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Chapter 9 - Physician/Patient Discordance

Published online by Cambridge University Press:  20 July 2023

By
Tammy Jupic ,
Laura Smylie  and
Elizabeth Dubey
Edited by
Mark Curato ,
Kaushal Shah  and
Christopher Reisig
Mark Curato
Affiliation:
Weill Cornell Medicine, New York
Kaushal Shah
Affiliation:
Weill Cornell Medicine, New York
Christopher Reisig
Affiliation:
Weill Cornell Medicine, New York
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Summary

The Emergency Department (ED) is a microcosm of its greater surrounding community. Urban EDs in particular have a broad variety of people – both physicians and patients – who hail from various backgrounds, races, and ethnicities, each with unique primary languages and cultures. Urban metropolitans are the most diverse regions compared to more rural parts of a given country. Based on current demographic data and our own collective experiences in urban EDs internationally, ED physicians seldom have an opportunity to reflect on race, language, and culture in the populations that we serve. These differences, or the discordance between clinician and patient, can become problematic for emergency physicians.

Keywords

DiscordanceDiversityLanguageLinguisticRaceEthnicityCultureEmergency Department
Type
Chapter
Information
Urban Emergency Medicine , pp. 110 - 122
Publisher: Cambridge University Press
Print publication year: 2023

