Respecting Differences: Dermatology in a Diverse Society

  • Vimal Prajapati
  • Benjamin Barankin


In most of the Western world, we find ourselves living in an increasingly multicultural society. As a result, encounters between ethnically, racially, culturally, and religiously diverse patients and healthcare providers have become commonplace in all areas of medicine, dermatology being no exception. This chapter explores the ethical and professional issues that can arise from the practice of dermatology in today’s diverse society and also addresses the ethical and professional obligations of the dermatologist in these sensitive, difficult to handle, and often tension-provoking situations. The importance of cultural competence in dermatology training and practice as it relates to the core requirements is discussed.


American Medical Association Cultural Competence Limited English Proficiency Moral Objection Professional Obligation 
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  1. 1.
    Agency for Healthcare Research and Quality. National healthcare disparities report. Rockville: U.S. Department of Health and Human Services; 2004.Google Scholar
  2. 2.
    Betancourt JR, King RK. Unequal treatment: the Institute of Medicine report and its public health implications. Public Health Rep. 2003;118:287–92.PubMedGoogle Scholar
  3. 3.
    Institute of Medicine. Unequal treatment: confronting racial and ethnic disparities in healthcare. Washington: National Academic Press; 2003.Google Scholar
  4. 4.
    Health Canada. Certain circumstances – issues in equity and responsiveness in access to health care in Canada. Accessed 15 Apr 2010.
  5. 5.
    Betancourt JR, Green AR, Carrillo JE, et al. Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public Health Rep. 2003;118:293–302.PubMedGoogle Scholar
  6. 6.
    Kundhal KK, Kundhal PS. Cultural diversity: an evolving challenge to physician-patient communication. JAMA. 2003;289:94.PubMedCrossRefGoogle Scholar
  7. 7.
    Carrillo JE, Green AR, Betancourt JR. Cross-cultural primary care: a patient-based approach. Ann Intern Med. 1999;130:829–34.PubMedGoogle Scholar
  8. 8.
    Einbinder LC, Schulman KA. The effect of race on the referral process for invasive cardiac procedures. Med Care Res Rev. 2000;57 Suppl 1:162–77.PubMedGoogle Scholar
  9. 9.
    Horner RE, Oddone E, Matcher DB. Theories explaining racial differences in the utilization of diagnostic and therapeutic procedures for cerebrovascular disease. Milbank Q. 1995;73:443–62.PubMedCrossRefGoogle Scholar
  10. 10.
    Armstrong K, Ravenell KL, McMurphy S, et al. Racial/ethnic differences in physician distrust in the United States. Am J Public Health. 2007;97:1283–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Boulware LE, Cooper LA, Ratner LE, et al. Race and trust in the health care system. Public Health Rep. 2003;118:358–65.PubMedGoogle Scholar
  12. 12.
    Doescher MP, Saver BG, Franks P, et al. Racial and ethnic disparities in perceptions of physician style and trust. Arch Fam Med. 2000;9:1156–63.PubMedCrossRefGoogle Scholar
  13. 13.
    Corbie-Smith G, Thomas SB, St George DM. Distrust, race, and research. Arch Intern Med. 2002;162:2458–63.PubMedCrossRefGoogle Scholar
  14. 14.
    LaVeist TA, Nickerson KJ, Bowie JV. Attitudes about racism, medical mistrust, and satisfaction with care among African American and white cardiac patients. Med Care Res Rev. 2000;57 Suppl 1:146–61.PubMedGoogle Scholar
  15. 15.
    Corbie-Smith G, Thomas SB, Williams MV, et al. Attitudes and beliefs of African Americans toward participation in medical research. J Gen Intern Med. 1999;14:537–46.PubMedCrossRefGoogle Scholar
  16. 16.
    Gamble VN. Under the shadow of Tuskegee: African Americans and health care. Am J Public Health. 1997;87:1773–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Schulman KA, Berlin JA, Harless W, et al. The effect of race and sex on physicians’ recommendations for cardiac catheterization. N Engl J Med. 1999;340:618–26.PubMedCrossRefGoogle Scholar
  18. 18.
