Do we actually provide the same care to all patients, irrespective of "age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, (or) social standing"?
Accounting is much the same. You have the clients you smile when you hear they are calling, and the clients you grit your teeth because you know they will be difficult. But you still treat them the same after the first thought. The bullies, the ones who do not treat you with respect in that they bring their work in 3 days before the deadline and insist that it get done, are the ones I have to grit my teeth most about.
It is wonderful to hear from a kindred spirit. Yours is a testimony for being able to practice evidence-based medicine while applying the art of addressing our patients as individuals and meeting them where they are. Working well into the 3rd decade with most of my patients, I know them as the complex and lovely people that they are and this relationship helped me to navigate them through covid like I would a momma with her ducklings. I have told many of my colleagues that this approach is the anecdote for the prevention of burnout.
On equitability, I took care of prisoners in medical school and even surprised myself at how easy it was to see them as human beings with dignity. The parallax view of seeing patients without judgement made the experience enriching for both of us in those interactions. I always wonder whether treating those patients with respect led to any positive changes in their futures.
Great reflection! I wish you had been a doc for my clients in the court system. Many were so distrustful of physicians that they avoided addressing health concerns until they became major issues, or they actually had multiple issues and were prescribed so many medications that they couldn't keep track of them and deteriorated as quickly as those not receiving any care. We had a very part time psychiatrist on our team who informed us if our clients were hospitalized or seen at a crisis unit, but I often thought it would be of great benefit to have doctors we could work with, given the many instances of physical health issues that were contributing to problem behaviors. If you have a criminal mental health court in the county where you serve, perhaps you could look into working with them.
I loved your illustration of the difference between equitability and equality. Thank you for that. I was an avid reader of multicultural issues among different patient populations within my profession; if anything, I probably tended to be more attentive to those considered to be minorities, however, in the addictions field, I felt it extremely important to be able to meet everyone at a level that made sense to them. that included just about every race, creed gender, and all the current buzzwords. I was also considered to be a tough provider. I was working in a very messy end of the field and messy work, sometimes requires a messy intervention. The reason my patients appeared to love and respect me was because I loved and respected them. Behind closed doors I might vent and roll my eyes, but I did my best to make every person feel welcome. Thankfully I make darned sure of it bc I ask each patient to call me out as needed. It makes for a better egalitarian treatment team. Your article was a great reminder that I’m still on the right track most of the time.
A. Now you're aware of the possibility that you might deliver less quality of care to patients that trigger your irritation, are you planning to do something to prevent that of happening?
B. Do you have experiences where you overcompensated instead of deliver less quality?
What I plan to to do? To stop and think and make it transparent. A worthwhile challenge.
When I don't mindful notice my irritation I do the opposite: I feel uncomfortable, I want to get rid of that sense, and I don't want to deliver less than standard quality of care. So I unconsciously compensate the uncomfortable atmosphere by overachieving. Examples when I overcompensated?
Wonderful piece, usefully focused on the sociocultural factors that can potentially influence doctor patient interactions. But let's look more deeply at that 'social standing' element, beyond a shared college, advanced degrees, and the shared understanding of neighborhood and place. While Hammond and Hyde Park had similar racial composition in the 2020 census, the median income of Hammond is literally half that of Hyde Park. In the US health care, access to primary care, prenatal care, specialty networks, and mental health (and even to stable 2 parent families) are enormously predicated on education, wealth, educational and economic opportunity and adequate insurance. One example, looking at infant mortality here https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6487507/ When thinking about Martin Luther King's famous quote “Of all the forms of inequality, injustice in health is the most shocking and inhuman", I suspect the answers lie far more in the terrain of policy and advocacy, than introspection about nuances our personal clinic interactions.
Thanks Adam. It cuts both ways. As a patient I only ever found one doctor I could truly 'talk' to about my concerns. She was open and honest with me when I asked questions about drug use safety NNTT etc, and patient led interventions being an option to treat. Sadly she moved to a practice nearer her home when she had her first child a few months after we met. i think she found me a refreshing patient too, not just following doctor's order and swallowing a pill for an ill but asking relevant questions. It's a shame that you guys are so rare.
Keep up the good work, you are precious and valued.