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References

References

Cromartie, J. Rural America at a glance 2018 edition. Economic Information Bulletin No. EIB-200. 2018.Google Scholar
Bridges, AJ, Andrews, AR, 3rd, Deen, TL. Mental health needs and service utilization by Hispanic immigrants residing in mid-southern United States. J Transcult Nurs. 2012;23(4):359–368.CrossRefGoogle ScholarPubMed
www.healthaffairs.org/do/10.1377/forefront.20081119.000463/Google Scholar
Statistics ABo. 2016 Census QuickStats. 2016.Google Scholar
Canada, S. An increasingly diverse linguistic profile: Corrected data from the 2016 Census. The Daily; 2017.Google Scholar
Schouten, BC, Meeuwesen, L. Cultural differences in medical communication: a review of the literature. Patient Educ Counsel. 2006;64(1–3):21–34.Google Scholar
Takeshita, J, Wang, S, Loren, AW, Mitra, N, Shults, J, Shin, DB, Sawinsky, DL. Association of racial/ethnic and gender concordance between patients and physicians with patient experience ratings. JAMA Netw Open. 2020;3(11):e2024583.Google Scholar
Association of American Medical Colleges. Report on Residents. AAMC, 2020.Google Scholar
Association of American Medical Colleges. Diversity in the Physician Workforce: Facts & Figures 2010. AAMC, 2010.Google Scholar
Lett, E, Orji, WU, Sebro, R. Declining racial and ethnic representation in clinical academic medicine: a longitudinal study of 16 US medical specialties. PLoS One. 2018;13(11):e0207274.Google Scholar
Association of American Medical Colleges. Diversity in Medicine: Facts and Figures 2019. AAMC, 2019.Google Scholar
Association of American Medical Colleges. Diversity in Medicine: Facts and Figures 2019. AAMC, 2019.Google Scholar
Parker, K HJ, Brown, A, Fry, R, Cohn, DV, Igielnik, R. What Unites and Divides Urban, Suburban, and Rural Communities. Pew Research Center, 2018.Google Scholar
Blanchard, JC, Haywood, YC, Scott, C. Racial and ethnic disparities in health: an emergency medicine perspective. Acad Emerg Med. 2003;10(11):1289–1293.Google Scholar
Lee, JS, Tamayo-Sarver, J, Kinneer, P, Hobgood, C. Association between patient race/ethnicity and perceived interpersonal aspects of care in the emergency department. J Natl Med Assoc. 2008;100(1):79–85.Google Scholar
Cooper, LA, Beach, MC, Johnson, RL, Inui, TS. Delving below the surface. Understanding how race and ethnicity influence relationships in health care. J Gen Intern Med. 2006;21(Suppl 1):S21–27.CrossRefGoogle ScholarPubMed
Hagiwara, N, Slatcher, RB, Eggly, S, Penner, LA. Physician racial bias and word use during racially discordant medical interactions. Health Commun. 2017;32(4):401–408.CrossRefGoogle ScholarPubMed
West, TV, Schoenthaler, A. Color-blind and multicultural strategies in medical settings. Social Iss Policy Rev. 2018;11(1):124–158.CrossRefGoogle Scholar
DuBard, CA, Gizlice, Z. Language spoken and differences in health status, access to care, and receipt of preventive services among US Hispanics. Am J Public Health. 2008;98(11):2021–2028.Google Scholar
August, KJ, Nguyen, H, Ngo-Metzger, Q, Sorkin, DH. Language concordance and patient–physician communication regarding mental health needs. J Am Geriatr Soc. 2011;59(12):2356–2362.Google Scholar
Kenison, TC, Madu, A, Krupat, E, Ticona, L, Vargas, IM, Green, AR. Through the veil of language: exploring the hidden curriculum for the care of patients with limited English proficiency. Acad Med. 2017;92(1):92–100.Google Scholar
Soled, D. Language and cultural discordance: barriers to improved patient care and understanding. J Patient Exp. 2020;7(6):830–832.Google Scholar
Divi, C, Koss, RG, Schmaltz, SP, Loeb, JM. Language proficiency and adverse events in US hospitals: a pilot study. Int J Qual Health Care. 2007;19(2):60–67.Google Scholar
Waxman, MA, Levitt, MA. Are diagnostic testing and admission rates higher in non-English-speaking versus English-speaking patients in the emergency department? Ann Emerg Med. 2000;36(5):456–461.Google Scholar
Rogers, AJ, Delgado, CA, Simon, HK. The effect of limited English proficiency on admission rates from a pediatric ED: stratification by triage acuity. Am J Emerg Med. 2004;22(7):534–536.Google Scholar
Cooper, LA, Roter, DL, Johnson, RL, Ford, DE, Steinwachs, DM, Powe, NR. Patient-centered communication, ratings of care, and concordance of patient and physician race. Ann Intern Med. 2003;139(11):907–915.Google Scholar
Cooper, LA. Health disparities. Toward a better understanding of primary care patient-physician relationships. J Gen Intern Med. 2004;19(9):985–986.CrossRefGoogle Scholar
Schouten, BC, Cox, A, Duran, G, Kerremans, K, Banning, LK, Lahdidioui, A, van den Muijsenbergh, M, Schinkel, S, Sungur, H, Suurmond, J, Zendedel, R, Krystallidou, D. Mitigating language and cultural barriers in healthcare communication: toward a holistic approach. Patient Educ Counsel. 2020;S0738-3991(20)30242-1.Google Scholar
Ezenkwele, UA, Roodsari, GS. Cultural competencies in emergency medicine: caring for Muslim-American patients from the Middle East. J Emerg Med. 2013;45(2):168–174.CrossRefGoogle Scholar
Todd, KH, Samaroo, N, Hoffman, JR. Ethnicity as a risk factor for inadequate emergency department analgesia. JAMA. 1993;269(12):1537–1539.CrossRefGoogle ScholarPubMed
Carreras Tartak, JA, Brisbon, N, Wilkie, S, Sequist, TD, Aisiku, IP, Raja, A, Macias-Konstantopoulos, WL. Racial and ethnic disparities in emergency department restraint use: a multicenter retrospective analysis. Acad Emerg Med. 2021;28(9):957–965.Google Scholar
MBRRACE-UK. Saving Lives, Improving Mothers’ Care: Lessons Learned to Inform Maternity Care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2015–17. Oxford Population Health, 2019.Google Scholar
Shavit, I, Jacob, R, Friedman, N, Capua, T, Klein, A, Chistyakov, I, Moldaver, I, Krupik, D, Munchak, I, Abozaid, S, Rimon, A, Meirson, G, Leiba, R, Cohen, DM. Effect of patient and nurse ethnicity on emergency department analgesia for children with appendicitis in Israeli government hospitals. Eur J Pain. 2018;22(10):1711–1717.CrossRefGoogle ScholarPubMed
Biswas, S, Seman, M, Cox, N, Neil, C, Brennan, A, Dinh, D, Walton, A, Chan, W, Lefkovits, J, Reid, C, Stub, D. Impact of limited English proficiency on presentation and outcomes of patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction. Intern Med J. 2018;48(4):457–461.Google Scholar
Ramirez, D, Engel, KG, Tang, TS. Language interpreter utilization in the emergency department setting: a clinical review. J Health Care Poor Underserved. 2008;19(2):352–362.Google Scholar
Accreditation Council for Graduate Medical Education. ACGME Program Requirements for Graduate Medical Education in Emergency Medicine. ACGME, 2021.Google Scholar
Dehon, E, Weiss, N, Jones, J, Faulconer, W, Hinton, E, Sterling, S. A systematic review of the impact of physician implicit racial bias on clinical decision making. Acad Emerg Med. 2017;24(8):895–904.Google Scholar
Ngai, KM, Grudzen, CR, Lee, R, Tong, VY, Richardson, LD, Fernandez, A. The association between limited English proficiency and unplanned emergency department revisit within 72 hours. Ann Emerg Med. 2016;68(2):213–221.Google Scholar
John-Baptiste, A, Naglie, G, Tomlinson, G, Alibhai, SM, Etchells, E, Cheung, A, Kapral, M, Gold, WL, Abrams, H, Bacchus, M, Krahn, M. The effect of English language proficiency on length of stay and in-hospital mortality. J Gen Intern Med. 2004;19(3):221–228.Google Scholar
Agency for Healthcare Research and Quality. Improving Patient Safety Systems for Patients With Limited English Proficiency: A Guide for Hospitals. The Disparities Solutions Center, Mongan Institute for Health Policy, Massachusetts General Hospital, 2012.Google Scholar
Mechanic, OJ, Dubosh, NM, Rosen, CL, Landry, AM. Cultural competency training in emergency medicine. J Emerg Med. 2017;53(3):391–396.CrossRefGoogle ScholarPubMed

Further Reading

US Department of Health and Human Services. 2018 National Healthcare Quality and Disparities Report. AHRQ, 2019.Google Scholar
Vogel, L. Broken trust drives native health disparities. CMAJ. 2015;187(1):E9–E10.CrossRefGoogle ScholarPubMed

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