Presentation is loading. Please wait.

Presentation is loading. Please wait.

2 nd Annual Cultural Competence Seminar 2 nd Annual Cultural Competence Seminar Paul F. Foster School of Medicine Paul F. Foster School of Medicine Texas.

Similar presentations


Presentation on theme: "2 nd Annual Cultural Competence Seminar 2 nd Annual Cultural Competence Seminar Paul F. Foster School of Medicine Paul F. Foster School of Medicine Texas."— Presentation transcript:

1 2 nd Annual Cultural Competence Seminar 2 nd Annual Cultural Competence Seminar Paul F. Foster School of Medicine Paul F. Foster School of Medicine Texas Tech University Health Sciences Center Texas Tech University Health Sciences Center April 12, 2013 April 12, 2013 Religious Diversity, Spirituality & Implications for Clinical Practice Chaplain John W. Ehman University of Pennsylvania Medical Center – Penn Presbyterian Philadelphia, PA 4/1/13

2 Plan for the Presentation: 1) Review the significance of spirituality/religion for clinical practice in a diverse hospital setting 2) Provide a practical strategy for clinicians' support of diverse patients who engage their religion or spirituality in relation to their health and treatment 3) Suggest ways to manage potentially problematic aspects of interaction around spirituality/religion across lines of diversity

3 The challenges of diverse religious patients: The challenges of diverse religious patients: A Catholic patient is distraught as she goes to surgery after her request for the Eucharist has been denied by both her physician and priest because she is NPO.

4 The challenges of diverse religious patients: The challenges of diverse religious patients: A Catholic patient is distraught as she goes to surgery after her request for the Eucharist has been denied by both her physician and priest because she is NPO. A Muslim patient is found on the floor of his room, unable to get up. He had gotten out of bed in order to kneel and pray.

5 The challenges of diverse religious patients: The challenges of diverse religious patients: A Catholic patient is distraught as she goes to surgery after her request for the Eucharist has been denied by both her physician and priest because she is NPO. A Muslim patient is found on the floor of his room, unable to get up. He had gotten out of bed in order to kneel and pray. A Buddhist patient refuses pain medication, because he is worried that it will cloud his mindful awareness.

6 The challenges of diverse religious patients: The challenges of diverse religious patients: A Catholic patient is distraught as she goes to surgery after her request for the Eucharist has been denied by both her physician and priest because she is NPO. A Muslim patient is found on the floor of his room, unable to get up. He had gotten out of bed in order to kneel and pray. A Buddhist patient refuses pain medication, because he is worried that it will cloud his mindful awareness. A Jewish patient whose discharge paperwork was delayed until after sunset on Friday now refuses to leave the hospital because of religious restrictions on travel over the Sabbath.

7 The challenges of diverse religious patients: The challenges of diverse religious patients: A Catholic patient is distraught as she goes to surgery after her request for the Eucharist has been denied by both her physician and priest because she is NPO. A Muslim patient is found on the floor of his room, unable to get up. He had gotten out of bed in order to kneel and pray. A Buddhist patient refuses pain medication, because he is worried that it will cloud his mindful awareness. A Jewish patient whose discharge paperwork was delayed until after sunset on Friday now refuses to leave the hospital because of religious restrictions on travel over the Sabbath. A very spiritual patient with Cystic Fibrosis experiences a breathing crisis. Her nurse knows that the patient usually prays to control her anxiety and regulate her breathing, but the patient says, “I can’t pray anymore to a God who is so uncaring.”

8 Number of Medline-Indexed English Articles by Year, with Keywords: RELIGION and SPIRITUALITY [ Includes the variations: religious, religiosity, religiousness, and spiritual ] John Ehman, 2012

9 Number of Medline-Indexed English Articles by Year, with Keywords: RELIGION and SPIRITUALITY [ Includes the variations: religious, religiosity, religiousness, and spiritual ] John Ehman, 2012

10 Number of Medline-Indexed English Articles by Year, with Keywords SPIRITUAL or SPIRITUALITY John Ehman, 6/30/09

11 Number of Medline-Indexed English Articles by Year, with Keywords SPIRITUAL or SPIRITUALITY John Ehman, 6/30/09

12 Among the factors in the mid-1990s affecting the study of spirituality/religion & health: Greater attention paid to religious values, beliefs, and practices as key aspects of patient diversity (e.g., new emphasis by the Joint Commission) Growing sense among health care providers and researchers of religion’s role in health-pertinent behaviors and health care decision-making -- important for “knowing your patient” Research begins accumulating significant data that patients’ spirituality/religiosity may be important to medical outcomes and thus to the process of “healing your patient”

13 Two things to keep in mind about the modern field of Spirituality & Health: 1) It is still nascent in the current form 1) It is still nascent in the current form 2) It has somewhat fluid terminology

14 In the health care literature, religion is associated with institutional systems of beliefs and practices, whereas spirituality is associated with personal experiences and an individual quest for meaning. Spirituality is generally seen as a broad concept, going beyond the “limits” of religion.

