interested in learning more about cultural diversity in health care?
If so, I suggest
you read my book. I focus on case studies of actual cultural conflicts
with explanations of why they occurred and what could be done to achieve
cultural competency. Click on the links near the top of the page to
go directly to a specific section.
A handy reference guide!
A Guidebook for Health Care Professionals, 2nd edition
Written by Geri-Ann Galanti
A handy pocket reference guide to the important principles underlying culturally
competent health care. Provides easy access to potential patient behaviors and
beliefs that impact your success in providing care.
This guidebook, published by Joint Commission Resources, has been updated and expanded.
Online Tutorial on Culture and Health
Developed by Geri-Ann Galanti
for medical students and residents, but can be used by any interested healthcare professionals. Looks at Stereotypes vs. Generalizations; Dimensions of Culture; the 4 C's of Culture; Time Orientation; Removing Life Support; and Revealing a Fatal Diagnosis. Developed as part of a grant through the UC Schools of Medicine entitled "Statewide Initiative to Disseminate an End-of-Life Curriculum" funded through the National Cancer Institute. Each segment is 3-15 minutes long.
Culture and Healthcare
9 units of CME
Offered through PerforMax3
Developed by Geri-Ann Galanti
for any professional who cares for patients- physicians, nurses,
assistants, pharmacists, physical therapists, etc.
4 C's of Culture: A Mnemonic for Healthcare Professionals
simple way for healthcare professionals to remember the questions
to ask to get at the patient's perspective.
They are a key to providing culturally responsive, patient-centered
4 C's of Culture:
para la entrevista clínica culturalmente
The 4 C´s of Culture / PCCP”
Other Recommended Readings
Andrews, M.M. and
J.S. Boyle, eds. (1999) Transcultural
Concepts in Nursing Care, 3rd edition. New York: Lippincott.
Gardenswartz, L. and
A. Rowe (1998) Managing
Diversity in Health Care. San Francisco: Jossey-Bass Publishers.
Giger, J.N. and R.E.
Davidhizar, eds. (1999) Transcultural
Nursing: Assessment and Intervention. St. Louis: Mosby.
Gropper, R.C. (1996)
and the Clinical Encounter. Yarmouth, ME: Intercultural Press,
Lipson, J.G. and
S.L. Dibble, eds. (2005) Culture
and Clinical Care. San Francisco: UCSF Nursing Press.
S. (2005) What Language
Does Your Patient Hurt In? A Practical Guide to Culturally Competent
Patient Care. Amherst, MA: Diversity Resources,
Spector, R. (2000)
Diversity in Health and Illness, 5th edition. Upper Saddle River,
NJ: Prentice Hall.
Western Journal of Medicine (December, 1983) Volume 139, No. 6.
Special Issue: Cross-Cultural Medicine.
Western Journal of Medicine (September, 1992) Volume 157, No.
3. Special Issue: Cross-Cultural Medicine--A Decade Later.
Fadiman, A. (1997)
Spirit Catches You and You Fall Down. New York: Farrar, Straus
and Giroux. (Hmong)
Dancing Healers: A Doctor's Journey of Healing with Native Americans.
San Francisco: Harper & Row.
and Culture in Contemporary Japan. Cambridge: Cambridge University
Payer, L. (1996) Medicine
and Culture: Varieties of Treatment in the United States, England, West
Germany, and France. New York: Henry Holt & Co.
Sheikh, A. and A.R.
Gatrad, eds. (2000) Caring
for Muslim Patients. Oxford: Radcliffe Medical Press. [See review
I wrote for BMJ]
Snow, L.F. (1993)
Over Medicine. Boulder, CO: Westview Press. (African Americans)
Provider's Handbook Series on Culturally Competent Care provides an
overview of cultural
and epidemiological characteristics of the following groups: Latino;
African American; Asian and Pacific
Islander; and Lesbian, Gay, Bisexual and
Transgendered. They also have handbooks on Individuals with Disabilities
and Women's Health. They focus on general aspects of each group that
affect health care utilization, presenting background information and
health care statistics that can help providers become even more sensitive,
responsive and knowledgeable about diverse population. To obtain free (other
than shipping & handling) copies, use the online
These books do not have a cultural focus, but are related to competent
and compassionate health care delivery. They are books I would recommend
that all health care professionals read.
Callanan, M. and P.Kelley
Gifts: Understanding the Special Awareness, Needs,
and Communications of the Dying. New York: Bantam.
