Friday, December 3, 2010

Reducing Health Disparities Through Communication

Communication between doctor and patient can be fraught with misunderstandings and assumptions. The “Reducing Health Disparities: Teaching Residents to Deliver Culturally Competent Patient-Centered Care” workshops at Sinai Hospital are a call to action. The three workshops, spread over three months, are designed to provide information, skills and resources that enhance the ability of physicians to understand and communicate with patients from diverse cultural and language backgrounds.

According to research provided at the workshop, U.S. physicians reported “no preference for white vs. black patients or differences in perceived cooperativeness.” However, physicians showed “unconscious preferences favoring white Americans and unconscious stereotypes of black Americans as less cooperative with medical procedures.”

Medical residents and physicians working at Sinai Hospital have a unique opportunity to serve a diverse population that includes Orthodox Jewish and African-American communities.

At Tuesday’s workshop, health care providers completed exercises that promote a better understanding of patients’ diverse backgrounds. In one exercise, participants were given a handout with the picture of a multi-colored wheel. Three rings were drawn on the wheel. Written on the “internal dimensions” ring were characteristics including gender, ethnicity and race. The next ring was labeled “external dimensions” and included appearance, marital status, work experience, religion and personal habits. The outermost ring was labeled “organizational dimensions” and included the phrases "management status" and "work location."

Participants were asked to choose three words or phrases they felt demonstrated who they were. Most of the participants chose one word that was a physical identifying marker, such as gender or race. But the other two choices identified characteristics you would not know by looking at a person such as parental status.

“Only 10 percent of who we are is something I can see with my eyes,” said facilitator Marcos Pesquera, executive director of the Center on Health Disparities, a division of Adventist HealthCare. “Ninety percent are things we can not see. If we don’t talk to each other, we will never know. In other words, what I can see with my eyes is only 10 percent of who you are.”

Facilitators cited an example of an African man seeking medical help (in an unnamed American hospital) who was very unresponsive to the doctor. The physician could have dismissed the man as being “uncooperative.” But upon further questioning, it was learned the patient had recently lost a close relative in tragic circumstances. Information like that can lead to a different diagnosis or make the physician make additional recommendations, such as a referral for counseling.

The lesson? It is not wise to jump to conclusions about someone relying only on what you see.

“Are we really understanding the patient and the patients’ needs?” asked Diane Maloney-Krichmar, director of Graduate Medical Education at Sinai and a facilitator at the workshop. After the exercise, all of the participants had a much more thorough understanding of one another. It was an understanding that didn’t depend only on sight.
-Sandra Crockett

No comments: