Week 5 Human Behavior Flashcards
Race, Culture
Race = physical & biological characeristics (e.g. size of nose)
Culture = Set of values, beliefs, attitudes, languages, symbols, rituals, behaviors, and customs of a group of people; learned and shared; dynamic and changing
Ethnicity = classificationof people based on national origin or culture
Patient’s explanatory model (illness story)
Asking patient what they think about your sickness
- What do you think has caused your problem?
- Why do you think it started when it did?
- What do you think your sickness does to you? How does it work?
- How bad (severe) do you think your illness is? Do you think it will last a long time, or will it be better soon?
- What kind of treatment would you like to have?
- What are the most important results you hope to get from treatment?
- What are the chief problems your illness has caused you?
- What do you fear most about your sickness?
Cultural Consciousness
Culturally Competent
Cultural Humility
Cultural Consciousness (aware of differences, limitations, disparities, and injustices)
Culturally Competent (adaptation, acceptance, expasnion of cultural knowledge)
Cultural Humble (self-reflection and self-critique to promote healthy partnersips with patients; challenge you assumptions as a provider)
LEARN model
Listen to the patient’s perception of the problem
Expalin your perception of the problem
Acknowledge and disccuss differences and similarities
Recommend treatment
Negotiate treatment
Unconscious thinking
Implicit attitudes
Bias
Unconscious thinking (Maybe the biases that are contributing to racial/ethnic disparities in health care)
Implicit attitudes (are the positive or negative thoughts or feelings, which arise due to past experiences which one is either unaware of or which one cannot attribute to an identified previous experience.)
Bias (we are affected by what we are exposed to)
Define cultural humility and describe how it relates to culturally competent care
S&C Chapter 18: Culture and Ethnicity
A life-long attitude and approach to ocultural competence that recognizes a provider’s limited knowledge of a patient’s beliefs and values, engages in self-reflection to increase awareness of personal assumptions and prejudices, and acts to redress the imbalance of power in provider-patient relationship.
Define culture bound syndromes such as Nervios, Susto, Mal de ojo, and Amok (see Table 18.2)
S&C Chapter 18: Culture and Ethnicity
Diseases that are recognized by certain ethnic groups and not others are often classified as folk illnesses or culture-bound syndrome.
Nervios = “Nerves,” a condition affecting both men and women and allowing expression of strong emotions
Susto = Illness resulting from a frightening experience; may also refer to illness due to soul loss
Mal de ojo = A look from an envious person resulting in variety of illnesses, depending on the cultural gap.
Amok = Young men feeling excessive social pressure and role conflict experience a form of hysteria.
Summarize why explanatory models are important in health care, and describe a number of ways to elicit the patient’s and family’s stories
S&C Chapter 18: Culture and Ethnicity
EM is people’s beliefs about specific illness including etiology, symptoms, physiological process, projected course, and appropriate treatment.
(Story) Please tell me the story of your illness?
(Problem) What health problems do you have and for how long?
(Impact on individual) How is this illness affecting your daily life and doing things important to you?
(Impact of the illness on the family) What changes have occurred in the family since the illness began?
Explain why it is preferable to use professionally trained interpreters rather than family members in clinical encounters
S&C Chapter 18: Culture and Ethnicity
They provide first-person verbatim translations
Summarize some causes of population differences in health care
S&C Chapter 19: Health Care in Minority and Majority Populations
Together profound effect: porverty, lack of education, race
Other
Biological factors
Economic status
Education
Access to health care services
Name the racial group with the highest infant mortality rate in the US
S&C Chapter 19: Health Care in Minority and Majority Populations
African american
List the racial group with the highest life expectancy in the US
S&C Chapter 19: Health Care in Minority and Majority Populations
80.4 years for white females
Identify the racial group with the highest rate of mortality from cancer
S&C Chapter 19: Health Care in Minority and Majority Populations
African American (all cancers)
Asian American (liver/stomach)
Indians (kidney)
Explain what accounts for differences in infant mortality, life expectancy, and cause of death among minority and majority populations
S&C Chapter 19: Health Care in Minority and Majority Populations
Income / Poverty (biggest)
Education level
Insurance status
Access to health care
Racism
Describe why minority populations in the US have a higher death rate from cancer than whites
S&C Chapter 19: Health Care in Minority and Majority Populations
Asians (stomach/liver) - chronic infection with Helicobacter pylori and hebB/C
American Indians (kideny) - smoking and obesity
Summarize rates of being uninsured in racial groups in the US
S&C Chapter 19: Health Care in Minority and Majority Populations
2/5 Hispanic
1/5 Black
1/6 Asian
1/6 White
Summarize how racism affects health outcomes
S&C Chapter 19: Health Care in Minority and Majority Populations
Effect on social and economic life
Stress
Summarize how unconscious bias relates to medicine and health care disparities.
i.e., implicit bias and decision making in thrombolysis
Showed pro-white bias
When they were informed, the bias dissappeard
Summarize some of the historical background for health care disparities in the US
Wedding and Stuber Chapter 24: The impact of social inequalities on health care
Summarize some of the historical background for health care disparities in the US
Wedding and Stuber Chapter 24: The impact of social inequalities on health care
The U.S. Government thought Native-American health beliefs were odd, and the Office of Indian Affairs provided almost no medical services until the creation of the Indian Health Service in 1954.
African-Americans experienced forced emigration and enslavement in the 1600-1800s, and they were denied basic rights such as suffrage and freedom. African-Americans brought their own folk health system with them from Africa; however, these practices were not adequate to deal with the health challenges associated with poverty, slavery, and abuse.
Summarize definitions for health care disparities given by the NIH and IOM
Wedding and Stuber Chapter 24: The impact of social inequalities on health care
NIH: differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups in the United States.
IOM:“racial or ethnic differences in the quality of health care that are not due to access-related factors or clinical needs, preferences, and appropriateness of intervention.”
NIH definition is broader.
Tuskegee syphilis experiment
Wedding and Stuber Chapter 24: The impact of social inequalities on health care
Many patients distrust physicians. For example, African Americans are likely to be familiar with the infamous Tuskegee syphilis experiment, a clinical trial in which AfricanAmericans infected with syphilis were allowed to go untreated between 1932 and 1972-even though doctors knew antibiotics could cure the disease
Summarize the effects of prejudice, bias and stereotypes in medical practice
Wedding and Stuber Chapter 24: The impact of social inequalities on health care
Bias: Doctors prescribed different amount of
Bias: MD students evaluated two different patients with the same symptoms differently
Stereotypes influence physicians’ beliefs about whether or not patients will follow treatment recommendations
Describe the extent of implicit and explicit bias found in the resident physicians that were studied
Implicit bias among physicians and its prediction of thrombolysis decisions for black and white patients (Green et al., 2007)
Physicians reported no explicit preference for white versus black patients or differences in perceived cooperativeness.
In contrast, IATs revealed implicit preference favoring white Americans
Explain the relationship between implicit and explicit bias
Implicit bias among physicians and its prediction of thrombolysis decisions for black and white patients (Green et al., 2007)
Not strongly correlated with conscious (explicit) bias
