In contemporary Canada, a profession focused on health and well-being cannot ignore the importance of cultural considerations. Yet there are very few resources on culture that are specific to physical therapy. Into this void steps Cultural Competence: A Lifelong Journey to Cultural Proficiency, an excellent book with a bad cover:
The title does not identify this book as a work written (mostly) by physical therapists for physical therapists.
The book is not identified as being crafted from a U.S. perspective for a primarily U.S. audience.
The terms “cultural competence” and “cultural proficiency” are casually overlaid in the title, creating confusion for the reader, who questions whether these are identical, similar, or complementary concepts.
Were I to judge this book solely by its cover—and the cover's relationship to the content—I would declare it to have an identity crisis. Fortunately, the material between the covers has ample merit, which allows me to agree with the jacket copy that this book is “a comprehensive, theoretical and practical approach” to improving knowledge, awareness, attitudes, and skills at the intersection of culture and physical therapy.
The book's content ranges from the usefully theoretical (e.g., chapter 3, “The Historical Development of Theory, Models, and Assessment Tools”) through the immediately practical (e.g., chapter 9, “Cross-Cultural Communication”) to the professionally insightful (e.g., the challenge of the medical model's primacy in physical therapy in chapter 5). For this reason, I see Cultural Competence as a useful resource to help Canadian physical therapists systematically process the misunderstandings that are inevitable in our contemporary multicultural society. Indeed, in chapter 9, author Helen Masin sets a good example of how an active clinician can approach cross-cultural challenges, discussing “critical incidents” from her own clinical practice to demonstrate how moments of confusion and frustration can be used to improve a physical therapist's capacity to connect with patients and/or professional colleagues from different cultures.
Beyond addressing culture-related issues relevant to physical therapy practice, Cultural Competence is particularly valuable for its direct approach to the metaphorical elephants in our professional room. I commend the editor for including chapter 8, “Understanding Racism,” and demonstrating how racial and ethnic minorities are under-represented among physical therapists (the evidence presented in this chapter is from the United States, but I suspect that such imbalances exist in most other countries without the topic's being discussed).
Despite the overall merits of this book's content, a flaw in its argumentation occasionally pokes through: while promoting a philosophy of critical cultural relativism (p. 21), the perspective occasionally slides into the taken-for-granted assumptions of mainstream Eurocentric culture. Examples include the suggestion of using Native American talking circles as a technique to “replace” aspects of Native American worldviews with Western equivalents (p. 66) and the presentation of economic impacts and efficiencies as overriding concerns in a discussion about time (p. 61). To be fair to the editor, such instances are rare, but they do demonstrate how challenging it can be to maintain a multicultural stance in a professional environment that has its own particular cultural groundings.
Cultural Competence makes an important contribution to the professional literature, given the current dearth of resources on physical therapy and culture. Its greatest contribution might, paradoxically, be an unintended one: it calls attention to the way in which culture needs to be discussed by physical therapists, but does so in a manner that begs to be improved upon. We can hope that by making the gaps in the literature more explicit, this book justifies the need for more material on the subject of physical therapy and culture.
When will a team of authors create a work that is unabashedly focused on physical therapy, more clearly considerate of jurisdictions outside the United States, and more consistent in its reference to and application of concepts? That question remains unanswered—but its clarity and importance have been established. In the meantime, more of our professional colleagues need to read this book.