A Word about Culture and Professionalism
Culture has been defined as the sum of attitudes, customs, and beliefs that distinguishes one group of people from another. Culture determines appropriate or acceptable behavior among specific people groups and it changes with time. For example, in Southern Nigeria thirty years ago, it was an insult to family members to expect them to call ahead and inform of an intended visit. Relatives would just show up for visits without any fore-warning and stay a few days, weeks or in some cases months. Today even though they are not required to call ahead, many relatives inform their family of their upcoming visit ahead of time. In Canada on the other hand, generally speaking, it appears that it has never been and is not customary to invite oneself over to stay the night in someone else’s home- whether or not they are your relatives. In Canada, it would appear that the appropriate thing for a guest who intends to stay the night would be to first phone ahead to confirm whether the visit would be convenient for the host family. Similarly, while it would be unthinkable in Nigeria to arrive at your hosts’ house or party bringing the food you intend to eat with you, it is customary in Canada to have parties where guests are expected to bring a salad, their own meat, their own drinks or even bring and share their entire meal.
Since culture consists of “acceptable” or “appropriate” behavior, well-meaning individuals will, in any given situation, automatically and naturally determine “acceptable” or appropriate” behavior in accordance with what they know. Therefore, for example, if a Nigerian invites a Canadian for a meal or a party, the Nigerian will normally not expect their guest to bring any part of the meal. On the other hand, if a Canadian invites you for a meal or party, the Canadian might consider it appropriate for you to ask what they would like you to bring. The fact is that no culture is superior to another and no one is entitled or qualified to judge another person’s culture.
It has been established that differences in culture account for the general approach which specific people groups have to life. Cultural differences also color perceptions and response to situations. For instance, most African cultures embrace a collectivist approach to life as opposed to European cultures which tend to be individualistic; some cultures are task oriented as opposed to relationship oriented; Direct versus Indirect; Equality versus Hierarchy; Verbal versus Nonverbal; Informal versus Formal and so forth. To illustrate, cultures that uphold hierarchy over equality tend to place value on titles and ascribe special respect to those considered to rank high in the society; as opposed to equality-oriented cultures where, names are generally encouraged over titles and not much special respect is accorded based on title, office or hierarchy. Another illustration is that most African cultures have languages that include non-verbal codes so that looks, tone and body language carry a lot of weight and play a significant part in understanding what is really being communicated. Growing up, one quickly learned that the words “yes” spoken in a certain tone and combined with a certain look may mean “proceed at your peril”. Similarly in Canada, it appears that in certain circumstances, polite suggestions, intonations, emphasis on words, body language, context and usage must be accurately decoded in order to understand what is being communicated.
Cultural awareness consists in accepting that upbringing, customs, values, beliefs and so on, impact the interpretation of matters and determines actions and reactions. It also consists in accepting that we are neither the standard for appropriate behavior, nor the judge. On the contrary, our actions will be viewed and judged in accordance with the prevailing culture in our current environment.
Cultural Competence involves the ability to (1) recognize differences in culture, (2) accept that others are entitled to have their opinion about “appropriate” and “acceptable” behavior, and (3) adapt your attitude and behavior without being judgmental. Cultural competence is a must for building and sustaining optimal physician-patient relationships and optimal working relationship with other colleagues and staff.
Professionalism in a Different Culture
Most professions have guidelines stating specific expectations regarding professional conduct. However, professionalism does not exist in a vacuum. Culture plays a significant role in defining “professional behavior”. One of the challenges of practicing in a different culture is that actions which may be perfectly acceptable, appropriate or in some cases even praiseworthy in your “home-culture” may be perceived as odd, inappropriate or even offensive in a different culture. In the past few years in Canada, there have been increased instances of professionals being tried for professional misconduct in respect of actions which they considered to be appropriate based on their “home culture”. Professionals need to develop cultural competence in order to avoid such unnecessary action.
The following are suggestions for achieving and maintaining cultural competence and minimizing the risk of professional misconduct litigation for Medical and Dental Professionals:
- Pay attention to the Rules/Regulations/Guidelines.
The Canadian Medical Protective Association (CMPA) through its publications provides excellent information, advice and guidance regarding professional standards for medical professionals. CMPA “Perspective” magazine periodically examines pertinent issues and again recently examined an issue which is a potential cultural stumbling block: treatment of family and friends.
The Canadian Medical Association’s Code of Ethics provides that treatment of self and family should be limited to minor or emergency services. In this regard, CMPA advises physicians to avoid treatment of the physician’s spouse, partner, parent, child, sibling, grandparent, grandchild, immediate family, spouse’s or partner’s immediate family; OR other individuals with whom the doctor has a personal or emotional involvement.
Irrespective of one’s cultural convictions, compliance with this and other rules will be beneficial.
- Err on the side of caution.
(a) If in doubt, don’t! (b) If you must, proceed with caution (c) Document everything and (d) Seek a second opinion or clarification at the earliest opportunity. Even the patient will appreciate that you waited to be sure before proceeding.
- Be open to continued learning and adaptation regarding culture. The ability to accept others’ points of view and to adapt your attitude without judgment requires continual and conscious effort.
Pay attention to colleagues and support staff and don’t despise their comments regarding manners or behavior. Many allegations of professional misconduct arise out of carelessness, lack of attention, or simple misunderstandings.
Culture affects and determines actions, reactions, interpretations, relationships. Culture is people-group specific and time specific; No culture is superior to another. Cultural competence is necessary for building and sustaining optimal physician-patient relationships as well as optimal working relationships with other colleagues and staff. Culture also plays a significant role in defining professional behavior. Professionals stand a better chance of avoiding professional conduct litigation and they can develop professional competence by paying attention to CMA and CMPA guidelines, proceeding with caution when in doubt and by being open to continuous learning and adaptation.
Foluke Laosebikan Ph.D