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Jun 27, 2008

Cultural Competency

Sorry if yesterday's post was a downer - I didn't mean for it to be, but I guess my absolute lack of any energy and total deprivation of motivation shone right through my good intentions. I'm feeling a bit better today and have managed not only to make myself food, but also to climb the stairs three separate times trying to finish moving all of my clothes downstairs. Yes, internet, that's right. I think I deserve a medal because I have found some energy.

I also managed to finish The Spirit Catches You and You Fall Down from yesterday's post. I generally enjoyed it, but some parts of it irked me, which lessens the overall experience. For example, I thought that the story itself was riveting, but was told so haltingly and with so many historical interruptions that I didn't feel like we were getting anywhere. I like the historical background, but the setup was too choppy for my limited concentration. Maybe I should have eased into summer reading with a romance novel or a Harry Potter book.

The bit that really chewed me up was that, after all was said and done with the story and the history, the author went into a chapter-long summation/suggestion about how medical schools should incorporate "cultural competency training" into their curriculum. I realize that this book was written more than ten years ago, and that such changes have since been implemented, so I wonder what she would think of present-day cultural competency. For me, our exposure to it was a waste of time, inappropriately timed, out of context, and essentially useless. We were told to be aware of the patient's background, conscious of the family value system, etc. but never were we actually told what should be different. We should take a bunch of extra time to learn all about these people and their culture and heritage, but then issue the same care that we issue anyone else.

This begs the question: what difference does it make, then, who a person is or where the person comes from? If we treat everyone with the same standard of care, it should not matter.

The answer, of course, is that we don't treat everyone the same. Some people require special treatment, sometimes more, sometimes less. But what does that mean, practically and specifically? No one really addresses that question. Obviously, it is not addressed because it is unanswerable and must be dealt with on a case-by-case basis. Which brings us back to the point of early cultural competency training in the first place. You cannot study and understand every culture in the world, nor can you expect that the standard of care is to be implemented in every case. Thus, doctors must work on a case by case basis, meaning that each patient will be dealt with on the fly, with little or no preparation or understanding of the individual forces at work.

In summary, the time that I spent at cultural competency lessons and classes - I want it back. Perhaps I would've done better on that immunology exam I had the next day.

All in all, it was an interesting read. I think I would have responded better if I'd read it either before or after medical school. This is an odd time in my training, and I think my perception is a little skewed.

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