November 2, 2001

Joseph Betancourt, MD, recalls a story from his days at New York Presbyterian Hospital-Weill Medical College of Cornell University: Clinicians were perplexed by a patient who always arrived at 9 am for her 3 pm appointments. Betancourt finally asked the woman – who hailed from a small village in Mexico – why she insisted upon coming so early. "Her answer was simple," he remembers. "She showed me a photo of a long line of hundreds of people, waiting to see the one doctor who came to her village. That was all she knew." Once he explained to the patient that she no longer had to wait so long for appointments, she understood and was relieved.

That experience confirmed an important lesson Betancourt had learned early in his career as a physician caring for patients of various races, cultures and ethnic backgrounds: communication is key. This simple concept grew into a philosophy that Betancourt now uses as he develops a curriculum to help MGH physicians better appreciate the importance of understanding patients' diverse cultures and backgrounds.

A bilingual physician of Puerto Rican descent, Betancourt was recruited to serve as senior scientist at the MGH Institute of Health Professions and head the Multicultural Education Program of the MGH Multicultural Affairs Office (MAO). He also will establish a clinical practice for Spanish-speaking patients at the hospital. Betancourt brings with him a background in health policy research that focuses on health care for minorities. His research has explored the root causes for racial and ethnic disparities in health care and has delved into incorporating cultural sensitivity into patient care as both a health policy initiative and a measure of quality of care.

Currently, Betancourt is working with a group of MGH physicians to develop a hospitalwide program that will train physicians in culturally competent care. Such care considers factors including the cultural aspects of communication and decision-making, spirituality, cultural traditions and customs, linguistic needs and health beliefs.

The program is building on a curriculum Betancourt and his colleagues developed at Cornell that adds to the successful initiative started by MGH Patient Care Services (PCS). PCS established the first culturally competent care training program at the MGH in 1999. The MAO program will focus on a curriculum specifically designed for MGH residents, medical students and physicians.

So far, Betancourt and his MGH colleagues have developed a survey to help internal medicine residents identify the barriers they face in caring for minority patients – obstacles such as language, beliefs about medication use and misunderstandings of the health care system. The group also has developed a training session for resident preceptors (attending physicians who teach interns and residents) in culturally competent care. Additional components of the program will be introduced later in the fall.

"The MGH is an opinion leader, and it is exciting to pioneer this program here," says Betancourt. "There are only half a dozen such programs in the country, and the MGH is taking a leadership role to respond to patient needs locally, nationally and internationally. It's an exciting way to live up to the tradition of excellence at the MGH."