For instance, today we were required to watch a stream of staged videos which were supposed to demonstrate how culturally insensitive situations can occur. I shit you not, the patients were all black and the docs all white. Every scenario was ridiculously staged... and then we were required to answer a series of questions which were insane.
Here's an example of what happened today:
Video: White doc, black patient. Patient has uncontrolled hypertension, previous MI, etc. Doc is speaking a little overly scientific and parental and patient is being a little too apathetic about his unhealthy lifestyle and a little too defiant about physician knowledge. Not to mention, the video contained every stereotype you could ever come up with... about the doc as well as the patient. Patient uses wrong verb tenses, says he's unemployed, and brags about using the ED for his primary care doc. Doc rolls his eyes every time the patient uses sub-literary journal level language, suggests buying organic foods and joining an expensive gym to work out.
Question: What is the main issue in this video?
Answers:
A) The patient should be more concerned about his severely unhealthy habits and should take more responsibility for his own health
B) The patient and the physician are talking past each other instead of communicating well
C) The patient should be re-assigned to a black physician
D) The physician is not being sensitive and is not picking up on cultural cues that would help him to appropriately solve the patients problems.
After a group discussion we settled on the best answer B (heaven forbid the answer is A). However, one of my group members says "Hey guys... I know B is the right answer... but I know how these assignments work. I bet my life that the answer is D. If we want the points for getting the right answer, we should pick D"
He managed to convince us... so we chose D for the points. And freakin-A... he was right.
Now, tell me that this situation doesn't in effect PERPETUATE racism. Instead of both parties taking responsibility for the miscommunication... which would imply equality...it's the "superior", white doc's responsibility to figure out how to solve the black patient's problems.... thus implying that the patient doesn't have the ability to assess and solve his own issues. Right there, in class, we just affirmed the notion that white doctors, in fact, are superior and should take the higher moral road. The whole thing is pure insanity.
I mean... if we're going to address racism... lets do it. But nix those lame-ass videos for god's sake.
so, I read the answer choices and zoned in on D), even before I read the part about that being the correct answer. while I agree that B) is what the answer *should* be (in a perfect world, i.e., one we will never ever live in), what I have learned in my pre-med wanderings is that one never, ever is to assign any of the blame, for anything, to the patient. hence, D)
ReplyDeleteI completely understand what you are saying. however, reimagine the video you watched, with a white, lower-income patient in place of the black patient. does this change your thoughts at all? maybe not...just something to think about
but yeah, I agree, sounds like that video contains just about every stereotype possible. you'd think that a less over-the-top approach might be a more useful and effective teaching tool
It is unfortunate that the videos help validate such stereotypes, but the stereotypes do exist. It is my experience working in an ED during undergrad that many doctors share such views regarding other cultures. I do not suggest that such an opinion is justified, but it does exist. I am not sure how to change it either. In fact, I think that many cultural stereotypes especially those regarding race have diminished among younger individuals.
ReplyDeleteI understand the frustration toward the course. It is less about learning and dialogue than guessing the expected answer. Maybe you should stir something up and posit your observation to the prof. I am sure others in your class find the teaching method artless too.
I consider cultural bigotry and racism to behave like new scientific theories. The new theories only replace the established theory once the scientists that were raised on the old theory retire and die off. Consider yourself fortunate for being so sensitive to cultural differences.
Anyway, it sounds like an annoying exercise, but I think that was the point. We had some similar scenario presented to us in our curriculum where the following point was made.
ReplyDeleteBoth people should take responsibility in real life. But as the professional in the situation, it is actually the doctor's responsibility to do whatever he/she can -- even if the patient is not receptive -- to get a good outcome. Even if the patient doesn't take care of him/herself.
Yes, that means our jobs as doctors to some extent become protecting patients from themselves. Everything is our fault because we're the ones with the power in that situation. It's our job to make patients change if they're hurting themselves, even if they're being obstinate about it. In reality, it IS the doctor's job to solve the problem regardless of the race of the patient. It's not that doctors are superior. That's just what the job description is.
Old MD Girl.... I totally disagree!! There are so many people in this world who WANT to be helped...way waste energy on those who refuse to? I have no desire to spend my life begging people to help themselves! I have BEEN THERE for years and it is frustrating, painful, and fruitless...
ReplyDeleteAt a certain point you have to give up on those that won't help themselves. It is a downhill slide and they will only drag you down with them. It is a sad fact of life, but a true one.
ReplyDeleteI too zoned in on D as the "correct" answer but not the "right" answer, if that makes sense. Just because I have sat through many of these so called sensitivity trainings.
I have been in the situation you're describing more than several times as an ER nurse. In fact, it's nice that that Af.American pt came into a primary care clinic - that's progress because in real life, that's hardly possible if they were as "uncaring" about their lives as you had described. I think with more experience you will truly understand that what Old MD girl is saying is true. It IS your responsibility as a physician (and mine as a nurse) to care for people and teach them a good lifestyle. It is your moral duty, not a waste of time. People from impoverished backgrounds have a sense of "learned helplessness" where even though they care, they cannot afford medications, do not have the resources and discipline to be able to care for their health, because let's face it, putting food on the table for themselves and the kids is much more important than climbing on that treadmill. That's the reality of life. Blood pressure meds may not allow someone function on the same level that they used to before due to side effects and it is YOUR job to find the best medication that works for them... that is once you figure out how they will pay for it, and if there is a pharmacy in town that will cover 30 pills for $4 without insurance. That is what differentiates a great doctor from a regular doctor. And I only have worked with a few great ones. I hope you become one of the great ones after all that you've endured in your own personal life. :) Please don't lose your compassion for others.
ReplyDeleteElla -- You help them because they're in your office.
ReplyDeleteElla - Ignore all those do-gooders above, and next time, go to class drunk.
ReplyDeleteSeriously, I had to watch those same videos, and they are about as effective as the "don't drive drunk or have sex" 1980s classics we had to watch in high school.
Lorrrrrrrrrd.