Skip to main content

Providing Medical Care to Diverse Populations

  • 584 Accesses

Part of the Current Clinical Psychiatry book series (CCPSY)

Abstract

It is not yet evident how strong of an influence diversity holds on clinical decision-making or quality of care. What remains unclear is the manner in which disparate patient characteristics function. The associated cognitive procedures are complex. Affordable care, access to care, and compliance with recommended treatment are examples of factors that influence health outcomes but fail to provide a definitive explanation for variations that deviate from the norm. Explanations for these differences are lacking. The capacity for race and ethnicity to influence treatment and resource allocations, for example, is a decision process open to interpretation. This is problematic because the ability to evaluate a clinical decision requires understanding the many interrelated elements that contribute to judgment. In the end, there exists the need to evaluate clinical choices and to understand the extent to which patient attributes have the power to influence those determinations. This chapter will tackle the challenge of what it means to provide culturally sensitive healthcare to arguably the most diverse population on the planet. Although the information provided is focused on the healthcare environment, the concepts discussed are relevant to educators, diversity trainers, and professionals from other social sciences.

Negative use of social categories influences clinical decision-making. Adverse incorporation of information such as race/ethnicity, sexual orientation, or cognitive ability disadvantages marginalized groups and tags some aspects of identity as undesirable. Concepts such as intersectionality and cognitive dissonance provide frames for unmasking mental models that inform personal perceptions. These influences highlight the challenge in grasping the inner nature of decision-making compromised by the significance assigned to aspects of identity.

Keywords

  • Depression
  • American identity
  • Income
  • Coherence
  • Posit

If we are to achieve a richer culture, richer in contrasting values, we must recognize the full gamut of human potentialities.

(Margaret Mead)

This is a preview of subscription content, access via your institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • DOI: 10.1007/978-3-030-20174-6_4
  • Chapter length: 20 pages
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
eBook
USD   59.99
Price excludes VAT (USA)
  • ISBN: 978-3-030-20174-6
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
Softcover Book
USD   79.99
Price excludes VAT (USA)
Hardcover Book
USD   109.99
Price excludes VAT (USA)
Fig. 4.1
Fig. 4.2

References

  1. Frey WH. Five charts that show why a post-white America is already here. The New Republic [Internet]; 2014 Nov 21 [cited 2018 Sep 28]. Available from: https://newrepublic.com/article/120370/five-graphics-show-why-post-white-america-already-here

  2. Frequently Requested Statistics on Immigrants and Immigration in the United States|migrationpolicy.org [Internet]; [cited 2018 Sep 28]. Available from: https://www.migrationpolicy.org/article/frequently-requested-statistics-immigrants-and-immigration-united-states.

  3. Immigrant and Refugee Mental Health|William James INTERFACE Referral Service [Internet]; [cited 2018 Sep 28]. Available from: https://interface.williamjames.edu/topic/immigrant-refugee-mental-health

  4. Hajjaj FM, Salek MS, Basra MKA, Finlay AY. Non-clinical influences on clinical decision-making: a major challenge to evidence-based practice. J R Soc Med. 2010;103(5):178–87.

    CAS  CrossRef  Google Scholar 

  5. FitzGerald C, Hurst S. Implicit bias in healthcare professionals: a systematic review. BMC Med Ethics. 2017;18(1):19. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5333436/.

    CrossRef  Google Scholar 

  6. Croskerry P. From mindless to mindful practice–cognitive bias and clinical decision making. N Engl J Med. 2013;368(26):2445–8.

    CAS  CrossRef  Google Scholar 

  7. Collins PH, Bilge S. Intersectionality. New York: Wiley; 2016. p. 289.

    Google Scholar 

  8. Clark M. Considering intersectionality in multiculturalism. Sch Psychol Forum. 2015;9(2):96–100.

    Google Scholar 

  9. DelVecchio M, James C, Good B, Becker A. The culture of medicine and racial, ethnic, and class disparities in healthcare. Russell Sage working paper #199; 2002. p. 594–625. http://www.russellsage.org/publications/workingpapers/The%20Culture%20of%20Medicine%20and%20racial/document.

  10. Harbison J. Clinical decision making in nursing: theoretical perspectives and their relevance to practice. J Adv Nurs. 2001;35(1):126–33.

