Cultural and Religious Humility: A Foundation for Relationships in Medicine (Workshop)
Ellery Sarosi, Medical Student, University of Michigan Medical School; and Adam Baruch, MD, Michigan Medicine
Within the same day, maybe even the same hour, practitioners on a Labor and Delivery floor may witness the joy of a healthy, uncomplicated birth and the tragic loss of a desired pregnancy. These patient encounters, while on vastly different ends of the emotional continuum, exemplify clinical moments that transcend language of physiology, expanding our medical imagination beyond a mechanistic view of the body. In one patient’s room, we are brought to wonder as we have the privilege of handing a newborn to their parents for the very first time. In the other patient’s room, we are brought to lament as we accompany the patient and their family in their mourning. In both rooms, there is a recognition that this single day marks a transition. Things are not the same as they once were. Amidst the wonder and lament, how do practitioners and patients make sense of such moments of transition? Is such a question even relevant to medical care?
Patients and practitioners bring their own unique stories, their cultural, religious, and/or spiritual backgrounds, to such questions of meaning. While we cannot delineate the molecular basis of these unrepeatable stories, Dr. Cicely Saunders, MD, the founder of modern hospice, would have likely argued that they are central to the patient-clinician relationship. In her “Theory of Total Pain,” she describes suffering as the sum of a patient’s physical, psychological, social and spiritual distress.1 In medicine, we focus on our ability to address the physical and psychological contributors to health and have recently demonstrated a greater awareness of sources of social distress. However, many clinicians report discomfort in discussing religion and spirituality with patients, noting that they feel particularly uncomfortable discussing this with patients whose religious background differs from their own.2
The practice of healthcare in our diverse clinical setting results in clinicians caring for patients from many different backgrounds, cultures, and faiths. In order to care for a patient from a background that is divergent from that of the practitioner, a practitioner needs to understand what is important to the individual who sits before them. However, the vastness of the backgrounds of patients precludes any one practitioner from comprehensively understanding the various cultures, ethnicities, and religions that patients come from. To bridge the gap between a practitioner’s understanding of the world and that of their diverse patients, we propose a disposition of cultural and religious humility that can be approached in a systematic way. We believe that approaching conversations about culture, religion, and background through this approach will properly dispose us to attend to the souls of our patients, even those whose background differs from our own.
Cultural humility is defined as “a lifelong commitment to self-evaluation and critique, to redressing power imbalances...and to developing mutually beneficial and non-paternalistic partnerships with communities on behalf of individuals and defined populations.”3 But how does an individual provider actually engage in this practice? We propose a process of (1) self-awareness, (2) humility, and (3) curiosity that ultimately leads to (4) flexibility as a productive space from which practitioners can provide culturally and religiously humble care:
1) Self-awareness: In acknowledging the context they bring to their patient encounters, a healthcare practitioner can better interpret the thoughts, feelings, blindspots, and biases that shape their ability to deliver care.
2) Humility: Once a healthcare practitioner has attempted to understand their own beliefs, assumptions, and biases, this creates an opportunity to acknowledge that a patient’s worldview may differ drastically from their own. Recognizing that unfamiliarity may lead to a reflexive desire for mastery within medicine, practicing humility allows practitioners to welcome the mystery of a patient’s story.
3) Curiosity: Upon humbly engaging the mystery behind a patient’s story, a healthcare practitioner can begin to formulate and ask questions that allow the patient to speak to how their cultural, religious, and/or spiritual backgrounds inform their narratives of health and suffering. Our effort is to bring these stories to light rather than extinguish them. In addition to extending thoughtful questions, practicing curiosity requires active listening.
4) Flexibility: The practitioner now has the opportunity to consider the privilege of being invited into the patient’s worldview. In an attempt to honor their story, we embrace the responsibility of reflecting on the points of ease and points of tension that characterized the encounter. Whether in future conversations with the same patient or in conversations with a different patient, the practitioner can now consider whether points of tension are indicative of bias and/or invitations for flexibility.