Apr 14, 2023·edited Apr 14, 2023Liked by Adam Cifu, MD
Thanks, Adam. I have argued that disparate outcomes of COVID in American society were often a reflection of cultural styles, to which you refer, as opposed to systemic racism. In your practice, I assume that there was a difference in the way and the frequency by which patients of different backgrounds and SES communicated with you with the onset of symptoms related to COVID and far more poor patients ended up in the hospital because of delays in diagnosis and initiation of treatment. I therefore would dispute conclusion #1 that increasing the diversity of background among physicians and APPs would automatically give better outcomes. We older white males need to give thought to how to make our practices more accessible to our patients and to encourage good health beliefs and responsible health actions. Diversity of culture and health beliefs will always be challenging, Our system generally failed during the pandemic in addressing these aspects. In Houston, where I live, there should have been targeted educational campaigns directed specifically at the Black and Hispanic communities. Lives were lost as a result of this failure, in my opinion.
Had my own experience of connection with a physician recently when I had to pick a surgeon. Was given 2 names. After researching and asking around about their reputations (both were highly recommended and appeared to have good outcomes). I chose the surgeon who went to the same university I went to. It wasn’t my highest priority box to check but it was a factor in the decision. We didn’t even reminisce a lot about our alma mater but that connection did give me a feeling of well being that I doubt would have been there with the other surgeon. Maybe it was placeboish but I’ll take anything that helps. I don’t know if he gave me any better care or was more attentive with his surgical technique. I don’t even know if he remembered this fact in the surgery room. But from my end of the relationship I felt that connection you mention in your article.
Thank you (again) for presenting the human side of healthcare people.
Wrote about a related issue -- how much of a pleasure it is to take care of nice patients -- which means I 100% agree that we should try to be aware of these things as best we can.
Accounting is much the same. You have the clients you smile when you hear they are calling, and the clients you grit your teeth because you know they will be difficult. But you still treat them the same after the first thought. The bullies, the ones who do not treat you with respect in that they bring their work in 3 days before the deadline and insist that it get done, are the ones I have to grit my teeth most about.
Your words made my morning!
It is wonderful to hear from a kindred spirit. Yours is a testimony for being able to practice evidence-based medicine while applying the art of addressing our patients as individuals and meeting them where they are. Working well into the 3rd decade with most of my patients, I know them as the complex and lovely people that they are and this relationship helped me to navigate them through covid like I would a momma with her ducklings. I have told many of my colleagues that this approach is the anecdote for the prevention of burnout.
On equitability, I took care of prisoners in medical school and even surprised myself at how easy it was to see them as human beings with dignity. The parallax view of seeing patients without judgement made the experience enriching for both of us in those interactions. I always wonder whether treating those patients with respect led to any positive changes in their futures.
Great reflection! I wish you had been a doc for my clients in the court system. Many were so distrustful of physicians that they avoided addressing health concerns until they became major issues, or they actually had multiple issues and were prescribed so many medications that they couldn't keep track of them and deteriorated as quickly as those not receiving any care. We had a very part time psychiatrist on our team who informed us if our clients were hospitalized or seen at a crisis unit, but I often thought it would be of great benefit to have doctors we could work with, given the many instances of physical health issues that were contributing to problem behaviors. If you have a criminal mental health court in the county where you serve, perhaps you could look into working with them.
We all have experience of these sort of subtle biases doing harm in paradoxical directions don't we?
Are those patients from the same side of the tracks being helped or harmed?
I loved your illustration of the difference between equitability and equality. Thank you for that. I was an avid reader of multicultural issues among different patient populations within my profession; if anything, I probably tended to be more attentive to those considered to be minorities, however, in the addictions field, I felt it extremely important to be able to meet everyone at a level that made sense to them. that included just about every race, creed gender, and all the current buzzwords. I was also considered to be a tough provider. I was working in a very messy end of the field and messy work, sometimes requires a messy intervention. The reason my patients appeared to love and respect me was because I loved and respected them. Behind closed doors I might vent and roll my eyes, but I did my best to make every person feel welcome. Thankfully I make darned sure of it bc I ask each patient to call me out as needed. It makes for a better egalitarian treatment team. Your article was a great reminder that I’m still on the right track most of the time.
Timely ... I saw a patient yesterday for early dementia, and re-read my last note:
"I have a bias against using Donepezil, and so I told her to get a second opinion, because who knows if I'm right about that."
