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September 2017

Clinical Care Across CulturesWhat Helps, What Hinders, What to Do

Author Affiliations
  • 1Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
  • 2Department of Medicine and Psychiatry, Harvard Medical School, Boston, Massachusetts
  • 3Department of Psychiatry and Forensic Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain
  • 4Vall d’Hebrón University Hospital, Barcelona, Spain
JAMA Psychiatry. 2017;74(9):865-866. doi:10.1001/jamapsychiatry.2017.1994

Today’s clinicians must develop therapeutic alliances with patients with diverse customs, values, and experiences. This can be challenging, as clinicians must make decisions quickly, opening the door to attributional errors and unconfirmed assumptions about patients. In one study,1 white therapists were more likely than Chinese therapists to describe Chinese patients as having depression with interpersonal skill deficits, while Chinese therapists judged white patients as demonstrating more severe psychopathology than did white therapists.1 Problems stemming from the power imbalance between majority group clinicians and minority group patients are exacerbated when the patient is poor, nonwhite, or does not speak English well. Research shows that those who are powerful (typically clinicians) are prone to making hasty judgments, often applying stereotypes to the behavior of others.2 Because of time constraints and unconscious biases, clinicians may not spend sufficient time in “perspective taking” to understand the patient’s circumstances and may see themselves as more objective than they are.

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