Empowering Women in Chiropractic – Cultural Competence 101 for the Chiropractor Part 4

Click here to download the transcript.

Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors.  We suggest you watch the video while reading the transcript.

Can you hear me?

Yes, sir. I can real live.

Go for it.

Hello. Welcome to cultural competence. One a one-on-one for the chiropractor. I’m Dr. Charmaine Herman. And this is our part four of this set of episodes that we’ve been doing here so far through ChiroSecure. So let’s go ahead and get started. It’s your Life university because of chiropractic as well as in private practice in Alpharetta, Georgia, I’ve been doing cultural competence for about 15, 20 years now, a lot longer, um, having been a trainer in cultural competence when I worked for the South Carolina department of health and environmental control. So our goals for today are first to figure out how to become culturally competent. And secondly, the understand conscious and unconscious bias. All of these are part of becoming cultural competent, so how to become culturally competent. That’s something to consider in our world that is diverse and ever-changing. So we want to talk about how we, as doctors of chiropractic can be culturally competent as a review, we talked about culture and that culture is actually the whole person.

Every individual is made up of their own culture. The culture includes the food. They eat the holidays, they celebrate the clothes that they wear, the things that they believe in their idea of modesty, their social, economic status. All of that is part of a person’s culture and everyone has their entire separate culture. So how does one become culturally competent? Well as a doctor of chiropractic, the definition for cultural competence in health care is someone that understands the importance of both social and cultural influence on our patients. How would they think believe how they’ve been raised in their experiences affect their understanding as well as their commitment to being under chiropractic care.

So becoming cultural competent is not learning all the cultures of the world. I had someone telling me that one time, who has all the time to learn all the cultures of the world, but that’s not what cultural competence is about. Becoming cultural confidence is first actually thinking about evaluating yourself. So evaluation is a big part of cultural competence. You have to evaluate yourself and determine who you are in order to become culturally competent onto the next slide. So again, being culturally competent is again, understanding firstly, this is a learned behavior. You’re not born culturally competent. That’s something you also have to teach yourself and learn through your own experiences. But again, first understanding your own culture, who you are. And then also honestly, and, um, deep determined to understand your biases, both conscious and unconscious biases, because we all have them as well.

So for example, if I look at myself, I know that I am like everyone else is a multiplicity of culture and experience. I’m a black female. I, um, I’m an, my family were immigrants. Uh, I currently teach at life university. I’m a born again, Christian. Um, I call myself an American because of my Caribbean background, as well as growing up in the United States. Um, I’m a chiropractor. My experiences have been things such as I’ve experienced racism. I was very sexism. Um, I lived through nine 11. I lived through seeing the Rodney king, um, uh, the Rodney king beatings and even the OJ Simpson trial things that have been part of my experiences that make me who I am that make up the multiplicity of my culture. So in order to become culturally competent, you have to first think about who you are, just what, who, who are you and what were your experiences that have actually shaped you?

Things that you’ve experienced over your many years as a person on this earth? So that’s one part of being culturally competent. So once I know who I am, then I can want to the next indication for cultural competence. So let’s first talk about bias because I have to understand both conscious and unconscious bias. Now bias is an inclination or prejudice for or against one person or group, especially in a way that is considered to be very much unfair. So we talk about being biased biases that we’ve developed over time. They can be divided into two types, both conscious and unconscious bias. Now conscious bias and things that you’re conscious about, right. Biases comes from various things, such as what we’ve experienced as we’ve grown up as children. Um, things that have happened to us in our lifetime of beliefs, from our families, our religious beliefs, um, things that we see on social media, things that we read in the newspaper or watch on TV.

These things actually shape our biases because again, children are not born biased. Children are born just to, as a clear slate. And as we grow older and we have these experiences on lives and come in contact with all this other type of media and influences, that’s what shapes our biases. So that’s where bias has actually come from now, unconscious bias and things we don’t really think about. It’s the way about our brain kind of organizes things. We’ll get more into that we can have. What’s called an affinity bias where we feel connected to people that are similar to us. So we have specific connections to them. So I’m a Jamaican. So I may have affinity bias for other Jamaicans, um, there’s perception, bias, stereotypes, and assumptions that we make about different groups, things that we’ve, we believe about different glues, oops, we call that perception bias.

Then there’s also the halo effect where we actually project positive, um, characteristics on people that without even knowing them, because they look a certain way or they come from a certain place that we kind of project these positive types of attributes on them that may not actually be for that individual. And then there’s confirmation bias. The bias that comes about by wanting to confirm things that I already believe. So I only enter conversations or talk to people that confirm the things that I believe I don’t go outside of what I believe, because I just want things to confirm my beliefs cause my, all my beliefs are correct and they’re right. So the different types of biases, and these are what we call unconscious biases, conscious biases are things like I like, um, um, chocolate ice cream over vanilla ice cream. I’m consciously making that choice, but unconscious bias biases all a little bit different than more ingrained.

