Health professionals responding to ethnic diversity

November 12, 2007

Guidelines and training for doctors have tried to address the problems they face when dealing with patients who come from cultures and ethnic groups different to their own. However, new research published in PLoS Medicine suggests that many British doctors and other health professionals still have profound difficulties when caring for such patients. More still needs to be done to improve their confidence.

Professor Joe Kai, a family physician, and his team from University of Nottingham, interviewed over 100 doctors, nurses and other health professionals in focus groups across the Midlands of the UK. They asked them to describe their experiences of caring for people from ethnic minority backgrounds. They were encouraged to recall actual cases and to identify what they saw as problems and strengths in their interaction with these patients.

The researchers found that health professionals wrestled with many challenges such as problems with language and communication. But an equally powerful challenge was health professionals feeling very uncertain about what to do (for example, deciding when it was acceptable to touch a patient to show empathy).This was because they felt they didn't know enough about different cultures and wanted to avoid causing affront or appearing racist. This uncertainty, the researchers report, disempowered health professionals, sometimes making them hesitate or fail to do what may be best for their patient.

The findings reveal health professionals experienced considerable uncertainty when caring for ethnically diverse patients, even after training in "cultural competency". They also show that this uncertainty can lead to hesitancy and inertia in practice, which might contribute to inequalities in care.

The researchers suggest several things that might be done to help. For example, health professionals should be encouraged to recognize their uncertainty and the inertia it may cause in them when dealing with patients from ethnic minorities. In addition, there should be a shift in emphasis away from health professionals relying solely on knowledge-based cultural information towards taking an "ethnographic" approach. In other words, health professionals should be helped to respond to patients as individuals. Rather than make assumptions, this may help them feel able to ask each patient about what matters most to them about their illness and treatment.
The research is discussed in a related perspective by Karen Daniels and Leslie Swartz.

Citation: Kai J, Beavan J, Faull C, Dodson L, Gill P, et al. (2007) Professional uncertainty and disempowerment responding to ethnic diversity in health care: A qualitative study. PLoS Med 4(11): e323.



Joe Kai
University of Nottingham Graduate Medical School
Division of Primary Care
Derby City General Hospital
Derby, East Midlands DE22 3DT
United Kingdom
+44 (0)1332 724606

Related PLoS Medicine Perspective:

Citation: Daniels K, Swartz L (2007) Understanding health care workers' anxieties in a diversifying world. PLoS Med 4(11): e319.



Karen Daniels
Medical Research Council
Health Systems Research Unit
South Africa

About PLoS Medicine

PLoS Medicine is an open access, freely available international medical journal. It publishes original research that enhances our understanding of human health and disease, together with commentary and analysis of important global health issues. For more information, visit

About the Public Library of Science

The Public Library of Science (PLoS) is a non-profit organization of scientists and physicians committed to making the world's scientific and medical literature a freely available public resource. For more information, visit


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