Aim: Clinicians will approach every encounter with humility and understanding that there is always something to learn from everyone.
Ask: What did I learn from each person in that encounter?
Clinicians are experts within their field of practice. Approaching an encounter with humility embraces the understanding that there is more to learn in life outside of one’s area of expertise. Reflection in practicing medicine requires the clinician to pause and consider what is available to learn from each situation and to connect meaning to those encounters. The associated question with this R coaches the clinician to identify what is available for him or her to learn beyond his or her current understanding of a situation.
Reflection is part of humility in practice. Humility can be conceptualized as doubt and self-deprecation. However, evidence supports that humility is perceived as a strength of character in exemplary clinical attendings.14 Reflection also provides a way for clinicians to make sense of difficult patient situations in relation to themselves.15 A reflective clinician has the ability to navigate personal emotional reactions to patient suffering and challenging patient care situations with an engaged concern and without losing a sense of self.15 Compassion is at the core of healing and highlights the shared humanity in all circumstances. The recognition of individuality within this interconnectedness allows practitioners of The 5Rs of Cultural Humility to learn from interactions with others. Intentional practice of self-reflection becomes a strength as it confronts clinician disengagement behaviors.16 Cultivating clinician reflection contributes to clinician well-being and perseverance in pursuing the passion to provide quality care.
Aim: Clinicians will treat every person with the utmost respect and strive to preserve dignity at all times.
Ask: Did I treat everyone involved in that encounter respectfully?
Respect is the process of honoring someone by exhibiting care, concern, or consideration for their needs or feelings. Respect extends to all individuals involved in a patient encounter, including other care providers, family members, and the individual clinician.17 The intention of this R is to aid the clinician during challenging circumstances. The associated question coaches the clinician to consider his or her actions and to determine if they align with the value of respect.
Individuals’ knowledge about and decisions related to health care are personal, varied, and impacted by their environment, cultural beliefs, and socioeconomic status.18 Clinicians have a moral duty to treat patients with respect by incorporating patients’ choices, preferences, and boundaries with evidence-based care.19 Respect allows patients to be active participants in decision-making regarding their care. It requires effort on the clinician’s part to understand the patient’s reasoning, to ask for clarity, and to offer guidance while understanding that patient expectations or decisions will not always align with the clinician’s values or medical advice. Pausing to consider the R of respect supports a dignified environment and values each person as an individual human.19
Aim: Clinicians will hold every person in their highest regard, be aware of, and not allow unconscious biases to interfere in any interactions.
Ask: Did unconscious biases drive this interaction?
Clinicians are caring for patients with diverse backgrounds during vulnerable moments. Whether in a hospital or clinic, clinicians are increasingly strangers to patients and must build trust and rapport quickly. This connection can be achieved by holding a patient in the highest regard. The aim of regard is to value a patient for his or her individuality and belief system. The associated question with this R coaches the clinician to consider his or her own biases, implicit or known.
Having regard for patients requires an understanding that everyone has implicit biases, which affect an individual’s understanding, actions, or decisions in an unconscious manner.2 Clinicians hold unconscious beliefs about various social and identity groups3,4,5 that places providers at risk for discrimination in making health care decisions.20 Additionally, biases from a clinician can potentially affect how a patient may perceive a clinician’s verbal communication, degree of empathy, and non-verbal body language.21,22,23
Invoking regard for patients within the 5Rs framework raises awareness of potential biases and allows clinicians to recognize, neutralize, and modify thoughts before they manifest into behaviors. Patients who sense their individuality is held in high regard and feel understood are more likely to have trusting relationships with their clinicians.24 This trust leads to a more therapeutic patient-provider relationship.
Aim: Clinicians will expect cultural humility to be relevant and apply this practice to every encounter.
Ask: How was cultural humility relevant in this encounter?
The relevancy of cultural humility is intertwined with the clinician’s quest for quality and promotion of patient-centered care (PCC). The associated question with this R coaches one to consider the pertinence of cultural humility with other values in the health care system.
The Institute of Medicine advocates for the practice of timely and safe evidence-based medicine within a PCC model that chooses wisely and is impartial.25 Additionally, PCC is an expression of value-based purchasing, which is a Centers for Medicare and Medicaid incentive program that rewards hospitals based on quality of care rather than quantity; it incorporates quality measures, patient outcomes, and the patient experience.26
The transformation necessary to improve health care and decrease disparities involves being more enlightened to the bio-psycho-social aspects of all patients. Relevance, in The 5Rs of Cultural Humility, coaches the clinician on how to advocate for his or her patients. The practice of cultural humility recognizes that patients have the ability to discuss, engage in, collaborate with, and choose their own plan of care. Embracing the relevance of cultural humility balances the power dynamic in this privileged relationship by acknowledging that the patient and the clinician are both valued in the partnership.
Aim: Clinicians will embody the practice of cultural humility to enhance personal resiliency and global compassion.
Ask: How was my personal resiliency affected by this interaction?
Cultural humility allows clinicians to recognize that they are experts in their respective fields and that patients are the experts in how they live their lives. The aim and question associated with resiliency bring awareness to the humanity of the clinician, patient, and all involved in the encounter. The associated question with this R coaches clinicians to consider self-care.
In an era where clinician burnout is reaching epidemic numbers, creating interventions and identifying tools to increase resiliency is an imperative.27 Of the three burnout components, physicians appear to be at most risk of experiencing depersonalization and emotional exhaustion during difficult encounters.28 During these encounters, the potential risk of burnout can be counteracted through the practice of cultural humility. This R highlights the importance of extending compassion to self, as well as others, during suffering. Pausing to examine one’s personal state affects patient care by influencing subsequent communication and interactions. Encouraging and implementing practices that improve communication decreases the risk of burnout while increasing connection with patients.29