I liked this article because it was a quick and easy read that really got it's point across about healthcare disparities and ways to avoid cultural exclusions and disadvantages. I really found it interesting reading the introduction that gave examples of why not all Americans have access to high quality care, stating: “Providers may order fewer diagnostic tests for patients of different cultural backgrounds because they may not understand or believe the patient’s description of symptoms. Patients are less likely to adhere to a prescribed treatment or medical advice if they do not understand or trust the medical provider.” I like the point made in these two sentences. It is interesting to look at cultural healthcare issues in these two different perspectives because it shows that both the healthcare provider and the patient seem to have a lack of trust and understanding in one another. I feel that if more healthcare providers were trained in cultural competence, it would be easier for those individuals to understand their patients and for their patients to be more trusting in turn. I also found it interesting to read the facts about women. I guess I never considered this a cultural disparity but in many ways it is. I think it sad that only 1/3 of uninsured pregnant women get prenatal care while insured pregnant women get more care then needed. I wish there was a way to help all women especially in times like those and I really hope programs like MassHealth can continue to help women in times of need. It was also sad to read that women are at a disadvantage paying for care because they are paid less than men. I like that the article included general recommendations to increase cultural competence and to diminish disparities in healthcare. One point that the article made was to “implement patient education programs to help increase patient knowledge of how to best access and maximize care.” I think this is a great recommendation because I feel that it is so important to provide programs to help educate patients so that they can become more aware of the programs offered. If i could include my own recommendations for creating a more inclusive, culturally competent, effective healthcare system I would encourage everyone to treat and see others, no matter their culture, as individuals who bring important values and gifts to our world. We need to see that everyone is different but we also need to put ourselves in the shoes of those around us. All in all, I feel like everyone should read an article similar to this in manner because it really illustrated how everyone is affected by disparities and ways to minimize these disparities.
Angela, The points you made were excellent. Being under-insured or not insured at all really puts one's health at risk. And seeing that insured pregnant women get more care than necessary is ridiculous. Being looked at and the amount of care that you should receive should not go by your insurance status. I guess we can add that to the list of "-isms", like racism and ageism. I totally agree that all healthcare providers should look at a person as you put it "as individuals who bring important values and gifts to our world." Unfortunately this does not happen, but should. This goes back to treating a person as a whole and not a symptom, illness, disease, and we can now add insurance status. Healthcare needs to understand that as individuals, there is more to us than just the person they see sitting on an exam table waiting to be examined. We all have intricacies that need to be met with our healthcare. Intricacies that include cultural beliefs, religious beliefs, age related needs, etc. You brought up a good point about the lack of trust between doctor and patient. When a patient cannot completely trust that all their needs are going to be met by their doctor, then they will not be fully honest and open about what is going on with them. And if a doctor cannot trust their patient to be completely honest with what is wrong with them, then how are they supposed to treat them successfully? It's a catch 22. Trust needs to be there on both sides. I think that if healthcare providers were more open and trustworthy with their patients and took all of their needs into account to fully care for them, then patients would be more willing to open up and be truthful. Great post.
I too enjoyed the brevity of this article. However, there was quite a bit of information on the two pages. I was reminded of our previous readings on disparities and multicultural awareness. I found it interesting that this article was put out by the Center for Medicare Advocacy, and yet still under the disparities for Women they mention the disparities of uninsured and over-insured pregnant women. While I do realize these disparities are true and sad, no healthcare to too many unnecessary interventions - I wonder why it is under the realm of Medicare Advocacy? Perhaps it is because of the problems during pregnancy may contribute to problems in later years? On another note: while I admit, I haven't been on this new Insurance Exchange, but my understanding is beyond Massachusetts, there is now Federal Healthcare, and if you have to have insurance...will that take care of the 1/3 uninsured pregnant women? Will they get care now? I took the cultural interview on the www.erc.msh.org, and I did not do well. I was a bit surprised! I reviewed, and read why one answer was better than the other, and it made a lot of sense. So with that, I say, training must help! Sometimes you just need to be aware. You may not have been in situations or realized how you were responded with an interpreter, or that the pat on the back might not be a good thing. Therefore, if you have multicultural training at a physician's center, hospital, etc. Even one aspect that hits "home" is helpful. Ongoing training, and some role playing are probably ways to assist in awareness of the vulnerability of cultural disparities and one's own impact it can have in a given situation. Another awareness that would probably help in so many areas, not just health, and that is “gossip”. Things like: Did you see her shoes? Did you see his eyes, they were so bloodshot! He was probably drinking. I think most of us have heard the sideline remarks somewhere, if not at work, in school. The thing about that is it is easy to get caught up in. And that remark, that may lead to a conversation about people is a prejudice. We make assumptions, we eye-up what we see and deliver the prognosis. We have to start with the small stuff, to begin to respect each other as a person in their entirety. Some may say it takes too much time or effort, well then those that think that need to “put themselves in their shoes” so to speak. This is why I believe role-playing can often assist in awareness.
Dear Christine, I really enjoyed reading your comment and your own recommendations. I think it is extremely important for their to be some sort of cultural competence training in every medical field because it makes people, as you mentioned, more "aware." I also agree that gossip is a dangerous cycle that often leads many to think in derogatory ways about other groups of people. It is extremely important to "role-play" as you said because it gives you a chance to experience how you would feel if the words you say to others were said to you.
I think that improving the healthcare system would include education of the consumer and changing the way Healthcare providers are educated. Consumers who are uncertain risk groups (e.g. African American women for HIV or Mexican Americans for diabetes) should be targeted by healthcare providers and by outreach organizations to inform them of what issues they Have a higher rish for and how to identify the symptom, as well as preventative measure.