15 The Two Most Common Views of the Relationship of Spirituality to Religion in the Current Health Care Literature Spirituality Religion Spirituality Religion

16 Terminology pairings in Medline articles, Terminology pairings in Medline articles,

17 ...And, how terms may be defined and used by researchers or providers, in academic articles or in clinical documentation systems, may not be in sync with how the public or an individual patient may relate to those terms.

18 Americans and Religious Affiliation A 2012 Pew Research Center survey found that one-fifth of the U.S. public – and a third of adults under 30 years old – now describe themselves as “religiously unaffiliated.” This is partly due to an increasing trend to drop all sense of connection to a specific religious tradition when there is not an active social involvement in a congregation. Moreover, 18% of American adults describe themselves now as “spiritual but not religious.” Pew Research Center’s Forum on Religion & Public Life, "'Nones' on the Rise…,” report issued October 9, 2012

19 What is the significance of spirituality/religion and of spiritual/religious diversity for clinical practice? I.

20 Polls re: Spirituality/Religion in the US 90-96% of adults in the US say they “believe in God” over 40% say they attend religious services regularly, usually at least once a week 50-75% say religion is “very important” in their lives 90% say they pray, and most (54-75%) say they pray at least once a day over 80% say that “God answers prayers” 79-84% say they believe in “miracles” and that “God answers prayers for healing someone with an incurable illness” --These percentages are summary characterizations of numerous national surveys showing fairly consistent results across time

21 Recent health care literature largely addresses spirituality/religion as… … a ground for “religious” social support … a value basis for personal meaning-making (and therefore understanding illness and coping with crises) and decision-making … a context for behavior that can influence the way the body works (e.g., meditation that can affect physiological reactions to stress)

22 Research increasingly indicates that health-positive effects of spirituality/religion far outweigh concerns about health-negative effects. For example: fewer dangerous behaviors (e.g., less substance abuse, unsafe sex, or neglect of health screenings) less suicide and generally greater aversion to suicide less depression and faster recovery from depression greater sense of meaning/purpose in life, hopefulness --See: Koenig, H.G, et al., Handbook of Religion and Health, 2001/2011; and Koenig, H.G., Testimony to the US House of Representatives Subcommittee on Research and Science Education, 9/18/08

23 lower rates of coronary artery disease lower cardiovascular reactivity greater heart rate variability lower blood pressure and generally less hypertension tendency for better outcomes after cardiac surgery better endocrine function better immune function lower cancer rate and better outcomes lower mortality and longer survival generally --ibid.

24 Theoretical Model of How Religion Affects Physical Health --adapted from Koenig, et al., Hand- book of Religion and Health, 2001 Religion also affects Childhood Training, Adult Decisions, and Values & Character; which then in turn affect mental health, social support, and health behaviors. Infection Cancer Heart Disease Hyper- tension Stroke Stomach & Bowel Liver & Lung Accidents & STDs Stress Hormones Immune System Autonomic Nervous System Disease Detection and Treatment Compliance High Risk Behaviors (smoking, drugs) Mental Health Social Support Health Behaviors RELIGIONRELIGION

25 A Caution about Expectations of “Dramatic” Effects of Spirituality/Religion on Medical Outcomes We should be prepared to appreciate how empirical findings may indicate significant -- but not “dramatic” or “sensational” -- effects of spirituality/religion on medical outcomes.

