In a diverse and complex world, the notion of 'cultural competence' is offered by some as an ethical solution to health care work which is culturally naive or inappropriate. Notions of cultural competence, however, may obscure the fact that many clinicians, regardless of background, may feel ill equipped to deal with difference in their daily work. Drawing largely on South African examples, I suggest that issues of cultural incompetence, linked both to personal anxieties and to the ways in which health care systems are structured, may be important to explore--personally, professionally, and politically. Through examining the difficulties of our own work and recognizing these, we may learn more only by learning a set of skills about the 'other'.