Can Culturally Competent Healthcare Close Disparities Gaps
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 pipelineif 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 diversestudents 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.
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 systemthey 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.