Within this workshop, we will explore our systematic approach to practicing cultural and religious humility through case presentations. The flow of the workshop will be facilitated by a PowerPoint presentation that will aim to do the following:
1) Introduce the concept of cultural and religious humility.
2) Acknowledge why these concepts are important in medicine.
3) Outline our systematic approach to practicing cultural and religious humility.
4) Introduce case presentations that will engender discussion about how to apply our systematic approach to patient care. We will discuss cases that touch on the following topics:
a) Patients with preferences for providers with particular identities.
b) Patients with unique dynamics with their partner, which impact their approach to medical decision making.
After each case is introduced to the attendees via the PowerPoint presentation, case discussions will occur in small groups of four attendees. Each small group will be provided with questions to prompt reflection on and discussion about what it looks like to apply our systematic approach to cultural and religious humility in each case. Following this initial discussion, the small groups will then be challenged to consider if/how their responses to the provided questions change if the patient’s cultural, religious, and/or spiritual context changes. These variations to the cases will be introduced via the PowerPoint. After small group discussion, we will reconvene, and each small group will have the opportunity for one representative to share the reflections of their group. This format will be repeated for each case. The third case will be followed by a brief summary of what was discussed and a conclusion of the workshop.
This workshop is geared towards attendees involved or interested in clinical care and may be of particular interest to those interested in Ob/Gyn, Family Medicine, Midwifery, and Chaplaincy. While prior involvement in patient care may provide a more robust contribution to group discussions, we welcome attendees at all levels of training!
The workshop will be organized by a fourth-year medical student at the University of Michigan who is currently applying to Ob/Gyn residency programs. She completed Duke’s Fellowship in Theology, Medicine, and Culture in May, 2022 and has stepped into the role of inaugural student fellow for the University of Michigan Medical School’s Program on Health, Spirituality, and Religion. She is joined by a clinical assistant professor of Ob/Gyn at Michigan Medicine who is a core faculty member for the University of Michigan Medical School’s Program on Health, Spirituality, and Religion. Together, they presented on this same topic at the University of Michigan Department of Ob/Gyn Grand Rounds in August, 2022.
Patients and practitioners bring their own unique stories, their cultural, religious, and/or spiritual backgrounds, to such questions of meaning. While we cannot delineate the molecular basis of these unrepeatable stories, Dr. Cicely Saunders, MD, the founder of modern hospice, would have likely argued that they are central to the patient-clinician relationship. In her “Theory of Total Pain,” she describes suffering as the sum of a patient’s physical, psychological, social and spiritual distress.1 In medicine, we focus on our ability to address the physical and psychological contributors to health and have recently demonstrated a greater awareness of sources of social distress. However, many clinicians report discomfort in discussing religion and spirituality with patients, noting that they feel particularly uncomfortable discussing this with patients whose religious background differs from their own.2
The practice of healthcare in our diverse clinical setting results in clinicians caring for patients from many different backgrounds, cultures, and faiths. In order to care for a patient from a background that is divergent from that of the practitioner, a practitioner needs to understand what is important to the individual who sits before them. However, the vastness of the backgrounds of patients precludes any one practitioner from comprehensively understanding the various cultures, ethnicities, and religions that patients come from. To bridge the gap between a practitioner’s understanding of the world and that of their diverse patients, we propose a disposition of cultural and religious humility that can be approached in a systematic way. We believe that approaching conversations about culture, religion, and background through this approach will properly dispose us to attend to the souls of our patients, even those whose background differs from our own.
Cultural humility is defined as “a lifelong commitment to self-evaluation and critique, to redressing power imbalances...and to developing mutually beneficial and non-paternalistic partnerships with communities on behalf of individuals and defined populations.”3 But how does an individual provider actually engage in this practice? We propose a process of (1) self-awareness, (2) humility, and (3) curiosity that ultimately leads to (4) flexibility as a productive space from which practitioners can provide culturally and religiously humble care:
1) Self-awareness: In acknowledging the context they bring to their patient encounters, a healthcare practitioner can better interpret the thoughts, feelings, blindspots, and biases that shape their ability to deliver care.
