Volume 60, Number 3 - Summer 2009

 

By Ian Hoffman, MD

As a board member of SCMA, I attended a meeting of the Medical Leadership Council on Cultural Proficiency this past May. Sponsored by the California Endowment and the California Academy of Family Physicians, the MLC’s mission is “… to improve language access, cultural proficiency, and health care workforce diversity in California.” The meeting included executives from the private sector (Kaiser, Sutter, St. Joseph’s, Scripps), along with board members and executives from county medical societies, physicians, nurses, and representatives from medical nonprofits.

Several presenters at the meeting addressed language access. One described a 2007 study at San Francisco General Hospital showing that patients with limited English proficiency who received invasive procedures were less likely than English-speaking patients to have documented informed consent on file. Another, from the National Coalition on Health Care Interpreter Certification, discussed regional differences among interpreters regarding the need for a national interpreter certification exam. Finally, several presenters from large health systems shared their experiences implementing language-access projects. The common theme in all was that many barriers still exist to patients with limited English proficiency, and that systems-based approaches are the only way to implement large-scale change.

We also heard about community projects supported by MLC grants. One such project, Decision Medicine, is a two-week summer program that exposes high school students from disadvantaged backgrounds to one-on-one mentoring from physicians, team-building activities, and extensive educational resources. The San Joaquin Medical Society, which sponsors the project, is now offering the model to other organizations that want to expand upon the work they’ve done. More information can be found at www.decisionmedicine.com.

Participants also discussed the barriers, pitfalls and opportunities that exist with the current expansion of electronic medical records through the Obama stimulus plan. All agreed that more widespread use of such records will ensure higher quality care for all patients, including more inclusiveness in the realm of cultural proficiency, and also help to close the quality gap in care of different populations. The cost of implementation, however, is likely to fall squarely on the shoulders of physicians and small practices. Surveys done by the California Endowment show that only 13% of physicians and 3% of community clinics are using electronic records. And while 70% of consumers say that such records are important for physicians, 77% of those same consumers say they are not interested in applying for health insurance online. In addition, more than half are not interested in discussing medical problems with their doctor by e-mail.

Of particular interest to more culturally appropriate medical care is the coding of ethnicity, race and language in electronic systems. While the opportunity exists to collect more precise data on language and ethnicity, there are pitfalls. One Catholic Healthcare West facility, for example, was found to have 15% Ukrainian-speaking patients. Further investigation revealed that the cause of the Ukrainian population boom was a data-entry error where “UKN” was entered for “unknown” language and interpreted as “Ukrainian.” Widespread use of more electronic data, while offering the possibility for large-scale analysis, also increases the potential for misleading information as we adopt and adapt.

As a retiring SCMA board member, I encourage other physicians in Sonoma County to get involved with MLC. Possible future directions for the group include cultural competency and language training in residency programs and medical schools, and CME credits for physicians who step out of their daily practice into settings that expand their cultural understanding. Groups like the MLC give me hope that we can and will solve the problems that face medicine today.

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Dr. Hoffman represented the Santa Rosa Family Medicine Residency on the SCMA board of directors until he graduated in June.