Listening with the third ear: Exploring the practical philosophy of transcultural understanding.

摘要

The problem of crosscultural misunderstanding in clinical contexts has given rise to a thriving field of "cultural competency" training and materials. With few exceptions, experts and institutions in this field have defined cultural competency using instrumental forms of reason and have studied the problem of crosscultural understanding and communication from within a positivist framework. This reduction has in turn spawned positivist and empiricist methods of teaching cultural competency that mimic the methods used to teach natural and social science.;Herein I argue that cultural competency should not be seen in terms of a model of technical knowledge as derived from the natural sciences, but rather be understood as an instance of what Aristotle termed phronesis or practical wisdom. As such, culturally competent medical practice is dialogical engagement between patient and health-care provider with the aim of mutual understanding that then facilitates health promotion.;Aristotle's concept of phronesis was a central tenet of Hans-Georg Gadamer's philosophical hermeneutics, which focuses on mutual understanding through dialogue. Gadamer argues that true understanding in the health-care context can come only through conversation and engagement with our interlocutors. Too often cultural competency materials and education attempt to alleviate the burden that health-care professionals shoulder: the work involved in understanding patients who are different from themselves. This work, however, is part and parcel of the understanding, and while it may be honed and improved upon with education in cultural competency, the work of understanding cannot be delegated or circumvented. Thus, any program of cultural competency that attempts to hand the health-care professional an encapsulated knowledge that would otherwise have taken work in conversation, listening, narrative sensibility, or interpretation, is not only ineffective, but may also be detrimental to cross cultural understanding.;In this dissertation I explore what a curriculum in cultural-competency based on Gadamerian dialogical engagement might look like and whether it is better suited than other education models of cultural competency to achieve the goal of increasing understanding between patient and physician. I conclude that it is indeed better suited as a basis for education and practice in cultural competence.