Sunday House Call, #903, November 26, 2023: “Dammit Jim, I’m a doctor, not a social justice activist!”

I came across this document recently from CanMEDS.  It is a competency framework for medical practice that the findings the rules and skills of learners and experts and different disciplines.  It includes organizations such as The College of Family Physicians of Canada, The Royal College of Physicians and Surgeons of Canada The Association of Faculties of Medicine of Canada, and the Collège des médecins du Québec

In my practice, I have patients that come from a myriad of countries. These include, Afghanistan, Pakistan, India, Korea, China. Kenya, Japan, the Sudan, Uganda, Ivory Coast, South Africa, Egypt, Libya, Syria, the Gaza and the West Bank, Israel, Turkiye, Romania, Bulgaria, The Czech Republic, Somalia, Brazil, Poland, Germany, Iceland, Spain, Portugal, the U. K. France, Mali, Colombia, the Philippines, Thailand, Malaysia, Australia, New Zealand, Venezuela, Mexico, Cuba and Ethiopia, to name a few.

I know my patients.  When they come to my office our group of physicians including myself do the best we can to address their concerns.

We listen to their histories, provide appropriate workup and diagnosis following the medical tenet of do no harm.  We engage with humanism, empathy, and respect. 

The recommendation stated in this document is: “ A new model of CanMEDS will see to center well use such as anti-oppression, anti-racism, and social justice, rather than medical expertise”.  In other words, medical expertise is secondary to diversity, equity, and inclusion? 

My question for you is “What do you want from your physician?”

The paper suggests that based on the certain color of one’s skin that there are people assumed to be complicit in systemic racism and bias within the practice of medicine thereby not providing the best care to certain groups of people.

As abhorrent as that is to me and likely to you, is this borne out by the evidence?  I’m not an expert in this area so I would leave this with people who have knowledge about it and to comment about it.

In an area that I do know what I am talking about, I can use our practice experience as an example.  It is true that this is anecdotal because we are dealing with one practice, but ultimately the statement in the paper implies that this is systemic thereby includes my practice in this recommendation for change.  It implies that all physicians are complicit.

My colleagues and I do not discriminate against our patients on the basis of their sex, gender, religion, race, culture, or country of origin.  From the list of countries that I provided at the beginning, if there are areas of care that can be improved given the disparate origins of many people, I’m all for it. 

Indeed, the implementation of technology that allows real-time language translation is exhilarating.  The ability for me to speak with a patient who speaks Mandarin and for them to respond in kind converted back into English fostering greater understanding is fantastic.  It breaks down the barriers that can happen with disparate languages and cultures.

However, the approach that we take to care for our patients and improving same cannot be accomplished by prioritizing diversity, equity, and inclusion principles over medical expertise and competence. 

We are cognizant of cultural differences.  We also are aware that there are bad actors in any profession including medicine.  However, is the document implying that there is a plethora or majority of physicians involved in this systemic bias and racism?  I would say that this doesn’t necessarily represent the reality on the ground at least in our neck of the woods.

In general, each country includes different cultures, ideas, opinions, races, genders, and religions.  It would be a Herculean task to try to meet all the criteria set out by this discussion paper leaving little room to practice medicine and provide care.

It does not imply racism or disregard for cultural backgrounds when we deal with what is most important to the patient, address the issues, and offer assistance and solutions.

How you treat someone has a significant impact on the relationship is established.  Actions speak to intent.

To assume the worst of someone because of the color of their skin or other metric does not lead to the promised land.  It dehumanizes and contributes to the law of unintended consequences; the exact opposite of what you intended to accomplish.

You can have your say and provide feedback to CanMEDS

CanMEDS: A competency framework for physicians throughout their career

Michael Higgins: ‘Anti-racist’ doctors would put social justice above medical expertise

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