Applying Cultural Humility in Geriatric Psychiatry: A Case of Diagnosis and Treatment for an Indian Patient

Introduction Cultural humility in geriatric psychiatry provides clinicians with skills to accurately diagnose and effectively treat patients of different backgrounds. Cultural humility includes 1) lifelong learning and self-reflection, 2) acknowledging and addressing power dynamics within the treatment relationship and 3) institutional accountability and partnerships. This poster discusses cultural humility in the diagnosis and treatment of 71-year-old man from India who spoke limited English. Methods A case report is presented with information gathered from clinical documents in our electronic medical records system. A literature review and application of cultural humility principles was performed. Results Lifelong learning and self-reflection seeks to further knowledge, training and experience to provide culturally competent care. Self-reflection is a skill that develops with time and can be achieved thought through mindfulness and the humility of acknowledging what we do not know. The patient presented for hospitalization after an extended depressive episode with psychosis, suicidal ideation and homicidal ideation. The diagnosis of major depressive disorder with psychosis during hospitalization was later changed to bipolar disorder at follow-up. The delay to care and initial misdiagnosis is discussed in the concept of lifelong learning and self-reflection. Imbalances of power dynamics may result in suboptimal care for patients and recognition and mitigation of imbalances may be critical for the care of people and developing effective relationships with patients and their families. For our patient, like many geriatric patients, treatment planning occurred with both the patient and his adult daughter. The patient would typically prefer his daughter communicate his symptoms and concerns. The treatment power dynamics between provider, patient and family is explored further. Institutional accountability works to have the structure of institutions operate in the model of cultural humility. The patient presented with cognitive impairments but would not engage in evaluation or cognitive assessment tools. There often appeared to be difficulty with use of phone interpreters and understanding the assessment tools. Institutional accountability may address barriers of communication and engagement in assessment by providing robust services for patients and education for providers. Conclusions This case demonstrates how cultural humility can be implemented in meaningful ways to improve patient outcomes. Future direction includes the application of cultural humility in clinical and research settings. Further studies to obtain the experience of cultural humility from patients, families and providers would be beneficial to increase the use of cultural humility in patient care. Funding No funding to declare.