Culture in Clinical Care.

Bonder B, Martin L, Miracle A. Thorofare, NJ 08086, Slack Inc, 2002, paperback, 208 pp, illus, ISBN 1-55642-549-0, $33.

This text provides an opportunity for students, educators, and practitioners in any health care discipline to "sort out," reflect, and assess issues of culture. For students and educators in schools accredited by CAPTE, cultural competence or cultural sensitivity is an educational requirement. For clinicians, patients from other cultures pass through their clinic on a regular basis. This text provides readers with an opportunity for "self-discovery" as they wind their way through 8 chapters of objectives, stories, tables, inserts, photographs, and questions. If readers approach these readings with an un-biased and open mind, they could be amazed at what they will discover.

One of the most impressive pieces of this book is its use of excerpts from The Spirit Catches You and You Fall Down, a book by Anne Fadiman that won the National Book Critics Circle Award. This book was published in 1997 and retells the true story of Lia Lee, a Hmong child, and her parents as they ventured into the American medical system. Fadiman's book itself is an educational masterpiece and learning experience. Stories from Fadiman's book were used as a prologue to each chapter and excerpts were used to illustrate points in the chapters.

Many texts approach the subject of cultural diversity in a book chapter or module. This entire text is dedicated to the understanding of "culture." Foundational materials that students or clinicians are usually exposed to include information on understanding culture, recognizing cultural differences, and personality and culture. This book tackles more complex subjects such as the role of culture in health and health care, negotiating cultural differences while working with patients or clients, examining patients or clients, designing interventions in a diverse world, and assessing intercultural interactions and interventions. The fascinating discovery comes in recognizing the intercultural variability as well as the intracultural variability among all of us. Opportunities for reflection, the development of alternative strategies, and the continuous evaluation of outcomes are well presented throughout the text.

Readers may find themselves exposed to new terms such as "culture emergent," "culture-bound syndromes," "culture contact," and "culture-specific expertise." The authors identify 2 common ways to describe culture--the descriptive approach (using major traits, patterns, and materials used or produced) and the rules approach (the descriptive approach plus understanding distinctions among categories of things, views of reality, and decisions about the right course of action). Because these approaches did not appear to be comprehensive enough, the authors added their own foundation for understanding. In the authors' opinion, the term "culture emergent" emphasizes "the ways in which the combination of experience, environment and personal preferences results in each individual having a unique set of cultural patterns."

The authors also discuss common strategies for becoming culturally competent. Readers will be familiar with the fact-centered approach, which allows people to learn about the beliefs and interactions of particular cultures. Another common approach is the attitude-centered approach, which allows people to examine their beliefs and identify potential stereotypes and false perceptions. The authors of this book use a new approach for teaching cultural competence called an inquiry-centered approach, which uses "field research" techniques and ethnographic principles. Readers will find this approach superior because it allows them to acquire a "specific set of tools and skills for effective clinical interactions in intercultural settings, without regard to which particular culture is represented by the patient."

The text is comprehensive and the stories are excellent. An extensive resource list on cultural beliefs about health is included. The flavor and novelty of the book can be traced to the diverse educational backgrounds of the authors: occupational therapy, linguistics, and anthropology. For those who need to explore "culture" as it relates to clinical care, this book is for you.

Susan Hanrahan, PT, PhD
Arkansas State University
Jonesboro, Ark

Dr Hanrahan is a Professor of Physical Therapy. She currently serves as Dean of the College of Nursing and Health Professions. Her research interests include health education, women in leadership, health behavior, and health policy.