48 AUSTRALASIAN DENTIST PARTNERING WITH PATIENTS The Institute of Medicine released a report, Unequal Treatment; it revealed that racial and ethnic disparities in healthcare often stem not only from access but also from bias, stereotyping, and clinical uncertainty (Institute of Medicine, 2003). These findings, though rooted in medicine, apply equally to dentistry and allied health. CALD (Culturally and Linguistically Diverse) patients in Australia have been shown to experience barriers to preventive care, miscommunication during consent, or difficulty navigating a health system built around majority norms (Mahmoud et al., 2021). ‘Across Australian studies, CALD populations face language, health-literacy and provider-competence barriers that reduce service utilisation and compromise care quality.’ (Khatri, R. B., & Assefa, Y. (2022) As such it has become clearer with the passing years that cultural competence is not only about providing a respectful or comfortable experience. It has a direct and measurable influence on patient outcomes including accuracy of diagnosis, adherence to treatment plans and patient compliance, and long-term oral health. The result of gaps in communication and cultural misunderstanding has been shown time and again to cause delayed treatment, compromised consent, or failure to follow preventive regimens. In this sense, cultural competence is not an abstract ethical ideal but a tangible clinical necessity. At its core, cultural competence means delivering care that is respectful of – and responsive to – patient values, cultural traditions, language, and social circumstances (Stubbe, 2020). It is closely aligned with patient-centred care, which prioritises the patient’s preferences and values in every clinical decision (Institute of Medicine, 2001). For dentists, this means that patient consent, adherence, and satisfaction are inseparable from cultural context. What we consider routine – such as a consultation about veneers – may be deeply shaped by a patient’s explanatory models of health, their cultural definitions of aesthetics, and their previous experiences of healthcare. Dentistry through a global view It is a foregone conclusion that growing up in apartheid South Africa was in fact, a bad thing. It is also rather foregone that being all levels, depths and types of minority/ diversity opened me up to a world of negative experiences as we chose to migrate several times as young professionals. My choices in postgraduate education have been strongly shaped through the lens of these experiences; that of a privileged, young, female Muslim migrant of South AfricanIndian descent living in Western Europe at the time of 9/11 and that was ultimately where my interest in Neuroscience and Communication Psychology was born. Many years and a thesis later, it is through this global lens that I approach the question of communication and cultural competence in dentistry. The field of neuroscience is vast and neverending. One of its biggest messages, however, is that every piece of information entering the brain is filtered through past experiences, cultural frameworks, and emotional memory (Kandel et al., 2013). Communication psychology teaches us that connection cannot happen without first understanding the other (Burgoon et al., 2016). Together, neuroscience and psychology remind us that language is never empty; that every message we send and receive is filtered through and carries the enormous weight of culture and lived experience. And that this is then ultimately received and perceived in ways we may never even realise. In Australia and New Zealand, nearly one in three residents is born overseas (Australian Bureau of Statistics [ABS], 2023); our patient base is as diverse as it is growing. This makes cultural competence not a luxury but a necessity. As every writer knows, you write what you know. I am an overseas-trained dentist from South Africa, and I now run The Overseas Dentist, a program supporting CALD clinicians to adapt to Australian practice culture. Cultural competence then, is not a one-way exercise–it is reciprocal; shaping both how we treat and how we learn from the patients and professionals around us. Barriers to communication in the dental chair The literature identifies five predictors of culture-related communication problems (Stubbe, 2020). In dentistry, these emerge as: X Different models of health and illness – Patients may interpret oral disease or aesthetics through cultural frameworks unfamiliar to us. X Different values – Some may prioritise function over cosmetics; others may see cosmetic work as essential for social acceptance. X Different preferences for the dentist – patient relationship – Some expect a directive expert; others expect shared decision-making. X Bias and perceptual blind spots – Unconscious assumptions (implicit bias) can distort how we interpret patient behaviour. X Language barriers – Misinterpretations of risk, consent, and aftercare instructions are common without careful adaptation. Recognising these predictors allows us to anticipate and reduce miscommunication before it fractures trust. Cultural competence and cultural humility Competence implies skills that can be learned; hands kills, dental knowledge base and increasing scope of practice. But the concept of cultural humility however is not as simple and adds a vital dimension; the Cultural competence in patient communication: A dental imperative The case for cultural competence By Dr Shahana Abed Dr Shahana Abed
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