All healthcare providers are require to complete conting medical education units (CME's). Incorporating cultural competence training units every few years will help to keep cultural issues at the front of their minds. These programs are usually offered regionally, so it would be possible to offer specific training for the cultures that are most prevalent in a geographic region.
A few years ago, RI opened a healthcare clinic In Providence to service the uninsured in RI. The clinic is completely free and those that qualify can apply for free or subsidized medications. Physicians across the state were encouraged to volunteer their time. Medical students from Brown and nursing students from Rhode Island College and the University of Rhode Island were also brought in to teach classes on Heath awareness issues like breast caned signs to look for and medication safety. The clinic has had a high degree of success. I think that this is a great model for other states to help care for the uninsured. Many people, specifically below the poverty line, cannot afford the care they need, and theybare typically at higher risk for certain conditions like obesity. Involving the whole community in wellness improves everyone's lives.
I like the information you gave about continuing medical education units. I absolutely agree with your response about the cultural issues. Without any great cost therefore, it could be done, to start education about cultural competence training. If this is already available, then something must be maneuvered to make changes. In other words I am not aware of the CME's that are available or necessary. If they are not mandatory, then each hospital, clinic, doctors' office needs to incorporate a plan. I am saying that if it is not a National Law, and if it is not a State Law, well then once again, my urge is the change in any given community. A hospital can mandate cultural training through CME's over a period of time, for instance by 2020...such and such needs to be completed. I realize it is not easy, but educating and advocating for the cause of cultural awareness and competency in the health field, is a viable way to help create change.
The healthcare clinic in Providence is good news. There are healthcare clinics around. A few years back, I had just started a new job in CT, and I had no health insurance, and would not have any for 3 months. I had a situation that scared me enough to find a free clinic. So it was through my "reaching out" that someone said there is a free clinic in East Longmeadow - The Pioneer Valley Free Health Clinic for the uninsured or under-insured. I didn’t even know they existed, otherwise I might have thought of looking on the internet. This was a saving grace for me, as I thought I had a cyst in my mouth, which made me think I had cancer, and I seemed more doomed because I had no insurance. So I found out the hours for this free clinic, and saw a physician who told me to make an appointment with a dentist, and if I didn't have a dentist, they would recommend someone for me to see. It was an abscessed tooth and I had no pain, because the poison was draining into my blood stream.
And so, here we see two stories of Providence, RI and across the state, and East Longmeadow, MA and across the Pioneer Valley to encourage physicians, and students to volunteer their time to help those under-insured or not insured. I agree: The whole community in wellness improves everyone's lives!
I enjoyed your post.... You had a lot of good comments and you definitely understood the article clearly. I never knew about the healthcare clinic in RI. That is awesome! We should get one in Mass!
I think Brittany is on the right track with educating the healthcare consumer . It seems the government is aware of the multiple disparities in healthcare access and quality and it is also commonly acknowledged that change is needed to reduce these . Yet change is or insufficient due to lack of programs , lack of money, lack of interest or for whatever reason, it might be more efficient reaching out directly to the consumer.My children all had " health class" in high school as it is a requisite . I spoke with my son about this and he relayed they learned only of the specific health issues and not how they may manifest differently in varying populations. My children attended Doherty Memorial High School which has about 1900 students of varying races , ethnicity, religions and countries of origin . This seems like a missed opportunity. Sending the future workers and consumers of the healthcare industry out into the world with an expectation of quality and comprehensiveness of care and an awareness of inadequacies and deficits might result in the industry and government stepping up to the plate to a greater degree .
Insurance is all for profit ,its monopolized by a few companies,and they lobby for regulations that better suit their agenda for profit.On the other hand having government solely in control of our insurance needs is also not valuable either.Balance is what will help but then again were in our society is there any balance.
All healthcare providers are required (at least in RI and MA - they are the only states I am familiar with) to complete education units, and they have to submit proof of completion to the licensing boards. The framework is already in place, so it would be fairly simple to make this kind of change. Cultural competence matters, and if a healthcare provider attends a training session or seminar on the issue, they are more likely to think about their how they can better serve their population.
Laurencia, It is unfortunate but true that the insurance companies have a great deal of power .They choose to wield that power in ways that financially benefit the company and its stockholders . I think some government regulations and fines would improve this. Most big businesses respond to financial threats. In healthcare many of the changes seen to benefit patients have as their impetus a financial penalty. For example quality measures or facility inspections ( joint commision or DPH ) However as you alluded to who is watching the watchers ? That role is probably left to us the consumers.
I think I have discussed my views about treating a person as a whole and not a disease or illness in this class. If not, a quick overview….I was taught in nursing school that a patient is not just the illness or disease that they came to the doctor/hospital/nursing home for. They are a complex individual consisting of cultural, spiritual, ethnic, gender, age, etc. needs as well as the disease/illness that is presenting itself. In order to treat and care for the person, we (the nurse) have to take into consideration all the aspects of the person and come up with a care plan that best suits their needs as a whole. I think that by taking these principles, treating a patient as a whole person, we could come up with a better healthcare system. Implementing a system like this would be a huge overhaul of the current healthcare system. It would first have to start with training all healthcare personnel. This would take a lot of time, effort, and money. It would also need to include and expand upon the general recommendations in the facts sheet we just read. I think ultimately the expenses incurred for this would be passed down to us, the patients, and how are we to afford such expenses now with the already expensive healthcare? Making healthcare more affordable is a huge issue and no one has seemed to come up with an acceptable answer to that. There is also the argument about a national healthcare insurance versus staying with what we have now. Last semester I had to research our healthcare system and compare it to other countries. For places like England who have national health insurance coverage, people do not have to worry about insurance because they already have it. Their coverage is very similar to ours as far as doctor visits, hospital stays, prescriptions, and such. Yes, there are some downfalls to this type of insurance. Downfalls like taxes are much higher to help pay for the insurance coverage and seeing a specialist takes much longer. My last suggestion would be to get more minorities into the healthcare field. Whether it is allowing for more scholarships and grants for those who want to get into this field and/or allowing those who already in this field the same advantages to the higher ranking positions, healthcare needs to be a more culturally rounded entity in order to treat everyone equally and with the attention that they deserve.
