St Thomas University Week 3 D

• This week was yet again a very interesting and productive week. I was able to assist with providing care to many patients, some came to for their annual physical, or pap smear, or simply to follow up on laboratory results from previous visits. One of the patients who caught my attention was a young African American woman who was scheduled for a first-time visit. She is 32 years old and has never been to a doctor visit, yet she has two children who were born without prenatal care. It is unfortunate that many young patients for various reasons who lives in low-income communities have difficulties seeing on a regular basis a physician for preventive and continuation of healthcare. Reducing health disparities to improve health outcomes is a complex challenge that extends far beyond the reach of traditional health care settings. Increasingly, the structural conditions in which people are born, live, learn, work, worship, play, and age are recognized as critical determinants of health and health disparities. (Brown et al., 2019) Minority populations often face multiple levels of mutually reinforcing structural disadvantage that contribute to poor health.

This visit took a lot longer than anticipated. My preceptor took her time to collect all the subjective data, she was very professional, nonjudgmental. She made the patient feels comfortable and that allowed her to feel at ease to answer questions without feeling like she was being interrogated or blamed for any previous health choices she had made in the past. She obtained family history, reasons to why she has not been to a doctor, past and present health problems. The physical examination was conductive in a matter that was respectful to the patient and provides her with privacy and explanation of everything she was doing. I noticed that my preceptor asked the patient for permission to touch her every time she was about to do so. To me that shows respect to another level. She ordered a complete laboratory studies, vision test, urine test, chest x-ray, bone density test, and a pap smear.

Health disparities emerge and persist through complex mechanisms that include socioeconomic, environmental, and system-level factors. To accelerate the reduction of health disparities and yield enduring health outcomes requires broader approaches that intervene upon these structural determinants. (Brown et al., 2019) Disparities in health and health care not only affect the groups facing disparities, but also limit overall gains in quality of care and health for the broader population and result in unnecessary costs. Addressing health disparities is increasingly important as the population becomes more diverse. However, the healthcare system is still looking for ways to bring these communities to actively participate in their own health prevention program and in return will ameliorate their health. Recent policy changes and current priorities may lead to coverage declines moving forward. Beyond coverage, there are an array of other challenges to addressing disparities, including limited capacity to address social determinants of health, declines in funding for prevention and public health and health care workforce initiatives, and ongoing gaps in data to measure and understand disparities. (Provencio-Vasquez & Thomas, 2009)

References

Provencio-Vasquez, E., & Thomas, T. (2009). Health Disparities: Often More Questions Than Answers. Hispanic Health Care International, 7(2), 58–59. https://doi.org/10.1891/1540-4153.7.2.58

Brown, A. F., Ma, G. X., Miranda, J., Eng, E., Castille, D., Brockie, T., Jones, P., Airhihenbuwa, C. O., Farhat, T., Zhu, L., & Trinh-Shevrin, C. (2019). Structural Interventions to Reduce