By Deborah Cho
I was excited to learn of an article in a recent issue of American Family Physician on the topic of caring for Asian American patients. The contents of the article are worth a read (most of it is available here), but it generally states that medical providers should consider the Asian American health care culture in their care of Asian American patients. That information is not new, but it does highlight important facets of the Asian American culture, such as the collectivistic approach within families to medical decisions and that many Asian American patients do not mention the use of supplements and herbals unless explicitly asked during medication review. Though these tips were worth mentioning, the main reason this article caught my attention was because it was about a population that often seems overlooked in health care.
I think one reason that there appears to be little attention on the nuances of caring for Asian American patients is buried in this phrase: “despite the common perception that all Asians are well-educated, many Asian immigrants have low educational attainment and poor medical knowledge.” (emphasis added). Perhaps we do not consider this population to be vulnerable or otherwise in need of particular concern. As the author of the AFP article notes, however, this perception is possibly misguided (“30% of Vietnamese Americans 25 years or older have completed less than a high school education (compared with 11% in non-Hispanic whites)” and “A high percentage of Asian Americans have limited English proficiency”).
Reading articles like this one can be frustrating because it seems so obvious that providers should consider a patient’s backgrounds in the delivery of health care. It seems doubly obvious that seeing an immigrant patient should prompt that provider to consider that language, cultural, and health literacy barriers may need to be addressed. On the other hand, we recently read Fisher v. University of Texas (2013) in my constitutional law course and made a point to discuss the amicus briefs vehemently opposing affirmative action filed by the Asian American interest groups on the grounds that Asian Americans, who “demonstrate academic excellence at disproportionately high rates,” are “[p]articularly hard-hit” by affirmative action. The concurring opinion by Justice Thomas also noted that “Blacks had a mean GPA of 2.57 and a mean SAT score of 1524; Hispanics had a mean GPA of 2.83 and a mean SAT score of 1794; whites had a mean GPA of 3.04 and a mean SAT score of 1914; and Asians had a mean GPA of 3.07 and a mean SAT score of 1991.” Highlighting these points (in an amicus brief, in a Supreme Court opinion, and in class discussion) seems to perpetuate the “common perception that all Asians are well-educated,” even if those facts were intended to apply only to that university for that case.
Regardless of one’s opinion on affirmative action, there is no denying that this perception of Asian Americans as well-educated exists, at least in some circles, and that it has affected the delivery of health care. Unfortunately, the Asian American population that has “often been [medically] underserved,” as described by the author of the AFP article, could not possibly be properly served by a health care system that operates on blanket assumptions.
Ebola-related postscript: In my last entry, I wrote on the Ebola epidemic in West Africa and the seeming lack of concern in the U.S. for the disease. That entry was written just hours before news broke that the first Ebola patient was diagnosed in the U.S. My post quickly became outdated as our concern (or interest) increased exponentially. As I spent my summer at the CDC during the period when it seemed like very few were willing to join the fight against Ebola, it has been interesting to see the dramatic shift in this country from caring too little to, arguably, caring too much over the span of just a few weeks.