*Patient's name has been changed
Considering the variability in how patients are treated in a hospital setting, we can all agree that their outcomes can be vastly different based on their ethnicity, resources, socioeconomic background, and beliefs. Two different people can come to the same hospital for the same procedure and have a completely different experience.
A patient of mine named Mariela* was recently admitted to labor and delivery for the birth of her baby. She was a high-risk, Latina patient who spoke only Spanish. Luckily, I did not have to use an interpreter as I am certified to speak Spanish to patients.
Mariela did not want to opt for an epidural, as she believed this was associated with complications such as back pain and paralysis. After listening to Mariela, I explained these risks were unwarranted as back pain is associated with pregnancy and the risks of paralysis are almost non-existent. Mariela ultimately opted to receive an epidural.
These decisions are critical as epidurals have been associated with a decrease in complications during birth, especially for medically complex patients like Mariela.
Stories like Mariela's are far too common. But the result isn't always the same -- if a healthcare team is unable to find an interpreter or provide otherwise culturally competent care, the outcomes may not be so favorable.
Data on health and healthcare by race and ethnicity from KFF shows unequivocally that persistent challenges remain for minorities looking to access the same level of care as white patients. For instance, infants born to women of color were at a higher risk for mortality than white infants, the children of minorities were more likely to go without some immunizations, and Black, Hispanic, and Asian adults were less likely than their white counterparts to receive mental health services. A related matter is access to healthcare coverage. Latinos in particular are more likely to be uninsured when compared to non-Latino whites (20% versus 8%), according to a report by HHS. Along with language and cultural barriers, socioeconomic factors also contribute to worse patient outcomes, in part fueled by the fact many report not seeing a doctor due to the cost.
Last year, I co-authored and published a research article that highlighted the drivers of health inequities, including patient factors like beliefs, education, resources, biology; healthcare system factors such as healthcare culture, financing, and delivery; and provider factors including knowledge, attitudes, competing demands, and bias. By considering these drivers as well as the structural and systemic causes -- like access to healthcare, government infrastructure, and hospital policies -- we can work toward reform to help address these disparities. Here I'll focus on Latino/a patients, who make up a large portion of the population I serve, but these changes can apply to a range of marginalized populations.
Policy-level changes and investment in marginalized communities are necessary to improve access to quality care. Clinicians should receive training regarding susceptibility to implicit bias. To support this research agenda, better collection of race and ethnicity data and anesthesia quality indicators is a priority.
Communication can also play a major role. Physicians who speak the same native language and are able to relate to the cultural experiences of their patients have been linked to better patient outcomes.
Unfortunately, Latinos account for just 6% of the overall physician and surgeon workforce, according to the Association of American Medical Colleges. Until we can find ways to get more Latino/a doctors serving patients in their communities, we must use additional tools and create new resources to communicate with and better serve patients who speak languages other than English or come from backgrounds with different customs and cultures.
As an example of one initiative to help bridge the language gap, the Stanford Center for Health Education created culturally competent and language concordant health information that is both reliable and accessible to patients of all health literacy levels. Under the sponsorship of the Stanford Medicine's Dean office, we've also created a centralized network of Latino faculty at Stanford School of Medicine and Stanford Healthcare called Latino/a Faculty Alliance Meetings (LFAM). Our mission is to highlight the urgency relating to Latino health disparities as it pertains to the lack of Latino representation in medicine. LFAM also supports initiatives to create a diverse physician workforce as a strategy for reducing disparities related to the Latino population. Recently, LFAM helped host an event at Stanford featuring California's Surgeon General Diana Ramos, MD -- California's first Latina surgeon general -- where she discussed racial and ethnic disparities in California's obstetric population. Other health systems and facilities can use initiatives like these as models for their own programs focused on reducing healthcare disparities.
As I saw recently with Mariela, patients must be able to effectively communicate with their physicians so they can trust their health concerns are being addressed appropriately.
For us to effect lasting change and improve healthcare outcomes for people of all backgrounds, there's much more to be done. It starts with just one initiative. One system pushing for change. So, we plan to keep working.
Cesar Padilla, MD, is an obstetric anesthesiologist, a clinical associate professor at Stanford University, and chair of Stanford's LFAM. He is the vice chair of the Justice, Equity, Diversity, and Inclusion Committee for the California Society of Anesthesiologists.