You know, I don’t remember life without needing to code switch. It was a crucial skill for me – matching how I acted to who I was around and where I was. I have two phone voices. I enunciate my words at school, but I let myself slur and speak ebonics at home. I temper my enjoyment of rap in public (which sucks when you hear Be Humble by Kendrick Lamar in public forums). In a perfect world, of course, I shouldn’t have to code switch. But I’m not crazy enough to think that I have enough privilege not to. Urban Dictionary defines code switching as “customiz[ing] [one’s] style of speech to the audience or group being addressed.” Code switching isn’t a new phenomenon, though the phrase has gained more popularity in recent years. And in a way, there is an possible connection between the ability to code switch and providing culturally competent healthcare.

Code switching isn’t about when to sound or not to sound “ethnic” or hiding your true self in this context. It is an allegory for developing an emotional compass for your surroundings. This is a very fine line. It requires a nuanced perception of needs, a desire for open dialogue about different cultures, and conversation about preconceptions and assumptions. A very good example of how a healthcare code switch was not executed well was in what I’ll unofficially dub the Pearson Textbook Twitter Debacle. A photo of a Pearson Education Nursing textbook was tweeted last week with descriptions of general cultural responses to pain management. The language was not empathetic to different cultures and relied on stereotypes.  It also did not account for the cultural overlaps between the groups (i.e. Afrolatinos/Afrolatinas, Black Jews, Black Muslims). The photo went viral and created backlash at the descriptions given of “Arabs/Muslim”, “Asians”, “Blacks”, “Jews”, “Hispanics”, and “Native Americans.” A friend of mine actually sent me the tweeted photo and all I could do was shake my head. I could see how Pearson Education thought it was progressive and necessary to discuss cultures perceptions and beliefs of pain management. I think they published this textbook with the right ideas in mind. However, the execution of those ideas did not reflect that sentiment. I would guess that Pearson was attempting to teach healthcare providers how to code switch. But by relying on stereotypes and not the way information sounds, feels, and on nuance, they completely missed the mark.

I believe that the art of executing a healthcare code switch can be taught, integrated into healthcare education facilities, and into continuing education programs. While that is being integrated, however, there will continue to be a gap in applying that skillset to patients. And no hospital or clinic wants to be forced into making a public apology after being dragged by the internet for being culturally insensitive. This is why patients’ services such a bioethics mediation (additional service that combines clinical ethics consultations with mediation techniques to help resolve issues between patients, their families, and their healthcare providers) are important and helpful. Tensions get high in healthcare. You need people who are trained to code switch – whether thats emotionally or culturally – on staff. Of course, some would say that providing those additional resources a waste of resources. Patient Services and ethics committees handle these issues. However, I would suggest that if a hospital dedicates resources to teaching their healthcare providers to code switch, they would be doing a greater work in encouraging patients and their community to use their services again. Which benefits everyone involved. To be honest, I’m a very logical person and usually it is to a fault. But I’ve learned that logic can only take someone so far in tense and emotional situations. Eventually, someone will have to switch their approach and speak the language of the person who is hurting. And Pearson Education’s method was not it. You don’t learn to speak the language by relying on stereotypes and assumptions. You learn by dedicating resources to developing continuing education (check out a potential learning program here), providing bridge services during implementation, and good, old-fashioned practice. Listening for more than symptoms. Aiming for more than a physically well patient. Not glossing over cultural competency.

Let me know in the comments what you all are thinking and thanks for reading this week’s post! I also put together “starter pack” of books to read about stereotypes, bioethics mediation, and developing listening skills. If you have a suggestion for a book that should make this list, I would love to hear from you!

See ya,

The Neighborhood Bioethicist

THE HEALTHCARE CODE SWITCH STARTER PACK

• Bioethics Mediation: A Guide to Shaping Shared Solutions by Nancy Dubler and Carol B. Liebman
• What Patients Say, What Doctors Hear by Danielle Ofri
• Medicine in Translation by Danielle Ofri
• Whistling Vivaldi: How Stereotypes Affect Us and What We Can Do by Claude M. Steele

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