Woods, Michael S. (2004) Healing
Words: The Power of Apology in Medicine.
Oak Park, IL: Doctors in Touch.
Diversity: Beyond the Vital Signs
This comprehensive training program from CRM Learning features a 20-minute
video and a Leader's Guide with exercises and role-plays for 2-4 hours
worth of training on the topic of cultural diversity in healthcare. The
A Mexican man whose
loud post-operative suffering is not taken seriously by the nurse,
who stereotypes him as a typical "expressive" Mexican. His pain, however,
is real, and due to internal hemorrhaging. It serves as a reminder not to stereotype patients.
A Cambodian boy is brought in covered with welts;
healing remedy (coining) is mistakenly thought to be child
An Hispanic woman brings in
her infant because she believes one of the nurses gave her baby the “evil
An African American woman refuses treatment because she believes God is
punishing her for a past transgression. A culturally compentent nurse
succeeds in changing her mind by communicating though the patient's belief
Chinese patient's wife rejects the hospital food because it is the
wrong balance of yin and yang.
more information, go to CRM
Or call 1-800-421-0833.
I served as a consultant on the film and wrote the Leader's Guide.
Permanente's award winning cultural issues videos were produced
by Kaiser Permanente's MultiMedia Communications and the Educational
Theatre Program's CareActors, M. Jean Gilbert, Project Director,
Jo Ann Lesser, Producer. The project was jointly funded by Kaiser
Permanente and The California Endowment. Now available in both video
and DVD format.
Issues in the Clinical Setting-Series A and B
The brief but dramatic vignettes are each
accompanied by support materials for facilitators and participants which
will be sent electronically and are included in the nominal price. The
vignettes raise numerous issues around differing health beliefs and practices,
conflicting values, stereotyping, overt and covert prejudices, and language
barriers. The video is 70 minutes long and contains 10 vignettes.
Diabetic Compliance: Latino. Two versions of an interview with a
non-English-speaking, non-compliant diabetic Hispanic woman. The
first uses a family member
as the interpreter and is an example of how not to handle an encounter.
The second uses a professional interpreter and goes much better. It’s
a good example of why professional interpreters are important.
Sickle-Cell Case in the E.R. An African American adolescent is in crisis
and needs pain medication; the E.R. staff is not so sure. A good example
Pediatric Asthma: A Middle-Eastern doctor and an aggressive mother tangle
over the care of a young girl...a values clash. The second part of the
segment is a good example of how foreign physicians’ presentation
of self may be misinterpreted by Americans.
A Somatic Complaint: Long buried painful memories of an Asian woman manifest
in diffuse symptoms that are not well understood by this physician. A
good example of how Asians may somaticize psychological problems into
A Gay Adolescent: An adolescent football player comes out to his family
doctor. The doctor deals with the situation both knowledgeably and sensitively.
Series B: Birthing Issues
Goes through a day in the life of a young OB/Gyn physician coping with
a diverse group of patients. Good advice from another, more experienced
physician is at first spurned then sought as the doctor is confronted
by special needs and circumstances.
Lesbian Parents: The physician is caught off-guard when she learns that
the two women before her are both the prospective parents and have some
The Hmong Way: The physician is startled when young woman's mother wishes to
incorporate unusual birthing practices in the birthing care of her pregnant daughter,
including keeping the placenta.
A Middle Eastern Dilemma: A conversation between the more experienced physician
and one of her Middle Eastern patients reveals conflicts and familial concerns
around acculturation in an immigrant family.
A Big Baby is Coming: A non-English speaking woman from Mexico is delivering
a very large baby with macrosomia. She is diabetic and has lost several babies
at birth. Her husband is very uncomfortable in the labor room and a nurse reveals
her tendency to stereotype through prejudicial remarks.
A Circumcised Somali Mother in Labor: A by now tired and concerned
physician discovers that the woman presenting for childbirth, having had no prenatal
must have her vaginal opening enlarged in the presence of thick scar tissue or
Download order form
10 vignettes, 6-11 minutes each
Walking in Beauty:
Navaho beliefs about illness & curing.
The case focuses on a Navaho man with cancer. It emphasizes both aspects of communication
and of world view. His understanding of the cause of his disease and how it should
be treated are very different from those of biomedicine.
Day of Rest: The Jewish Sabbath
An orthodox Jewish man brings his wife into the hospital to deliver a baby on
the Sabbath. The segment focuses on the conflicts he has with the nurses due
to his religious beliefs.