I agree with all your ideas ..the one that i believe will be more likely would be getting more minorities in he healthcare filed .Its absolutley crucial for our nation to make the investment in minorities in getting them to be providers(if that is the what our society is actually about).It would be such a good thing o have the resources available for people that would like pursue that field and they in turn work in their respective communities. Wouldn't that be great.
Nena, I enjoyed hearing about your first hand experience and what you learned in nursing school. Having no experience in the health care field I wondered if nursing students were taught something like this. I think it is a great thing to learn because you often find doctors who will only focus on the disease or illness and not the person as a whole. I think it makes for a better experience if a doctor or nurse focuses on the whole person and not just focused on their problem.
I love how you stated that a patient is not just the illness they have but an actual person who has many layers to consider. It's so true that not every case is the same. Just because two people appear to have the same illness and some medical book teaches us that this is how you handle it, doesn't mean you can ignore an individuals needs in the situation. I refer to my teaching career a lot in this blog but I truly believe that cultural competence and understanding is so important in what I do. I feel as though I would be doing a disservice to any child if I chose to ignore the individualism (culture, race, ethnicity) of that child and how it contributes to their growth, development, and education.
I think that this article by the Center for Medicare Advocacy Inc. is although very short article, I found it to have a lot of useful and well-organized information about health disparities of different races and also between the two genders. Although these facts are nation-wide, I think that in Massachusetts, these problems will soon be resolved thanks to MassHealth. I understand that MassHealth is a somewhat new option for health insurance, and I think it is wonderful for people who cannot afford the healthcare that they need. I learned many facts and statistics that I did not know before reading this article, specifically about women. I was shocked to read that “less than 1/3 of uninsured pregnant women get proper prenatal care”. That is awful! For the past paper we wrote on comparing health insurances, I researched my insurance compared to MassHealth, and I discovered that MassHealth indeed does cover all prenatal care and hospital bills! I think that all women should not have to worry about getting the care that they need for their own child. I think that as a nation we should have a nation-wide healthcare for those who need it! I think it would fix many health disparities.
This was very useful information..I enjoyed the short but yet informative article .I can agree with most of the data.Not to be a pessimist but the information only reiterates what we all know and expect.I can agree with the data about immigrants and the list provided as reason why this is so is accurate .cultural .language differences ,the lack if access to health services in their country of migration could all be relevant factors. But then we read the data on women and you start to get annoyed ..I dont know why women are not treated accordingly ..this information is obviously not a secret ,so why is there any changes in to address the issues of womens health.Womens health should be such a vital aspect of our healthcare system.Healthcare is pure classicism.Similar to everything else in our society.Our healthcare system doesn't do a good job of representing the diverse population it caters to. Its not inclusive,minorities dont have a face in healtcare.I wish there where more woemn ,black hispanic,asian doctors.But thats not the case .These recommendations that were listed were spot on form me : · Increase awareness of racial and ethnic disparities in health care among the general public and key stakeholders, and increase health care provider’s awareness of disparities. · Promote the consistency and equity of care through the use of evidence-based guidelines · Provide the use of interpretation services where community need exists. The use of community health workers and multidisciplinary treatment and preventive care teams should be encouraged. · Implement patient education programs to help increase patient knowledge of how to best access and maximize care. · Integrate cross-cultural education into the training of all current and future health professionals. · Conduct further research to identify sources of racial and ethnic disparities and assess .. Unless a serious approach is taken to resolve these issues ,not much will change but more research conducted to inform as that these things are still happening in our healthcare system.
I enjoyed reading this article and found it very informative. I also like how it was brief, straightforward and to the point. For me the bar graph really stood out. It’s sad and what we saw is true from previous course work that certain races receive better health care than others. It seems like the health care field is recognizing that there is a disparity problem in health care but doing nothing to solve the problem but make suggestions that are not actually used. Something more has to be done! Another point I found interesting is "less than 1/3 of uninsured pregnant women get proper prenatal care, while well-insured pregnant women suffer from many unnecessary interventions, such as cesarean sections, episiotomies, labor inductions and continuous electronic fetal monitoring." What I found unbelievable was that 1/3 of pregnant women are uninsured. I think something should be done about this and women should always have access to proper healthcare while pregnant. Overall, an interesting article to read.
I also think it is important for pregnant women to have access to top quality healthcare. It's important for the newborn child to at least start their life from the very beginning being able to visit the doctor on a regular basis to make sure the baby is healthy, and when a woman is pregnant to make sure that the baby is developing properly.
Disparities in health care in our society today have been a longstanding challenge resulting in some groups receiving less and lower quality health care than others and experiencing poorer health outcomes. This article was very interesting to read. As we all know, many racial and ethnic groups, as well as poor and less educated individuals, are more likely to have report poor communication with their physicians. And many racial and ethnic minorities and poor individuals report more problems with some aspects of the individual provider relationships. Further more, Asians, Hispanics, and those of lower socioeconomic status have greater difficulty accessing health care information, including information on prescription drugs. This article said it all. what I liked was some of the recommendations, how they provide the use of interpretation service where community need exists. An example is in the hospitals, interpreters are very efficient when one needs them. Also an excellent one was the increase health care providers awareness of disparities. I think if Health care providers are aware of this, they will surely passed it on to the others. Great article.