The fact is biases can also form because of stereotypes and stereotypes or biases that are often begin, but how biases actually begin. So are stereotypes about a person or a thing or a belief about an individual, even if it’s not, or members of a particular group, even if it’s not accurate based upon our experiences or what other people have told us, we formed these types of stereotypes that can influence bias. For example, um, when we form stereotypes, we actually become very, um, over gender generalization, we put our, our stereotypes on everyone in a particular group or a particular country. We put the same stereotypes and attribute them to everyone that fall under that particular headache. For example, if I believe that people of advanced age, um, were very slow and unskilled and couldn’t do things like learn how to use a computer. And I make that general statement, um, maybe I met one person or one, um, old elder person who could not do that.

But that knowing that one person I over-generalize and say, all people of advanced age are unable to, um, quickly think or to adapt to technology or they’re slow thinkers or things that does that. So I’ve made one stereotype, maybe from one person that I have known that had that characteristics, but I’ve over generalized it and attach it to everyone that looks similar or everyone who was at advanced age. I say, they’re all unable to think quickly and adapt to new technology things such as that, which is definitely wrong because there’s no way that I can know every person of advanced age in this world. So I over-generalize that characteristic or that becomes a stereotype on the, upon those people. So in other words, if we’re not sure how we feel about people and how we think, um, I mean, I love to talk about this because people say, well, I’m not, I’m not biased. I don’t have those issues. Um, I like everybody. I love everybody. And that sounds great, but I’m going to do a quick exercise. I want to ask everyone to go with your gut feeling on the next five images that are about to be shown and think it fits. All right. So again, just go with me on this. All right. Image number one, is this person honest, lazy, hardworking, or manipulative?

They mentioned. Number two, is this person honest, lazy, hardworking, or manipulative? Choose one image. Number three, is this person honest, lazy, hardworking, or manipulative image? Number four, is this person honest, lazy, hardworking, or manipulative Image? Number five, is this person honest, lazy, hardworking, or manipulative?

Now that’s just a quick evaluation exercise. A self-evaluation actually. But when you honestly think about it, I’m looking at these five slides. You quickly can make judgements and answer those questions with your gut before you actually know these people. And it’s easy to do that. And I always get scary how easily it is to come to conclusions about people just based upon what they look like, or how they dress, or I see them. It’s amazing how our brain automatically draws specific conclusions. And those are part of our unconscious biases. Cause our brains use that to categorize all the information that we get in and get in this world as we just live in this world. So again, I would like to reflect on that and it always surprises me how easy it is to draw conclusions and make assumptions of people just by looking at them and having no other information about them.

Again, this is a phenomenon of our brain, our brain unconsciously, um, um, co categorizes inflammation. When you think about living in this world, the human brain has to actually deal with 11 million pieces of information every second, that’s a lot. And that’s all just from our senses eyes, nose, what we hear, what we see, what we smell and out of all of that information that comes to our brain to have to categorize and organize only 40 pieces actually are what the brain actually takes in per second. So 11 million things coming towards your set, coming from your senses towards your senses and only 40 with your brain actually has time to categorize and organize. So not a matter how well-meaning we are and saying, well, I’m not a biased person. I don’t, I don’t bias my bias against certain races or genders or height. So wait. So things like that, our brain uses that to organize how we relate to the world. It categorizes things and biases, unconscious biases are part of that catalog categorization process.

So when we think about becoming culturally competent, one thing in order to become cultural competence, you have the first is understand that the origins of where our biases actually come from our experiences, the things we’ve seen in our lives, and these we’ve been exposed to in our lives. We also have to choose to set our biases aside, especially when it’s important to be fair and impartial. And when we’re working with our patients, we’re making decisions and choices. We want to be fair and impartial. We have to actually consciously set our biases aside. Once you realize that we do have them, and then we have to utilize, um, so many different things, such as trainings and making opportunities to meet people and find out different things about different cultures, actually put ourselves in a position where we can actually interact with people from different cultures. So we can understand that these biases aren’t true, that these biases are things that came from what my mother said or what my father said or experience I had with one person in this, um, in this group years ago when I was a child. So you have to definitely utilize opportunities for training and education to retrain your unconscious biases, retrain your brain, to see things differently.

