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C
ultural competency has become would be rejected by anthropologists, of the doctor, nurse, or social worker,
a fashionable term for clinicians today, since it leads to dangerous and the culture of biomedicine
and researchers. Yet no one can stereotypingsuch as, Chinese believe itselfespecially as it is expressed in
dene this term precisely enough to this, Japanese believe that, and so institutions such as hospitals, clinics,
operationalize it in clinical training and onas if entire societies or ethnic and medical schools [14]. Indeed, the
best practices. groups could be described by these culture of biomedicine is now seen
It is clear that culture does matter in simple slogans [1113]. as key to the transmission of stigma,
the clinic. Cultural factors are crucial Another problem is that cultural the incorporation and maintenance
to diagnosis, treatment, and care. factors are not always central to a case, of racial bias in institutions, and the
They shape health-related beliefs, and might actually hinder a more development of health disparities
behaviors, and values [1,2]. But the across minority groups [1518].
large claims about the value of cultural
competence for the art of professional Culture Is Not Static
care-giving around the world are simply Box 1. Case Scenario: Cultural In anthropology today, culture is
not supported by robust evaluation Assumptions May Hinder not seen as homogenous or static.
research showing that systematic Practical Understanding Anthropologists emphasize that culture
attention to culture really improves
A medical anthropologist is asked by
clinical services. This lack of evidence
a pediatrician in California to consult in
is a failure of outcome research to take
the care of a Mexican man who is HIV Funding: Our work on cultural aspects of clinical care
culture seriously enough to routinely
positive. The mans wife had died of AIDS has been supported by the Michael Crichton Fund,
assess the cost-effectiveness of culturally Harvard Medical School, and by a National Institute of
one year ago. He has a four-year-old son
informed therapeutic practices, not a Mental Health Training Grant on Culture and Mental
who is HIV positive, but he has not been Health Services (5T32MH018006-21).
lack of effort to introduce culturally
bringing the child in regularly for care.
informed strategies into clinical settings Competing Interests: The authors declare that they
The explanation given by the clinicians
[3]. have no competing interests.
assumed that the problem turned on a
radically different cultural understanding. Citation: Kleinman A, Benson P (2006) Anthropology
Problems with the Idea of Cultural in the clinic: The problem of cultural competency and
Competency What the anthropologist found, though, how to x it. PLoS Med 3(10): e294. DOI: 10.1371/
was to the contrary. This man had a near journal.pmed.0030294
One major problem with the idea of
complete understanding of HIV/AIDS
cultural competency is that it suggests DOI: 10.1371/journal.pmed.0030294
and its treatmentlargely through the
culture can be reduced to a technical
support of a local nonprot organization Copyright: 2006 Kleinman and Benson. This is
skill for which clinicians can be trained an open-access article distributed under the terms
aimed at supporting Mexican-American of the Creative Commons Attribution License,
to develop expertise [4]. This problem
patients with HIV. However, he was a which permits unrestricted use, distribution, and
stems from how culture is dened in reproduction in any medium, provided the original
very-low-paid bus driver, often working
medicine, which contrasts strikingly author and source are credited.
late-night shifts, and he had no time
with its current use in anthropology
to take his son to the clinic to receive Arthur Kleinman is Chair and Esther and Sidney
the eld in which the concept of Rabb Professor in the Department of Anthropology
care for him as regularly as his doctors
culture originated [59]. Culture is at Harvard University, and Professor of Psychiatry
requested. His failure to attend was not and Medical Anthropology at Harvard Medical
often made synonymous with ethnicity,
because of cultural differences, but rather School, Boston, Massachusetts, United States of
nationality, and language. For example, America. Peter Benson is a PhD candidate in medical
his practical, socioeconomic situation. anthropology in the Department of Anthropology
Talking with him and taking into account at Harvard University, Cambridge, Massachusetts,
his local world were more useful than United States of America.
The Essay section contains opinion pieces on topics
of broad interest to a general medical audience.
positing radically different Mexican * To whom correspondence should be addressed.
health beliefs. E-mail: kleinman@wjh.harvard.edu