So I have a question regarding this information that we read:
On the bottom is a graph of Physicians by Race 2002: So what do we make of the Unknown which shows 33% and more than half the number of "white" physicians?
I think those are sub categories ,that are not specific to race but more of ethnicity ,like Indians from India ,Africans mixed races etc ,I dont know I ma assuming that's what it could be.
This article is clearly very informative. It definitely gave me another insight. Clearly, Americans are not getting the same type of treatment. There is a big division between the different types of treatments the people are receiving with the poor receiving worst treatment as compared to the wealthier. Clearly, those who have a better insurance end up getting more treatment. The bar graph was clearly a big impact. Till today, African Americans feel they do not receive the best treatment and are stereotyped. This is such an an ongoing problem and must be changed. Immigrants are an interesting target. They may have some disease such as Tuberocluosis or even Malaria and this really makes sense. Certain nationalities are also at greater risk of certain diseases such as Hispanics being at risk for obesity.
People come to America to find a better and safer life with equal opportunity. Equal opportunity of healthcare should also be possible for everyone. Since the United States is so diverse, and many people come here speaking different languages the availability of interpreters should be a must in the healthcare system for people to acquire the proper assistance. If a person visits a doctor and shares the symptoms they are experiencing they should be given the same treatment that everyone gets, regardless of their race or ethnic background. I never understood why some people dislike others so much and never give them a chance. It doesn’t make any sense to deny someone healthcare because they are different. If they come for help they should be given the help they need. One thing that surprised me was “Some insurance companies have sought to deny coverage to battered women on the grounds that they constitute a high risk population.” These women have nothing, and could certainly use top quality healthcare living in such a dangerous environment. Just because the majority of physicians are white, doesn’t mean other ethnicities go unaccounted for and should not be helped. It’s bad enough racism exists in the world on a day to day basis, there is no place for it when a person’s life could possibly be in jeopardy. The stats at the bottom show how certain races of people are at more of a risk to get a certain disease, with this knowledge there should be ways to help people get the help they need, not avoid them and let them suffer. It's sad to see that most minorities think they would receive better healthcare if they were a different race. There's no reason some people should feel more comfortable than others when we are all human. - Andrew K
The first thing I thought about after reading this fact sheet was that obviously the high rates of illnesses in minority groups is accredited to disparities in the healthcare industry, but also can be largely attributed the lack of education on the customer end as well as the workforce end. There is clearly a lack of cultural education within the healthcare field, especially when it's stated as a fact that some physicians may provide fewer diagnostic test because they do not understand or believe their patients symptoms. I would like to think that a profession in which you are responsible for a person's health and could make the difference between life and death, you would be required to at least take some sort of cultural education course. Also, I am curious to as to the many factors that must contribute to the vast quantity difference of white doctors to other races of doctor, ranging from unequal rights to college education, job opportunities, and socioeconomic factors. Aside from the effect of the lack of quality care for minorities, agree that there is definitely a lack of health education for these groups of people as well, causing them to be more susceptible to illnesses because they are unaware of how or unable to take preventative health measures, or are not educated about where to seek preventative care. I think the gist of the recommendations provided in this fact sheet is that the healthcare field as a whole needs to crack down on policies and consistency of quality care, by holding everyone responsible for their duties, regardless of their patient's race or ethnicity. Becoming a doctor should be like taking an oath to provide the quality care to the best of your ability no matter who the patient, and healthcare companies should be providing resources to doctors as well as patients to promote preservation of human life.
Hi Sally, the only thing I wonder about your comment that "the high rates of illnesses in minority groups is accredited to disparities in the healthcare industry" is that why are these illnesses more prevalent in the first place in minority groups. I agree that it would make more sense to increase the education to these groups and that there are significant disparities in the healthcare industry, but maybe we should look at what is happening before these groups are even entering hospitals or doctors offices for care?
This article was interesting and seemed like a quick guide to sum up some of the issues regarding equality, or why there may be a lack of equality in healthcare. The points addressed in the article seemed like a good starting point but if we can move on from there, or take those points and begin to address them, then we may be able to make some way of creating a culturally competent healthcare system. For example, if we find that certain diseases progress more rapidly in the African American population (including prostate and breast cancer) than in the general population, we would want to build their care unique to them and maybe treat their disease with different drugs, or more aggressively. I also think that we should talk to the people in these different ethnic catagories and find out why THEY think that "African-American women are far more likely than women of the general population to be infected with HIV, and about 64% of all women with new HIV infections in a given year are African American" and what THEY think the solution is. Maybe some of the answers are closer than we think, maybe all along we have been asking the wrong people for answers, people that dont live the lives of the people of the ethnicities that are actually affected. Also, it seems there is a huge discrepency between the ethnicities of doctors. Since the discrepency is so large, a "quicker" fix does not seem possible at the moment, education of the doctors to what different ethnicities are facing could be helpful. Maybe a bonus to doctors from other ethnicities to come to America to practice? Doctors should not only be educated on being sensitive to different cultures, but also of the disease most prevalent to those ethnicities.
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ReplyDeleteI liked this article because it was a quick and easy read that really got it's point across about healthcare disparities and ways to avoid cultural exclusions and disadvantages. I really found it interesting reading the introduction that gave examples of why not all Americans have access to high quality care, stating: “Providers may order fewer diagnostic tests for patients of different cultural backgrounds because they may not understand or believe the patient’s description of symptoms. Patients are less likely to adhere to a prescribed treatment or medical advice if they do not understand or trust the medical provider.” I like the point made in these two sentences. It is interesting to look at cultural healthcare issues in these two different perspectives because it shows that both the healthcare provider and the patient seem to have a lack of trust and understanding in one another. I feel that if more healthcare providers were trained in cultural competence, it would be easier for those individuals to understand their patients and for their patients to be more trusting in turn.
