Most healthcare institutions now have some kind of cultural competency training through their human resources department, as well as customer relations training in the basics of communication and conflict resolution. Understanding cultural backgrounds and the effects of living in a society that limits one's education, advancement, and respect is of some use, but it probably isn't the real issue. Rather we need to learn about our own problems as health professionals in establishing effective communication with our patients. The dominant society (whether it be male or white or young; or wealthy or credentialed, in our case) is where the causes of sexism, racism, ageism, classism, and elitism reside. Studying the victims of these oppressive styles isn't going to solve the problem.

I do believe that training will help people to identify failed communication, and that some will be able to identify in themselves the causes, and that some will be able to adopt remedial behavior.

But many of the “racist” behaviors that community members describe are organizational behaviors — things we call regulations, policies, and qualifications. These require organizational action.

The only reason women are now allowed into medical school in numbers equal to men is because of changes in institutional policies starting in the 1970s, when only 10 percent of medical students were women. Communication seminars may be part of the change, but it also requires social and legal action.
Bruce Block, MD, is a family physician and director of the University of Pittsburgh School of Medicine

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