Multicultural Madness

silk flowersOne of the nicer things about having a blog is the ability to rant periodically about things which are maddening, but utterly out of your control. It is healthy to have an outlet for such frustrations, and although my dog seems to understand and cares deeply when I express my concerns about troubling issues, she doesn’t seem to fully grasp some of their subtleties. Hence I turn to my readers, most of whom are quite a bit more intelligent than my dog–although there have been a few notable exceptions.

The rant of the day has to do with our fine state legislators in the great State of Washington. Their noble accomplishments in the arena of healthcare in the State of Washington have included an utter inability to satisfactorily address the state’s spiraling malpractice crisis, phenomenally high rate of uninsured, the migration of physicians out of the state because of a hostile malpractice environment and dismal Medicaid and Medicare reimbursements, and a punitive approach which attempts to recover the cost of their incompetence by treating all physicians as fraudulent. Be sure–when you hear Democrats talking about how they are going to solve the healthcare crisis–to take a close look at Washington State, where they control both the governors mansion (by coup) and the State legislature. Consider it a crystal ball into what might be accomplished at the federal level.

Nevertheless, our elected officials are currently considering legislation which will utterly transform the healthcare arena in the state–for which I am immensely proud. The State legislature is currently considering, and will likely pass, a law which requires physicians to have a certain number of hours of CME training in cultural diversity. Color me impressed.

Now, not that I am a culturally insensitive fellow–by no means. Some of my best friends are Democrats, after all. And I’m sure, in the big picture, that this is simply a tiny paper cut in healthcare’s death by 1000 cuts in this state. But for some reason, this drives me nearly insane.

Current state licensure requirements in every state mandate that healthcare professionals take a certain amount of continuing medical education (CME). This requirement, though largely unnecessary for most physicians (since they generally are well-motivated to improve their skills and knowledge without state requirements), nevertheless strikes me as at a reasonable requirement for medical licensure. Increasingly, however, the state is requiring that this continuing medical education be on specific, state-mandated topics. The camel’s nose under the tent began with a requirement that a certain number of CME hours be dedicated to education in medical liability. This was part of some sort of previous liability reform, which never accomplished its main goal of reducing medical malpractice and spiraling malpractice premiums, but nevertheless left a silly requirement in state law that physicians spend time thinking about how to reduce their liability–as if this is something they do not think about every minute of every waking day. Now we must dedicate an additional number of hours learning how to be culturally sensitive–which apparently means not telling overweight patients that they are obese, dining out at ethnic restaurants, and being careful to not offend our African-American male patients like telling them that their risk of prostate cancer is higher, or that the cultural diet they prefer is killing them through high lipid intake and hypertension. Keep in mind that most physicians are busy enough that time for continuing medical education, while important, is nevertheless a relatively scarce commodity. Spending time on extraordinarily stupid topics like cultural diversity means your physician is now spending less time at a conference to better manage your diabetes, or cancer, or improve his or her surgical or diagnostic skills. Of course, the moronic social engineers in our State legislature are far more interested in feel-good measures which paint them as “tolerant” and “sensitive” to improve their chances of reelection in a state which values quotas more than quality health care.

Sigh–I’m sure I’ll conform like the rest of my sheep-like colleagues to the new requirements, and rediscover yet again what a worthless, oppressive white male worm I truly am. Let’s just hope that some day, there will still be a few of us sheep left around to take care of sick patients.

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18 thoughts on “Multicultural Madness

  1. Dr. Bob – no apology needed. I can sense your frustration. As for Grumpy’s note about the elimination of bias being PCBS, I’d suggest that the facts say otherwise–that the elimination of bias in health care is a matter of life or death in many cases. Institutional racism is well documented in health care:

    The infant mortality rate for people of color is 2-3 times higher than for whites. People of color are 1-1/2 times more likely to die of heart disease and 1-1/2 times more likely to die of cancer than whites. People of color are twice as likely to die of stroke. Despite the higher incidence of these diseases, African-Americans are less likely to receive the invasive procedures used to diagnose and treat some of these diseases, such as cardiovascular disease. For example, in a recent study, coronary artery bypass graft surgery was performed on 28 percent of whites and only 6.5 percent of African Americans. The total of patients receiving coronary bypass surgery or angioplasty was 16.5 percent of African Americans as opposed to 44 percent of whites. Forty-three percent of blacks received cardiac catheterizations while 76 percent of whites did so.

    While other, related issues obviously contribute to this state of affairs, bias does play a role. Eliminating that bias can only be a positive step and not just PCBS. I’m not suggesting that it is only the role of the physician to change this situation, but to dismiss that bias exists or should be addressed is irresponsible.

    I’ll stop now – thanks for the prompt to think about these issues.