ReplyDeleteI also found it interesting to read the facts about women. I guess I never considered this a cultural disparity but in many ways it is. I think it sad that only 1/3 of uninsured pregnant women get prenatal care while insured pregnant women get more care then needed. I wish there was a way to help all women especially in times like those and I really hope programs like MassHealth can continue to help women in times of need. It was also sad to read that women are at a disadvantage paying for care because they are paid less than men.
I like that the article included general recommendations to increase cultural competence and to diminish disparities in healthcare. One point that the article made was to “implement patient education programs to help increase patient knowledge of how to best access and maximize care.” I think this is a great recommendation because I feel that it is so important to provide programs to help educate patients so that they can become more aware of the programs offered.
If i could include my own recommendations for creating a more inclusive, culturally competent, effective healthcare system I would encourage everyone to treat and see others, no matter their culture, as individuals who bring important values and gifts to our world. We need to see that everyone is different but we also need to put ourselves in the shoes of those around us. All in all, I feel like everyone should read an article similar to this in manner because it really illustrated how everyone is affected by disparities and ways to minimize these disparities.
Angela,
DeleteThe points you made were excellent. Being under-insured or not insured at all really puts one's health at risk. And seeing that insured pregnant women get more care than necessary is ridiculous. Being looked at and the amount of care that you should receive should not go by your insurance status. I guess we can add that to the list of "-isms", like racism and ageism. I totally agree that all healthcare providers should look at a person as you put it "as individuals who bring important values and gifts to our world." Unfortunately this does not happen, but should. This goes back to treating a person as a whole and not a symptom, illness, disease, and we can now add insurance status. Healthcare needs to understand that as individuals, there is more to us than just the person they see sitting on an exam table waiting to be examined. We all have intricacies that need to be met with our healthcare. Intricacies that include cultural beliefs, religious beliefs, age related needs, etc. You brought up a good point about the lack of trust between doctor and patient. When a patient cannot completely trust that all their needs are going to be met by their doctor, then they will not be fully honest and open about what is going on with them. And if a doctor cannot trust their patient to be completely honest with what is wrong with them, then how are they supposed to treat them successfully? It's a catch 22. Trust needs to be there on both sides. I think that if healthcare providers were more open and trustworthy with their patients and took all of their needs into account to fully care for them, then patients would be more willing to open up and be truthful. Great post.
Nena T.
I too enjoyed the brevity of this article. However, there was quite a bit of information on the two pages. I was reminded of our previous readings on disparities and multicultural awareness. I found it interesting that this article was put out by the Center for Medicare Advocacy, and yet still under the disparities for Women they mention the disparities of uninsured and over-insured pregnant women. While I do realize these disparities are true and sad, no healthcare to too many unnecessary interventions - I wonder why it is under the realm of Medicare Advocacy? Perhaps it is because of the problems during pregnancy may contribute to problems in later years?
ReplyDeleteOn another note: while I admit, I haven't been on this new Insurance Exchange, but my understanding is beyond Massachusetts, there is now Federal Healthcare, and if you have to have insurance...will that take care of the 1/3 uninsured pregnant women? Will they get care now?
I took the cultural interview on the www.erc.msh.org, and I did not do well. I was a bit surprised! I reviewed, and read why one answer was better than the other, and it made a lot of sense. So with that, I say, training must help! Sometimes you just need to be aware. You may not have been in situations or realized how you were responded with an interpreter, or that the pat on the back might not be a good thing. Therefore, if you have multicultural training at a physician's center, hospital, etc. Even one aspect that hits "home" is helpful. Ongoing training, and some role playing are probably ways to assist in awareness of the vulnerability of cultural disparities and one's own impact it can have in a given situation.
Another awareness that would probably help in so many areas, not just health, and that is “gossip”. Things like: Did you see her shoes? Did you see his eyes, they were so bloodshot! He was probably drinking. I think most of us have heard the sideline remarks somewhere, if not at work, in school. The thing about that is it is easy to get caught up in. And that remark, that may lead to a conversation about people is a prejudice. We make assumptions, we eye-up what we see and deliver the prognosis. We have to start with the small stuff, to begin to respect each other as a person in their entirety. Some may say it takes too much time or effort, well then those that think that need to “put themselves in their shoes” so to speak. This is why I believe role-playing can often assist in awareness.
Dear Christine, I really enjoyed reading your comment and your own recommendations. I think it is extremely important for their to be some sort of cultural competence training in every medical field because it makes people, as you mentioned, more "aware." I also agree that gossip is a dangerous cycle that often leads many to think in derogatory ways about other groups of people. It is extremely important to "role-play" as you said because it gives you a chance to experience how you would feel if the words you say to others were said to you.
DeleteI think that some of the women will be covered, but honestly not sure about all! It would be interesting to see the numbers now! Nice post Christine!
DeleteI think that improving the healthcare system would include education of the consumer and changing the way Healthcare providers are educated. Consumers who are uncertain risk groups (e.g. African American women for HIV or Mexican Americans for diabetes) should be targeted by healthcare providers and by outreach organizations to inform them of what issues they Have a higher rish for and how to identify the symptom, as well as preventative measure.
ReplyDeleteAll healthcare providers are require to complete conting medical education units (CME's). Incorporating cultural competence training units every few years will help to keep cultural issues at the front of their minds. These programs are usually offered regionally, so it would be possible to offer specific training for the cultures that are most prevalent in a geographic region.
