Tuesday, October 11, 2011

Healthcare disparities

Finally! A good lecture in Medical Humanities. Most of our lecturers make three mistakes:
  1. They openly lean left. This is pedagogical.
  2. They do not defend their conclusions. This is a cross for the TACer (and any intellect).
  3. They employ heavy filler in their presentations (this hurts the medical student soul; we're constantly thinking, "is this a good use of time?? I need to study G-coupled protein receptors!!").
Today, we had a woman who made none of these mistakes. She gave a stimulating lecture, had strong ethos to support her position, and reached beyond politics and academia for the good of patients. Some highlights:
  • people do not need to look the same to treat each other without unjust disparity (she was asked before the lecture whether, if the racial distribution of doctors matched the racial distribution of patients, healthcare disparities would disappear)
  • not all disparities in care are rooted in racism or biases (she found that poorer women were not getting mammograms in one office, but discovered that this was because these women were more likely to forget the referral they'd stuffed in their purse, being busier with their job(s) and other duties)
  • our educational system bears guilt for many disparities, especially in patients' health literacy
  • social studies in healthcare disparities has become an "industry" (her word), a self-perpetuating field that has yielded no improvement in the past twenty or thirty years; people's research uncovers the same findings (she called this "recycling" research) and little talk is had about actions that would change things
Her advice to us as future providers, to actually change things:
  • make use of teachable moments, however short, to truly cause the patient to understand the need for the treatment you think is best
  • you do not make progress without listening (a.k.a. with the context of the patient's position, such as their day-to-day challenges, their cultural impressions, etc.; she quoted Einstein as saying "No problem can be solved from the level of consciousness that created it.")
  • be honest that you see people differently; know where you are on the spectrum between denying healthcare disparities and being very aware of your biases.
Before this lecture, I was very resistant—almost allergic—to the phrase "healthcare disparities." Even though I know of certain healthcare disparities (e.g., abortions are more common in black women), all the jaw-wagging about them was pushing me toward the "There aren't healthcare disparities! The liberals are making it all up!!" end of the spectrum.

Now, I see more clearly. There are healthcare disparities, and they are more complex than our previous lecturers allowed. Moreover, I am not culpable for them. Further still, I can work to close them as much as naturally possible, not by policymaking, but by talking as earnestly and patiently as possible with each patient.

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