So for example, when it comes to biases and comes to culture, never assume for one thing that people who look alike are share, or have the exact same culture. I have a lot of friends who are Asian and they’re all very, very different. So I never make the assumption that this person from Singapore is the same as this person from Taiwan. I have to definitely never make those assumptions. So when it comes to culture and being culturally competent, never assume it’s better to just respectfully ask people love when you ask them about their cultures and want to tell you more about who they are and the things that they’ve experienced that sets up relationships and allows us to become a bigger part, this entire diverse world that we live in. So again, when it comes down to culture, never assume that again, people that look the same have the same culture, it’s better just to respectfully ask when it comes to being culturally competent, it means understanding that one size does not fit all. So again, not making assumptions that people that look the same are the same patients that come from the same communities may have very different values. Patients that come that have the same racial group may have definitely different experiences. So never make those assumptions. One size does not fit all when it comes down to our patients and becoming cultural competent, culturally competent chiropractors.

So cultural competence is actually a continuum. You actually start and continue to grow. You start from a place. And again, hopefully no one has started from a place of cultural destructiveness where you believe in things like forced assimilation, like what happened to the native Americans back in the 18 hundreds in our country’s history, when they were forced to assimilate the mainstream society’s culture, and you go from cultural, um, click, you go from cultural destructiveness to cultural incapacity, where racism is maintained by and by the dominant culture. So stereotypes are believed to be true and racism continues to be maintained by the dominant culture, similar to things such as the Jim Crow laws or the, um, um, slave laws and slave codes back again in the 18 hundreds, early 19 hundreds.

And you get to a place also what we call cultural blindness, where, you know, I don’t see differences. Everyone is the same. I don’t see anyone as different. I treat everybody the same. Most people say this, but because biases are unconscious, we really don’t. We need to understand that that is not true. We can’t just say we treat everyone the same. It sounds great, but it’s not true for the majority of individuals. We can get to a place of being pre a cultural pre competence, where we actually explore the issues and start to think about how culture and culture culture relates to our practices are our lives, our life, our communities, things of just like what we call pre competence. And we get to cultural competence. We’re actually looking at that information differently. We’re actually seeing and trying to draw information from people of all the cultures.

So we can ourselves, um, get destroyed some of our biases and stereotypes, and actually work together in a larger community. Um, being culturally competent that we try to actually employ people that are unbiased. And we start looking for more and more people who are more rounded as far as how their view of society actually is. And then there is what we call cultural proficiency, and that’s a long way away. In most cases, I’m still striving toward cultural proficiency or I’m actually doing research and bringing on more viewpoints, understanding how to use that, to shape how I work in my practice, how I teach my classes, things such as that that’s cultural proficiency. And again, that’s a work in progress. So cultural competence, we don’t start off with just get there overnight. We have to determine where we are on the continuum and work towards cultural competence. And hopefully I’ll have to cultural proficiency as well as we grow as human beings.

So being the cultural competent chiropractor for me to say, I’m a cultural competent chiropractor that I’m someone that will first acknowledge my own culture. I’m also going to acknowledge, um, that I have biases that are both conscious and unconscious and recognize those biases. I’m going to strive to respect other cultures. And I’m also going to educate myself about the culture of the communities that I serve since things such as health disparities in my community. How can I reach my socially, um, socioeconomic communities that are more impoverished than my community. I’m going to research and find out more about that as a, as a cultural competent chiropractor, I’m going to refuse to stereotype or profile individuals before I actually get to know them. I’m not going to wait for get my assumptions or my conscious biases, um, affect the way I treat people. And I’m going to try to be fair when I have to be in all cases impartial.

When I meet people for the first time before I start making assumptions based upon stereotypes, I’m also going to be making a concerted effort to serve outside of my community, not just in my neighborhood and the community where my practice is, but what about these other communities? How can I reach those other communities and tell them what chiropractic is and how can I help those in those areas, become people who car become better, healthier people because of chiropractic. And also if I’m a culturally competent chiropractor, I’m not going to be afraid to ask questions. When I meet people from other cultures, I’m going to respectfully ask so I can understand, and definitely not, not use unconscious biases to, um, judge these individuals, but definitely ask questions to find out more about them. And then if I want to be culturally competent, I’m going to continue to self assess myself. Am I getting there? What am I, what are the differences between now compared to where I was before I’m going to take self-assessments and just judge myself so I can see how I’m learning to be culturally competent with my community and the other communities that surround me as a chiropractor.

So that’s all for now, as far as becoming culturally competent as a doctor of chiropractic. And on next episode, we’re going to talk about how to apply cultural competence to our practice, and then what’s next after that. So I have some more information to share with you as always. It’s a pleasure to talk to you. I hope you think some sincerely about this topic. I want to thank you for all of your time, and I’m definitely want to thank ChiroSecure for allowing the segment have a great day.