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The 2002 Institute of Medicine report “Unequal Treatment,” a report on disparities in health care, hypothesizes that unacknowledged sociocultural differences between patient and provider may lead to poor health outcomes. The report also suggests that providers must be educated about the care of diverse patients. This chapter focuses on one aspect of such diversity: culture.

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Addressing cultural difference between patient and provider is one goal of the cultural competency programs that have proliferated in medical training and practice settings. In these programs, cultural difference between patient and provider is seen as a gap that must be bridged or crossed in the process of patient care. These programs, which have traditionally focused on the cultural attributes of various groups, raise a range of concerns. One concern is that in summarizing cultural attributes of groups, these courses present stereotypes, the use of which can actually be detrimental to patient care.1-3 Another concern is that culture becomes “medicalized” or “pathologized,” a process that involves making value judgments about cultural aspects of certain groups.4 These critiques call for a different approach to thinking about culture and medicine, an approach that shapes the content of this chapter.

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This chapter borrows heavily from the humanities and social sciences and covers 2 different but overlapping ways for thinking about culture and its relationship to the practice of medicine. The first makes use of the work of medical anthropologist Arthur Kleinman and his colleagues on the distinctions between illness and disease.5,6 The second centers around Rita Charon’s work on narrative medicine.7,8 Accompanying the description of each framework are ways to apply them in practice. The chapter also includes a discussion of more traditional approaches to culture and medicine, by discussing the practice of co-sleeping. The chapter ends with a brief discussion of socioeconomic status and its relevance to medicine.

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A working definition of culture is necessary in order to consider the relationship between culture and the practice of medicine. Anthropologist Janelle Taylor suggests that within medicine, culture is defined, in ways that are too limiting, as “a static set of beliefs and ideas that only other people have.”9 The first step toward a broad and more inclusive definition of culture is to recognize that culture is not simply the beliefs and practices of groups of people; culture is the context in which individuals make sense of their experiences. The distinction between illness and disease is a useful one in understanding how culture, defined in this way, is relevant to medicine. Diseases, “abnormalities in the structure and function of body organs and systems,” are what physicians are trained to diagnose and treat.5 Illnesses, on the other hand, are what patients experience, and the experience of illness is shaped by culture, along with other factors. The relevance of culture to medicine is about more than quantifying beliefs and cataloging practices of groups of people; it is about understanding ...

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