During the six weeks I was on psychiatry in medical school, I became interested in the doctor-patient relationship in psychiatry, which I felt was unlike that in other specialties in medicine. It’s a special relationship that can become incredibly intimate. You enter someone else’s mind, inhabit their life for a little while, explore and poke around. It was the one adult specialty where I felt like asking about the quality of people’s childhoods truly mattered.
Given that it’s important for psychiatrists to understand their patients on such an intimate level, I would think that it’s important to understand how patients’ sociocultural and economic contexts have affected their lives.
I became curious about diversity training in psychiatry. As this Psychology Today essay shows, there’s a lot of confusion about diversity even MEANS in the realm of psychiatry. (To no one’s surprise.) And the quality of diversity training is so variable. “However, there is evidence to suggest that the patients of clinicians who respect different patient perspectives have improved healthcare outcomes, feeling better understood, respected and valued as partners in their own care.”
If a psychiatrist doesn’t understand a patient’s cultural background, this can lead to mismatched expectations, patient rejecting the physician’s care because of non-verbal cues, and the physician getting frustrated when it seems like the patient “doesn’t get it” or “isn’t doing what’s best for them.” Not to say that all problems are attributable to cultural differences, but certainly some are.
Psychiatry has a reputation for being a specialty of Old White Men, but trainee demographics speak to an interest in creating a more diverse group of practitioners. The number of female psychiatry residents has gone up from 49% in 2001 to 55% in 2010 (although this was most overwhelmingly in child psychiatry). In 2010, white residents made up 53%, the number of Asians has risen to 26.7% (though I haven’t seen any at my institution), black residents were 7.8%, and Hispanic residents were 8.6%. Interestingly only 63% were native US born citizens; the number of international medical grads (IMGs) has stayed stable.
But even if the demographic proportions of psychiatrists were perfectly aligned with that of the US population, we wouldn’t be guaranteed 100% culturally sensitive interactions in psychiatry. Don’t fall into the trap of thinking that all people of a certain cultural tradition/background believe in the same things and express that culture in the same way. An individual’s culture needs to be understood for that individual, rather than extrapolated from given generalities. Patients should be able to choose how they define themselves, rather than have services define them on the basis of their skin colour or any other characteristic.
Studies have found that what patients value more than having their specific culture acknowledged is the ability of staff to engage with them and see the world from their perspective. This was not dependent on ethnic matching.
Perhaps this explains the sad truth that “cultural competence training” does little to improve things. DiversityRx is studying this and has some interesting findings. On their website I found reference to a paper from Tirado & Thom. They found no statistically significant impact of training on physicians’ cultural competence, on healthcare processes or outcomes of care. However, they did find that culturally competent physicians had a positive impact on the care of patients with hypertension and/or diabetes. Perhaps “cultural sensibility” is a better approach than “cultural sensitivity?”
It seems like the basic message when treating psychiatric patients is to treat them with the same respect and kindness that you would any other patient. Cultural solutions to psychiatric problems should be dealt with on a case-by-case basis. You don’t have to have the same background as your patient to understand them–you just have to be willing to see the world as they do and accept them for what they’ve been through.