Posted by Suzanne Salimbene. “Equality” is a key word in U.S. culture.  There is a consensus that equality is always good and that, in all things, everyone should be treated equally.  However, in today’s diverse U.S. population, we need to re-examine that concept—especially in healthcare. Because our cultures mold our needs and expectations regarding the amount and type of healthcare we receive and even who provides that care, we cannot assume that the care which is considered good by members of one culture will be considered good by members of another cultural group.  Therefore, it is important that we re-evaluate our belief that equality of care is the best way to serve all patients, regardless of their cultures, religions, or country of origin. For example, what if a patient who comes from a culture in which physicians make all treatment decisions according to what he or she considers best for that patient interacts with our health system? Our health system is vastly different. In the U.S. physicians practice full disclosure to the patient, follow rules of patient confidentiality by not disclosing information to the family, and expect the patient participate in the medical decision-making process by choosing from a number of possible treatment plans. While this procedure might be expected by most members of our majority U.S. culture, how would persons from cultures in which physicians are expected to make medical decisions and patients expected to be ‘protected’ from ‘bad news’? Do you think that patient would feel that he or she was receiving caring and quality care even though it was ‘equal’ in terms of the common practices of the U.S. system? Furthermore, a person’s definition of quality care does not only depend upon whether or not a patient expects to participate in the decision-making process or a negative prognosis be disclosed, but many other culturally learned attitudes and needs. For instance, learned attitudes include: whether or not one interprets a caregiver’s pat on the hand or head as a caring or an invasive gesture, the types of treatment and medications expected, whether or not one expects to be hospitalized, and the types of food and liquids one expects to be given during a hospital stay or prescribed by the physician. My textbook, What Language Does Your Patient Hurt In? A Practical Guide to Culturally Competent Care, summarizes not only some of the traditional health beliefs and practices that specific cultural and religious groups that may mold individual member’s definitions of quality care but common expectations of social roles and perimeters. This information is not provided as a description of all member beliefs but only to help caregivers better understand a patient’s possible expectations regarding care and their interactions with them.   Factors such as the length of time the patient has lived in the U.S., whether or not the patient lives in a community largely populated by other immigrants from his country or culture of origin, educational level, work or profession, etc. will mold that patient’s belief system uniquely  and thus their definition of quality care.  It will determine his or her healthcare needs and expectations regarding the type and extent of care. In other words, each individual is unique in what health beliefs and practices he or she takes from the primary culture to which he or she belongs. Next month, I will share how healthcare professionals can treat patients in the manner that they wish to be treated and thus meet their unique definitions of “quality care”.Until then, has this made you rethink your view of “equal care” being good for all patients? If so, how?