Asian Americans are the fastest-growing racial group in the United States, with 18.9 million currently in the U.S. and a projected 35.8 million by 2060 with many Asian Americans being immigrants. A study of over 6,700 Asian Americans, Hispanics, African Americans, and Caucasians revealed that Asian Americans were least likely to feel that their physician understood their background and values, and compared to Caucasians, Asians were less likely to be satisfied with their medical care (45% vs. 65%, p << 0.0001). As the U.S. population becomes more diverse, it becomes more important for clinicians to be able to provide quality care for all ethnicities and cultures.
With the COVID-19 pandemic and rise of anti-Asian hate crimes, there is more attention and awareness of the Asian American experience. However, there continue to be racial inequities among the Asian community. Particularly in the realm of medicine, Asian Americans are not typically thought of as communities of high interest when focusing on interventions for health disparities or their health needs. Specifically, Chinese elders are noted to under-utilize the U.S. health care system, which can be attributed to linguistic and cultural barriers with providers, leading to delays in the presentation, diagnosis, and treatment of disease. Hospitals that cater to large Chinese and Chinese immigrant populations must consider the specific barriers to care and the health needs of this growing population.
Influence of traditional Chinese medicine on Chinese patients
The ethnic minority patient’s cultural identity influences their view of their own disease and treatment. Specifically, in Chinese culture, traditional Chinese medicine (TCM) practices have been utilized by Chinese people prior to 300 BC. While often not regarded as an integral part of treatment in Western countries, TCM is fully recognized as part of the Chinese health system, and its use remains prevalent amongst first-generation immigrants and those with a lower degree of acculturation.
Food emphasis on TCM
TCM emphasizes the use of healing foods as a therapy to maintain health and complement medicine. There are specific principles of using food to heal the body, such as balancing foods that are considered “hot” or “cold” (related to the character of the food, not its temperature) and combining foods with different healing properties to treat certain health conditions. Chinese patients, particularly immigrants, who present to allopathic hospitals may therefore prefer TCM-based interventions like healing foods versus strictly traditional Western medicine therapies during treatment.
Aligning medical practice with cultural preferences: examples and solutions
Many patients prefer to eat culturally familiar foods. For example, a study showed that Chinese female breast cancer patients preferred traditional Chinese foods after chemotherapy. Furthermore, in the hospital setting, Chinese patients with poor oral intake may be mistakenly labeled with the diagnosis of failure to thrive or dysphagia and undergo a workup to rule out these conditions, but the solution may involve having culturally familiar foods available to the patient. By recognizing patients’ preferences, unnecessary interventions and costs can be avoided. Thus, a lack of culturally focused interventions can adversely affect a patient’s clinical course and overall satisfaction.
A simple solution like adding congee, low-cost food that can be made in bulk, can ameliorate some stressors related to hospitalization and improve patient satisfaction. Congee, a Chinese porridge, is made of rice boiled until soft in either a broth or water with simple ingredients like scallions, protein, ginger, etc., added as toppings. With an increasingly diverse population, hospitals that cater to large ethnic populations must consider adding simple and cost-effective foods, like congee, to their hospital menus which bring common comfort to these patients. These foods may also be appealing to non-Asian patients as they are simple and light, not too different from the BRAT (bananas, rice, apple sauce, toast) diet encouraged during a viral gastroenteritis.
A case for hospital menu expansion and culturally focused interventions
In recent years, many efforts have been made to expand hospital menus to be more inclusive of patients’ dietary preferences; vegetarian, vegan, kosher, halal, and other options are all now being offered. Though these options are available, cultural dietary preferences should also be considered.
Hospitalization is a stressful experience for patients, which can be magnified with additional barriers to care, such as language, education level, or economic status. In a meta-analysis evaluating patient satisfaction in the acute care setting, Chinese patients who received on-site Chinese cultural services during their course of care reported a statistically significant increase in satisfaction with physicians, with the provision of meals, and more informed knowledge about treatment and procedures compared to those who did not. Regarding cultural foods, Chinese patients who received Chinese meals were more satisfied than those who received regular meals (76% vs. 29%, p < 0.001) in the inpatient setting.
Conclusion
This article emphasizes the importance of fostering a culturally inclusive environment within the inpatient setting to align patient preferences while meeting clinical needs. This includes culturally inclusive menus, having onsite cultural services, eliminating language barriers through interpreters, and recruiting bilingual physicians. While interpreters are already widely adopted across health systems, an additional simple and cost-effective method to increase patient satisfaction is by incorporating culturally aligned food menus, especially in medical centers catering to large immigrant populations. Specifically for Chinese patients and other East Asians, including foods like congee, a fundamental staple dish in Chinese culture that promotes healing, can bring comfort and satisfaction to hospitalized patients, while also preventing adverse health outcomes by potentially reducing complications and length of stay due to malnutrition and failure to thrive. Cultural competency signals collaboration and respect between the health care system and the immigrant patient and is crucial in bridging gaps and better tailoring care to patients.
Cherry Au is an internal medicine resident. Christine Tsai is a hospitalist. Mandy Che is a graduate student.
