health care beliefs and practices, and health characteristics of this unique and medically challenging population. Generalizable strategies for providing culturally competent care for any such ethnically, socially, or medically unique community are presented.

Developing cultural competence in general practitioners: an integrative review of the literature

Background

Cultural competence is a broad concept with multiple theoretical underpinnings and conflicting opinions on how it should be materialized. While it is recognized that cultural competence should be an integral part of General Practice, literature in the context of General Practice is limited.

The aim of this article is to provide a comprehensive summary of the current literature with respect to the following: the elements of cultural competency that need to be fostered and developed in GPs and GP registrars; how is cultural competence being developed in General Practice currently; and who facilitates the development of cultural competence in General Practice.

Methods

We conducted an integrative review comprising a systematic literature search followed by a synthesis of the results using a narrative synthesis technique.

Results

Fifty articles were included in the final analysis. Cultural competence was conceptualized as requiring elements of knowledge, awareness/attitudes and skills/behaviours by most articles. The ways in which elements of cultural competence were developed in General Practice appeared to be highly varied and rigorous evaluation was generally lacking, particularly with respect to improvement in patient outcomes. Formal cultural competence training in General Practice appeared to be underdeveloped despite GP registrars generally desiring more training. The development of most aspects of cultural competence relied on informal learning and in-practice exposure but this required proper guidance and facilitation by supervisors and educators. Levels of critical and cultural self-reflection amongst General Practitioners and GP registrars varied and were potentially underdeveloped. Most standalone training workshops were led by trained medical educators however the value of cultural mentors was recognised by patients, educators and GP registrars across many studies.

Conclusions

Cultural competency development of GP registrars should receive more focus, particularly training in non-conscious bias, anti-racism training and critical self-reflectiveness. There is a need for further exploration of how cultural competence training is delivered within the GP training model, including clarifying the supervisor’s role.

It is hoped this discussion will inform future research and training practices in order to achieve quality and respectful care to patients across cultures, and to remove health inequities that exist between cultural groups.

Factors that affect the occurrence and chronicity of occupation-related musculoskeletal disorders

The components that affect the occurrence and chronicity of musculoskeletal disease are multifactorial. The return to work process and prevention of future chronic disability commences at the time of the initial assessment. The clinician can identify, at an early stage, patients with negative expectations of return to work and adopt a care plan oriented to functional adaptation. Medical and psychosocial treatment plans taking account of coping preferences, beliefs and practices are more likely to help prevent chronic disability. Other factors that can influence the long-term disability rate include medically discretionary or unnecessary time off work and litigation itself. Workplace factors can result in unnecessary absenteeism and poorly managed presenteeism.