I'm curious:
A. Now you're aware of the possibility that you might deliver less quality of care to patients that trigger your irritation, are you planning to do something to prevent that of happening?
B. Do you have experiences where you overcompensated instead of deliver less quality?
What I plan to to do? To stop and think and make it transparent. A worthwhile challenge.
When I don't mindful notice my irritation I do the opposite: I feel uncomfortable, I want to get rid of that sense, and I don't want to deliver less than standard quality of care. So I unconsciously compensate the uncomfortable atmosphere by overachieving. Examples when I overcompensated?
I always enjoy your commentary, Dr. Cufu, and I read/listen thoroughly. Please keep up the good work. And your spoken voice isn’t bad either ;-).
As a GP I'm curious. Now you're aware of the possibility that you can deliver less quality care to
Wonderful piece, usefully focused on the sociocultural factors that can potentially influence doctor patient interactions. But let's look more deeply at that 'social standing' element, beyond a shared college, advanced degrees, and the shared understanding of neighborhood and place. While Hammond and Hyde Park had similar racial composition in the 2020 census, the median income of Hammond is literally half that of Hyde Park. In the US health care, access to primary care, prenatal care, specialty networks, and mental health (and even to stable 2 parent families) are enormously predicated on education, wealth, educational and economic opportunity and adequate insurance. One example, looking at infant mortality here https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6487507/ When thinking about Martin Luther King's famous quote “Of all the forms of inequality, injustice in health is the most shocking and inhuman", I suspect the answers lie far more in the terrain of policy and advocacy, than introspection about nuances our personal clinic interactions.
Thanks Adam. It cuts both ways. As a patient I only ever found one doctor I could truly 'talk' to about my concerns. She was open and honest with me when I asked questions about drug use safety NNTT etc, and patient led interventions being an option to treat. Sadly she moved to a practice nearer her home when she had her first child a few months after we met. i think she found me a refreshing patient too, not just following doctor's order and swallowing a pill for an ill but asking relevant questions. It's a shame that you guys are so rare.
Keep up the good work, you are precious and valued.
Thanks, Adam. I have argued that disparate outcomes of COVID in American society were often a reflection of cultural styles, to which you refer, as opposed to systemic racism. In your practice, I assume that there was a difference in the way and the frequency by which patients of different backgrounds and SES communicated with you with the onset of symptoms related to COVID and far more poor patients ended up in the hospital because of delays in diagnosis and initiation of treatment. I therefore would dispute conclusion #1 that increasing the diversity of background among physicians and APPs would automatically give better outcomes. We older white males need to give thought to how to make our practices more accessible to our patients and to encourage good health beliefs and responsible health actions. Diversity of culture and health beliefs will always be challenging, Our system generally failed during the pandemic in addressing these aspects. In Houston, where I live, there should have been targeted educational campaigns directed specifically at the Black and Hispanic communities. Lives were lost as a result of this failure, in my opinion.
Had my own experience of connection with a physician recently when I had to pick a surgeon. Was given 2 names. After researching and asking around about their reputations (both were highly recommended and appeared to have good outcomes). I chose the surgeon who went to the same university I went to. It wasn’t my highest priority box to check but it was a factor in the decision. We didn’t even reminisce a lot about our alma mater but that connection did give me a feeling of well being that I doubt would have been there with the other surgeon. Maybe it was placeboish but I’ll take anything that helps. I don’t know if he gave me any better care or was more attentive with his surgical technique. I don’t even know if he remembered this fact in the surgery room. But from my end of the relationship I felt that connection you mention in your article.
Thank you (again) for presenting the human side of healthcare people.
i dont mind this substack twitr so far. it's kida oright? _JC
Nice commentary. It would make your father proud.
Wrote about a related issue -- how much of a pleasure it is to take care of nice patients -- which means I 100% agree that we should try to be aware of these things as best we can.
https://blogs.jwatch.org/hiv-id-observations/index.php/a-thank-you-to-nice-patients/2011/07/12/
Excellent commentary.
I just saw my allergist today...whom I usually only see about once a year.
I love how genuinely caring, friendly and thorough he is.
I love people and always ask him about his life, and after listening to your discourse, it helped me realize why I may have so many good doctors.
Maybe because I care about people; the doctors can feel that too.