26 Spirituality, the Brain, and Cell Life Studies using MRI indicate not only that certain kinds of religious/spiritual meditative practices can influence blood flow and activity in the brain but can even have a lasting effect on brain function and perhaps structure. --Newberg, A. B., et al., "Cerebral blood flow differences between long-term meditators and non-meditators,“ Consciousness & Cognition 19, no. 4 (Dec 2010): Some forms of mindfulness meditation, practiced over time, appear to control cognitive stress reactions like threat appraisal and rumination to such a degree as to protect against the cellular process of the deterioration of telomeres, affecting cell life. --See: Epel, E., et al., "Can meditation slow rate of cellular aging? Cognitive stress, mindfulness, and telomeres," Annals of the New York Academy of Sciences 1172 (Aug 2009):

27 Frontal Lobe Activity of Buddhists Meditating --see Newberg, et al., "The measurement of regional cerebral blood flow…,” Psychiatry Research: Neuroimaging 106, no, 2 (April 10, 2001):

28 Parietal Lobe Activity of Buddhists Meditating --see Newberg, et al., "The measurement of regional cerebral blood flow…,” Psychiatry Research: Neuroimaging 106, no, 2 (April 10, 2001):

29 Non-Meditators and Long-Term Meditators --Newberg, A. B., et al., "Cerebral blood flow differences between long-term meditators and non-meditators,“ Consciousness & Cognition 19, no. 4 (Dec 2010):

30 Patients’ Spiritual Beliefs, Health Care Decision-Making, and Physician Inquiry A University of Pennsylvania study (n=177) indicated that nearly half of patients may have spiritual/religious beliefs that would influence their health care decision-making if they became gravely ill. Two-thirds of patients would welcome a carefully worded exploratory question about spiritual or religious beliefs. (E.g., “Do you have spiritual or religious beliefs that may affect your medical decisions?”) Two-thirds of patients think that such an inquiry by a physician would make them trust the physician more. -- Ehman, J.W., et al., “Do patients want physicians to inquire…,” Archives of Internal Medicine 159, no. 15 (1999):

31 Spiritual/Religious Support & Medical Costs A multisite study by a Harvard group found that medical costs for cancer patients in the last week of life (n=339) were higher for those who reported not receiving sufficient spiritual/religious support from the care team as a whole. On average, care cost $2441 more than for those who received spiritual/religious support from the team, but $4060 for “high religious coping” patients and $4206 among racial/ethnic minorities Costs centered around ICU care and hospice care in the last week of life. -- Balboni, T., et al., “Support of cancer patients’ spiritual needs and associations with medical care costs at the end of life,” Cancer 117, no. 23 (Dec 1, 2011):

32 The picture emerging from spirituality/religion & health research is promising, but application to the clinical setting remains complex. Causal relationships/mechanisms are not well understood. The nascency of the field means that few findings have been tested across diverse populations. Application of the findings relates not only to questions of health but to patients’ rights regarding spirituality/religion. The role or function of spirituality/religion in the life of any patient is notoriously hard to predict.

33 Spirituality  Grave Illness & Treatment ● Congregational connections may bring social support and practical assistance ● Patients’ own clergy may bring “authoritative” support and guidance for coping ● Scriptures may help patients find focus and direction amid crisis ● Religious rituals may bring a sense of assurance and “deepening” ● Prayer/meditation may bring peace and encouragement

34 Spirituality  Grave Illness & Treatment ● Congregational connections may bring social support and practical assistance (or constrict the patient by the imposition of the group’s norms) ● Patients’ own clergy may bring “authoritative” support and guidance for coping (or may give “simple” answers, poor guidance, or even shaming chastisement) ● Scriptures may help patients find focus and direction amid crisis (or, as complex documents, scriptures may be confusing or disturbing) ● Religious rituals may bring a sense of assurance and “deepening” (but are often disrupted by illness and treatment, causing stress) ● Prayer/meditation may bring peace and encouragement (but some patients find prayer/meditation practice difficult during illness)

35

36 Grave Illness & Treatment  Spirituality ● Patients may experience “stress-related growth” that is spiritual in nature or is spiritually enriching ● Questions of “what really matters” can open some gravely ill patients to affirm who they are “at the core,” spiritually ● Patients may find in their self-experience of resilience an affirmation of their spirituality ● The experience of loss of control can shift a patient’s sense of locus of control from himself/herself to a “higher power”

37 Grave Illness & Treatment  Spirituality ● Patients may experience “stress-related growth” that is spiritual in nature or is spiritually enriching (or they may feel diminished, cut off, and beaten by illness/treatment and spiritually withered) ● Questions of “what really matters” can open some gravely ill patients to affirm who they are “at the core,” spiritually (or can lead them to question long-held spiritual/religious beliefs) ● Patients may find in their self-experience of resilience an affirmation of their spirituality (or may see in their self-perceived weaknesses, such as feelings of fearfulness, a spiritual “failure”) ● The experience of loss of control can shift a patient’s sense of locus of control from himself/herself to a “higher power” (or can create a sense of sheer vulnerability and “abandonment by God”)

38 What are practical strategies to recognize the potential importance of spirituality/religion in the clinical setting while working with diverse patients? II.

