The Time Objection: Cross-Cultural Care and the Ever-Shortening Office Visit

By Alexander Green, MD, MPH on 5/1/18 8:38 AM

The most common objection

I've given hundreds of presentations on culturally-competent care to busy clinicians around the world. At the end of my talk, someone always asks the "time question." I know plenty of other clinicians are thinking it, but don’t want to appear insensitive. So I wait for a brave soul to say, “Dr. Green, you’re telling me that if I want to be culturally competent, I have to do all of these things on top of what I already have to cover? I have to ask my patients how they understand their condition? What their religious practices are? Whether they trust me? I’d love to—but I just don’t have time!”

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News Roundup | Week of April 27, 2018

By Megan Bedford on 4/27/18 12:21 PM

Asian Americans Undertreated for Mental Health Disorders

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How to Approach Medical Decision-Making Across Cultures

By Megan Bedford on 4/24/18 1:16 PM

How should important medical decisions be made?

If you've grown up in the U.S., you're probably familiar with the concept of a patient's "right to know." American culture holds that patients are entitled to be fully informed in their own medical care, including the decision-making process. In some cultures, however, autonomy in decision-making is not the norm. For many people, it is essential to involve (or even defer to) others, particularly family members, in important health decisions. In such families, it's common to look to an authority figure (determined by gender, position in the family, or level of acculturation) as the primary decision-maker within the group. In some cases, these families may wish to exclude the patient from decisions in order to avoid what is perceived as undue stress. This can cause friction between health providers, patients, and their relatives.

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News Roundup | Week of April 20, 2018

By Megan Bedford on 4/20/18 5:00 PM

Racial Bias Isn't Just a Problem at Starbucks

A video of two black men getting arrested at a Starbucks in Philadelphia has sparked widespread outrage directed at both Starbucks and the police. In response, Starbucks announced that it will close 8,000 stores in May so employees can engage in racial bias training. "While this is not limited to Starbucks, we're committed to being a part of the solution," said CEO Kevin Johnson. The problem certainly isn't limited to one company, or one industry, or one region of the country. There are any number of examples of white Americans calling the police on black Americans without real justification. Deeply ingrained and unconscious racial bias routinely leads to instant, often fear-based judgements about people that can have dire consequences. The question is, what can we do to break this cycle?  

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News Roundup | Week of April 13, 2018

By Megan Bedford on 4/13/18 9:41 PM

Unconscious Bias in Healthcare Impacts Bottom Line

Unconscious bias leads to health disparities for patients, and has a negative effect on healthcare workers as well. Unconscious bias can cause both patients and staff to be treated differently based on gender, race, language spoken, lifestyle choices, and more. This results in higher staff attrition and and lower patient satisfaction—and in turn, it negatively effects healthcare organizations' bottom line.

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News Roundup | Week of April 6, 2018

By Megan Bedford on 4/6/18 1:04 PM

We're Failing Dr. King's Legacy in Healthcare

This past week marked the 50th anniversary of Dr. Martin Luther King Jr.'s death. Dr. King famously said, "Of all the forms of inequality, injustice in health is the most shocking and inhumane." He said that in 1966. In 2018, the US still struggles with pervasive health inequality that weakens our overall healthcare system, and reduces our standing compared to other developed nations. The city of Atlanta, where Dr. King grew up and went to college, is a national healthcare hub, boasting world-class healthcare facilities. It is home to the Centers for Disease Control (CDC), the American Cancer Society, the Arthritis Foundation, and several schools of medicine and public health. But Atlanta also has some of the widest gaps in black and white health outcomes in the country. Among these disparities are:

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News Roundup | Week of March 30, 2018

By Megan Bedford on 3/30/18 9:57 AM

Implicit Bias Controversy Based on Misunderstandings

Implicit bias, and especially the Implicit Association Test (IAT), has been the subject of recent debate in both scientific and popular press. Is the IAT accurate? Are its findings useful? Does the concept of implicit bias impede efforts to address explicit bias? A new piece in Scientific American argues that the controversy around implicit bias and the IAT is based on fundamental misunderstandings. For example, the IAT isn't designed to predict individual behavior, like how a particular physician will interact with a particular patient. Rather, the aggregate data can help predict (and correct) big-picture functions.

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3 Simple Ways to Alleviate Patient Mistrust

By Alexander Green, MD, MPH on 3/28/18 11:56 AM

Do your patients really trust you?

Trust in the healthcare system is at an all-time low—only 34% of Americans have “great confidence” in medical leaders, as compared to 73% in 1966. So if you are a health professional, you're wise to assume patient mistrust, rather than the other way around. Depending on your role and the setting, mistrust can present itself in very different ways. But I've learned that you can respond effectively to patient mistrust in any scenario using three simple communication techniques.

Topics: mistrust
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News Roundup | Week of March 23, 2018

By Megan Bedford on 3/26/18 7:13 PM

How to Improve Diversity in Clinical Trials

As reported in previous News Roundups, a lack of diversity in clinical trials results in disparities in care among under-served populations. Recruiting different racial and ethnic groups, especially African-Americans, remains a challenge. A focus-group study conducted by Louisiana State University Health Sciences Center sought to learn what it would take to address this problem. Results show that trust and communication are key to increasing minority participation in clinical trials.

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News Roundup | Week of March 16, 2018

By Megan Bedford on 3/16/18 4:43 PM

Want to Get People to See a Doctor? Target Their Beliefs

The Tsimane people are an isolated tribe in Bolivia with a life-expectancy of only 50 years. Researchers from the Integrated Anthropological Sciences Unit at UC Santa Barbara published a paper analyzing why the Tsimane often refuse medical care, even when it's free and offered by people they trust. Their findings provide insights into why so many people around the world, regardless of background and education, resist going to the doctor even when they know they should.

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