Cultural humility: treating the patient, not the illness

P atient populations across the world are becoming increasingly diverse, introducing a variety of health behaviours that are influenced by a patient's cultural background. Tomorrow's Doctors guidelines state that all qualified doctors must respect patients 'without prejudice', irrespective of 'diversity of background and opportunity, language, culture and way of life' (1). Are medical students currently being fully supported to acquire this fundamental skill? A suggested definition of culturally competent care assumes that healthcare providers can 'learn a quantifiable set of attitudes and communication skills' that will allow them to work effectively within the cultural context of the patients they come across (2). However, the broad nature of cultural competency limits its integration into an already intense medical curriculum (3). So, how can developments in medical education overcome this chal-lenge? It can be done by promoting cultural humility. In the medical context, cultural humility may be defined as a process of being aware of how people's culture can impact their health behaviours and in turn using this awareness to cultivate sensitive approaches in treating patients (4). Unlike cultural competency, there is no specific end point to cultural humility as we are not being asked to demonstrate a 'quantifiable set of attitudes'. This concept is a continual process, one that requires self-reflection and self-critique. Developing cultural humility in itself is a prerequisite to cultural competency. It does so by forming a foundation for students to consider possible power imbalances that may arise between a doctor and patient when cultural differences may have an impact on the potential clinical outcome for the patient. Subsequently, the student may be encouraged to develop approaches and skills that could contribute to a harmonious dynamic of the doctorÁpatient relationship (5). Patient care is individua-lised as we take time to consider a patient's personal beliefs rather than attempting to place them under a cultural label. Developing cultural humility will therefore allow students to appreciate someone's culture as a dynamic entity. Drawing upon the philosophy of Daoism, which is based on the concept of humility leading to the attainment of knowledge, Chang et al. argue that cultural humility can greatly increase the student's receptiveness to learn about their own attitudes (5). Chang et al. further describes the concept of cultural humility in which the elements of self-questioning, immersion into an individual patient's point of view, active listening, and flexibility all serve to confront and address cultural biases or assumptions …