instead of as a legitimate illness. HIV/AIDS evokes fear in providers and demonstrates a lack of understanding of the basic principles of transmissibility, and a “blame the victim” attitude. Stereotyping can contribute to health disparities by degrading the quality of care. Most health professionals, for example, would feel well versed in principles of privacy and confidentiality, which may limit the disclosure of health information to designated individuals. If the client or patient has HIV, however, and asks the therapist not to share her or his diagnosis, some therapists might feel conflicted due to the nature of the illness and the intimacy of massage therapy treatments. Poverty can be considered a health risk. Lack of adequate resources can be directly attributed to poverty and can include lack of healthy food choices, clean water, reliable transportation, substandard living conditions, the availability of medical care, and the inability to pay for care. These challenges all adversely affect acute and chronic health. Health care providers too often contribute various health risks to patient behaviors. This is not dissimilar to the 1920s when overcrowding and the lack of facilities resulted in poor health. These challenges were attributed to the patient, not to the environment. Lack of a patient’s compliance and/or follow through may be due to specific financial barriers the patient is facing in accessing health resources, rather than a lack of concern or commitment to his/her health. regardless of personal characteristics, such as age, gender, ethnicity, religion, geography, sexual orientation, socioeconomic status, as well as special needs? ● Efficient – Do I ensure that my mindfulness of wasted resources (personal energy and ideas, supplies, equipment, advocacy) occurs equally with all of my patients, or do some groups or people push me to an overemphasis on “not wasting resources?” These questions are not presented in a “blame the therapist” perspective; rather they are a mechanism to uncover a hidden bias. The code of ethics for massage therapists includes principles of professional excellence, delivery of high-quality care, and the obligation to do no harm. To improve the systems of care, a realistic appraisal of the areas of excellence and those needing attention should be identified. This duality of an appraisal, strength-based and deficit identification is useful for improving practice and to evaluate clients and patients.
Across gender groups, women are sometimes perceived to be less powerful. From an economic perspective, women in the same occupation as a man make 70 to 80 percent of his wage. This economic disparity plays an even larger role in aging because elderly women are often financially disadvantaged due to fixed incomes or the loss of a spouse. Religious minorities are another group at risk for stereotyping. Not all therapists are comfortable discussing spirituality and its role on health. The omission of this information about the role of religion is significant for many patients. For example, an overweight patient with poorly controlled hypertension may be told by her physician that she needs avoid eating fatty meat, such as pork. She indignantly informs that she is a practicing Muslim and does not eat meat. Lack of familiarity with the habits, religious traditions, and preferences of various religious groups can result in unintentional or prejudicial comments or interpretations. Individuals with alternative sexual orientations are another group at risk for stereotyping. Unkind and disrespectful treatment due to sexual or gender choice may occur in the health care setting. Massage therapists may stereotype clients – due to fear, aversion or discomfort – that are perceived to have a higher degree of stigma, such as mental illness, HIV/AIDS, or drug addictions. Unlike diseases or conditions that do not carry stigmas - like heart disease or cancer - a therapist may view a client or patient’s mental health or addiction as a character flaw, ● Effective – Do I deliver quality care for those in need? Do I inadvertently decide that some groups of clients or patients will not benefit from my energies? Do I have data that supports my impression? Am I doing sufficient self-care to prevent burnout to be able to be effective? ● Safe – Am I equally mindful of safety issues? When teaching, educators might add, “to the same level you would want for a family member?” ● Timely – To the best of my ability and as a deliverer of care and key advocate of change, do I strive to decrease delays and waits that can result in harm? ● Client/patient-centered – Do I ask about my client or patient’s preferences, values and needs, and check to see that their input is considered in decision-making? Do all of my clients equally feel that I am respectful to them and their wishes? What data exists to support this? ● Equitable – Do I embed quality assurances that evaluate the degree that I deliver the same quality of care,
How might unconscious stereotypes or social shortcuts undermine the delivery of quality care? Consider the following questions outlined for self-reflection and evaluation (IOM, 2012):
SECTION 3: CROSS-CULTURAL CLINICAL SKILLS
Alternatives for improving communication in a cross-cultural setting during daily interactions will be discussed. General principles will be reviewed to avoid miscommunication that may result in poor understanding and compliance that ultimately can lead to health disparities. Skills for effective therapist-client interaction will be identified that will enhance culturally effective care.
Communication skills are at the core of culturally sensitive practice. They are inherently vital in compiling a medical and social history, explaining and performing a physical examination or procedure, obtaining informed consent, or counseling about lifestyle and diet modification. This section will review some models of effective cross-cultural communication, and will provide examples of ineffective communication based on poor or limited technique, lack of knowledge, personal biases, or inattention. Skills to enhance cross cultural communication Skills for working in a culturally sensitive manner extend from basic communication skills to offering compassionate care. It can be said that “every encounter is a cross-cultural encounter” because there are similarities and differences between a therapist’s and patient’s real or perceived differences in beliefs about disease etiology and treatment,
the role of self-care, treatment of conditions, decision- making and communication styles. The therapist and client’s values and expected outcomes can generate issues that may be interpreted as “cultural.” A highly educated man faced with the diagnosis of a potentially terminal condition, for example, whose physician
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Book Code: MMD0724
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