Conversations in Cultural Competency

Manage Chronic Disease with the EFST Model for Cultural Competence

How can clinicians help ease the stress of chronic disease? Recent healthcare news stories published in The New York Times draw attention to the incredible burden of serious illness and chronic disease on critically sick patients. Not only are they physically uncomfortable and often fighting for their lives—they are also baffled by a confusing healthcare system and swamped by medical bills. Now imagine adding a language barrier to the mix! The challenges of serious illness are compounded when there are cross-cultural issues at play. Quality Interactions' EFST Model is designed to help clinicians uncover and address these issues and provide culturally-sensitive care to all patients with chronic disease.

Our recent live learning event, Social Determinants & Cross-Cultural Care, presented by Dr. Emilio Carrillo, explored the history and impact of social determinants of health (SDOH) and presented real-world case studies to show how health practitioners can make a real difference to improve patient health outcomes. Here are the answers to questions submitted by participants that Dr. Carrillo did not have time to answer during the event. You can also access the event slides and recording.

In the 1990s, before I started my second year of medical school at University of California, San Diego (just 30 minutes north of the Mexican border) I made a decision that would change my life. The second-year curriculum allowed for a number of elective courses. We were supposed to select from a catalogue of options—radiology, advanced anatomy, medical ethics, and many others. Most students chose two per semester. I chose one that spanned the entire year: Medical Spanish.

How clinicians can address social determinants of health

We have known for decades that income, education, race, gender, and other social factors have a bigger impact than medical care on people’s health and life expectancy. Social determinants of health (SDOH) are well documented by respected organizations such as the Centers for Disease Control (CDC) and World Health Organization (WHO).

The U.S. spends more on healthcare than any other country. Yet we struggle with healthcare access and quality, and our overall population is less healthy than other developed nations. One possible solution to this problem is value-based care. This article provides an overview of value-based care models and shows how cultural competency training is essential for doctors and healthcare organizations to provide high-value care for patients. 

This content was originally presented as part of our live learning event, "Expanding the Role of Interpreters in a Value-Based System," by Dr. Alexander Green. View the recorded event here.

As a primary care physician, I take care of a large Spanish-speaking population, among other culturally and socioeconomically diverse patients. I’m fluent in medical Spanish and communicate directly with my Spanish-speaking patients. But regardless of whether I’m speaking Spanish or working with a medical interpreter, visits with limited English proficiency (LEP) patients always leave me with a worried feeling in the pit of my stomach. I’m keenly aware that most healthcare takes place outside of the doctor’s office, and this is where LEP patients fall through the cracks. I wonder, “Did Mrs. Ramirez really understand how to prep for her colonoscopy next week?” or “Was Mr. Luan actually convinced that he needs to take the medication I prescribed for his diabetes?”

Why Being Black in America is Bad for Your Health

After more than a year of in-depth reporting in Baltimore, The Atlantic has published a long read that explores why, as a group, black Americans are significantly less healthy than white Americans. The piece follows a woman named Kairra, who is 27, black, very overweight, and suffers from a host of health problems that are usually associated with people three times her age. In Baltimore, as well as other segregated cities like Chicago and Philadelphia, the low-income, mostly black neighborhoods have a life expectancy that is 20 years lower than more affluent, whiter neighborhoods. The gap can be attributed to several factors, including violence, diet, environmental hazards, substance abuse, and stress.

Address the patient, speak clearly, avoid jargon, and check for comprehension

If you’re a healthcare provider who works with some of the 25 million limited English proficient (LEP) patients in the U.S., you know how important interpretation is to successful patient outcomes. Poor communication increases the chance of medical errors with any patient, and LEP individuals are especially vulnerable in this regard.

In this week's News Roundup:

• Creating Financial Success at a Small Rural Hospital
• Gender Bias Hinders Research in Chronic Disease
• The Business Case for Racial Equity

Creating Financial Success at a Small Rural Hospital

An in-depth piece from Politico Magazine explores how a small, rural hospital in Kansas has become an economic powerhouse by serving the local refugee/immigrant population and specializing in labor and delivery. Ben Anderson, the hospital's CEO, relies on community partnerships, infrastructure grants, and targeted recruiting. His recruiting model is especially interesting: He attracts young physicians who are interested in helping Third World populations. "You can do that work right here in Kansas," he says. Having a staff that actively seeks to work with diverse populations improves patient experience and outcomes.

• Health Equity Bill Introduced in Congress
• Medical Schools Must Do More to Combat Racism
• Experiment with Barbershop Clinics is Succeeding
  
  

Health Equity Bill Introduced in Congress

The Congressional Tri-Caucus, made up of the Congressional Asian Pacific American Caucus, Congressional Black Caucus, and Congressional Hispanic Caucus, has introduced the Health Equity and Accountability Act of 2018 (HEAA), a bill that attempts to address health disparities based on race and ethnicity. The authors note several reasons for these disparities, including language and cultural barriers to care.