Culture and medicine: reflections on identity and community in an age of pluralism.

Labels of Identity— Race, Ethnicity and Culture One of the great challenges in modern medicine is creating effective therapeutic relationships in an era of ever-increasing cultural diversity. Our hospitals and communities have become global villages where, daily, many languages, cultures, and customs intersect, clash, merge, and evolve. Yet in spite of this spiraling complexity, health caregivers, physicians, and patients visit and revisit this therapeutic encounter ever hopeful that it will provide solutions and solace. Beliefs, communication, and trust are the currency for a successful interchange. They are not the “stuff” of normal scientific discourse but they are every bit as real. How can we negotiate this uncertain terrain of relationship more effectively? Are there principles to guide us and stories to illustrate the pitfalls? Is there a “primer” for this? I would like to relate a story that introduces the meeting that occurs between worlds when two people encounter each other in all their particularity and richness and with the depth and intimacy that Martin Buber referred to as a meeting of I and Thou. Something is created in this—a new experience of Self and Other. Mr Buber wrote I and Thou in 1922 and it remains one of the most remarkable documents on relationship ever written. In it he said: “All real living is meeting” and “In the beginning is relation.” It is in this spirit that I engage in these deliberations with you.