Posted on February 3, 2009

Foreign Doctors, Our Values

Margaret Wente, Globe and Mail (Toronto), February 3, 2009

When Andrea and Ginette Markowski, a same-sex couple, went doctor shopping last month, they got a rude surprise. The doctor they approached confessed she was uncomfortable with lesbians–so uncomfortable she advised them to look elsewhere.

The doctor, Kamelia Elias, who works in a Winnipeg clinic, has practised in Canada for five years. She received her medical training in Egypt, and her religion condemns homosexuality. Lesbians “get a lot of diseases and infections,” she told the local paper, incorrectly. “I said it’s better to find someone who will take this type of patient.” But the couple was furious. “She clearly was shocked by our relationship, unable to recover,” said Andrea Markowski.

Dr. Elias is just one of an increasing number of immigrant medical professionals whose beliefs and backgrounds clash with Canadian ways. Some discover that the struggle to have their credentials recognized is not the only barrier; there’s also the culture gap. The Markowskis have filed a complaint with the Manitoba Human Rights Commission, and Dr. Elias has found herself condemned by gay-rights groups across the country.

The doctor shortage means Canada is increasingly dependent on foreign physicians, who now account for 20 per cent to 25 per cent of the physician work force. So we can expect more cross-cultural conflicts such as this one, says Bill Pope, head of Manitoba’s College of Physicians and Surgeons. “Often, their basic knowledge is good, but it’s all in the way in which you operationalize it in a culture that might be quite different.”

Until recently, cultural problems among foreign doctors have been an underground issue. The subject is touchy, and officials don’t want to appear to be stereotyping ethnic groups in unflattering ways. But Health Canada and other medical groups have realized that it needs far more attention. Foreign medical professionals used to come mostly from the U.K. and South Africa; now they come from China, India, Pakistan and the Middle East, where beliefs and traditions can be radically different. Many male doctors from the Middle East have never performed a pelvic exam. Some doctors have never laid hands on a patient at all. Some insist there’s no such thing as homosexuality in their countries, and many come from cultures where it’s regarded as a grave sin.

Attitudes toward women can be a problem, too. When confronted by a woman showing signs of abuse, some male Muslim doctors are inclined to send her home, with instructions to be nicer to her husband. One pharmacist refused to dispense birth-control pills to a 16-year-old girl, insisting he contact her parents first.

Not all Western practices are necessarily superior, of course. Foreign professionals are deeply shocked–and with good reason–by the shabby way we treat the elderly.

Zubin Austin, a pharmacy professor at the University of Toronto, is helping to develop a nationwide orientation program for foreign health-care professionals. He says one challenging cultural difference is the notion that physician reigns supreme. In most cultures, the doctor’s role is to tell everyone else what to do, and his authority is unquestioned. Canada, by contrast, has embraced a “patient-centred” ethic. In other cultures, for a doctor to admit error or apologize would be unthinkable. “It’s not a behaviour that’s modelled, learned or even accepted,” says Prof. Austin.

Today, most foreign doctors go through some kind of cultural sensitivity training before they get a licence. In Ontario, they have to pass a series of demanding tests involving simulations in which patients are played by trained actors with complicated and misleading symptoms.

“You can’t abandon a patient whose values aren’t the same as yours,” doctors are repeatedly told. And when the values of doctors and their patients are so different, Canada faces yet another multicultural test.