Healthcare in the U.S. faces two interpenetrating certainties.
First, with over 66 racial and ethnic groupings, our "American
Mosaic" of worldviews and values unavoidably generates clashes in
hospitals and clinics. Second, our public increasingly mistrusts
our healthcare system and delivery. One certainty fuels the other.
Conflicts in the clinical encounter, particularly with patients
from other cultures, often challenge dominant assumptions of
morally appropriate principles and behavior. In turn, lack of
understanding, misinterpretation, stereotyping, and outright
discrimination result in poor health outcomes, compounding further
mistrust. To address these cultural fault lines, healthcare
institutions have initiated efforts to ensure "cultural
competence." Yet, these efforts become institutional
window-dressing without tackling deeper issues, issues having to do
with attitudes, understanding, and, most importantly, ways we
communicate with patients. These deeper issues reflect a
fundamental, original fault line: the ever-widening gap between
serving our own interests while disregarding the concerns of more
vulnerable patients, those on the margins, those Others who remain
disenfranchised because they are Other. This book examines this and
how we must become the voice for these Others whose vulnerability
and suffering are palpable. The author argues that, as a vital and
necessary condition for cultural competency, we must learn to
cultivate the virtue of Presence - of genuinely being there with
our patients. Cultural competency is less a matter of acquiring
knowledge of other cultures. Cultural competency demands as a
prerequisite for all patients, not just for those who seem
different, genuine embodied Presence. Genuine, interpersonal,
embodied presence is especially crucial in our screen-centric and
Facebook world where interaction is mediated through technologies
rather than through authentic face-to-face engagement. This is
sadly apparent in healthcare, where we have replaced interpersonal
care with technological intervention. Indeed, we are all potential
patients. When we become ill, we too will most likely assume roles
of vulnerability. We too may feel as invisible as those on the
margins. These are not armchair reflections. Brannigan's incisive
analysis comes from his scholarship in healthcare and intercultural
ethics, along with his longstanding clinical experience in numerous
healthcare settings with patients, their families, and healthcare
professionals.
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