39 -- John Ehman

40 Need for a strategy for health care providers to support patients spiritually... …that can work across lines of religious diversity …that takes very little time in the clinical encounter, while potentially bringing clinically significant benefits …that does not necessitate a large knowledge base regarding spiritual/religious traditions and issues …that does not blur professional roles/boundaries, and especially does not ask health care providers to act as spiritual counselors

41 A Pastoral Care Approach …with Implications Chaplains often work across lines of religious diversity by focusing on the experiential and emotional issues or dynamics that affect the patient’s sense of meaning, quest, and relationship. Chaplains try to follow the lead of the patient, to help him/her feel heard, connected, and safe to venture wherever he/she feels distress or otherwise has need. The chaplain expresses an openness to spiritual concerns and keeps in mind that identified needs which are not explicitly religious/spiritual may still be spiritually relevant for the patient. Also, non-religious or non-theistic patients may have “spiritual” needs. This approach may have implications for the general spiritual support of patients by physicians, nurses, and others.

42 Health care providers can support diverse patients spiritually by: ● acknowledging patients’ statements of meaning, quest, and relationship ● affirming the emotional nature of our humanity ● looking/listening for indications of possible spiritual distress ● expressing interest in the patient’s spirituality per se: particular spiritual resources & issues pertinent to the provider-patient relationship

43 MEDS

44 Supporting Patients Spiritually with MEDS M = acknowledge statements of meaning/quest/relationship E = affirm the emotional nature of our humanity D = look/listen for indications of possible spiritual distress S = express an interest in the patient’s spirituality per se: particular resources and issues pertinent to the particular resources and issues pertinent to the provider-patient relationship; and consider options provider-patient relationship; and consider options for explicit inquiry for explicit inquiry

45 MEDS M = acknowledge statements of meaning/quest/relationship E = affirm the emotional nature of our humanity D = look/listen for indications of possible spiritual distress S = express an interest in the patient’s spirituality per se: particular resources and issues pertinent to the provider-patient relationship; and consider options for explicit inquiry

46 Acknowledging Patients’ Statements of Meaning, Quest, and Relationship Patients may make overtly religious/spiritual statements of meaning, quest, and relationship, but often the expression is more subtle and indirect. E.g.: “God has a plan,” “I know God’s with me,” or “God didn’t bring me this far to let me down now”; but also, “I'm sure learning a lot,” “Something like this changes your priorities,” or “I'm so thankful for my family.” Acknowledgement can be made as simply as reflecting or paraphrasing the patient's statement or by saying, for instance: “I appreciate your perspective,” “You're finding your way ahead through this,” “You're in touch with what's important,” or “This is a journey.” --Such statements generally open up communication

47 Responding to a patient is these ways might seem a matter of general courtesy and sensitivity, but at the right moment can be experienced very much as a spiritual support.

48 MEDS M = acknowledge statements of meaning/quest/relationship E = affirm the emotional nature of our humanity D = look/listen for indications of possible spiritual distress S = express an interest in the patient’s spirituality per se: particular resources and issues pertinent to the particular resources and issues pertinent to the provider-patient relationship; and consider options provider-patient relationship; and consider options for explicit inquiry for explicit inquiry

49 Emotion and Spirituality Emotion and Spirituality Emotion may be said to be the “heart” of spirituality, and an affirmation of emotion can help patients express spiritual need. E.g.: patients who are ashamed of their anxiousness or tears may be blocked from expressing or exploring spiritual issues, or emotional lability may be experienced as a spiritual problem. Affirmation of emotion can occur through acknowledgement and normalization. For instance: ● “ Your tears show how deeply you feel, how important things are to you. ” ● “ There's so much about what’s happening that’s scary. ” ● “ Illness and treatment can be such an emotional rollercoaster. ” ● “ Your spirit feels heavy. I want to affirm how well you are managing in all of this. ” --Listen for spiritual content in patients’ responses. --Listen for spiritual content in patients’ responses.

