Monday, April 18, 2005

"Cultural Competency" and Medical Licensing

Here's a news article that raises some interesting points. It has to do with the need for physicians to be cognizant of cultural differences that may exist between them and their patients.

The state of New Jersey has passed a law requiring some type of (currently unspecified) "cultural competency" training in order for physicians to maintain their medical licenses.

Consider that in any patient-physician interaction, its success is defined in at least two ways:

  • The patient has an improved clinical outcome. That is to say the physician uncovered important clinical data that resulted in optimized medical care. Obviously, this is in most cases the most important value in medicine. It is often referred to as quality of care.

  • The patient has a good feeling about the interaction. Perhaps no clinically actionable medical data was gleaned but the patient felt better leaving the office than when he arrived. This may sound trivial but is crucial to the art of healing and is actually the way most patients evaluate their relationships with their doctors. This is also the way in which many, even most doctors evaluate their contributions to society and the pleasure they take in their profession. This parameter is usually called patient satisfaction.
Apparently, the idea of this new legislation is that such training will enhance patient-doctor relationships and promote better patient outcomes and/or satisfaction. I say "apparently" because it is unclear that there is any data to support that such is the case. By mandating some training or competency in managing cultural differences between patients and physicians, are either of these two parameters improved? I strongly doubt any clinical studies have demonstrated this.

To me, when I read about stories like this, I can't help but think that there is more than a little political correctness involved. Such mandated training sounds good and is obviously easy to support politically. I believe however that all policy decisions, even seemingly benign ones, need to be made scientifically with careful weight applied to both the potential benefits and risks of such decisions.

I'm not a libertarian advocating no government involvement in anything but I do believe that government needs to be on very firm ground regarding a new policy's utility when it promotes that policy no matter how seemingly trivial it is.

I doubt that has been done here. As Medical Society of New Jersey president S. Manzoor Abidi, MD very aptly put it, "You really don't teach people cultural competency in a classroom. You learn it in the lap of your grandmother." If that is true (as I believe) then very little positive impact will come of such legislation.

I also believe that rather than being an inconsequential policy move, there will be some downsides. First of all, such training is not free. I seriously doubt that the state of New Jersey is going to set aside funding for this. Physicians will certainly have to pay for this themselves both in the cost of the courses and in the time lost actually doing the training. Does anyone in the New Jersey legislature care or is this new law simply political window-dressing?

I don't see patients benefiting from this new law. The real beneficiaries will be a few politicians relishing an easy decision that will make them look good to their constituencies and the companies that organize continuing medical education conferences (CME) for a fee.

The other potential downside is in physician satisfaction. This is simply one more case of a regulating body making one more intrusion on the practice of healthcare which is already perhaps the most regulated of all U.S. endeavors. What does such a law do to the psyche of the conscientious, caring physician who already thinks of himself as an advocate for his patients? To go through the arduous, lengthy and expensive training necessary to become a doctor and be treated in such a paternalistic manner is bound to be at least a little demoralizing.

Has anyone reflected on the possibility that physician satisfaction itself might be somehow involved with quality of care and patient satisfaction? Doesn't it make sense that when a physician feels his work is appreciated both by his patients and his community, that may manifest itself in more favorable patient-doctor interactions? I can't prove this but instead state it for purposes of discussion.

In short, I can't support a policy with completely unproven benefits and very real potential risks. Hopefully trends such as this will not spread but given the perceived political benefit, I have my doubts.


Blogger Henry Stern, LUTCF, CBC said...

Wow. This just begs the question: whose culture? For example, your Asian patients will require a different subset of "cultural competency" than your patients of African descent.

And the list goes on.

And as you asked, who pays for this? I suppose, in the short term, the providers, but surely that cost has to be recaptured somewhere.

Talk about the law of unintended consequences.

I also appreciated your comment about "physician satisfaction." There's a point that is rarely seen, much less discussed. Good on you!

BTW, you may want to re-word your observation about "the success of its success." ;-)

April 18, 2005 2:04 PM  
Blogger The Medicine Man said...

Henry, thanks for the editing help! Is this revision better?

April 18, 2005 2:12 PM  
Blogger Henry Stern, LUTCF, CBC said...

Much! ;-))

And they're good points, too.

My family is lousy with doc's (um, maybe I should be thinking about re-wording, too): my uncle is a retired surgeon, one BIL is an orthopaedic surgeon, another BIL is a pathologist, and a SIL is a, uh, psychiatrist ;-))

Over the years, we've had a LOT of discussions about healthcare, reimbursement rates, medicare, you name it. But we've NEVER touched on "physician satisfaction," and now I'm intrigued.

I think this could lead to some VERY interesting conversations.

Thank you.

April 18, 2005 3:50 PM  
Blogger Fred Mangels said...

You wrote, "The real beneficiaries will be a few politicians relishing an easy decision that will make them look good to their constituencies".

Exactly, and that's probably all it's about. Politicians with too much time on their hands and too much power. As a wise man once said, "When you give government a hammer, everything ends up looking like a nail".

April 20, 2005 7:15 AM  

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