CULTURE IN PERSON- AND PEOPLE-CENTERED HEALTH CARE

Abstract

Background: Person- and people-centered medicine (PCM) underscores the importance of accounting for culture and cultural values. Objective: The objective of this article is to clarify the concept of culture and describe misleading or faulty ways of understanding this concept in averting blind-spots for culture in person- and people-centered health care. Method: Drawing on the conceptualization of PCM, the philosophy of values, values-based Practice, and principles of anthropology, misleading or faulty ways of understanding the concept of culture are identified by meeting criteria of conflation, confusing contingency as if necessity, being too narrow, or contracting blind-spots. Results: Six ways of understanding the concept of culture are identified that may undermine person-centered practice. These may be corrected by understanding culture as necessarily constituted by a set of shared practices underpinned by values. So understood, this clarifies the distinction between culture and group identity, and that: subcultures and counter-cultures are proper cultures; symbols, language, and geographic locality are contingent qualities of culture; culture is subject to change and not fixed by history or an individual’s group identity; and that culture is readily ascribed to others/foreigners owing to blind-spots for one’s own culture. Conclusion: By averting too narrow an understanding of culture and overcoming one’s blind-spot for one’s own cultural values, the clinician may recognize and account for culture and cultural values in person-centered health care. When the differences in cultural values bring about conflict or potential alienation in the interpersonal relationship, the differences need to be subjected practically to a process of dissensual decision-making, accounting for the uncommon ground within a safe space created by common ground and consensus.