–Prashasti Sharma
Good day, dear readers. I am Prashasti Sharma, and this is a story of my experience and how I navigated a huge transition from one healthcare system to another, dealing with a very culturally diverse population. When I moved to the United States as an international medical graduate (IMG), I knew that I was transitioning to a new healthcare system. What I didn’t realise was how cultural influences can shape medicine in so many aspects of its practice, understanding, and respect by patients. My training has taught me to recognise diseases, create treatment plans and lead clinical situations, but I have learned from living and working in the U.S. that to be a good physician, one must also be a student of culture.
I remember one of my first patient encounters here, the patient was receiving a commonly prescribed medication for a chronic medical condition, but was hesitant to start it. When I asked the patient to explain what was keeping him from starting the medication, he noted that as a family, they preferred using herbal remedies first, and viewed any prescription as a “last resort.” As an IMG from India, I was no stranger to a family using traditional medicine and embracing a holistic approach that included allopathic treatments as appropriate, but in the U.S., where adherence and outcomes are monitored closely, I only needed a second to figure out that this situation was not non-compliance, but rather culture.
That small shift in perspective helped me to engage with the conversation with more empathy. I did not push him toward the prescription, but rather asked him about the remedies he believed would work, talked about their potential effects, and then worked together with the supervising physician to implement a plan that would keep the patient safe while respecting his beliefs.
My experiences have made me realise that cultural sensitivity is not an optional skill in medicine; it is an essential competency. Patients present with their symptoms, but also bring along their traditions, values, and lived experiences when consulting with a physician. I began to notice that some families wanted every detail of the illness explained, while others wanted us to have limited discussion. Some patients wanted to include extended family in their decisions, while others wanted the utmost privacy. Sometimes these nuances bend as much to clinical decision-making as the lab work.
In the same vein, I was also adjusting as an IMG. The terminology, style of communication, and even the way the notes are structured could differ greatly from what I was accustomed to. Consults in India sometimes turned into long-winded conversations that did not just discuss health, but life.
In the United States, the visits were more formal and time-constrained, but the prescriptive expectation for clarity and documentation was far greater. At first, I struggled to find the sweet spot between efficiency and connection. Over time, I realised that simple, open-ended questions (“What matters most to you in your care?”) would help frame the encounter and re-establish that human connection. Patients were usually quite warm and open once they felt they were truly being heard.
There have certainly been difficult moments for me. Adapting to new protocols, electronic health records, and even some of the norms of non-verbal communication left me occasionally wondering if I had missed something obvious. However, as an IMG, I have the gift of being able to see a lot of things with a unique perspective. I am able to carry with me the cultural richness of my own background and medical education, while also learning to utilise my own perspective in the culturally diverse American context. Because I can inhabit both perspectives, I realise I can observe things quite differently. For example, when a patient is silent, it might actually mean that they are acting respectfully, rather than being disengaged. Alternatively, when a patient does not understand a recommendation, it may be due to a difference in generational beliefs or cultural precepts rather than a misunderstanding.
Medicine is actually, at its core, inherently universal.
The biology of disease is consistent, but the experience of patients and their illness is distinctly shaped by culture. If a treatment plan is effective medically, but is not congruent with a patient’s goals, then medical treatment falls short. Finding this congruency is the art of medicine.
As I progress in my professional development in the United States, I have come to appreciate each of my patient encounters as more than just a medical disclosure. It is a cultural exchange, an opportunity to learn and to connect. I feel that the practice of medicine is more than treating an illness—it is honouring the person attached to a particular diagnosis. I feel that is where true healing begins.