Influences in Health Outcomes
In the culturally diverse country of America, it is very important that providers have an excellent understanding of patients’ cultural, ethnic, racial, and socioeconomic backgrounds in order to provide quality care to all patients. The three scenarios presented in “A Day in the Sleep Clinic” of Dr. Williams’s interactions with three different child patients and their families is a good example of how a doctor’s lack of knowledge in these areas can be detrimental to the care patients receive, making it more likely for patients to have worse health outcomes.
Several aspects of Dr. Williams’s behavior are likely to influence the decisions of the families he works with and will affect the health outcomes of their children. First, he lets his attitude about his “terrible day,” his frustration with patients lacking health insurance, and the fast pace of his job influence his overall feelings toward his work (“A Day in the Sleep Clinic” ¶ 2). This overall attitude towards his work could make it hard for him to adapt to the different kinds of people he will encounter or have any enthusiasm in participating in continuing education that would help him improve his bedside manner. Second, the assumptions he makes about patients based on race causes him to ignore the special issues a family faces in dealing with medical care practitioners, in following treatment plans, and receiving follow-up care.
Third, his ignorance about ethnicity causes him to generalize about racial groups, because he does not understand the variety of cultural values that influence not only the patients’ relationship with him, but also their customs and beliefs that can affect treatment and health outcomes. His encounter with the Phan family is so terrible, with his rushed attitude, overuse of technical terminology, loud speech, and threat of a trach, that as the family leaves the clinic, Bao says to his wife, “I think we should ask our friends for the name of another doctor. I do not want to come back to this rude place” (“Sleep Clinic” ¶ 8). Finally, Dr. Williams appears to worry much more about whether or not patients have insurance than their health outcomes. His ignorance about socioeconomic status and possible alternatives, such as asking the sleep lab to do a daytime nap study, which the lab will sometimes do free, definitely has an impact on patient health outcome.
Culture, ethnicity, race, and socioeconomic status all have an impact in families’ experiences in the health care system, especially for minority populations. They may feel reluctant to visit a doctor who is of a different racial, ethnic, or cultural background than themselves, especially if they have had bad experiences before with doctors like Dr. Williams who makes many assumptions and has a bad attitude. If there are no providers in the area who are from their racial, ethnic, or cultural background, they may forgo treatment altogether and this leads to worse health outcomes overall. Socioeconomic status also plays a role in whether or not a family believes they can afford treatment for health issues; if they do not have insurance or Medicaid, they may not seek out medical treatment at all. Even in cases like Dr. Williams’s encounter with Johnny and Becky Reese, his assumption that because their socioeconomic status is higher that they are “a nice family,” that “they have good insurance,” and that they will naturally follow a treatment plan is unfounded because he was unaware of the family’s chaotic home life with three children under age five (“Sleep Clinic” ¶ 3).
Several other factors other than provider-patient communication can influence disparities in health outcomes. For example, cultural influences such as religion may play a role in when, how, and if a person will seek treatment. In addition, areas that have a high concentration of families living below poverty level tend to have lesser quality health services available than wealthier areas. Because minority populations such as African Americans tend to be concentrated in the more impoverished areas, their health outcomes are worse because of a scarcity of good health services. Lack of insurance also plays a role in health outcomes, since people without insurance tend to put off medical care for as long as possible.
As Dr. Williams’s example shows, many factors are involved in influencing the health outcomes for patients, not all of which he is in control of. However, there is much a provider who is educated in differing cultural, ethnic, racial, and socioeconomic issues can do to influence patients’ health outcomes for the better.
References
“A Day in the Sleep Clinic” n.d. Cross Cultural Health Care – Case Studies. Retrieved from http://support.mchtraining.net/national_ccce/case5/case.html
