The modern physician’s oath promises to not allow “considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor” to interfere with the patient relationship. At the same time, it is known that disparities in health and access to care exist among population groups. Health care providers have the power to effect significant change for these Oregonians.
Overview of Cultural Competency
“Cultural Competency” is synonymous with an array of phrases and concepts which are currently in flux and controversial. We can think about this concept on a variety of levels - individual, institutional, cultural, and systemic. There is overlap and dispute here, too.
Oregon defines Cultural Competency as: A life-long process of examining values and beliefs, of developing and applying an inclusive approach to health care practice in a manner that recognizes the context and complexities of provider-patient interactions and preserves the dignity of individuals, families and communities.1
Disparities in health outcomes related to various demographics are indisputable. These disparities exist in Oregon, in the US, and throughout the world.2
Oregon health care providers frequently do not match the demographics of their marginalized patients. This accounts for miscommunication and discomfort, and perhaps exacerbates health disparities. Because the impacts are happening right now, and demographic changes are constantly evolving, we must take action with limited information and incomplete conceptions. Health care providers have tremendous power to transform patient experience, health, and lives by increasing their own skills in cultural competence.
Engagement in ongoing professional development around culturally competent practice is therefore essential.
Please see the Oregon Medical Board's Statement of Philosophy on
Cultural Competency.
Diversity, Equity, and Inclusion in Medical PracticeThe Oregon Medical Board’s mission is to protect
the health, safety, and wellbeing of Oregon citizens
by regulating the practice of medicine in a manner
that promotes access to quality care. To further
the mission, the OMB’s Diversity, Equity, and
Inclusion Action Plan takes active measures against
harassment, discrimination, racism, xenophobia,
stigmatization, violence, and hate crimes within the
practice of medicine and acupuncture.
One action item in the Plan is to define discrimination
in the practice of medicine and acupuncture as
unprofessional conduct, which the Board implemented
by proposing an amendment to OAR 847-010-0073(3)(b). A draft rule was first reviewed by members of
the Board in March-April 2024 and a public comment
period was opened until May 22, 2024. No comments
were received. After the comment period closed,
the Board received comments and a request from
an association to extend the comment period. In
response, the Board updated the draft rule, extended
the comment period until August 26, 2024, and held
a public hearing on the updated draft of the rule
on August 26, 2024. During the extended comment
period there was overall support for the intent of the
proposal to promote health equity; however, there
were differing opinions as to which rule language
would achieve that intent (original v. updated).
On October 3, 2024, the full Board reviewed the rule
and voted to approve the updated draft: Unprofessional conduct includes the behavior
described in ORS 677.188(4), defined as conduct
which is unbecoming to a person licensed by the
Board or detrimental to the best interest of the
public, and which includes: …. Discrimination in the
practice of medicine, podiatry, or acupuncture
resulting in differences in the quality of
healthcare delivered that is not due to accessrelated factors or clinical needs, preferences,
and appropriateness of intervention. OAR 847-010-0073(3)(b)(J).
The Board does not expect this rule to change the way
physicians, physician associates, or acupuncturists practice because discrimination in the practice of
medicine/acupuncture is already considered unethical
and prohibited by federal laws and facility bylaws.
Additionally, the Medical Practice Act (ORS 677)
already allowed the Board to take disciplinary action
for discrimination within the practice of medicine or
acupuncture as “unprofessional or dishonorable conduct”
defined as conduct or practice contrary to recognized
standards of ethics of the medical professional.
American Medical Association Recognizes Racism as Public Health Threat
A new policy from the American Medical Association (AMA) acknowledges racism's role in perpetuating health inequities and inciting harm against historically marginalized communities and society as a whole. Specifically, the policy recognizes racism in its systemic, cultural, interpersonal, and other forms as a serious threat to public health, to the advancement of health equity, and a barrier to appropriate medical care. Read more about the AMA's policy
here.
The Legacy of Dr. Unthank
DeNorval Unthank, MD, was an African American doctor who lived life boldly facing adversity and improving the lives of Oregonians. Dr. Unthank graduated from high school at the age of 16, attended the University of Michigan for his undergraduate studies, and went on to Howard University where he earned his medical degree in 1926.
Dr. Unthank moved his family to Portland, Oregon, in 1929 where he would be the only African American doctor for over 10 years of his medical career. Dr. Unthank persistently served the Portland area and went from not being allowed in hospitals to eventually being on staff at four Portland area hospitals. The Oregon State Medical Society named him Doctor of the Year in 1958. Dr. Unthank retired from his practice in 1970 having served a richly multicultural group of patients.
Alongside an influential medical career were Dr. Unthank's numerous contributions to Civil Rights. He cofounded the Portland Urban League in 1945 and was accepted as the first African American member of the Portland City Club. Additionally, he was a driving force behind the Oregon Civil Rights Bill passed in 1953. In 1977, Dr. Unthank passed away having greatly impacted medicine and Civil Rights in Oregon.
1 Oregon Health Equity Alliance. (n.d.). HOPE Coalition 5-Year Plan Final (p. 4, Rep.). doi:http://www.oregonhealthequity.org/wp-content/uploads/2012/04/HOPECOALITION-FIVE-YEAR-PLAN-FINAL_-Sept-26.docx
2 Cultural Competence Continuing Education Brief (p. 1, Issue brief). (2014). Portland, OR: Oregon Health Authority. doi:https://www.oregon.gov/oha/oei/Documents/Cultural%20Competence%20CE%20Brief_FINAL.pdf