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. wow. how do you really feel about it?

    i would just ask you to consider the possibility that cultural competence in health care does not mean being culturally sensitive in the ways you described (which – by the way – sound more like political correctness than cultural competency), but more importantly learning how culture impacts the ways in which everyone (and especially an increasingly diverse patient base) sees health issues, how patients (and you) make cultural assumptions that can be (and are) deadly, and many more core issues along those lines that – if not addressed – will minimize your effectiveness (and, hence, your bottom line). I’d suggest that if done well, training in cultural competence will be done in a way that enhances your ability to treat diabetes or cancer, not detract from it.

    I can’t help but wonder why this seems such a win/lose proposition for you.

  2. patti,

    Thanks for commenting. With all due respects, I have to disagree with you–totally. First of all, the legislation working its way through the legislature specifically implements cultural sensitivity, not cultural competence. But even if it did, it would make no difference: the chances that any sort of state-mandated requirement will have any positive impact on patient care is exactly zero. How do I know? Any physician worth his or her salt already has “cultural competence”–we make an effort to understand the environment, culture, family structures, religious beliefs of our patients in order to benefit their health–it’s part of being a good physician, and every worthwhile physician I have ever met or worked with understands this. If he or she doesn’t have this sort of insight, no seminar’s gonna give it to them. The chances that some state-mandated PC pap (and that’s exactly what this legislation is talking about) will improve our ability to care for patients is non-existent.

    The broader issue is why a bunch of state legislators, whose competence in the political arena is marginal at best (and in health care legislation, disastrously poor) should be dictating any CME topic is ludicrous. Should every physician carve hours out of their schedule and CME training simply to satisfy the whims of the “issue of the week”–even when it would be, at best, applicable to the very few? Social engineering at its finest.

    But as opinionated as I am on this, I’m open to a compelling argument to the contrary: You show me one area of “cultural competence” which will save one of my patients’ lives–in my surgical specialty, and which I don’t already know about; show me one area where my bottom line will be improved by spending hours at a cultural sensitivity seminar instead of gaining specialty-specific knowledge about delivering the best surgical care to my patients–and I’ll most certainly reconsider it. But if all there is to offer is generalizations about how “cultural competence” can avoid patient deaths and make me healthy, wealthy, and wise, then you’ll be best to direct your efforts elsewhere.

  3. Thanks for the additional insights into your argument – obviously you know more about what the legislature has in mind than I do – and far more about being a doctor.

    As for your last statement, I didn’t intend to sound as if I was directing my efforts to sway your opinion – so if I did, I apologize – I was just curious about your viewpoint.

  4. Dr. Bob,

    I have recently discovered your blog and have enjoyed your thoughts immensely. As a doctor/closet writer myself, you have been an inspiration. I am sorry to hear of the impending mandate for sensitivity training in Washington. Perhaps reason will prevail, but I have yet to see it happen where politicians and medicine intersect. So many of us are looking for a way or reason to get out of medicne; bone-headed, poorly-thought, feel-good-about-being trendy actions like this will hardly make more of us want to stick it out. NC can hardly be described as physician friendly, but I pray that we are a long way from such. The much-ballyhooed sensitivity training classes to which I’ve been exposed generally promote stereotyping us as aggrieved members of groups rather than individuals; or they are angry, “let’s beat up the white guys” opportunities for unhappy people to rant. With all due respect to Ms. Digh, I have never found any of the journal articles or conferences on cultural issues in medicine to be any more helpful than just being compassioante and treating everyone with courtesy and respect.

    Good luck, Brother!


  5. I just finished a good book, “The Pathology of man: A Study of Human Evil” by Steven J. Bartlett, in which he states that the majority of man are sheep, preferring to be led rather than risking doing something by themselves that may make them look stupid. There are a few, very few, who are the rebels, outlaws, independent thinkers who make societies advance. I like how you think and it appears like you might be an independent thinker. Do not stop, do not follow the butt in front of you. Step out of the dust and breath.

  6. I appreciate the due respect from Randy in NC (also my state), but would just reiterate my original assertion: “I’d suggest that if done well, training in cultural competence will be done in a way that enhances your ability to treat diabetes or cancer, not detract from it.”

    I think the key statement is this one: “if done well.” Obviously, there is bad, confrontational, guilt-inducing, vapid cultural diversity training out in the world that focuses on “sensitivity” rather than “skill” – you’ll get no argument from me on that point. Even so, I do believe that understanding the impact of cultural (and other difference) does have an impact on science and medicine. If done well.

    Perhaps we’re in violent agreement on that point?

  7. Dr. Bob, don’t the MD’s up there have lobbyists? As much as I often think lobbyists are a tool of selfishness, there are times when a group like yours needs someone who can get to the lawmakers. Otherwise, can you all agree to bombard your representatives with well-stated objections? And, yes, I know that takes time. Would you rather spend it in these stupid classes?

    Patti, you seem to have missed Dr. Bob’s distinction between cultural competence, in which doctors are already trained, and cultural sensitivity, which is the target of this proposed legislation. I’ve never known of any “cultural sensitivity” training being done well, by anyone, for any group.

    Of course, I have little faith in lawmakers to focus on the really important, valid concerns, anyway, since most of them care almost not at all for anything that will not promote their re-election.

  8. Vicki,

    Yes, we have the WSMA (state medical association)–and they have thrown up their hands, saying it will likely be impossible to stop: no politician wants to be seen as “culturally insensitive” in their next election.

    And Patti–sorry if I slapped back a bit hard–my frustration was showing. I’m not saying the issue is totally unimportant–but in the big picture, it ranks about 500th behind little issues like pregnant women going without obstetric care because OB-GYN docs can’t afford the malpractice insurance; head trauma patients having to be air-evaced 50+ miles because the few remaining local neurosurgeons no longer can afford to handle trauma; over half of all state physicians unable to see Medicaid patients because of reimbursements which cover less than 1/2 of their expenses; net yearly loss of physicians in Washington despite a booming population. These very real problems cause huge ripples in health care delivery and quality–but our legislators (Republican and Democrat, BTW) fiddle while Rome burns, passing cultural sensitivity training mandates.

  9. California lawyers have been subject to a silly continuing education requirement for years. It includes not only a certain number of hours, but specific requirements for study of ethics (don’t steal from your clients!)), drugs and alcohol, and “elimination of bias.” This, of curse, is PCBS.

    The meaning of most regulation of professions is “Screw the professionals!” Screw the doctors. Screw the lawyers. Screw the exterminators, etc.

    The traditional idea is that professonals could be independent and ethical because they were bound to certain traditional standards and could earn a living without being dependent upon powerful institutions. This freedom, of course, is anathema to our collectivists.

    Now you, and I, must sit and listen to multicultural and feminist propaganda for a certain prescribed time each year, like the Jews of Rome, who were once required to listen, against their will, to Catholic sermons. There was a time you could smoke a cigar at such a gathering. No dobut this, too, is now forbidden. Nothing forbids us, however, to eat beans beforehand and editorialize from below.

    (Did I really write that? Guess I did . . . .blat!)

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