Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Practicing Cultural Humility


When caring for patients with whom you don’t share the same cultural background, open-ended questions may help disclose their goals-of-care. 

My patient was from another country in the Caribbean, with different cultural norms. I watched her during our telehealth visit trying to speak. She moved her lips, but all I could hear were incoherent sounds. She attempted nonverbal communication with gestures, but her muscles only flickered, and her toes barely wiggled as she tried to flex her hips and knees.  


She’s suffered a stroke and was now dependent on her grandchildren, children, and me. With my white coat, I thought I would swoop in and save the day by giving advice to protect her from stroke complications and reassure family members that things would improve. Our different countries meant different cultural norms, medical systems, healthcare access, and resource allocations that I didn’t know, understand, and thus couldn’t account for when sharing my recommendations. 


I watched my patient’s family members struggle in a way that was appropriate for them but was difficult for me to understand. Here’s what a learned:


1. Ask open-ended questions that help you to understand your patient and their loved one’s goals of care.


2. Determine what barriers exist in their access to healthcare and think creatively to solve them.


3. It takes a village. Create a partnership with your patient’s primary care doctor so you can attend primary care visits by video and give suggestions when creating goals-of-care with the patient and their loved ones. 


4. Everyone makes mistakes. These will help you learn and grow.







This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.