Notes on the book by M.C.Brannigan  “Cultural Faultlines in Healthcare: Reflections on Cultural Competency”

This book is meant to draw the readers’ attention to the problems of providing the sensitive care to the patients within American health care system. Brannigan describes the problems caused by the diversity of worldview and values among the patients and doctors that meet through the health care system. The differences in approaches and understandings are causing what he calls cultural faultlines, the divisive issues that cause misunderstandings and create obstacles for better care. This outstanding problem is further fuelled by the fact that the American society in general has grown a profound distrust of the healthcare. 

Having described the essential problem, the author proposes a solution. He believes that the key to resolving most cultural problems lies within the development of cultural competency by the health care providers. He makes a special emphasis on what he sees as the core of cultural competency – it is the cultivation of the virtue or presence – the way of being with patients that is whole, complete. Brannigan brings in both the findings of research on the patients’ perception of the doctors (proving that their “way” is more important than their “words”) and various religious teachings to show the importance and value of being truly present. 

I found this book not only informative, but also deep, in the way it touches some aspects of life and interaction with others that we may often miss or take for granted. The book is written in the way that we are taken together with the author in the journey of exploration of what health care looks like from the humane perspective, what makes it this way, and what can be done about it. Though, Brannigan digs deeper than that. For example, he draws distinctive lines between cultural competency and tolerance, warning the reader to not confuse the two. 

The subject I found most profound is the description of what actual essence of cultural competency is. While it is important to be educated and trained to work with people from various cultural backgrounds, we would not be able to provide really culturally sensitive care if we don’t find a certain reference point within ourselves while being with/for others. Brannigan calls this the cultivation of the virtue of presence and shows its evidential necessity in healthcare settings. He says that only through embodied presence that caregivers can genuinely give care and emphasise with the patients in their pain and suffering. 

Authentic presence is achieved by being genuinely there with the patient in the most transcendent way we can, based on our personal grounds. “Being-there”, he says, “means encountering the patient’s lived reality and not allowing [our] view, image, or concept of patient from interfering with our encounter” (p.58). 

What I believe to be especially powerful is the way Brannigan describes the moral duty of the care giver that lies within the personal presence. He uses the philosophical reasoning of Levinas to show that the face-to-face rapport is itself a moral event, “one in which the patient, the Other, covertly embodies the request to be acknowledges, recognized, and responded to, a response to which the health professional or caregiver is morally called to heed” (p. 55) In other words, he is pointing out the doctors’ and other healthcare professionals’ moral obligation of benevolence towards their patients, which, again, in my opinion, inevitably includes spiritual care.