This thesis examines how cultural understandings are generated and transmitted in a Canadian multicultural teaching hospital. It explores how issues of 'culture' are addressed formally and informally in the experiences of patients and practitioners. Using the approach of an institutional ethnography, emphasis is placed upon informal strategies of cultural care as a taken-for-granted practice in clinical life. It illuminates how pressure to learn culturally sensitive care seeps into the fabric of daily clinical life, and how cultural practices are constructed within a complex set of organized social practices. / The study concludes that advocacy of multicultural policies, must consider the dominance of existing western health care paradigms. It advocates culturally responsive care as a parallel force that can collaborate with the regimes of formal health practices. It argues that providing effective health care to all segments of Canadian society requires structural changes in health education which need to address existing disjunctures between 'effective ideals' and ideological knowledge, in order that all are ensured optimum health care.

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