50 MEDS M = acknowledge statements of meaning/quest/relationship E = affirm the emotional nature of our humanity D = look/listen for indications of possible spiritual distress S = express an interest in the patient’s spirituality per se: particular resources and issues pertinent to the particular resources and issues pertinent to the provider-patient relationship; and consider options provider-patient relationship; and consider options for explicit inquiry for explicit inquiry

51 Spiritual Distress Any sign of physical or psychological distress may have connections to a patient's spirituality, including unexplained or unmanaged pain, trouble sleeping, anxiety or agitation. Spiritual distress can have mundane indicators.

52 Conversational Hints of Possible Spiritual Distress 1) Interruption of religious practices / rituals of every kind (e.g., congregational or social religious activities, prayer) 2) Issues of meaning amid change (e.g., questions/statements about the meaning or purpose of his/her pain or illness or of life in general, expressions about a sense of injustice, overwhelming salience of loss, hopelessness, abandonment/withdrawal from relationships or groups) 3) Religiously associated expressions (e.g., mentions illness as “deserved” and/or “punishment,” talks of “evil” or “the enemy,” describes self as “bad” or “sinful,” uses colloquial expressions with religious overtones like “this is hell,” repetition of “forgiveness” language, refers to death as “judgment day,” or wonders about “God's plan”)

53 One effective way to be alert to spiritual distress is to think of how a patient’s physical challenges may be problematic to spiritual activities: ● Barriers to attending congregational activities (including treatments or check-ups over religious holidays) ● Inability to kneel [--also a falling hazard] ● Difficulty using hands (e.g., to make religious gestures or to hold religious objects or scriptures) ● Trouble seeing (e.g., to read religious material) ● Trouble hearing (e.g., to listen to music or religious broadcasts or speak on the phone with friends/clergy) ● Pain and medication issues (e.g., affecting meditation/prayer) ● Body image issues affecting a sense of “cleanliness” (including difficulty washing)

54 MEDS M = acknowledge statements of meaning/quest/relationship E = affirm the emotional nature of our humanity D = look/listen for indications of possible spiritual distress S = express an interest in the patient’s spirituality per se: particular resources and issues pertinent to the particular resources and issues pertinent to the provider-patient relationship; and consider options provider-patient relationship; and consider options for explicit inquiry for explicit inquiry

55 An Inquiry about Spiritual/Religious Beliefs ● Provider initiative may be necessitated by patients' reluctance to introduce the topic --because of fears of provider reaction (and power dynamics), lack of salience about the subject during often highly directed clinical interactions, or uncertainty about how to talk about beliefs outside of a familiar religious context. ● Inquiry can bring to light important information affecting how providers and patients work together, including how patients may make health care decisions. ● A carefully worded inquiry about spiritual/religious beliefs may be experienced as a significant support, and that could have larger implications for provider-patient communication and relationship.

56 Health care provider inquiries Health care provider inquiries about spirituality should… about spirituality should… …implicitly or explicitly indicate that the purpose is to provide health care that honors patients’ beliefs and values (and that the question is not a judgment about the patient’s values) …give patients an “easy way out” if they don’t want to talk about their spirituality Note the construction of a question like: “Do you have religious or spiritual concerns that may affect your medical care?”

57 Taking a Spiritual History Taking a Spiritual History FICA The FICA tool was created by Christina Puchalski to help physicians engage patients about spiritual/religious factors that may be pertinent for care. It is a guide for conversation in the clinical setting, covering four basic areas. F F – Faith or Beliefs I I – Importance or Influence C C – Community A A – Address in Care For more, see: George Washington Institute for Spirituality & Health

58 Overall Primary Strategy for Clinicians: Overall Primary Strategy for Clinicians: Find ways of inviting patients to interpret to you how their spiritual/religious values, beliefs, and practices may affect their health and care. Note that this strategy tends to go against the medical culture of clinical deduction and challenges some assumptions about the practice of assessment.

59 The Conundrum of Spiritual “Assessment” The Conundrum of Spiritual “Assessment” (or Why We Currently Focus Mostly on Information-Gathering) ● no consensus at this point, esp. re: diversity dynamics ● gap between research measures and clinically useful tools ● logistics of implementation ● patient experience of the process ● pressure in modern health care to assess spirituality in ways beyond what can be supported sufficiently by the relatively new field of spirituality/religion & health

60 How can we in the clinical setting manage potentially problematic aspects of interaction around spirituality/religion, across lines of diversity? III.

