Every person is a culture of one. Every individual is sublime. Each person carries a unique tapestry of experiences, beliefs, traumas, values and ways of seeing and making meaning. Most of these lie beneath the surface, unseen and unspoken. Just like a fingerprint, no two cultural identities are the same, even among people who share a background, within the same family. Every person is the sum of the vast, complex and often overwhelming depth of individual human experience. This uniqueness makes every clinical encounter not just a meeting between a professional and a patient, but a crossing of worlds.

To understand culture in healthcare, then, we must begin with this recognition: that every patient embodies a singular cultural reality that is shaped by personal history as much as by community norms. And because this reality often defies simple explanation or classification.

This simple truth challenges the assumption that culture can be neatly categorised or fully captured by ethnicity, language or heritage.

In the last article, we explored how culture operates like an iceberg: the visible aspects are only a fraction of what influences the clinical encounter. Below the waterline lies a vast, often unspoken terrain, dense with meaning, memory, values and expectations.

This submerged realm is not easily grasped. In many ways, this is the sublime: a domain of complexity and depth that defies simple explanation. And in healthcare, it is not enough to admire the sublime from afar. Healthcare professionals need to learn to approach it. This article is about how we do that: how healthcare systems and practitioners can begin to bridge the gap between what is seen and what is felt, between surface recognition and deep engagement.

Giving Voice to the Unseen

To engage with culture at depth, healthcare professionals must first create the conditions in which its hidden aspects can safely surface. This does not happen through tokenistic gestures, such as signage or leaflets in Punjabi. It happens in spaces where people feel culturally respected, listened to, given dignity and not reduced to a demographic category. People can tell when a service tokenises them, when inclusion is performed but not practised. They feel patronised, belittled and ‘othered’.

Creating environments that are sincere means recognising and actively addressing the power dynamics that exist in healthcare interactions. It means understanding that silence may not mean agreement, that politeness may mask discomfort and that patients may carry histories of marginalisation and trauma that shape their relationship to care.

It also means making room for stories and not just symptoms. Patients must be able to bring their own explanatory models, their own language of suffering, into the conversation, without fear of being dismissed by a doctor that robs them of their validity. Questions like “What do you think is happening?” or “What helps in your community when someone feels like this?” should not be deviations from clinical lines of inquiry. They need to be essential devices for understanding the patient’s story, peering into the individual’s sublimity.

From Tokenism to Relationship

Too often, healthcare responses to culture remain stuck at the symbolic level – translated materials, signage in dominant community languages or cultural competence training sessions. These are not harmful in themselves, but they are in no way sufficient or of much practical use. And when this happens, they become tokenistic and insincere.

Assigning demographic categories to an individual is not real cultural engagement. It begins with the person in front of the healthcare professional. Each individual is a culture of one: layered, specific, shaped by many intersecting forces and totally awesome. The individual’s story defies simplification. To meet someone at this depth requires more than knowledge; it requires relationship, built on foundations of sincerity and humility.

The healthcare professional-patient relationship is a space where trust is either built or broken. When each patient is approached, not as a representative of a group but as a singular and sublime expression of human experience, something shifts. The focus moves from cultural competence to cultural humility, from pretending to understand in an elaborate performance to actively pursuing and achieving it.

This posture of humility calls for deep listening, sustained curiosity and the courage to be changed by what we hear. Culture, in this sense, is not a checklist. It is a living, dynamic presence in the room, held uniquely by each person that we meet.

Understanding the Sublime

Relationship building with the culture of one is not about memorising facts or following scripts but developing the ability to accommodate ambiguity. To sit comfortably with uncertainty. To notice discomfort. To reflect on your own assumptions, biases and limitations.

Better questions need to be asked, not just of patients, but of themselves. Why does this clinical consultation feel tense today when it didn’t before? What is the healthcare professional missing? How does their position – their language, their authority, their semiotics (white coat, stethoscope), their cultural frame – shape what is being said or not said?

Relationship building is slow work and not always comfortable. But it is essential if healthcare professionals want to honour the full humanity of those who come into their care.

Recognising the Sublime

Traditionally, the checklist approach of cultural competence has dominated diversity discourse. Cultural humility is the alternative to that. It begins with the honest recognition that no clinician can be expert in someone else’s experience. Instead of aiming to master “other” cultures, it asks questions such as ‘how can I learn to listen better?’, ‘How can I remain open to perspectives that unsettle my own worldview?’

A person’s identities are always shifting, layered, in flux. They can be shaped by trauma, inequality and ambivalence about the demographic boxes that they may be pushed into. Humility invites healthcare professionals to hold space for that complexity, rather than reducing it.

In the face of this individual vastness, there should follow a feeling of awe. Awe, in the sense of the quiet recognition that something important is unfolding, something that cannot be fully known, but must be responded to with care.

This is the sublime in practice. It comes in small, attentive moments: the pause before a question or the willingness to follow a patient’s metaphor.

Clinicians do not even need to understand the full depth to acknowledge the depth’s presence. What they need is the courage to stay open, the patience to listen and the commitment to meet others with respect, even when their worldviews diverge dramatically from their own.

Standing on the Shoreline

To bridge the visible surface and the opaque depths is to walk towards the unknown with intention. Culture, like the ocean, cannot be fully mapped, but clinicians can learn to navigate it by observing its natural rhythms. They can become more attuned to the undercurrents, at times quiet and at others turbulent, that shape a patient’s health-related choices.

This is not a technical fix, but a moral stance. It enables moving beyond performative inclusion towards genuine encounters.

Standing at the shore, contemplating the horizon, is an act of respect. It can signal the beginning of healthcare that is not only responsive to the individual, but fully human.

Thank you for reading.

Mark Gibson

Leeds, United Kingdom, May 2025