Is Your Doctor Culturally Competent? Your Life Could Depend On It
By Angela D. Johnson © 2003 DiversityInc.com
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Despite years of medical training, one of the most poignant lessons Dr. B. Waine Kong
learned about the impact of cultural competence on medical care came from an experience with his own mother.
"My mother lived in New Jersey , seeing white cardiologists, and she was in bed, couldn't get out, just ready to die," said Kong, chief executive officer of the Association of Black Cardiologists.
Kong's mother, who was 70 years old at the time, couldn't describe her diagnosis or explain the type of medication she needed or why she was taking it. "She couldn't even pronounce the name of the guy taking care of her."
To alleviate her failing health, Kong decided to relocate his mother to his hometown of Atlanta so she could receive treatment from an African-American cardiologist.
"Immediately, her eyes lit up, she was able to hug him, she flirted with him, she has this kind of informality about him," said Kong, about his mother's visits to her new doctor. "[Her doctor] will claim it was good science and good medicine, which is true, but it's really about the non-tangible."
Numerous studies have shown that people of color have better health outcomes when they are treated by physicians who share their ethnic, racial or cultural background.
"When the provider is the same racial or ethnic background, there is increased trust," said Kimothy Jones, national director of Community Catalysts, a Boston-based consumer-advocacy group. "If there is increased trust, the patient is more likely to be compliant."
However, given the limited the number of doctors of color, the probability of a patient of color being treated by a physician of a similar racial or ethnic background is low. According to the American Medical Association, African Americans make up 2.6 percent of practicing physicians and Latinos account for 3.5 percent, both significantly lower than the representation of these groups in the country's general population (each roughly 13 percent). Asian Americans are the only physicians of color over-represented in the medical profession, comprising 9.1 percent of the working physician pool, compared with 4 percent of the overall population.
Given the limited number of physicians of color, it is imperative that doctors of all races and ethnicities understand the medical issues, such as hypertension or diabetes, that impact people of color disproportionately.
"There are many physicians who have treated African-American patients who have severely elevated blood pressure and have told them that it's OK for their blood pressure to be elevated," said Dr. Randall W. Maxey, president of the National Medical Association. He said a culturally competent doctor would know that it is unacceptable for African Americans to have high blood pressure, even if they belong to a racial or ethnic group that suffers disproportionately from the disease.
"Part of cultural competence is doing the homework to find out what are the best clinical practices that apply to this particular disease and does the research apply to these individuals," said Maxey.
When treating patients of color, doctors' communication skills and cultural understanding are just as critical as their medical knowledge. "It's not just a matter of diagnosing them," said Maxey. "You have to develop a relationship that is conducive to compliance." Language and family are just some of the cultural issues that present a potential challenge for physicians treating Latino patients.
"The whole family tends to go to the doctor," said Dr. Elena Rios, president of the National Hispanic Medical Association. "It may be the grandmother is taken by the adult son or daughter…. It's an issue where doctors may not be able to handle more than one person in a room."
Rios said Spanish-dominant Latinos often rely on younger family members to serve as translators; however, the person playing the role of interpreter may be hesitant to discuss personal issues or relay bad news.
Kong said a simple act, such as how a doctor addresses his or her patients, can be problematic. "If an African American goes to a white physician and the African American says, 'Good morning, Dr. Johnson' and Dr. Johnson says 'Bessie, how are you today?,' whites are not likely to see that as a problem, but given the history of the old days where the African-American maids or household help or whatever had to refer to the master as mister and they called her by her first name, it becomes a problem," said Kong.
"Immediately, there's an attitude and if there's an attitude there's likely to not be good care, because you have a patient who's fighting the doctor rather than working with the doctor to provide the care she needs," said Kong.
Rios added that doctors often are revered by their Latino patients; however, this respect may not be reciprocated. "There's a lot of respect in terms of how a (Latino) patient sees the doctor," said Rios. But because of time constraints, "doctors tend not to think about how to better improve their communication with patients."
Maxey and Kong noted that being of a particular ethnicity or race does not eliminate the need for cultural competency training when serving patients of the same group.
"All physicians need to be culturally competent," said Maxey. "It's not just people who are in ethnic minorities that need special care." "Even in the black community, you naturally suspect that doctors come mostly from middle-class African Americans (would understand African-American patients) however, there are some cultural differences with African Americans from different income groups," said Kong. "We've made a blanket statement that cultural competency training is appropriate for all Americans."
Various groups in the medical industry have backed up this belief. Rios said cultural
competency is mandated by several U.S. medical licensing and accreditation organizations. The National Center for Cultural Competency (NCCC) at Georgetown University has developed a 30-item check list of steps doctors should take to ensure that their practices are equipped to serve a diverse patient population.