In a recent position statement, the Canadian Society of Obstetricians and Gynecologists argued that immigrant patients’ expressed wishes to be treated by a doctor of their own sex, race, culture or religion — reportedly a common phenomenon — should not be reflected in our country’s health-care policy. These professionals feel services should be provided by the most qualified personnel available, period.
As Tom Blackwell reported in the National Post this week, some doctors disagree with this attitude, which they regard as excessively rigid. Dr. Kevin Pottie, an Ottawa doctor who helped to draft the Canadian Guidelines on Immigrant Health, for example, is sympathetic to immigrants’ demands, saying, “The experience of a lot of vulnerable people, marginal people, is they are faced with a lot of discrimination, they have a lot of issues with trust, they may only trust their community.”
As someone who has worked with immigrants for decades, I am somewhat skeptical about Dr. Pottie’s assumption that this is a “trust” issue. Indeed, what I have found is that many immigrant patients have had such negative experiences with health care in their countries of origin that, once in Canada, they prefer treatment from someone outside their ethnic community. And many female immigrants in particular may have good reasons to prefer doctors from other cultures.
I am a South Asian immigrant to Canada. I am a counsellor and educator who has worked intimately with South Asian victims of abuse for 30 years. I hold workshops for health care professional to guide them on culturally embedded practices related to health and family structure. Among the issues we discuss are patriarchal control over female sexuality, gender inequalities, and the culturally ingrained preference for sons.
There is now extensive literature on immigrant women and their attitudes relating to health care. The most common concern South Asian women identify is the insistence of husbands (and/or his family members) that they accompany them into the examining room. This is a practice tolerated by many doctors from the South Asian community, even when language is not a barrier. This inhibits women from speaking freely about their symptoms or feelings.
I am not critiquing the medical expertise of South Asian doctors. And it is important to note that South Asian female doctors have been in the forefront of educating the larger South Asian community about gender inequity and its impact on women’s health, empowering women to take control of their health related concerns and sexuality. I also have witnessed some doctors take a stand against the demands of women’s extended families, in particular in cases where a specialist colleague happens to be male and not from the South Asian community.
In areas of Canada where there are large populations of South Asian immigrants (some of whom may not speak English or French), there typically are hundreds of doctors of both sexes, who speak different South Asian languages, available to the community. Members of the community usually are well aware of their location, and women who prefer to see female doctors from their own community can go to these professionals for their health needs.
But in health units where the patients and medical personnel are diverse, patients should not have the right of refusal of service based on race, culture or religion. We would have no sympathy for white people who refused medical care from black people — and according to many physicians, that too is a common phenomenon — even if they insisted their health depended on it. We should therefore not encourage analogous forms of medical apartheid disguised as compassion for immigrants. The position taken by the Society of Obstetricians and Gyncecologists is both fair and reasonable.