An older, Anglo American man comes into the clinic for a check-up. He’s
not happy to find that a young, female, East Indian physician with a rather
heavy accent has replaced his regular doctor of 20 years. It is a good example
for foreign-born physicians of how to deal with prejudice on the part of patients.
Voice Inside the Phone: Using the Interpreter Line
Vignette illustrates the use of the language line service for interpreting
in a medical setting. The physician is skeptical at first, but finds it very
easy and helpful in treating the young son of an Armenian woman.
End of Life.
Dr. Jerry Mitchell empathically assists an ethnic Chinese
they come to terms with the unexpected
death of their 22 year-old daughter. He benefits from a “cultural consult” with
a Buddhist colleague.
Pocketful of Miracles: Alternative Medicine/Literacy Issues.
Dr. Funaki is surprised to learn that his patient from Colombia is using
along with her prescribed medication and also finds out that she can’t
read her prescription labels even though they are in Spanish.
Proof: Domestic Violence.
Nurse Singh brings suspicions
of domestic violence in a South Asian family to the attention of Physician
Assistant, Eliza Polanco.
Suspicions are confirmed when the patient finally whispers a request for
Lupe's Dilemma: Sexually Transmitted Disease. Lupe Pena
is pregnant and infected for the second time with chlamydia. Physician Assistant
helps her come up with a safe, family-supported way to get her partner to
come in for treatment.
Lost Opportunities: Mistrust and Denial.
Roy Turner, an
African American patient who came to the emergency room with a heart attack,
is finally coming in
for a follow-up visit in cardiology. Dr. Ryan provides appropriate clinical
and education, but cultural and economic barriers are ignored; trust and
rapport are never achieved.
Between Two Worlds: Refugees Confronting the American Medical
A care team comes to understand the unique concerns and sacrifices
made by the Rhamatis
in fleeing their native Afghanistan. The couple leaves this visit reassured
that they will receive ongoing care in a safe, confidential, and welcoming
Download order form
Four-Part Series on Cross-Cultural Healthcare by Maren Grainger-Monsen,
MD, and Julia Haslett, Stanford University, Center for Biomedical
Contains 4 video documentaries, each highlighting a different ethnic
group, disease, and cultural issue. Comes with an excellent facilitator’s
guide. Videos range from 10-14 minutes each. Topics covered are:
• Mohammad: An Afghani Muslim man who refuses chemotherapy for
stomach cancer due to religious reasons. Addresses issues of language
• Justine: A young Laotian girl with Atrial Septal
Defect whose grandmother fears that a scar left by surgery to close the
mark her in
lifetimes. Addresses the issue of various explanatory models.
• Robert: An African American man with End Stage Renal Disease
who is awaiting a kidney transplant.
Addresses issues of racial/ethnic disparities
in medical care.
• Alicia: A Puerto Rican woman with diabetes, hypertension, and
asthma. Adresses issues of non-adherence to medical regimes and use of
A short (5:41), powerful video about stereotyping, posted on YouTube.
Below are PowerPoint
presentations by M. Jean Gilbert and/or Geri-Ann Galanti, created for
physicians as part of a pilot project entitled "Implementing CLAS
Standards: Designing, Implementing & Evaluating 3-Tiered Cultural
Competency Training." Project is funded by The California Endowment
and headed by Miya Iwataki, Director, Office of Diversity Programs,
Department of Health Services.
There are QuickTime
videos embedded in this PowerPoint. The videos are from Kaiser Permanente's
Multicultural Health Series. They will not play when you download this
file. However, you can purchase them at minimal cost from Kaiser
(Cultural Issues in the Clinical Setting, Series B).
for presentation on Racial
and Cultural Disparities in Healthcare (PDF file only)
Religous and Cultural Competence for Medical Students
Free resource and curriculum for medical educators to improve the knowledge and practice skills of their students in caring for religiously and culturally diverse patients. Each module includes a PowerPoint presentation and facilitator's guide.
game is designed for use in the continuing education of physicians,
nurses, non-medical front-line support staff and administrators
in healthcare organizations and for integration into the Nursing and
Medical school curriculums. For more information and additional resources,
An e-mail discussion group
sponsored by Resources for Cross Cultural Health Care and the DiversityRx
website (www.diversityRx.org). Participants
can raise issues, ask questions, share information and resources and
network with each other around topics related to the design, delivery
and evaluation of culturally and linguistically appropriate services
(CLAS) in health care.