“Unequal Treatment” turns 20: How does the abstract sound today?

10 Minutes to Better Patient Communication

It’s the 20th anniversary of the Institute of Medicine’sUnequal treatment: Confronting racial and ethnic disparities in healthcare. In honor of thislandmark report, we’re spending some time with the abstract and considering how it sounds now.

It’s the 20th anniversary of the Institute of Medicine’s landmark report, Unequal treatment: Confronting racial and ethnic disparities in healthcare. I don't know about you, but I've never actually read the report. So in this episode, we’re just gonna spend some time with the abstract.

Hi everybody. I'm Dr. Anne Marie Liebel, and this is 10 Minutes to Better Patient Communication from Health Communication Partners, your partners in health-equity focused education and communication. Visit healthcommunicationpartners.com.

Back when this first hit, in 2003, 20 years ago, it’s clear that there were many people who had been working for a long time on issues of racial and ethnic disparities in healthcare. So I'm going to guess, I wasn’t in the field at the time, but I'm gonna guess that bringing these people together, and this research, in a large volume, was a powerful move. An impressive one.

I’ve never read it, it occurred to me. It’s so much in the air. I've read about it. I’ve read studies which cite it. But I never really read it.I don’t know how this text, this report has shown up in your work, in the conversations you’re a part of. But right now I'm going to read the abstract to you and to myself.

I’m doing this for a few reasons, beyond what I hope is obvious and that’s to devote some time to honor this text.

One is that I want to read the report! I wanted a way into it that could help orient me to it and not feel so overwhelmed by it. So I thought the abstract was a good place to start. I guess you could argue I could’ve started w the title, and maybe I'll do that another time. But another reason is I've done a few episodes in the past on how we make sense of what we read and hear, and how the sense making process of all of us is important in health communication and education.

So in this reading, that I'm gonna, that I'm gonna do, I’m gonna invite you to reflect on how this is, how these words are hitting your ears right now. What emerges for you. What leaps out to you. I’m inviting you to reflect, really. You know I'm a reflective practitioner. If you're not sure what I mean there, I'll go ahead and drop some links in where I talk about reflective practice and the way I engage in it.

I wanted to do this with you, too, because I think about us, and I think about this show, as a kind of community of practice. I’m constantly learning from you. And we have a newsletter! If you don’t get the newsletter, I'll put that link in the show notes too.

But all of us are here for a reason, right? We’re thinking about or we’re doing equity-oriented work in the health sector, related to communication and education. We have some similar goals, and I believe that some of those goals were probably shared by some of the people working on Unequal Treatment.

And just last week, a physician just last week said to me, It can feel lonely doing this work sometimes. And I heard that! And this is a reminder that we’re not alone. And so I thought it was appropriate for us to reflect together, even asynchronously, on an important part of an important text.

That’s another reason I’m doing this. Using a text as a way to reflect can be very powerful, alone or in a group. So I'm reading it to you, so you can hear the words. Because reading aloud can open texts up to us, and I hope it will here.

So I'm gonna invite you to sit with it. I’m sitting right now. Usually when I do the show I'm standing. But somehow sitting seemed more appropriate. So my chair might creak, I apologize.

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And I invite you to hear the words, hear how they hit you, how they land. Just spend some time with these words. What does this abstract make you think of, now? In this historical moment but also in this moment in your professional life, in your practice? I invite you to share your thoughts with me. Find me on linked, find me on twitter. Anne Marie Liebel. And like I said if you don’t get the newsletter, go ahead and sign up for it because then you can respond to that and it comes right to me.

Ok deep breath, here we go. [Source text here.]

“Racial and ethnic minorities tend to receive a lower quality of healthcare than non-minorities, even when access-related factors, such as patients’ insurance status and income, are controlled. The sources of these disparities are complex, are rooted in historic and contemporary inequities, and involve many participants at several levels, including health systems, their administrative and bureaucratic processes, utilization managers, healthcare professionals, and patients. Consistent with the charge, the study committee focused part of its analysis on the clinical encounter itself, and found evidence that stereotyping, biases, and uncertainty on the part of healthcare providers can all contribute to unequal treatment. The conditions in which many clinical encounters take place characterized by high time pressure, cognitive complexity, and pressures for cost-containment may enhance the likelihood that these processes will result in care poorly matched to minority patients’ needs. Minorities may experience a range of other barriers to accessing care, even when insured at the same level as whites, including barriers of language, geography, and cultural familiarity. Further, financial and institutional arrangements of health systems, as well as the legal, regulatory, and policy environment in which they operate, may have disparate and negative effects on minorities’ ability to attain quality care.

“A comprehensive, multi-level strategy is needed to eliminate these disparities. Broad sectors including healthcare providers, their patients, payors, health plan purchasers, and society at large should be made aware of the healthcare gap between racial and ethnic groups in the United States. Health systems should base decisions about resource allocation on published clinical guidelines, insure that physician financial incentives do not disproportionately burden or restrict minority patients’ access to care, and take other steps to improve access including the provision of interpretation services, where community need exists. Economic incentives should be considered for practices that improve provider-patient communication and trust, and reward appropriate screening, preventive, and evidence-based clinical care. In addition, payment systems should avoid fragmentation of health plans along socioeconomic lines.

“The healthcare workforce and its ability to deliver quality care for racial and ethnic minorities can be improved substantially by increasing the proportion of underrepresented U.S. racial and ethnic minorities among health professionals. In addition, both patients and providers can benefit from education. Patients can benefit from culturally appropriate education programs to improve their knowledge of how to access care and their ability to participate in clinical-decision making. The greater burden of education, however, lies with providers. Cross-cultural curricula should be integrated early into the training of future healthcare providers, and practical, case-based, rigorously evaluated training should persist through practitioner continuing education programs. Finally, collection, reporting, and monitoring of patient care data by health plans and federal and state payors should be encouraged as a means to assess progress in eliminating disparities, to evaluate intervention efforts, and to assess potential civil rights violations.”

Whew. Well those were powerful, very packed, very dense sentences, which is appropriate for the genre. A lot there to unpack. And I'm wondering how it hit you. I’m wondering what emerged for you. What did you hear? What questions does this raise for you now? Like I said, I'd love to hear, so reach out to me on the socials, or at HealthCommunicationPartners.com, click on contact.

This has been “10 Minutes to Better Patient Communication” from Health Communication Partners. Audio engineering and music by Joe Liebel. I’m Dr. Anne Marie Liebel..

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