A few years ago, RI opened a healthcare clinic In Providence to service the uninsured in RI. The clinic is completely free and those that qualify can apply for free or subsidized medications. Physicians across the state were encouraged to volunteer their time. Medical students from Brown and nursing students from Rhode Island College and the University of Rhode Island were also brought in to teach classes on Heath awareness issues like breast caned signs to look for and medication safety. The clinic has had a high degree of success. I think that this is a great model for other states to help care for the uninsured. Many people, specifically below the poverty line, cannot afford the care they need, and theybare typically at higher risk for certain conditions like obesity. Involving the whole community in wellness improves everyone's lives.
Hi Brittany:
DeleteI like the information you gave about continuing medical education units. I absolutely agree with your response about the cultural issues. Without any great cost therefore, it could be done, to start education about cultural competence training. If this is already available, then something must be maneuvered to make changes. In other words I am not aware of the CME's that are available or necessary.
If they are not mandatory, then each hospital, clinic, doctors' office needs to incorporate a plan. I am saying that if it is not a National Law, and if it is not a State Law, well then once again, my urge is the change in any given community. A hospital can mandate cultural training through CME's over a period of time, for instance by 2020...such and such needs to be completed. I realize it is not easy, but educating and advocating for the cause of cultural awareness and competency in the health field, is a viable way to help create change.
The healthcare clinic in Providence is good news. There are healthcare clinics around. A few years back, I had just started a new job in CT, and I had no health insurance, and would not have any for 3 months. I had a situation that scared me enough to find a free clinic. So it was through my "reaching out" that someone said there is a free clinic in East Longmeadow - The Pioneer Valley Free Health Clinic for the uninsured or under-insured. I didn’t even know they existed, otherwise I might have thought of looking on the internet. This was a saving grace for me, as I thought I had a cyst in my mouth, which made me think I had cancer, and I seemed more doomed because I had no insurance. So I found out the hours for this free clinic, and saw a physician who told me to make an appointment with a dentist, and if I didn't have a dentist, they would recommend someone for me to see. It was an abscessed tooth and I had no pain, because the poison was draining into my blood stream.
And so, here we see two stories of Providence, RI and across the state, and East Longmeadow, MA and across the Pioneer Valley to encourage physicians, and students to volunteer their time to help those under-insured or not insured. I agree: The whole community in wellness improves everyone's lives!
I enjoyed your post.... You had a lot of good comments and you definitely understood the article clearly. I never knew about the healthcare clinic in RI. That is awesome! We should get one in Mass!
DeleteI think Brittany is on the right track with educating the healthcare consumer . It seems the government is aware of the multiple disparities in healthcare access and quality and it is also commonly acknowledged that change is needed to reduce these . Yet change is or insufficient due to lack of programs , lack of money, lack of interest or for whatever reason, it might be more efficient reaching out directly to the consumer.My children all had " health class" in high school as it is a requisite . I spoke with my son about this and he relayed they learned only of the specific health issues and not how they may manifest differently in varying populations. My children attended Doherty Memorial High School which has about 1900 students of varying races , ethnicity, religions and countries of origin . This seems like a missed opportunity. Sending the future workers and consumers of the healthcare industry out into the world with an expectation of quality and comprehensiveness of care and an awareness of inadequacies and deficits might result in the industry and government stepping up to the plate to a greater degree .
DeleteInsurance is all for profit ,its monopolized by a few companies,and they lobby for regulations that better suit their agenda for profit.On the other hand having government solely in control of our insurance needs is also not valuable either.Balance is what will help but then again were in our society is there any balance.
DeleteThanks for sharing Brittany. Very good ideas, didn't know RI had health service like that to offer.
DeleteHi Christine,
DeleteAll healthcare providers are required (at least in RI and MA - they are the only states I am familiar with) to complete education units, and they have to submit proof of completion to the licensing boards. The framework is already in place, so it would be fairly simple to make this kind of change. Cultural competence matters, and if a healthcare provider attends a training session or seminar on the issue, they are more likely to think about their how they can better serve their population.
Laurencia,
DeleteIt is unfortunate but true that the insurance companies have a great deal of power .They choose to wield that power in ways that financially benefit the company and its stockholders . I think some government regulations and fines would improve this. Most big businesses respond to financial threats. In healthcare many of the changes seen to benefit patients have as their impetus a financial penalty. For example quality measures or facility inspections ( joint commision or DPH ) However as you alluded to who is watching the watchers ? That role is probably left to us the consumers.
I think I have discussed my views about treating a person as a whole and not a disease or illness in this class. If not, a quick overview….I was taught in nursing school that a patient is not just the illness or disease that they came to the doctor/hospital/nursing home for. They are a complex individual consisting of cultural, spiritual, ethnic, gender, age, etc. needs as well as the disease/illness that is presenting itself. In order to treat and care for the person, we (the nurse) have to take into consideration all the aspects of the person and come up with a care plan that best suits their needs as a whole. I think that by taking these principles, treating a patient as a whole person, we could come up with a better healthcare system.
ReplyDeleteImplementing a system like this would be a huge overhaul of the current healthcare system. It would first have to start with training all healthcare personnel. This would take a lot of time, effort, and money. It would also need to include and expand upon the general recommendations in the facts sheet we just read. I think ultimately the expenses incurred for this would be passed down to us, the patients, and how are we to afford such expenses now with the already expensive healthcare?