61 One of the biggest barriers to working across lines of religious diversity is fear of awkward missteps that can create embarrassment and conflict. Fact of life: working with religious diversity is complex and messy and often leads to faux pas.

62 What spirituality/religion adds to the dynamics of cultural diversity: ● moral dimension ● complexity of dogma and ritual ● increased “hard-to-relate” factor ● authoritative claims regarding an absolute reality ● particular historical sensibility/sensitivity ● increased potential for visceral feelings/reactions

63 What spirituality/religion adds to the dynamics of cultural diversity: ● moral dimension ● moral dimension ● complexity of dogma and ritual ● complexity of dogma and ritual ● increased “hard-to-relate” factor ● increased “hard-to-relate” factor ● authoritative claims regarding an absolute reality ● authoritative claims regarding an absolute reality ● particular historical sensibility/sensitivity ● particular historical sensibility/sensitivity ● increased potential for visceral feelings/reactions ● increased potential for visceral feelings/reactions These prospects can make us especially apprehensive about faux pas.

64 Modeling Behavior: Modeling a non-anxious response to faux pas can be helpful to patients, since crossing lines of religious/cultural diversity can be as intimidating a task for patients as it can be for care providers. Affirming the Patient-Provider Relationship: It is often the case that a “break” in one’s sense of safety with another person can lead to a deeper sense of trust when that “break” is sensitively redressed. The experience can lead to an explicit affirmation of care and concern.

65 Responding to Faux Pas re: Religion ● Check your natural response to protect yourself (e.g., flee, deny, dismiss, blame, etc.) ● Keep in mind that anything related to religion touches us at a deep level. ● Observe that a misstep has occurred, and express concern about how this feels to the patient. ● Show that you’re interested in listening to the patient and working together toward the goal of healing. ● Be personal. Use “I” statements. ● Avoid getting drawn into a religious debate.

66 Example of Avoiding Religious Debate: Example of Avoiding Religious Debate: Patient: “What do you believe about ____________?” Physician: “That’s an interesting question, but I think I should stay focused on medicine. Is something troubling you, though?” Patient: “I was just wondering _______________.” Physician: “It sounds important that you have an opportunity to discuss this. Would you like to talk to a hospital chaplain?” Respond positively and show an interest in engagement, while setting a boundary to discussion that recognizes your professional role.

67 Responding to Patient Invitations of Prayer: If a patient asks for prayer, providers may choose to decline but should still respond appreciatively/positively. For instance: ● “I'd prefer if you’d pray, and I could be with you quietly.” ● “Thank you for offering to have me join you in prayer, but it's not my practice to pray with my patients.” ● “I'm not sure about praying together, but I am sure that we can work together, and I do honor your spiritual life. ”

68 However, what if you do want to participate in corporate prayer with a patient: ● Keep it simple ● Act to "mark off" or distinguish the prayer time (e.g., a few seconds of silence; take a breath) ● Avoid putting doctrinal statements into the patient’s mouth (esp. in light of patient-provider power inequity) ● Be alert to how any formal “traditional” prayer is laden with a specific theological history ● Focus on the immediate situation (as has been indicated by the patient) ● Consider making personal well-wishing statements

69 ● Shared prayer can be a helpful support to patients, under the right circumstances, but it must be done very carefully. ● Caution is necessary to protect against the imposition of the provider's values or a blurring of the provider's role. ● Consulting a chaplain about a particular case may be helpful. Example: "I pray for Bob, who is in the midst of so much and who is today feeling anxious about the tests that are planned. I pray that he feel an affirmation and a peace in all that he is doing. I pray for blessings upon him. Amen." --Note that such a personal and spontaneous prayer may not be aligned with the religious practice of patients from traditions that tend to use formal, set prayers. This fact bespeaks the inherent complexity of interfaith corporate prayer.

70 An encouraging thought: Never underestimate the drive of many patients to connect with you across lines of cultural diversity, including religious diversity …and… how much patients often appreciate your efforts to connect personally with them in a time of health crisis.

71

72

73

74


Download ppt "2 nd Annual Cultural Competence Seminar 2 nd Annual Cultural Competence Seminar Paul F. Foster School of Medicine Paul F. Foster School of Medicine Texas."

Similar presentations


Ads by Google