Cultural Competency and Chiropractic: Mother Was Right

I admit I'm a little nervous as I write about this topic. There is no escape, walking back or clarifying anything I am about to write. The topic? I call it, "Stuff I've noticed about people in my practice"; but others might call it, "Thoughts on being "culturally competent."

In this day when people want to announce their chosen pronouns, I never know who might criticize me for an unintentional slight, misunderstood "micro-aggression" or some misspelled or misconstrued missive.

I practice in a big city, right in the middle of a megapolis. Never did I think this would be my place. I grew up in a small town in southern Illinois, a region where it seems nobody is from – except me. You might not believe it, but I never met an African-American person until I was in high school. I never knew anyone of Asian or Jewish ancestry until I was in college.

But over the years, I have treated patients from just about every part of the world, of many ethnicities and religions, and authentic refugees. It has been a privilege and a great learning opportunity. As I became more experienced as a chiropractor, it became clear that people needed to be treated differently with respect to their culture as long as they were treated fairly and appropriately.

The early emphasis on teaching "cultural competency" in institutions of government, schools or hospitals was confusing to me. Does this really need to be taught? Shouldn't this just be like mother saying to "be polite and respect your neighbors"? No, not really. Coming to the city as a rube from rural America, I have to admit that I could have used some education about cultural differences early on.

A Few Personal Practice Examples

A few years ago, I attended a seminar sponsored by the state's Division of Workers' Compensation. The speaker was a woman MD from Brazil, with African-Portuguese lineage, married to an orthodox Jewish physician from the Bronx. Her topic was "How to exam a woman in a burka."

This doctor had the academic credentials to talk about the differences in the global population, and how we providers should learn "cultural competence" in our health care efforts. Her presentation was humorous and thought provoking.

When question time came, I asked her why many of my patients, raised in Europe, often closed my treatment door and turned off the lights when they left the room. "They don't want to waste energy," she replied. "That's a big deal in Europe."

I have had numerous patients from southeast Asia. A large family referred many immigrants to me, and if they were new patients, they often had little or no English-language skills. Appointment times did not mean much to many of them. I was never sure when they would show up. There seemed to be only two appointment times: morning or afternoon.

One patient explained it to me this way: "In my country, we sometimes had to walk for hours to get to a clinic. When there was a big rain, there was no way to know when we would get there."

Some of my education in "cultural competency" came from making mistakes. I learned not to touch the head of a Hmong boy, which is considered almost abusive by the Hmong. One of my most embarrassing moments was when I somehow, mistakenly, thought that a large, affable woman was Polynesian, and asked her what island she came from. No, she was Navajo. I could go on with many of my faux pas, humiliations, and such, but I am not that masochistic.

There are just plain differences among people that can't be missed. One Sicilian girl seemed to have one of the heaviest heads I have ever lifted during a cervical adjustment. That was because she had perhaps the heaviest head of hair I have encountered, almost long enough to sit on. She was blessed with apparently wide and massive hair follicles common in her genetic haplotype (so she told me).

It was a blessing, but also a curse whenever she would shake her frocks and hurt her neck. The sheer mass of her hair could create a rotary contrecoup strain anytime she quickly looked over her shoulder.

My Best Advice: Listen to Mother

Let's go back to my early confusion about the need to teach cultural competency. Now, years later, it appears times have changed. Teaching about cultural differences seems to have become an industry, mandating that institutional employees must comply with indoctrination, rather than education. As with many similar attempts to "do good," this effort has had questionable results.

An article in the Harvard Business Review titled "Why Diversity Programs Fail"¹ sums it up, in my opinion. I paraphrase: Forcing people to attend "indoctrination" (my word) sessions just increases "anger and resistance." In other words, when workers are forced to comply, it just annoys them, and does not change attitudes.

Yes, I could have used some tips about certain cultures I encountered when I came to the Big City. But mother was right: Be polite and treat all people with respect. But she also said, "Always wear fresh underwear every day in case you are in an accident and have to go to the hospital." Bless her heart, she was just full of advice!

Reference

1. Dobbins F, Kalev A. "Why Diversity Programs Fail." Harvard Business Review, July-August 2016.