Social inequities effect on patient health and provider burnout
Preedar Oreggio, MD, Regional Medical Director, LA Northeast / San Gabriel Valley, Optum California
Practicing medicine is more than providing clinical care. The job of doctor is singular: This work brings us into the most intimate corners of human lives. We get to give the best news, and sometimes break the worst news.
Very few of us become doctors with great wealth in mind. The wellness of our patients is our main driver.
We’re trained observers, and we see the patterns that leave our poor, isolated, disenfranchised, non-English fluent, Black, indigenous and people of color suffering. This inequity sits uneasy.
The tilted field
But for all doctors, as we have the chance to look up from our medical textbooks and lay hands on our patients, we recognize that the playing field for good health is not equal. In many communities of color, resources we count on for wellness are missing. Patterns emerge.
- How does access affect care?
- Getting there: Will it take multiple buses, reliance on friends and family or cost to pay for a cab or ride service?
- Waiting: Emergency department wait times are shown to be higher for Black people.
- Trust: Black people are less likely to trust their primary care doctors, leading to less preventative care. The reasons for distrust are many but include a history of egregious mistreatment by health care systems, individual experiences of racism and social-cultural disconnect with a non-Black doctor.
- How does environment affect wellness?
- Housing: Albuterol and steroids are good medicine for asthma, but a mold-free home works best.
- Food and water: A diabetic diet prescribes water over soda, and fresh vegetables over packaged food. Access to clean water and a walkable store that sells produce are problems that continue to afflict “food desert” neighborhoods where people of color live.
- Safety: Nina Simone defined freedom as “no fear.” Recent Social movements have helped highlight how frightening it is to be a person of color in America. Trauma from gunshot wounds is something doctors might be able to stitch up—but preventing the gunshots or limiting the stress to a body bathed in fight or flight hormones is beyond a doctor’s reach.
Examining the doors we open, the doors we close
As doctors, we value our oath. We give good care to every patient we see—no one goes to school for this long to do any less. Socioeconomic status, race, ethnicity, language—none of these change our commitment.
Still, we must acknowledge our humanness. With it comes imperfection. Errors, assumptions and unknown bias are inherent in each of us.
The ability to shine light on those imperfections without shame is important to improving access and quality of care. As we move forward into the light we can see how our actions may close doors to better care for our Black, indigenous and people of color patients, or how new choices may open those doors.
Simple things mean a lot. Does the office close at 5? How will that affect a person who can’t get work hours off? Or maybe someone who relies on a full-time worker for transportation? Widening hours and offering walk-in appointments opens the door.
Being an advocate can mean awareness of the patient’s ability to bear the burdensome labs, scans and specialists for “just in case.” Keeping the load appropriate will help them follow through with what is crucial, and avoid the unhelpful label “noncompliant” when they miss a round of physical therapy due to lack of sick days.
The move toward telehealth has thrown the doors wide open to provide greater access. Still, while we plan our digital future we must keep in mind the decreased value we offer to people with limited data and more barriers to a visual medium on their device. How do we even this inequity?
Decision by decision, we need to keep the whole array of patients we serve at the table. People of color, women, rural and city dwellers, elderly and the young, able-bodied people and individuals with disabilities are all key to keeping our assumptions checked and our minds open to inclusive solutions.
Bearing the burden of health inequity
Without doubt, bearing witness to health care’s innate injustices weighs on clinicians. So often we desperately work to solve health problems that, if life were fair and primary care and prevention in place, would not exist. We patch up patients that the world’s inequities have harmed.
A connection to your passion and purpose as a physician is important to fighting burnout. Finding the way back to what makes you the doctor you are is a practice that must be repeated.
Allowing myself to serve in a role outside of “doctor” has been a personal boost to me. Improving the lives of my patients by dragging my kids to help set up cots in the cold weather homeless shelter, volunteering time at a community nonprofit and going out on a limb to request Christmas donations filled me in ways I could then bring into the exam room.
We are allowed to admit that alone we will not solve racism and poverty. But continuing to improve, to view the community you are in with a door-opening mindset, will help you see what your patients need most. Engagement, good works and positivity help us continue on towards our goal to be good doctors.
This publication is informational and for educational purposes for practitioners only. The views and opinions expressed herein are those of the authors and do not necessarily represent the views of Optum Care. The views and opinions expressed may change without notice.