Sunday, October 22, 2006

Cultural Competence? Incompetent

So, there I was, awake and alert with a Glasgow Coma Score of 15, freshly infused with a huge cup of coffee as black as murder, and ready to gain the insight of the finest minds in all of surgicaldom. I picked up my registration materials and program and began to plan out the first morning of the American College of Surgeons meeting. I was pleased to quickly spot a few lectures given the group heading of "Evidence-Based Perioperative Risk Reduction." Productive, for sure, and a worthwhile update for dealing with the elderly, sick patient population in my tertiary care center. As outlined below, it was a good use of my time.

But then I made a mistake. The kind of mistake that caused that aromatic coffee to scald my nasopharynx as it was forcibly transported out of my nose. The kind of mistake that made my arms twitch and twist so uncontrollably that I looked like I was auditioning for the remake of Dr. Strangelove. The kind of mistake that gave me heartburn --- no, not heartburn. Angina!

What did I do? I simply perused the other offerings on the slate for Monday's Clinical Congress. Let's see --

  1. Laparoscopic Colectomy: Beyond the Basics (been there, done that)
  2. Breast Cancer Update: What Every Surgeon Needs to Know (not much new news this year for anyone that keeps up)
  3. New Prevention and Treatment Strategies for Male Sexual Dysfunction (why do we let urologists come to these meetings?!)
  4. Open vs. Endovascular Approaches for Vascular Disease: What Are the Outcomes? (interesting, but I don't do vascular surgery)
  5. Postoperative Pneumonia: Strategies for Prevention, Diagnosis, and Treatment (I'd like to hear some of this, but can't be in two places)
  6. Pancreatic Pseudocysts and Chronic Pancreatitis: Evidence-Bases Management (difficult patients, but the treatment is really not that difficult)
  7. Inguinal Hernia Repair: An Evidence-Based Approach (old controversy, but the data to be presented is somewhat new --- and has been touted in every surgical journal for about 2 years)
  8. Information Systems: How the Information Explosion Will Change How We Educate Surgeons and Treat Patients (I've heard variations on this theme for years)
  9. Update on Blood Transfusion (boooooooring)
  10. Cultural Competency: Does It FacilitateBetter Delivery of Health Care (WTF?!?!?)
(Deep breath. Must. Get. Nitroglycerin!)

I hardly know where to begin. Well, yes I do. This kind of absurdity, this rubbish, this preposterous lunacy, this AB-SO-LUTE SOCIAL ENGINEERING BULLSHIT should be presented in front of surgeons only to initiate a program to COMBAT IT!

Was it too much to ask that surgeons, for Pete's sake, the last group of physicians that one would expect to go for politically correct pablum, would try to bring some semblance of sanity to this arena. Yes --- it was too much to ask. The Clinical Congress News, the official "press" of the meeting, had a fawning page one article explaining to us insensitive rednecks that cultural competency is simply a "no-brainer." But just what is this thing called cultural competence? Here is one definition, and a Google search brings up a paltry 9,650,000 sites listing the term; however, as pointed out by this essay, it mutates depending upon the prevailing wind being blown by those windbags who espouse multiculturalism as the cure for all of our ills. New Jersey politicians have already passed a law mandating that physicians undergo "cultural competency training as a condition of obtaining or renewing their licenses to practice medicine." And you won't be able to get this type of indoctrination training like traditional CME, according to one of this law's proponents:
Like believes cultural competency training can succeed, but will not be attained through a "cookbook approach to care. We have to see this as different from other types of CME courses," he says. "It has to be a process of how we continue to learn about the diverse populations we're caring for as well as our own personal and professional biases, values, beliefs, and behaviors—I don't think taking a one- or two-hour course is going to be effective." He also argues that cultural competency training should extend to all health care workers, including nurses, dentists, physical therapists, pharmacists, psychologists, social workers, and other allied health professionals.**
**Yes --- that means you, too will get to share in this wonderful, mandated politically correct groupthink experience.

Other physician bloggers have had a few things to say about this, and it's unlikely that I'll add anything substantive in this post. But let me just blow off a little steam, so that the next time I'm faced with this crap I can try to be a bit more articulate --- if this comes up for debate in my state legislature, I'll have to carry a scalpel and not a Howitzer.

I am a surgeon. A white, male surgeon, to be "culturally identified." I was raised in Texas, but have no more "Texan" in me than an unladen African swallow. I lived in France for a few years, and --- horror of horrors --- learned the language and tried to "fit in." I have been fortunate to have visited Mexico, New Zealand, Australia, Germany, Italy, England, Belgium, The Netherlands, Switzerland, Luxembourg, Canada and the foreign country of Louisiana. But while those experiences certainly have enriched my life I am, and always will be, an American. And I intend to continue to treat patients in the best manner I know how ---- and dammit, it's just too bad that I can't speak Bantu or understand the complex courtship dances of every Pilipino tribe. I can, and do, learn about many things that are of interest to me, but don't expect me to be so "culturally aware" that I will perfectly mesh with every person who comes through my office door. And who is to say what cultures I should be appraised of? The answer would hardly be the same if I was practicing in New York City or in Bay City, Texas. And what about the diversity that is seen within our own country? Are we to be indoctrinated soaked in the social customs of the midwestern corn farmer, the southern oil magnate, the southern "belle," etc.? I kindafuckindoubtit.

The bottom line is that I cannot be everything to everybody. If I am perceived by a patient as not communicating well with them, for whatever reason, because I'm culturally insensitive or because I'm just not nice enough, they have the opportunity to seek care elsewhere. If I find that a whole lot of patients are doing just that, I will have to find a way to change my behavior or go out of business. That is the American way. I don't need a Cultural Competency Czar making me sit in seminars and sing Kumbaya in Norwegian to understand that basic priniciple of life.

I guess what really stuck in my craw was the way that this is being passed off as a self-evident, overwhelmingly important movement in surgery, without a shred of evidence that it holds any intrinsic value whatsoever. Buried at the end of the article puff piece is the indicator of the way that this "discussion" is to be held in the future:
During the question/answer session that followed, the panelists agreed that although there are no concrete data to support the claim that cultural competence is an important element of effective health care delivery, it is a given and that the need for such cultural competence in health care must be addressed.
Uh-huh. It is a given. I would say that it is a given that the more of these feel good, do-nothing policies that get forced upon busy physicians, the fewer there will be available to care for the urgently ill --- because they'll just say "screw it." It amazes me that on the one hand the ACS has finally awakened to the problems we have just covering emergency rooms, and on the other hand is wasting its time on drivel such as this.