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Can Culturally Competent Healthcare Close Disparities Gaps?

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Can white doctors provide quality care to communities in which the racial/ethnic demographics are shifting dramatically? One DiversityInc reader addresses this question in her passionate response to our article, Is There a Black, Latino Doctor in the House? about Rutgers University’s ODASIS program. See what she had to say about cultural competency and diversity in healthcare. Her edited comment is below:

Comment: I feel the need to respond to the comment, “does this mean that white doctors do not provide good quality of care?” and to the blatant sarcasm of the person who commented about Asian doctors. I did not come from a background of economic privilege, but I did become a doctor through a fantastic scholarship program (Navy). When I noticed the great disparity in the primary and secondary education that students receive in the Washington, D.C. metropolitan area and the incredibly low numbers of students of color applying to and being accepted by U.S. medical schools, I figured out the connection. There is great discrepancy in guidance, exposure and opportunity among students attending different schools geographically in this area, and I am sure that is true of any urban area.

I decided to address the pipeline—if students are not exposed to opportunities outside their neighborhoods before it is “too late,” that window (or door) will be shut permanently. My biomedical science summer program for high school students is designed to be diverse­—students come from public and private schools, D.C., Virginia, Maryland (and out of state), and come from nuclear or non-nuclear homes. All staff are volunteers. The students do all the same activities and have the same expectations. The dynamics are unbelievable. One of the recurrent comments we receive from the suburban students is that they had NO IDEA that students just like them living less than 10 miles away had to make decisions everyday that they never think of. For example, how many suburban kids whose next summer activity is sleep-away lacrosse camp have to decide whether they should use the $5 their foster mother gave them to take the metro to our hospital OR eat lunch (but not both)? How much of society obsesses about single parent households when some of our students come from zero parent households and still have the drive to succeed?

So, the answer is yes, white doctors do provide good care, but there are many patients to whom they may not relate if they have not been exposed to the decisions that some of our patients have to make every day. If you don’t understand the culture, experience, or background that another person comes from, you will naturally impose your own experiences on them. This is a natural instinct, but can lead to dangerous judgmental decisions that can impact your interaction with your patients and result in poorer outcomes. For example, many of us take half a day off for a doctor’s appointment. What about the patient who is late for an appointment because they couldn’t get off work from an hourly-wage job (and is not getting paid for the hours not worked) who has to find child care and take a bus? Why do office personnel yell at these patients or judge them because they are late for an appointment or why does the doctor refuse to see them if they are late? Cultural competency alone can improve the health literacy and outcomes for this high-risk population.


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The majority (and I recognize that not all white men have had the same economic, social, etc. experiences) physicians are and will continue to be the backbone of the health care system—they trained us, mentored us, and celebrated our successes and will continue to do so. Programs that will allow students of color or educationally disadvantaged students to realize their potential, besides being the right thing to do, are economically and ethically sound and do not threaten the deserving majority.

With regard to Asian doctors, it is time for all of us to understand that each of the census categories is diverse within itself. “Hispanic” for example covers at least three continents and a multitude of customs, traditions, values, and beliefs. The Asian population additionally is not tied together by language, history, appearance/color, religion, or immigration accession point. Some of us are third and fourth generation and are still asked where we learned to speak English. While Asians may be visible as physicians, scientists, and engineers, they still only constitute less than 5% of the U.S. population. The sad reality is that there are only very few states where this may be true. AND furthermore, this stereotype leaves a huge underserved immigrant and first-generation Asian population at an even greater disadvantage. And many of the languages, customs, traditions, values, and beliefs among these Asian cultures prevent them from ever advocating for each other or even themselves. Cynthia Macri, U.S. Navy

The views expressed herein are solely those of the writers and do not necessarily reflect the opinions of DiversityInc.

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7 Comments

  • Anonymous

    I give you kudos for your understanding, your generosity of spirit and your egalitarianism. If we had more people like you, there would be much less violence.

  • Anonymous

    Businesses get a greater margin of return on good customer service if they offer it when their industry becomes more competitive. (Think of it this way: if two people are in a cake-baking contest and they are close in their baking ability, the victory is more likely to go to the one who is also a better cake decorator.) If competition is lacking, there is less of an incentive to offer good customer service. (If one contestant eliminates all the others by getting the judges to change the rules, then that contestant need only bake something passable, and need not decorate his cake at all.)

    The problems with healthcare everywhere in the US, and in minority communities in particular, stem from a lack of competition brought about by a healthcare system based around insurance and employment, rather than around a simple exchange of services for money.

    Add to this the effect of drug prohibition on Spanish-speaking and black communities and it is easy to see where the problems Macri describes come from, and what effective solutions to them would look like.

  • Anonymous

    I am preaching cultural competency everyday and the point I try to drive home is cultural is not the color of your skin or the race you identify with. Cultural is language, customs, traditions, values and/or experiences that are unique to a group. Thank You Ms. Macri

  • Anonymous

    As a full-blooded Native Pueblo American from New Mexico; a while doctor is the berst we have; we have maybe 2% Native American medical doctors. The white doctors have treated us efficiently. It is in the mental health realm that I
    would like to have Native Pueblo Americans because if if a psychiatrist or psychologist, a non-pueblo will not understand us. Our New Mexico pueblo tribes have a different ceromonial & traditional lifestyle. We are not Pow Wow Indians; though we appreciate that of other tribes.

  • Anonymous

    It is good to finally see someone taking the discussion beyond the rhetoric of the past two decades. Equality of opportunity is more than about preventing discrimination, it’s also about enabling, enpowering and giving vision – through the provision of opportunities, to encourage people to break out of the mindsets that hold them back and the cutural limitations they may conciously or unconsciously constrain them.

    The grace with which you responded here is a benchmark of the maturity which is required to move these issues forward in a way that results in true equality of outcomes.
    Thank you

  • Anonymous

    Culturally competent healthcare is ultimately patient-centered care. It recognizes that one size does not fit all when it comes to treatment. This is the heart of inclusion, being able to see the individuality of a person, in order to engage them as a customer, employee, or brand ambassador. We are all a minority of one. Forty percent of nurses are born outside the US. Thirty five percent of doctors are born outside the US. So there is great complexity. The inability to see beyond our own cultural lenses has a tremendous impact on treatment and prevention.

  • Anonymous

    May I suggest that in our conversations around diversity, inclusion, equity and engagement in all areas we shift our language from cultural competence to “cultural humility.” Humility is a character trait that most of us white folk would do well to become more proficient at. If you are unsure of what cultural humility would look like, I recommend a start with Melanie Tervalon & Jann Murray-Garcia’s guest editorial in the May, 1998 Journal of Health Care for the Poor and Underserved.

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