"Cultural competence" in medicine can't be learned in a single lecture or course, author Ann Fadiman cautioned during a lively panel discussion on the UC Davis Medical Center campus Monday afternoon. Yet the ability to communicate with patients from other cultures is essential to good medicine.

Fadiman, whose book documents the tragedy that can result when doctor and patient fail to understand one another, urged health care providers to think about culture in every patient encounter.

Fadiman's appearance at the medical center drew an audience of more than 100 medical school faculty, staff and students. The Grand Rounds discussion was led by Michael Wilkes, vice dean of medical education. Dan Murphy, a family physician who features prominently in The Spirit Catches You and You Fall Down, also participated in the panel, along with Moon Chen, professor of epidemiology and preventive medicine and a leading expert in health issues affecting Asian Americans.

As the best way to avoid care-compromising cultural blunders, Fadiman urged health care providers to rely on a set of eight questions developed by Arthur Kleinman, a Harvard psychiatrist and medical anthropologist. The questions, which appear in her book include: What do you call the problem? Why do you think it started when it did? What do you think the sickness does, and how does it work? What are the most important results you hope the patient receives from treatment? And what do you fear most about the sickness?

Dan Murphy, a family practice resident in Merced during the years described in the book, said even the most skeptical doctors tend to embrace such tools once they realize the techniques can help them do their jobs more efficiently. And all of the panelists emphasized the importance of medical interpreters and agreed that cultural competence in medicine requires lifelong learning.

"Achieving cultural competence is analogous to fluency in a language," Chen said. "To become culturally competent, as to become fluent in a language, requires lifelong learning and practice -- but, most importantly, an attitude of willingness."