Cultural Competency in Medicine: A Two Way Street?

There is a giant push in education of medical students, interns and residents in the United States to develop more cultural competency to enhance a more humanistic approach to the care of patients of all cultures in this country. For physicians in practice, promoting cultural competency has also become important. For example, in October 2005, California Governor Arnold Schwarzenegger signed Assembly Bill 1195 into law. The law mandates that the continuing medical education accrediting agencies must develop standards of compliance with the law making subjects of cultural and linguistic competency a mandatory part of the continuing educational requirements that all physicians must complete. "Cultural competency" is defined as as a set of integrated attitudes, knowledge, and skills that enable a physician and surgeon to care effectively for patients from diverse cultures, groups, and communities. "Linguistic competency" as the ability of the physician and surgeon to provide patients who do not speak English or have limited ability to speak English, direct communication in the patient's primary language.

What isn’t within a law is the requirement that those patients whose culture is different from the “American” culture as applied to the diagnosis, care and treatment of patients, both in ethical as well as legal aspects be required to also have cultural competency and acquire linguistic competency as they interact with the healthcare system in America. One example might be, as seen in some cultures, the necessity to avoid providing the patient with “bad news” (such as a diagnosis of cancer). And yet in the American medical culture, informed consent by the patient for testing and treatment is a norm and without the patient being fully informed regarding the diagnosis and the benefits and risks of procedures or treatments, any consent might not be considered a legal as well as ethical standard of medical practice.

I am not prepared to support this demand upon patients or their families for this understanding of American culture and English, but I do want to offer it here for discussion. Shouldn’t the doctor-patient relationship be a “two-way street” with both parties attuned to the other’s cultural backgrounds and requirements? Or is this too big a burden to place on any patient or family especially at a time of illness or in a relationship where the playing field is not perfectly equal in terms of apparent power? There is another question: Is American medical culture in all of its dependence on technology, lack of humanistic care and consideration, unequal distribution and to some inadequate medical care, publicity encouraging miracles and cosmetic enhancements, encouragement to malpractice suing, etc. etc. actually a culture even worthy of following? ..Maurice.