When in Doubt, Patronize

Some of My Best Friends…

If I suggested to you that different races had easily identifiable personality traits and that not only could I use these traits to predict their behavior but that I should make prejudicial assumptions based on these traits you would rightly label me a bigot. And yet, this idea is running rampant through the medical training establishment and has gained a surprising legitimacy among people who profess to be wholly untouched by the stain of bigotry.

I am, of course, talking about diversity training and cultural competency. In reality, it’s nothing but racial profiling. To be culturally competent, we must modify both our approach and our expectations of patients according to their race. The barely hidden subtext of diversity training is that white, middle class patients who are medically compliant represent the norm and other races and ethnic groups stray from the norm to varying degrees. These differences are usually objectively bad, at least as reflected in medical outcomes and thus a cottage industry has been created to explain why this is so.

Black patients, I learned in one session of diversity training, have a more relaxed sense of the passage of time and thus cannot be expected to always be on time for their appointments or even keep them at all. It’s just part of their culture. Additionally, the race scholars tell us, since African culture is more vibrant and demonstrative than the repressive, protestant culture of the northern Europeans, blacks have different priorities when it comes to health and taking responsibility for their actions.

When the Imperial Wizard of the Ku Klux Klan says pretty much the same thing, that blacks are lazy and shiftless, it causes cries of outrage and an endless stream of self-righteous letters to the editor from the outraged multicultural intelligentsia.

You learn all kinds of stereotypes in diversity training. All of the stereotypes attempt to show things in a good light but if you think about it, if the good stereotypes are true, why aren’t the bad ones? If so, can I extrapolate from my large stock of racially insensitive jokes an algorithm for relating to my ethnic patients? And if not, why not?

Cultural competency, the vicious cousin of diversity, represents forty years of white intellectual guilt and is part of our inexplicable, lemming-like urge to be non-judgemental. A few decades ago Western intellectuals decided that there was nothing of value in the West and that we must look to primitive, less developed societies for inspiration. It is probably part of the never-ending quest for the noble-savage, untainted by the stain of modern life. This point of view has finally spread to the medical profession which had been better able to resist it due to the basic intelligence and skepticism of physicians.

In practice most of us will rarely encouter any cultural situation which we can’t handle by simply applying common sense and good manners. People are not that different, no matter from where they come. An acute abomen is an acute abdomen regardless of whether it belongs to a white baptist male or a full-fledged Inuit from byond the arctic circle. I don’t care what the inuit traditional practices are to deal with abdominal guarding. The fact that he has presented to my hospital means that at some level he has abandoned his traditional healing in favor of something that works.

The consecrated walrus blubber is obviously not doing the trick.

Pray let us not patronize the poor fellow. I once saw an attending dancing around the issue of traditional practices with an obvioulsy foriegn and exotic-looking patient. She was the soul of sensitivity and was being fastidiously careful not to imply that our Western Medicine had the answers.

Finally the patient held up his hand and said, “That’s all well and good but my cousin in Dakka said I needed to be on a beta-blocker and a statin.”

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