How important is it to be culturally competent as a physician?

[Pablo94]

what the ? is

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[B-Lymphocyte]

Could you elaborate a little more?

 

[Frogger27]

It's very important.

/thread

 

[freak7]

Important enough for them to add a P/S section on the MCAT

 

[Mad Jack]

It's helped make a couple of key diagnoses that I've seen in the past, and avoid some terrible missteps. Communication is everything, and understanding culture is a big part of communication.

 

[Espressso]

I'd say it's one of the more important non-clinical characteristics for a physician,

 

[----x----]

The ICCA defines cultural competence as follows:

(Inter)cultural competence is the ability to communicate effectively and appropriately with people of other cultures.

As defined, any physician who regularly interacts will patients will find cultural competence as an essential characteristic. Even if you are a pathologist or diagnostic radiologist your colleagues and ancillary staff will be of various backgrounds and cultural competency will be at minimum a desired characteristic.

 

[Catalystik]

How important is it to be culturally competent as a physician?
what the ? is

Important enough that some interview questions are aimed to determine if you have experiences from which one could project a likelihood for its acquisition.

 

[ortnakas]

Important. You're likely to have patients from multiple cultures, not just your own.

 

[starspells]

https://www.aamc.org/initiatives/admissionsinitiative/competencies/

It's one of the 15 core competencies...

Cultural Competence: Demonstrates knowledge of socio-cultural factors that affect interactions and behaviors; shows an appreciation and respect for multiple dimensions of diversity; recognizes and acts on the obligation to inform one’s own judgment; engages diverse and competing perspectives as a resource for learning, citizenship, and work; recognizes and appropriately addresses bias in themselves and others; interacts effectively with people from diverse backgrounds.

 

[plinkko]

I suppose it depends on what you mean by "culturally competent", as I've found explanations from students, residents, and physicians to vary a lot. Anecdotally, I have worked with a low income, majority-Hispanic (mostly Mexican/Central American in origin) for a while and there are definitely some characteristics that affect the visit. For example, during a diabetes-management visit, telling a mom who speaks little English that she needs to cook her kid kale and increase his peanut-butter intake may make 0 sense to her, but advising her to cook more chayote at home or use less oil in her pozole makes more sense. Having the talk about birth control with a Flower Child-generation mom from California is different than having the talk with a child's mimi from Alabama.

On the other hand, excusing the practice of harmful "healing methods" on children and calling it "cultural competence" is another thing entirely. Caogio, feeding children pay-loo-ah lead powders, or abstaining from medical necessary treatment for children in favor of naturalistic medicine are beyond the realm of cultural sensitivity and are all scenarios I've seen played out in real life.

Judgement about which situations falls into which category take common sense and experience, I guess. Above all, try to understand your patients and do what's best for them.

 

[vellez]

As much as I don't want to admit it, I actually think it's really important. Nearly every day I am in clinic, I am interacting with patients whose culture/worldview are different that my own. I surround myself with med students, who are usually upper-middle class and educated. That's very different than most patients.

 

[DoctorCrush]

I'll bite. For example, understanding the difference between bruising from abuse and ancient method such as coining that are still widely used today.

 

[NeuResurgens]

Incredibly important. If you don't understand the different backgrounds of your patients, communicating with them will be difficult and you might have a hard time getting the clinically relevant information from them, or getting them to follow the treatment plan.

 

[Promethean]

Imagine you lived in a very different culture. Like, say you were dropped down into a place where most people spoke a different language, where they had a different opinion of the causes of disease and how to go about treating them than what you'd always been taught, and they had very different ideas about how to behave toward sick people.

Imagine the things that you expect when you go to a doctor's office, and imagine that those things were not the way things are done at all in the place that you found yourself.

Would it be important to you for the doctor who was going to take care of you to at least hear your concerns and be respectful of your needs and your wishes for your own healthcare?

That is how important it is for physicians to be culturally competent. Being able to step outside your own perspective and imagine what someone else's might be like and what that might mean for how they would want you to treat them is a skill that you can practice. It doesn't mean putting people into boxes and stereotyping them based on their culture. ("Ah, patient from a traditionally patriarchal culture... they are only going to want me to talk with the eldest man in the room, even when the patient is a woman.")

It means being willing to ask questions and to demonstrate to your patients that, even if you don't understand everything about their culture, that you are willing to learn what you need to know in order to care for them, without imposing your own values upon them to the extent that you are ethically able to avoid. (So, you are still going to need to report actual child abuse, even if it is not seen as abusive in their culture, but maybe you can appreciate that coining is not intended as abuse but as treatment... and in that case you could attempt education and offering alternative treatments if you sincerely believe that it is not in the child's best interest rather than going straight to reporting it as malicious mistreatment.)

