Understanding the Cultural Lens of Your Patient

Mary McNeill, MS, RD/LD, CDE, MBA

I was working at the hospital when I saw him again. He was a 45-year-old gentleman that had type 2 diabetes. The medical team had just instituted insulin therapy prior to his discharge three months earlier. Upon this patient’s return, his chart indicated glucose values in the 300 to 400 mg/dL range; this was not the glycemic control for which we hoped.  Something was wrong. I made my way to his room to inquire. It turned out that he had recently visited his family in rural Mexico where, unbeknownst to us at the time, there was a strong belief that insulin could cause blindness.  His mother cried every night as he injected himself, terrified he would go blind.  So he decided to stop the injections altogether.

The Patient Cultural Lens: A Discussion

That was my introduction to the importance of understanding the cultural lens of a patient. The term cultural lens refers to viewing things from the perspective of another culture.  My lack of knowledge in this area caused our treatment plan of insulin therapy to fail.  We gathered the local family together and provided them with more accurate information behind their belief that insulin can cause blindness.  We explained that it was actually long-standing, uncontrolled diabetes that caused microvascular changes in the retina and that this in turn could lead to blindness.  Even more, we explained that in some cases, it would be too late for insulin therapy to prevent any long-term damage to the visual system. Once my patient’s family understood, they were able to share this information with other members of the family.
It is possible for the best treatment plan to be created. However, it takes diligence to uncover how a patient’s cultural background might influence their choice to follow their treatment plan.  For example, a patient may reject porcine or bovine-based preparations, or prefer alternative therapists (healers), products (herbs), or additional medicines available in other countries that are then brought into the United States. Culture may also inform a patient’s perspectives on gender.  This can translate to a provider speaking only to the male head of household and not speaking to or examining the female patient.
Understanding a patient’s cultural lens does not happen by luck or happenstance. It requires intentionality. Even in rushed visits, we must be mindful and deliberate about including this aspect in our care—and that takes practice.

Here are a couple things to keep in mind during the process of getting to know your patient:

Patients can tell if you are listening.
It is easy for patients to identify whether you are listening to learn or just waiting your turn to speak, because they pick up on your non-verbal cues.  Authentic listening cannot be faked. 
Patients’ beliefs about healthcare and seeking help can be a barrier.
A patient’s cultural background might influence their decision to seek out healthcare when they are sick. They may have varied perspectives about how illness may disrupt their personal and social experiences. Therefore, a patient may be resistant to engaging during an initial assessment, much less following a treatment plan.
Having cultural humility and respect is more than just being nice.
It is possible for you to lack cultural humility but still have great bedside manner. As a provider, being pleasant does not mean that know your patients’ values, beliefs, or priorities. It is also possible to be respectful and lack cultural respect.  This means that you can have a great tone, make terrific eye contact, but be irresponsive to the health beliefs, practices, and cultural and linguistic needs of diverse patients, especially in a busy practice.
An additional benefit to understanding the cultural lens is that it is actually a time saver.  While contrary to the usual perception, it takes less time to ask, listen, and design than to try to explain. So what can you do?

According to the US Department of Cultural Health, here are a few strategies you can incorporate:
Don’t assume. Ask, then listen:
“What do you think caused this?”
“What do you think you can do?”
“Can you think of anything that might help you remember to take your medicine?”
“What do you think will get in the way of being able to do this plan?”

Be cognizant of your language. 
How often do you use “I” versus “we” and “you”?  A good care plan is the product of a partnership between you (who knows how to treat the illness) and the patient (who knows what will work in their world).

Be aware of your own cultural beliefs and values. 
Our lens absolutely affects our perception. Being aware that other people’s lenses differ is critical. In my cultural lens, the use of touch is comforting and eye contact is reassuring.  However, for others, this action may be seen as invasive, confrontational, or dominant.

Find better resources.
Often, written materials in other languages are too general to be applied practically in the case of your patient.  Bring in translators who are familiar with the culture of your patient.
Imagine if my patient never had the opportunity to be re-admitted. Imagine if I had not taken the time to dig deeper and investigate the origins of his beliefs. For him, this could have meant the difference between life and death.  This is why it is key to understand your patients’ cultural lens. The benefits are numerous, and include: a better care plan, improved adherence, enhanced outcomes, and greater patient satisfaction. 
Mary McNeil, MS, RD/LD is the Director of Clinical Health Outreach at True Health Diagnostics, a clinical diagnostics and chronic disease management company. She may be reached at
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