Healthcare disparities and their systemic causes

Hanin from New Haven

This is an individual with earning disability and takes good care of herself. She has dental problem where her teeth are rotting. She is an individual who needs some serious work but she is unfortunate that she has no dental insurance. In effect, she is not able to get dental treatment due to lack of this insurance. She has been keen to find help and the last was a dental clinic that she heard about on TV but on follow-up she was informed that they no longer took new cases. From her appearance, this patient is a young African American woman of the age range of between 20-28 years old.

Hanin’s case is a typical example of where poverty and environment plays a big role in increasing the health care disparity within the US. This is a lady who has no employment, in effect she is not able to pay for the dental insurance on a monthly or annual basis. It could be that it is the rotting teeth that prevent her from getting into serious and meaningful employment. This means that she will be in this perpetual poor position without dental insurance for a long time. The encounter that Hanin had with the health care system was a disturbing one knowing that she may as well be in pains for a long time and even lose her teeth yet the health care system would not help her. The main reason why the patient feels she received less than optimal reception was due to her poor status.

Hanin felt discouraged and despaired at the thought of not being able to get dental are and hence not being in a position of engaging in meaningful employment. If provided, the patient would be more than willing to have the dental services as she has been looking out for free dental clinics for treatment.

Tamara from Manchester

She is a young woman of African American race. She is suffering from anemia. On this particular instance, Tamara had driven to the hospital in great and while on her way, she turned on the music so loud in order to drown the pain she was feeling. Unfortunately, when she got to the hospital, the doctor did not believe Tamara that she was in great pain. The doctor told her that they had seen her in her car and that if she could listen and dance to the music that was such loud then she was not in pain.
The encounter that Tamara had with the health care system was less than pleasant one as the doctor did not focus on the pain that Tamara had, but looked at her as a liar seeking attention. The most disturbing thing in this encounter was the lack of sensitivity to the needs of the patient but instead stereotyping her and branding her as a liar. The patient felt disrespected and branded as a liar instead of her medical conditioned being taken care of, this was less than optimal care for her. This is s classic example of what Hall J.W. et.al, (2015) refer to as covert discrimination which they say still exists extensively within the American society. The patient may not be keen on coming back to this particular hospital in the future. Statistics has it that Latinos and Blacks when they fall sick are less likely to receive effective treatment for treatment of pain in ER.

Marijane from Salem

This is a grandmother who seems to be of Latino race. This patient suffered from a fall and was taken to the emergency room. Upon arrival at the ER, the staff took away her hearing aid hence incapacitating her even more. Apparently the staff members did not bother to find out if she was able to hear even slightly without the aid of the hearing aids, or it seems they took them away and forgot about them in the process. When the daughter arrived, the staff members asked the daughter for the history of the client upon which the daughter directed them to ask the client since she was of sound mind and would answer them accordingly. Even at that point the staff members did not see the need to bring in the client and insisted that she was confused and not in a position to speak for herself. The old lady agreed that she was confused because of the absence of her hearing aids that were taken away. The solution top her problem was a simple as returning her hearing aid but the members of staff did not bother to underrated her situation to help expedite her treatment and constantly ignored her disability. The workforce here was not skilled on cross cultural handling of clients, hence not effective in understanding the challenges of the client, resulting in an angry client who was not treated accordingly. This client has high possibility of not coming back to the health facility again since the principle of doing no harm to the patient in the process of offering medication was not respected. She felt violated due to her disability hence not offered the optimal care as should have been. The patient felt the reason she was alienated from her own treatment was because of her disability and in the future, it is highly likely that she will have bare minimum contact with doctors, unless it is very necessary, bearing the trauma she underwent (CTMHP, 2010).

The experiences of the three patients highlighted above had some similarities to the cases of Tuskegee experiment and the Hopkins research on the levels of trust that existed more than three decades after the Tuskegee experiment. For instance in the last patient described, the old lady’s opinion on the medical procedure being conducted on her was seen not to matter much and the opinion of a third person is what was deemed best to be used to treat her. This was the same attitude that existed among the researchers of the Tuskegee experiment where the opinions of the subjects were not sought, indeed their consent to subject them to the medical procedure was not sought but they were all the same taken through the medical procedure. The lack of trust that the Hopkins research found out among the subjects questioned also came out in the case of Tamara above with the statistics on 28% of blacks against 22% of whites feeling that their physicians would willingly expose them to unnecessary risks being justified here. Tamara had the right to feel that just because she was listening to music then the physicians would use what they saw and not she told them to expose her to further risks despite the fact that she was suffering great pain. Hanin from new Haven also was exposed to undue suffering by the health care system just because she was not in a position to afford the insurance for the kind of medication she needed. Indeed her case is not very much divorced from the Tuskegee experience where the subjects were denied medical attention despite the fact that the government knew that they were suffering from syphilis. Tamara is also denied dental medication by the government despite suffering extensive pain that makes her not able to even work.

The National CLAS standards are necessary bare minimum qualities that need to be observed when dealing with patients at all levels. In these three above cases, there are various CLAS standards that needed to have been observed to make the medical experience better for each. In the case of Marijane, there is need for health care organizations to ensure that patients receive effective, understandable and respectful care and this is CLAS standard 1. There was need to respect the disability of the old lady and the age as well in the process of offering care to her. In the case of Hanin, there is need to apply CLAS standard 11 which dictates that health care organizations should assess the needs of the community. The needs of Tamara as an African American who is a victim of systemic health care alimentation were ignored all together in this case. In the case of Tamara there is need to apply CLAS standard 2 which indicates that there is need for health care organizations to recruit, retain, and promote a diverse staff and leadership. This would have helped the staff understand the place of music therapy to a young African American woman hence not judge her on the basis of music only. When the health care system embraces diversity, medical ethics and uses the above CLAS standards, there will be great improvements in the health care services offered to the patients in the US.

References

CTMHP, (2010). Faces of Disparity Video. http://www.ctmhp.org/press/faces-of-disparity-video/

Hall J.W. et.al, (2015). Implicit Racial/Ethnic Bias Among Health Care Professionals and Its Influence on Health Care Outcomes: A Systematic Review. American Journal of Public Health.Vol.105. No.12.