    CAS  CrossRef  Google Scholar 

  11. Rawls A. Race as an interaction order phenomenon: W.E.B. DuBois’s “double consciousness” thesis revisited. Sociol Theory. 2000;18(2):241–74.

    CrossRef  Google Scholar 

  12. Betancourt J, Green A, Carrillo J. Cultural competence in healthcare: emerging frameworks and practical approaches (Commonwealth fund rep. no. 576); 2002. www.cmwf.org.

  13. Campinha-Bacote J. The process of cultural competence in the delivery of healthcare services: a model of care. J Transcult Nurs. 2002;13(3):181–4.

    CrossRef  Google Scholar 

  14. Brown R, Capozza D. Introduction: social identity theory in retrospect and prospect. In: Capozza D, Brown R, editors. Social identity processes: trends in theory and research. London: Sage; 2000. p. viii–1.. http://knowledge.Sagepub.Com/iew/social-identity-processes/SAGE.xml.

    Google Scholar 

  15. Teal CR, Street RL. Critical elements of culturally competent communication in the medical encounter: a review and model. Soc Sci Med. 2009;68:533–43.

    CrossRef  Google Scholar 

  16. Betancourt JR, Green AR, Carrillo JE, Park ER. Cultural competence and health care disparities: key perspectives and trends. Health Aff. 2005;24:499–505.

    CrossRef  Google Scholar 

  17. Epstein RM, Street RL. Patient-centered communication in cancer care: promoting healing and reducing suffering (NIH Publication No. 07-6225). Bethesda: National Cancer Institute; 2007.

    Google Scholar 

  18. Mead N, Bower P. Patient-centered consultations and outcomes in primary care: a review of the literature. Patient Educ Couns. 2002;48:51–61.

    CrossRef  Google Scholar 

  19. Saha S, Arbelaez JJ, Cooper LA. Patient-physician relationships and racial disparities in quality health care. Am J Public Health. 2003;93:1713–9.

    CrossRef  Google Scholar 

  20. Beach MC, Saha S, Cooper LA. The role and relationship of cultural competence and patient-centeredness in health care quality. Report No. 960. The Commonwealth Fund; 2006.

    Google Scholar 

  21. Shapiro J, Hollingshead J, Morrison EH. Primary care resident, faculty, and patient views of barriers to cultural competence, and the skills needed to overcome them. Med Educ. 2002;36:749–59.

    CrossRef  Google Scholar 

  22. Betancourt JR. Cross-cultural medical education: conceptual approaches and frameworks for evaluation. Acad Med. 2003;78:560–9.

    CrossRef  Google Scholar 

  23. Kim-Goodwin YS, Clarke PN, Barton L. A model for the delivery of culturally competent community care. Am J Adv Nurs. 2001;35:918–25.

    CrossRef  Google Scholar 

  24. Kleinman A, Benson P. Anthropology in the clinic: the problem of cultural competency and how to fix it. PLoS Med. 2006;3:e294.

    CrossRef  Google Scholar 

  25. Buyck D, Lang F. Teaching medical communication skills: a call for greater uniformity. Fam Med. 2002;34:337–43.

    PubMed  Google Scholar 

  26. Krupat E, et al. The four habits coding scheme: validation of an instrument to assess clinicians’ communication behavior. Patient Educ Couns. 2006;62:38–45.

    CrossRef  Google Scholar 

  27. Makoul G. Essential elements of communication in medical encounters: the Kalamazoo consensus statement. Acad Med. 2001;76:390–3.

    CAS  CrossRef  Google Scholar 

  28. Epstein RM. Making communication research matter: what do patients notice, what do patients want, and what do patients need? Patient Educ Couns. 2006;60:272–8.

    CrossRef  Google Scholar 

  29. Zoppi K, Epstein RM. Is communication a skill? Communication behaviors and being in relation. Fam Med. 2002;34:319–24.

    PubMed  Google Scholar 

  30. Trounson R. U.S. reaches historic demographic tipping point. Los Angeles Times; May 18, 2012. Retrieved from http://articles.latimes.com/2012/may/18.

  31. Clayton-Matthews A, Watanabe P. Massachusetts immigrants by the numbers (White Paper); 2012. Retrieved from www.ilctr.org.