Making healthcare more affordable is a huge issue and no one has seemed to come up with an acceptable answer to that. There is also the argument about a national healthcare insurance versus staying with what we have now. Last semester I had to research our healthcare system and compare it to other countries. For places like England who have national health insurance coverage, people do not have to worry about insurance because they already have it. Their coverage is very similar to ours as far as doctor visits, hospital stays, prescriptions, and such. Yes, there are some downfalls to this type of insurance. Downfalls like taxes are much higher to help pay for the insurance coverage and seeing a specialist takes much longer.
My last suggestion would be to get more minorities into the healthcare field. Whether it is allowing for more scholarships and grants for those who want to get into this field and/or allowing those who already in this field the same advantages to the higher ranking positions, healthcare needs to be a more culturally rounded entity in order to treat everyone equally and with the attention that they deserve.
I agree with all your ideas ..the one that i believe will be more likely would be getting more minorities in he healthcare filed .Its absolutley crucial for our nation to make the investment in minorities in getting them to be providers(if that is the what our society is actually about).It would be such a good thing o have the resources available for people that would like pursue that field and they in turn work in their respective communities. Wouldn't that be great.
DeleteNena, I enjoyed hearing about your first hand experience and what you learned in nursing school. Having no experience in the health care field I wondered if nursing students were taught something like this. I think it is a great thing to learn because you often find doctors who will only focus on the disease or illness and not the person as a whole. I think it makes for a better experience if a doctor or nurse focuses on the whole person and not just focused on their problem.
DeleteI love how you stated that a patient is not just the illness they have but an actual person who has many layers to consider. It's so true that not every case is the same. Just because two people appear to have the same illness and some medical book teaches us that this is how you handle it, doesn't mean you can ignore an individuals needs in the situation. I refer to my teaching career a lot in this blog but I truly believe that cultural competence and understanding is so important in what I do. I feel as though I would be doing a disservice to any child if I chose to ignore the individualism (culture, race, ethnicity) of that child and how it contributes to their growth, development, and education.
DeleteI think that this article by the Center for Medicare Advocacy Inc. is although very short article, I found it to have a lot of useful and well-organized information about health disparities of different races and also between the two genders. Although these facts are nation-wide, I think that in Massachusetts, these problems will soon be resolved thanks to MassHealth. I understand that MassHealth is a somewhat new option for health insurance, and I think it is wonderful for people who cannot afford the healthcare that they need.
ReplyDeleteI learned many facts and statistics that I did not know before reading this article, specifically about women. I was shocked to read that “less than 1/3 of uninsured pregnant women get proper prenatal care”. That is awful! For the past paper we wrote on comparing health insurances, I researched my insurance compared to MassHealth, and I discovered that MassHealth indeed does cover all prenatal care and hospital bills! I think that all women should not have to worry about getting the care that they need for their own child.
I think that as a nation we should have a nation-wide healthcare for those who need it! I think it would fix many health disparities.
This was very useful information..I enjoyed the short but yet informative article .I can agree with most of the data.Not to be a pessimist but the information only reiterates what we all know and expect.I can agree with the data about immigrants and the list provided as reason why this is so is accurate .cultural .language differences ,the lack if access to health services in their country of migration could all be relevant factors. But then we read the data on women and you start to get annoyed ..I dont know why women are not treated accordingly ..this information is obviously not a secret ,so why is there any changes in to address the issues of womens health.Womens health should be such a vital aspect of our healthcare system.Healthcare is pure classicism.Similar to everything else in our society.Our healthcare system doesn't do a good job of representing the diverse population it caters to. Its not inclusive,minorities dont have a face in healtcare.I wish there where more woemn ,black hispanic,asian doctors.But thats not the case .These recommendations that were listed were spot on form me :
ReplyDelete· Increase awareness of racial and ethnic disparities in
health care among the general public and key
stakeholders, and increase health care provider’s
awareness of disparities.
· Promote the consistency and equity of care through
the use of evidence-based guidelines
· Provide the use of interpretation services where
community need exists. The use of community health
workers and multidisciplinary treatment and
preventive care teams should be encouraged.
· Implement patient education programs to help
increase patient knowledge of how to best access and
maximize care.
· Integrate cross-cultural education into the training of
all current and future health professionals.
· Conduct further research to identify sources of racial
and ethnic disparities and assess ..
Unless a serious approach is taken to resolve these issues ,not much will change but more research conducted to inform as that these things are still happening in our healthcare system.
I enjoyed reading this article and found it very informative. I also like how it was brief, straightforward and to the point. For me the bar graph really stood out. It’s sad and what we saw is true from previous course work that certain races receive better health care than others. It seems like the health care field is recognizing that there is a disparity problem in health care but doing nothing to solve the problem but make suggestions that are not actually used. Something more has to be done! Another point I found interesting is "less than 1/3 of uninsured pregnant women get proper prenatal care, while well-insured pregnant women suffer from many unnecessary interventions, such as cesarean sections, episiotomies, labor inductions and continuous electronic fetal monitoring." What I found unbelievable was that 1/3 of pregnant women are uninsured. I think something should be done about this and women should always have access to proper healthcare while pregnant. Overall, an interesting article to read.
ReplyDeleteI also think it is important for pregnant women to have access to top quality healthcare. It's important for the newborn child to at least start their life from the very beginning being able to visit the doctor on a regular basis to make sure the baby is healthy, and when a woman is pregnant to make sure that the baby is developing properly.
DeleteDisparities in health care in our society today have been a longstanding challenge resulting in some groups receiving less and lower quality health care than others and experiencing poorer health outcomes. This article was very interesting to read. As we all know, many racial and ethnic groups, as well as poor and less educated individuals, are more likely to have report poor communication with their physicians. And many racial and ethnic minorities and poor individuals report more problems with some aspects of the individual provider relationships. Further more, Asians, Hispanics, and those of lower socioeconomic status have greater difficulty accessing health care information, including information on prescription drugs. This article said it all. what I liked was some of the recommendations, how they provide the use of interpretation service where community need exists. An example is in the hospitals, interpreters are very efficient when one needs them. Also an excellent one was the increase health care providers awareness of disparities. I think if Health care providers are aware of this, they will surely passed it on to the others. Great article.