 

[plinkko]

I'll bite. For example, understanding the difference between bruising from abuse and ancient method such as coining that are still widely used today.

Yeah, most clinicians still consider caogio/coining to be abuse. Every pediatrician in my area still files to CPS if they see it continue.

 

[DoctorCrush]

Yeah, most clinicians still consider caogio/coining to be abuse. Every pediatrician in my area still files to CPS if they see it continue.

Hmmm, that's interesting considering the infamous case where (Not sure if it's a doctor or whoever) who reported the man's two kids to CPS for coining to the point where the children were taken away and he was so devastated to the point of suicide. And that was just the very first incident.

 

[DoctorCrush]

One of the biggest thing I tell people is too look at the patterns of coining marks. They're arranged in an organized manner, not sporadic patterns like abuse.

 

[freak7]

One of the biggest thing I tell people is too look at the patterns of coining marks. They're arranged in an organized manner, not sporadic patterns like abuse.

You do realize that abuse can be methodical too, right? That's not a great defense.

 

[plinkko]

One of the biggest thing I tell people is too look at the patterns of coining marks. They're arranged in an organized manner, not sporadic patterns like abuse.

Right, but the kids were still being caused harm intentionally using an antiquated therapy that has 0 evidence of being effective in multiple clinical, means-tested studies. Gua Sha is touted as a cure for nearly everything, and panaceas are almost always quackery.

I suppose those who have mutilated their female children's genitals under the guise of "spiritual cleanliness" in a ~methodical way~ would also be quite upset if their children are taken away from them.

 

[IlDestriero]

Based on our hospital's regular emphasis on it in required online training as well as our numerous cash cow international patients, I'd say it's critically important.


--
Il Destriero

 

[DoctorCrush]

Right, but the kids were still being caused harm intentionally using an antiquated therapy that has 0 evidence of being effective in multiple clinical, means-tested studies. Gua Sha is touted as a cure for nearly everything, and panaceas are almost always quackery.

I suppose those who have mutilated their female children's genitals under the guise of "spiritual cleanliness" in a ~methodical way~ would also be quite upset if their children are taken away from them.

**

 

[DoctorCrush]

You do realize that abuse can be methodical too, right? That's not a great defense.

You're right, touche.

I'm not gonna argue. But from someone who grew up in these type of culture where treatments like coining is still largely practice today, all I ask is to listen to your patient and see what they have to say.

 

[freak7]

You're right, touche.

I'm not gonna argue. But from someone who grew up in these type of culture where treatments like coining is still largely practice today, all I ask is to listen to your patient and see what they have to say.

That's exactly what we're advocating for though. If a kid comes in and says "I don't like when they do that and it hurts" but Mom says "well it's just our culture," I'm going to listen to the patient every time. Sure it may mean having a difficult talk with Mom about how there's insignificant evidence that coining actually helps with pain management and even though it's within their culture, when the child says "stop you're hurting me" you had better freaking stop. It's one thing for a consenting and lucid adult to undergo a treatment like that under their own volition as long as the equipment being used is sterilized etc. and will cause no other harm to them, but it's another thing to subject a child to that same treatment when it is neither indicated nor necessary.

Listen to the patient. Your duty is to your patient. Mom and Dad are not your patient.

 

[DoctorCrush]

That's exactly what we're advocating for though. If a kid comes in and says "I don't like when they do that and it hurts" but Mom says "well it's just our culture," I'm going to listen to the patient every time. Sure it may mean having a difficult talk with Mom about how there's insignificant evidence that coining actually helps with pain management and even though it's within their culture, when the child says "stop you're hurting me" you had better freaking stop. It's one thing for a consenting and lucid adult to undergo a treatment like that under their own volition as long as the equipment being used is sterilized etc. and will cause no other harm to them, but it's another thing to subject a child to that same treatment when it is neither indicated nor necessary.

Listen to the patient. Your duty is to your patient. Mom and Dad are not your patient.

I think this can be a good MMI topic.

 

[Kgizzle]

Mucho importante

 

[NeuResurgens]

.

 

[freak7]

.

 

[NeuResurgens]

You may want to delete that @UNMedGa . I'd hate for an acceptance to be withdrawn for something as silly as violating an NDA

Haven't been accepted there and not really specific enough to identify, but better safe than sorry I guess.

 

[freak7]

Haven't been accepted there and not really specific enough to identify, but better safe than sorry I guess.

Yeah haha that's why I didn't reply to his comment. Anything further I'd have said would've ventured into grey area

 

[NeuResurgens]

Yeah haha that's why I didn't reply to his comment. Anything further I'd have said would've ventured into grey area

Yeah I was careful not to mention any schools or specific prompts. Sufficient to say I've seen the topic.

 

[JB50]

Read the AMCAS pdf on basically the evaluating items of an applicant once. There's your answer.