    van Ryn M, Burke J. The effect of patient race and socio-economic status on physicians’ perceptions of patients. Soc Sci Med. 2000;50:813–28.PubMedCrossRefGoogle Scholar
  19. 19.
    Canadian Medical Association. CMA Code of Ethics. 2004 [cited April 15, 2010].
  20. 20.
    American Medical Association Code of Medical Ethics. Principles of Medical Ethics. 2001. [cited April 15, 2010].­medical-ethics/code-medical-ethics/principles-medical-ethics.shtml.
  21. 21.
    American Medical Association Code of Medical Ethics. Opinion 9.12 – Patient-Physician Relationship: Respect for Law and Human Rights. 2008. [cited April 15, 2010].
  22. 22.
    Council on Ethics and Judicial Affairs of the American Medical Association. CEJA report 4-A-00 potential patients: ethical considerations. 2000 [cited April 15, 2010].
  23. 23.
    Lavizzo-Mourey R, Mackenzie E. Cultural competence: an essential hybrid for delivering high quality care in the 1990’s and beyond. Trans Am Clin Climatol Assoc. 1996;107:226–38.PubMedGoogle Scholar
  24. 24.
    Beach MC, Price EG, Gary TL, et al. Cultural competence: a systematic review of health care provider educational interventions. Med Care. 2005;43:356–73.PubMedCrossRefGoogle Scholar
  25. 25.
    Lie DA, Lee-Rey E, Gomez A et al. Does cultural competency training of healthy professionals improve patient outcomes? A systematic review and proposed algorithm for future research. J Gen Int Med. 2011;26:317–25.PubMedCrossRefGoogle Scholar
  26. 26.
    The Office of Minority Health. National standards for culturally and linguistically appropriate health care: final report. Washington: U.S. Department of Health and Human Services; 2001.Google Scholar
  27. 27.
    The American Board of Dermatology, Inc. ABMS/ACGME core competencies in Dermatology. Accessed 6 Sept 2010.
  28. 28.
    Royal College of Physicians and Surgeons of Canada. Objectives of training in Dermatology. 2009 [cited September 6, 2010].
  29. 29.
    Curlin FA, Lantos JD, Roach CJ, et al. Religious characteristics of U.S. physicians: a national survey. J Gen Intern Med. 2005;20:629–34.PubMedCrossRefGoogle Scholar
  30. 30.
    Catlin EA, Cadge W, Ecklund EH, et al. The spiritual and religious identities, beliefs, and practices of academic pediatricians in the United States. Acad Med. 2008;83:1146–52.PubMedCrossRefGoogle Scholar
  31. 31.
    Sulmasy DP. What is conscience and why is respect for it important? Theor Med Bioeth. 2008;29:135–49.PubMedCrossRefGoogle Scholar
  32. 32.
    Council on Ethics and Judicial Affairs of the American Medical Association. CEJA report 6-A-07 physician objection to treatment and individual patient discrimination. 2007 [cited April 15, 2010].
  33. 33.
    American Medical Association Code of Medical Ethics. Opinion 9.06 – free choice. 1977 [cited June 15, 2010].
  34. 34.
    Sechzer JA. Islam and woman: where tradition meets modernity. History and interpretations of Islamic women’s status. Sex Roles. 2004;51:263–72.CrossRefGoogle Scholar
  35. 35.
    McLean M, Al Ahbabi S, Al Ameri M, et al. Muslim women and medical students in the clinical encounter. Med Educ. 2010;44:306–15.PubMedCrossRefGoogle Scholar
  36. 36.
    Hammoud MM, White CB, Fetters MD. Opening cultural doors: providing culturally sensitive healthcare to Arab American and American Muslim patients. Am J Obstet Gynecol. 2005;193:1307–11.PubMedCrossRefGoogle Scholar
  37. 37.
    Aldeen AZ. The muslim ethical tradition and emergent medical care: an uneasy fit. Acad Emerg Med. 2007;14:277–8.PubMedGoogle Scholar
  38. 38.
    American Medical News. Making sure your patients know what you’re saying. 2009 [cited June 22, 2010].
  39. 39.
    American Medical News. How to handle a prejudiced patient. 2008 [cited June 22, 2010].
  40. 40.
    Easmon C. Ethical dilemma: dealing with racist patients. Commentary: isolate the problem. BMJ. 1999;318:1130.PubMedGoogle Scholar

Copyright information

© Springer-Verlag London Limited 2012

Authors and Affiliations

  1. 1.Division of Dermatology and Cutaneous Sciences, Department of MedicineUniversity of AlbertaEdmontonCanada
  2. 2.Toronto Dermatology CentreTorontoCanada

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