Cultural Sensitivity and Bogus Credential


Respect is my firm conviction.
but not for gross dereliction
The test, I suppose,
From a course that I chose
With scenarios that were pure fiction.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, travelled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I am back having adventures in temporary positions until they have an Electronic Medical Record (EMR) system I can get along with. I spent the winter in Nome, Alaska, followed by assignments in rural Iowa. This summer included a funeral, a bicycle tour in Michigan, cherry picking in Iowa, a medical conference in Denver, and working Urgent Care in suburban Pennsylvania. Any patient information has been included with permission

I woke this morning and started working on my Cultural Competence Module for my American Board of Family Medicine recertification. The ABFM didn’t write the module; the Department of Health and Human Services did. They used slick computer graphics. They could have gotten better writers.

The fictional patient that started the day, a 55-year-old Ethiopian with a heart attack, had switched doctors.  He felt he could talk to the African American physician more easily than the Chicana because they share racial background.  As the video developed, he wanted the new doc to come to a community meeting to lecture on good health habits.

Another scenario featured a distraught Spanish-only speaker with emotional problems getting worked in without an appointment.  She had overdosed her 14-year-old son on his prescribed amitriptyline (over sertraline due to cost) because the English word once means 11 in Spanish.  But the situation resolved in 4 minutes.

Yet another centered on a 74-year-old Vietnamese speaker with no English and loss of appetite, whom the doctor suspects has cancer of the cervix. Her 9-year-old granddaughter served as interpreter, ineffectively.

I firmly believe in cultural sensitivity starting with speaking to the patient in their own language, continuing to cultural respect, and not being judgmental.

The people who write the scenarios don’t know much medicine and they don’t know much sociology.

I worked with Ethiopians; the country has more than 80 ethnicities, languages, and religions, with overlap.  Christians and Moslems who speak the same language may or may not get along.  Ethiopians community meetings might exist, but, if they do, they happen rarely.  And I never met an Ethiopian who identified with African Americans, though some of the Moslems among them identified with me because of my beard.

Highly emotional people demanding to be seen without an appointment never finish in less than 45 minutes.  A doc doesn’t pick amitriptyline over sertraline because of cost.

If my septuagenarian patient lost her appetite, I’d worry about vitamin B12 deficiency, anemia, hypothyroidism, congestive heart failure, constipation, UTI, gallbladder disease, hepatitis, stomach cancer, esophageal stricture, esophageal cancer, or depression long before cervical cancer.

The morals to the stories are valid: children in general, especially family members, shouldn’t serve as interpreters; any healer has to be alert to the patient’s sensitivities, every human being deserves respect, every culture has its strengths and weaknesses.  Be careful with language barriers.

I have cultural sensitivity. And now I have the credential, regretfully bogus.

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