HEALTH EQUITY
"At Brown EM, we strive to recruit a diverse group of residents from various backgrounds as well as train our residents in the management of a diverse patient population. Through our blog, we hope to provide our residents with another avenue to advocate for equity not only within medicine, but within the community at large. "
One in four children live in an immigrant family, meaning that they have at least one parent born outside the US [5]. Besides restrictions to healthcare, these children face life stressors unique to their population group including fear of deportation, family separation, xenophobia, and racism…
Resilient remediation of inequities will require us to deconstruct the social fabric that perpetuates pervasive prejudice and bias. Difficult conversations will have to be had among colleagues. Uncomfortable moments of learning will be inevitable in order to break down barriers between providers and patients…
The institutions we are in shape our behaviors. When institutions shape our behaviors such that our behaviors are no longer in line with our values we experience burnout. Burnout is a problem with the company not the individual” (Harvard Business Review) [2]. How we approach remediating harms, whether it be from workplace accidents to healthcare inequities, we must remember that our institutions hold the power and the responsibility of our culture…
When we think of basic behavior patterning we think of classical vs. operant conditioning [1]. In 1904 Ivan Pavlov won the Nobel prize in Physiology [2] for his experiments of classical conditioning. In his experiments, he trained a reflex behavior, salivating to food in dogs to salivating to a bell (instead of to food), thereby re-routing a reflex behavior through conditioning. Operant conditioning is a term coined in 1937 by B.F. Skinner to describe conditioning voluntary behavior change based on punishment or reward (consequences) [3]…
Historically bias was a synonym of preference. In psychology and anthropology bias is defined as an inherited preference or learned preference. For example, an inherited dislike of bitter foods. In this way, bias is seen as a conserved evolutionary trait because of how it connoted a survival benefit…
The CDC definition of health disparities acknowledges the role of “-isms” as significant contributing factors of inequities. Some examples of pervasive toxic “-isms” include: racism, sexism, ageism, ableism, heterosexism (i.e., homophobia), classism, sizeism, and antisemitism. “-isms” are the behavioral manifestation of bias, conscious or unconscious, that reinforce oppression and inequities in our culture.
I picked up the next chart during my fast track shift. I read the triage note: Back pain, ESI 4. Possibly a herniated disc or some other kind of musculoskeletal back pain…
A thin 27-year-old male with no known past medical history presented to the ED for evaluation of 3 days of fever and several weeks of fatigue. Associated symptoms included nausea, diarrhea, and a 15 pound weight loss. On further questioning, the patient reported food and housing insecurity. He stated he was living at a bathhouse and had multiple male sexual partners in the past month. He smokes cigarettes and endorses occasional alcohol and drug use. He stated that he has no source of income or cell phone, and reported being estranged from many family and friends…
A 60-year-old man with a history of hypertension and smoking presents to the medical center with chest pain. Over the weekend, he developed chest pain while cleaning out his gutters that resolved with rest. This morning, he was working at his computer when he developed chest pain radiating to his left arm. It has since resolved, but he presents to the clinic for evaluation. An EKG obtained on arrival is unremarkable, but he soon develops chest pain again…
Research has demonstrated significant disparities in healthcare access and quality as well as health outcomes for communities that have been historically marginalized or excluded. Diagnostic imaging—and differences in clinical decision-making around which patients undergo imaging and when—is one such area that has been a topic of interest in recent literature…
Health policy creation is an important way that physicians can guide the future of medicine and the care of our patients. ..