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Disparities/Minority Health

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Efforts to help physicians improve care for underserved patients should address issues of communication and respect

Underserved patients are typically defined by poverty, transportation problems, poor literacy or limited English proficiency, and different race, ethnicity, or culture from their providers. Recent focus groups with these patients and their doctors revealed the importance to them of communication, respect, and cultural issues, as well as their frustration with health insurance, transportation, and health delivery systems. Medical curricula to teach care of the underserved, which currently focuses on medical diagnoses, should address these issues as well, according to lead study author Wendy L. Hobson, M.D., M.S.P.H., of the University of Utah.

In a study that was supported in part by the Agency for Healthcare Research and Quality (HS11826), the researchers conducted two patient focus groups, one for Spanish-speaking and one for English-speaking individuals, and one physician group of five pediatricians and three family practitioners. They addressed the question, "What does a physician need to know to care for the underserved?" to inform curricula to train residents to care for the underserved.

Many participants said that their doctors did not listen and often interrupted them or offered a diagnosis before they had finished talking. Many also expressed concern about the rudeness of front desk office staff. Patients wanted to be able to see the same doctor each time, were concerned about the cost of medical care, did not know how to access public resources, and lacked knowledge about Medicaid and Medicare. On the other hand, physicians were concerned with language barriers and felt that underserved patients often did not know how to communicate. Doctors wanted to know better how to show respect for underserved patients (many felt they knew little about specific cultures), and they wanted more time to establish quality patient relationships.

More details are in "Caring for the underserved: Using patient and physician focus groups to inform curriculum development," by Dr. Hobson, Roberto Avant-Mier, Ph.D., Susan Cochella, M.D., M.P.H., and others in the March 2005 Ambulatory Pediatrics 5(2), pp. 90-95.

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