  2. The health care mess, in all of its myriad aspects, is SO big that I think it’ll only get worse until it breaks. But, hey, we may all be hiding out in our shelters from Avian Flu/Nuclear fallout/Muttawa (Islamic religous police)/___________(fill in the blank) by that time. Look at the bright side–we may not have to fix anything at that point.

  3. Dr. Bob,
    So where are all of the clinicians fleeing to? I’ve been in three or four states in the last few years and they all have a malpractice crisis with my specialists fleeing to points unknown. Are there any safe states left?

    As for the cultural sensitivity training, perhaps this is just a way for fat legislators to get out of their yearly digital exams.

    Hang in there,

  4. The stats I’ve seen suggest that those physicians who relocate, do so to states where malpractice is less critical, and/or reimbursements are better. The AMA map of crisis states is here (although I always take the AMA’s info with a grain of salt). The exodus is not all relocation: many physicians are retiring at much earlier age than they anticipated, or going into second careers outside of medicine.

    And patti–thanks for the stats–I’ve seen some of these figures, and honestly I am a bit skeptical: not about the figure per se, but I suspect some tendency to conflate correlation with causation. That African-Americans have poorer outcomes, lower rates of diagnosis and treatment, etc, may be due to bias or racism, but I suspect is far more likely due to socioeconomic factors which disproportionally affect these communities. In my own experience, practicing for over 20 years in a large metropolitan medical community with a substantially higher proportion of African Americans (as well as Hispanics, Southeast Asians, and other ethnicities) than the national average, I can honestly say I have never seen any evidence of discrimination in diagnosis or treatment based on race or ethnicity among the large medical community here. And I don’t think this is just a “see no evil” approach to the problem: I spent a lot of time in the urban Northeast (New York, Newark NJ, Philadelphia, Baltimore, and D.C.), and had no problem seeing a lot of racism and prejudice in those places.

  5. Patti,

    I agree with Dr. Bob that a lack of sensitivity is a minor factor in different health outcomes among different groups.

    The following are all probably more significant:

    1. Genetics, which are clearly reflected in many diseases, to an extent that’s just beginning to be understood.

    2. Cultural differences (diet, propensity to be stoical or to seek help, support networks or their absence, the place of violence in daily life, etc.)

    3. Economics (the relatively affluent have health insurance, the very poor get Medicaid, the working poor suffer; farmers have more accidents than accountants, certain occupations have high rates of occupational disease, etc.)

    All these concerns are legitimate matters for epidemiology and for health care delivery. So is language where it’s a barrier.

    It’s the forced participation in the diversocrats’ indoctrinaton sessions that offends, not sustained and serious research and policy attention to factors that have real health consequences. I’m agin’ the former, all for the latter.

  6. It’s the forced participation in the diversocrats’ indoctrinaton sessions that offends, not sustained and serious research and policy attention to factors that have real health consequences.

    I’m with Grumpy.

    Government has no place forcing itself into CME’s … any more than it does into a huge load of other places it currently has shoved its way into.

    I call that the “big dog” complex … each legislator seems to think that he has to “leave his mark” before he leaves office. That saddles us with a lot of laws which are not only invasive, they should never have been written in the first place.

    Add the idea behind the particular subject matter – “Cultural Diversity” – and you are faced with the insult which has been plopped on top of the injury. Physicians learn this in medical school. They live it every day in their offices, and in their hospitals. They could teach a bit of sensitivity to the politicians!

    Living it day by day is part of the practice of medicine … however being forced to give time to a government mandated CME on this subject is part of the touchy-feely, liberal, effeminization of the practice of medicine.

  7. I have a Masters in Social Work, I’ve been licensed independently in the State of Ohio for almost twenty years, and I’ve been in private practice for 18 years. We are now mandated to have 3 hours of CEU on ethics. I don’t have too much of an issue with this requirement (so far, at least, this is the only topic which is required, although I have a feeling the state will be requiring us to take some sort of “cultural sensitivity CEU, etc., before too long). Anyway, what bothers me more than anything is that the ethics classes that I do attend tend to be extremely liberal. If I even open my mouth to start a discussion about a Christian perspective about a certain topic, I am immediately glared at by the presenter and participants, then all hell usually breaks loose! I’m getting to the point now that I want to quit my membership in my association because I do NOT support their stance on many issues. BUt, I’m stuck – because I get my malpractice insurance through them.

  8. If the legislators in Washington were applying their gifted perspective to us woodworkers, we’d have to give up our table saws and Biesmeyer fences and go back to radial arm saw, babbit bearing planers, square cutterhead jointers and high speed steel router bits. And non-stearate sandpapers. Maybe only Doctor Bob understands these references. If the state of Washington had any sense, they’d recommend Aristotle’s ethics, Thomas Aquinas’ reasoning and Jesus’ simplicity. And that will not happen either. Grrr!

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