Most medical care takes place outside of the physician-patient encounter. Phlebotomy in the lab, “clean catch” urines, EKG’s, colonoscopy preps, mammography, and nasopharyngeal swabbing all happen when the physician is busy elsewhere. If there is a delay between the order and the completion of this task then the interpreter for that encounter has often moved on to the next encounter. Each site (i.e. the lab, the MA, radiology) then calls an interpreter for very routine tasks that are discrete, quick, and often require some demonstration.Continue reading
Among the health disparities prevalent among asylum seekers, refugees and immigrants is a history of political violence in the form of imprisonment, war fare, interrogation, threats and torture. You will find that this experience is shared by Vietnamese survivors of the re-education camps, Egyptian students, gay men from Pakistan, Ethiopian shopkeepers, Angolan obstetricians, and the political opposition from Congo. In the diversity of occupation, gender and ethnicity is a shared experience of a violent suppression of democracy that plays itself out in their lives through dislocation, chronic pain and disease, sometimes for decades.Continue reading
Being poor can be like treading water with the waterline right under your nose. The slightest ripple and you choke, a wave will submerge you. The novel coronavirus pandemic is a tsunami for those living in poverty. As a recent New York Times article illustrates, communities living in crowded conditions, with uncontrolled chronic diseases like diabetes and hypertension, marginalized by the lack of comprehensible health information, and mistrusting the current systems to treat them fairly will be disproportionately ravaged by Covid-19. We have seen this in the past with tuberculosis, HIV, and hepatitis B. But the novel coronavirus acts faster and in some cases more aggressively and so reveals disparities even more dramatically.Continue reading
Migrants exist in two worlds simultaneously: one in the country of asylum and the other through their calls, connections, and visits, to the people back home. Global warming is changing both worlds; in fact it is why many have been forced to migrate. Recently, world representatives met in Poland to coordinate efforts to address climate change. As they acknowledge it is almost too late, many realize the stakes are far too high to trust politicians alone to handle the broad cultural changes needed to address environmental collapse.Continue reading
With co-authors Maggie Cheng, Staff Attorney, Northwest Immigrant Rights Project and Elizabeth E. Dawson-Hahn, MD MPH Attending Physician, Harborview Medical Center and Seattle Children’s Hospital.
The trust between physician and patient is a core tenant of the medical profession. By extension, trusting relationships with nurses,technicians, hospitals and clinics are where this relationship plays out. This trust is now threatened by U.S. Immigration and Customs Enforcement (ICE). In a startling breach of precedent, ICE agents have begun to target clinics and hospitals to enforceimmigration policy. It is our opinion that these enforcement actions actively jeopardize patient care.Continue reading
Fourteen years ago the Institutes of Medicine published Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Among their recommendations was the observation that to find disparities in care, health systems must first collect Race, Ethnicity, and Language (REAL) data at registration. Many health systems across the country began to make this effort. But then in 2008 the economy collapsed and health systems found themselves launching a rearguard effort to shore up their IT and EMR departments as budgets were cut and IT work forces downsized.Since then, the Affordable Care Act was passed and equity became a pillar of care. Electronic medical records were enhanced and since have evolved to facilitate the sharing of medical information.Continue reading