2) Humility: Once a healthcare practitioner has attempted to understand their own beliefs, assumptions, and biases, this creates an opportunity to acknowledge that a patient’s worldview may differ drastically from their own. Recognizing that unfamiliarity may lead to a reflexive desire for mastery within medicine, practicing humility allows practitioners to welcome the mystery of a patient’s story.
3) Curiosity: Upon humbly engaging the mystery behind a patient’s story, a healthcare practitioner can begin to formulate and ask questions that allow the patient to speak to how their cultural, religious, and/or spiritual backgrounds inform their narratives of health and suffering. Our effort is to bring these stories to light rather than extinguish them. In addition to extending thoughtful questions, practicing curiosity requires active listening.
4) Flexibility: The practitioner now has the opportunity to consider the privilege of being invited into the patient’s worldview. In an attempt to honor their story, we embrace the responsibility of reflecting on the points of ease and points of tension that characterized the encounter. Whether in future conversations with the same patient or in conversations with a different patient, the practitioner can now consider whether points of tension are indicative of bias and/or invitations for flexibility.
Within this workshop, we will explore our systematic approach to practicing cultural and religious humility through case presentations. The flow of the workshop will be facilitated by a PowerPoint presentation that will aim to do the following:
1) Introduce the concept of cultural and religious humility.
2) Acknowledge why these concepts are important in medicine.
3) Outline our systematic approach to practicing cultural and religious humility.
4) Introduce case presentations that will engender discussion about how to apply our systematic approach to patient care. We will discuss cases that touch on the following topics:
a) Patients with preferences for providers with particular identities.
b) Patients with unique dynamics with their partner, which impact their approach to medical decision making.
After each case is introduced to the attendees via the PowerPoint presentation, case discussions will occur in small groups of four attendees. Each small group will be provided with questions to prompt reflection on and discussion about what it looks like to apply our systematic approach to cultural and religious humility in each case. Following this initial discussion, the small groups will then be challenged to consider if/how their responses to the provided questions change if the patient’s cultural, religious, and/or spiritual context changes. These variations to the cases will be introduced via the PowerPoint. After small group discussion, we will reconvene, and each small group will have the opportunity for one representative to share the reflections of their group. This format will be repeated for each case. The third case will be followed by a brief summary of what was discussed and a conclusion of the workshop.
This workshop is geared towards attendees involved or interested in clinical care and may be of particular interest to those interested in Ob/Gyn, Family Medicine, Midwifery, and Chaplaincy. While prior involvement in patient care may provide a more robust contribution to group discussions, we welcome attendees at all levels of training!
The workshop will be organized by a fourth-year medical student at the University of Michigan who is currently applying to Ob/Gyn residency programs. She completed Duke’s Fellowship in Theology, Medicine, and Culture in May, 2022 and has stepped into the role of inaugural student fellow for the University of Michigan Medical School’s Program on Health, Spirituality, and Religion. She is joined by a clinical assistant professor of Ob/Gyn at Michigan Medicine who is a core faculty member for the University of Michigan Medical School’s Program on Health, Spirituality, and Religion. Together, they presented on this same topic at the University of Michigan Department of Ob/Gyn Grand Rounds in August, 2022.
- Ong CK, Forbes D. Embracing Cicely Saunders's concept of total pain. BMJ. Sep 10 2005;331(7516):576. doi:10.1136/bmj.331.7516.576-d
- Alch CK, Wright CL, Collier KM, Choi PJ. Barriers to Addressing the Spiritual and Religious Needs of Patients and Families in the Intensive Care Unit: A Qualitative Study of Critical Care Physicians. Am J Hosp Palliat Care. Sep 2021;38(9):1120-1125. doi:10.1177/1049909120970903
- Tervalon M, Murray-García J. Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education. J Health Care Poor Underserved. May 1998;9(2):117-25. doi:10.1353/hpu.2010.0233