ReplyDeleteSo I have a question regarding this information that we read:
ReplyDeleteOn the bottom is a graph of Physicians by Race 2002: So what do we make of the Unknown which shows 33% and more than half the number of "white" physicians?
I think those are sub categories ,that are not specific to race but more of ethnicity ,like Indians from India ,Africans mixed races etc ,I dont know I ma assuming that's what it could be.
DeleteSo so slow responding, computer not cooperating! Any way that bar represents undisclosed. Hope that helps!
DeleteThis article is clearly very informative. It definitely gave me another insight. Clearly, Americans are not getting the same type of treatment. There is a big division between the different types of treatments the people are receiving with the poor receiving worst treatment as compared to the wealthier. Clearly, those who have a better insurance end up getting more treatment. The bar graph was clearly a big impact. Till today, African Americans feel they do not receive the best treatment and are stereotyped. This is such an an ongoing problem and must be changed. Immigrants are an interesting target. They may have some disease such as Tuberocluosis or even Malaria and this really makes sense. Certain nationalities are also at greater risk of certain diseases such as Hispanics being at risk for obesity.
ReplyDeletePeople come to America to find a better and safer life with equal opportunity. Equal opportunity of healthcare should also be possible for everyone. Since the United States is so diverse, and many people come here speaking different languages the availability of interpreters should be a must in the healthcare system for people to acquire the proper assistance. If a person visits a doctor and shares the symptoms they are experiencing they should be given the same treatment that everyone gets, regardless of their race or ethnic background. I never understood why some people dislike others so much and never give them a chance. It doesn’t make any sense to deny someone healthcare because they are different. If they come for help they should be given the help they need. One thing that surprised me was “Some insurance companies have sought to deny coverage to battered women on the grounds that they constitute a high risk population.” These women have nothing, and could certainly use top quality healthcare living in such a dangerous environment. Just because the majority of physicians are white, doesn’t mean other ethnicities go unaccounted for and should not be helped. It’s bad enough racism exists in the world on a day to day basis, there is no place for it when a person’s life could possibly be in jeopardy. The stats at the bottom show how certain races of people are at more of a risk to get a certain disease, with this knowledge there should be ways to help people get the help they need, not avoid them and let them suffer. It's sad to see that most minorities think they would receive better healthcare if they were a different race. There's no reason some people should feel more comfortable than others when we are all human.
ReplyDelete- Andrew K
The first thing I thought about after reading this fact sheet was that obviously the high rates of illnesses in minority groups is accredited to disparities in the healthcare industry, but also can be largely attributed the lack of education on the customer end as well as the workforce end. There is clearly a lack of cultural education within the healthcare field, especially when it's stated as a fact that some physicians may provide fewer diagnostic test because they do not understand or believe their patients symptoms. I would like to think that a profession in which you are responsible for a person's health and could make the difference between life and death, you would be required to at least take some sort of cultural education course. Also, I am curious to as to the many factors that must contribute to the vast quantity difference of white doctors to other races of doctor, ranging from unequal rights to college education, job opportunities, and socioeconomic factors.
ReplyDeleteAside from the effect of the lack of quality care for minorities, agree that there is definitely a lack of health education for these groups of people as well, causing them to be more susceptible to illnesses because they are unaware of how or unable to take preventative health measures, or are not educated about where to seek preventative care.
I think the gist of the recommendations provided in this fact sheet is that the healthcare field as a whole needs to crack down on policies and consistency of quality care, by holding everyone responsible for their duties, regardless of their patient's race or ethnicity. Becoming a doctor should be like taking an oath to provide the quality care to the best of your ability no matter who the patient, and healthcare companies should be providing resources to doctors as well as patients to promote preservation of human life.
Hi Sally, the only thing I wonder about your comment that "the high rates of illnesses in minority groups is accredited to disparities in the healthcare industry" is that why are these illnesses more prevalent in the first place in minority groups. I agree that it would make more sense to increase the education to these groups and that there are significant disparities in the healthcare industry, but maybe we should look at what is happening before these groups are even entering hospitals or doctors offices for care?
DeleteThis article was interesting and seemed like a quick guide to sum up some of the issues regarding equality, or why there may be a lack of equality in healthcare. The points addressed in the article seemed like a good starting point but if we can move on from there, or take those points and begin to address them, then we may be able to make some way of creating a culturally competent healthcare system. For example, if we find that certain diseases progress more rapidly in the African American population (including prostate and breast cancer) than in the general population, we would want to build their care unique to them and maybe treat their disease with different drugs, or more aggressively. I also think that we should talk to the people in these different ethnic catagories and find out why THEY think that "African-American women are far more likely than women of the general population to be infected with HIV, and about 64% of all women with new HIV infections in a given year are African American" and what THEY think the solution is. Maybe some of the answers are closer than we think, maybe all along we have been asking the wrong people for answers, people that dont live the lives of the people of the ethnicities that are actually affected. Also, it seems there is a huge discrepency between the ethnicities of doctors. Since the discrepency is so large, a "quicker" fix does not seem possible at the moment, education of the doctors to what different ethnicities are facing could be helpful. Maybe a bonus to doctors from other ethnicities to come to America to practice? Doctors should not only be educated on being sensitive to different cultures, but also of the disease most prevalent to those ethnicities.
ReplyDeleteDanielle: To sum it up: nicely stated, you bring out wonderful facts!
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