Cultural competence in health care means delivering effective, quality care to patients who have diverse beliefs, attitudes, values, and behaviors. Differences between healthcare providers and patients can affect communication. This can, in turn, impact both clinicians’ and patients’ decisions with regard to treatment. For example, a clinician may misinterpret a patient’s silence as a lack of interest in receiving care. As a result, the clinician may not order a diagnostic test, when in fact the patient’s response reflected their notion of respectful behavior. When healthcare providers fail to recognize the differences between them and their patients, they may inadvertently deliver lower-quality care. Cultivating skills that improve cross-cultural communication can play an important role in delivering equitable care.
In 1100, Henry I took on the English throne from his older brother, William II, who had died in a hunting “accident”. By 1124, three sons of Malcom III had reigned over Scotland, and the fourth was on the throne. Alexander I of Scotland had died at his court at Stirling without an heir, and was succeeded by his little brother David. Henry I was essentially a patron to David, as David had spent much of his younger years in exile in England. His beginning as a territorial lord came upon his inheritance of the title “Prince of the Cumbrians,” which was the vast swath of what is nowadays split between northwestern England and southern Scotland. David I’s brother Edgar bequeathed to David this territory in 1099; David was 15 years old. David I was installed as the King of Scotland in 1124, much to the resentment of the native Scots.
Alexander III was King of Scots from 1249 until his untimely death in 1286. His first wife was Margaret Plantagenet of England, the daughter of English King Henry III. During his reign, Scotland enjoyed a time of peace and economic growth which had seen many noble families grow in wealth and power. King Alexander’s heir-apparent was his three-year-old granddaughter and only living descendant: Margaret, Maid of Norway. While the succession of Alexander III was laid out in law by the time of his death, there were two small problems standing in the way of the Maid’s ascension. The first of these was the fact that the “Maid,” contradictory to her title, was only three years old. Secondly, and rather more substantially, was the matter of Alexander’s second wife Yolande of Dreux’s alleged pregnancy. This child would fill the gap in succession that existed directly under Alexander III after the deaths of his children Margaret (1261-1283), Alexander (1264-1284), and David (1272-1281). It is uncertain whether Yolande suffered a miscarriage, the child was stillborn, or if any child really existed at all. What is known is that Margaret, Maid of Norway’s ascension to the throne was all but a certainty.
Scotland’s First Interregnum (1286-1292) was overseen by a regency of two bishops (Glasgow and St Andrews), two high lords (the Lord of Badenoch and the 5th High Steward of Scotland), and two earls (Buchan and Fife). These six men governed Scotland from the death of Alexan