  32. Hammond R, Axelrod R. The evolution of ethnocentrism. J Conflict Resol. 2006;50(6):926–36.

    CrossRef  Google Scholar 

  33. Catton W, Hong S. The Relation of apparent minority ethnocentrism to majority antipathy. Am Sociol Rev. 1962;27(2):178–91.

    CrossRef  Google Scholar 

  34. Raden D. Ingroup bias, classic ethnocentrism, and non-ethnocentrism among American whites. Polit Psychol. 2003;24(4):803–28.

    CrossRef  Google Scholar 

  35. Herring M, Jankowski T, Brown R. Pro-black doesn’t mean anti-white: the structure of African American group identity. J Polit. 1999;61(2):363–86.

    CrossRef  Google Scholar 

  36. Grant Makers in Health. For the benefit of all: ensuring immigrant health and well-being (Issue Brief No. 24); 2005. www.gih.org/user_doc/GIH_Issue_Brief_24_Final.pdf.

  37. Hobson W. Racial discrimination in health care interview project. Public Health Seattle & KingCounty. 2001. http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.696.5295&rep=rep1&type=pdf.

  38. Rosenthal D. Effects of client race on clinical judgment of practicing European American vocational rehabilitation counselors. Rehabil Counsel Bull. 2004;47(3):131–41.

    CrossRef  Google Scholar 

  39. Bodenhausen G, Mussweiler T, Gabriel D, Moreno K. Affective influences on stereotyping and intergroup relations. In: Forgas E, editor. Handbook of affect and social cognition. Mahwah: Erlbaum; 2001. p. 319–38.

    Google Scholar 

  40. Brunk D. Efforts to improve mental health disparities underway. In: Clinical Psychiatry News Digital Network. Clinical Psychiatry News; 2013.

    Google Scholar 

  41. Street RL, et al. Understanding concordance in patient-physician relationships: personal and ethnic dimensions of shared identity. Ann Fam Med. 2008;6:198–205.

    CrossRef  Google Scholar 

  42. Street RL, Gordon H, Haidet P. Physicians’ communication and perceptions of patients: is it how they look, how they talk, or is it just the doctor? Soc Sci Med. 2007;65:586–98.

    CrossRef  Google Scholar 

  43. Schon D. The reflective practitioner: how professionals think in action. London: Temple Smith; 1983.

    Google Scholar 

  44. Carrillo JE, Green AR, Betancourt JR. Cross-cultural primary care: a patient based approach. Ann Intern Med. 1999;130:829–34.

    CAS  CrossRef  Google Scholar 

  45. Hayes-Bautista DE. Research on culturally competent healthcare systems. Am J Prev Med. 2003;24(3S):8–9.

    CrossRef  Google Scholar 

  46. Markides KS, Coreil J. The health of Hispanics in the southwestern United States: an epidemiological paradox. Public Health Rep. 1986;101:253–65.

    CAS  PubMed  PubMed Central  Google Scholar 

  47. Hayes-Bautista DE, et al. Health and medicine in the southwest: a window to medicine in the US in 2050. Med Am. 2000;1:4–12.

    Google Scholar 

  48. Dovidio J, Penner L, Albrecht T, Norton W, Gaertner S, Shelton J. Disparities and distrust: the implications of psychological processes for understanding racial disparities in Health and health care. Soc Sci Med. 2008;67(3):478–86.

    CrossRef  Google Scholar 

  49. Drevdahl D, Canales M, Dorcy K. Of goldfish tanks and moonlight tricks: can cultural competency ameliorate health disparities? ANS Adv Nurs Sci. 2008;31(1):13–27.

    CrossRef  Google Scholar 

Download references

Acknowledgments

Thank you to Ms. Taquesha Dean for all of her administrative help during the writing of this chapter.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Deborah Washington .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and Permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Verify currency and authenticity via CrossMark

Cite this chapter

Washington, D., Doyle, R. (2019). Providing Medical Care to Diverse Populations. In: Parekh, R., Trinh, NH. (eds) The Massachusetts General Hospital Textbook on Diversity and Cultural Sensitivity in Mental Health. Current Clinical Psychiatry. Humana, Cham. https://doi.org/10.1007/978-3-030-20174-6_4

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-20174-6_4

  • Published:

  • Publisher Name: Humana, Cham

  • Print ISBN: 978-3-030-20173-9

  • Online ISBN: 978-3-030-20174-6

  • eBook Packages: MedicineMedicine (R0)