Ebook The itensivist''s challenge: Part 2
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Ebook The itensivist''s challenge: Part 2
Chapter 9Race and the ICUErrington c. ThompsonI'm standing in line at a relatively crowded local restaurant. My stethoscope is around my neck because, Ebook The itensivist''s challenge: Part 2, like my wedding ring, it seems I never take it off. I also have my ID badge from the hospital clipped on to my blue blazer. A short middle-aged man yells from across the restaurant. "Mr. Thompson!” Almost nobody calls me Mr. Thompson. Friends will call me. “Errington" and others will call me. “Dr. Ebook The itensivist''s challenge: Part 2 Thompson.” I reply, “Yes?” The man walks over to me as he says. “Did you go to Stale?” “I grew up in Dallas and went to college at Emory University iEbook The itensivist''s challenge: Part 2
n Atlanta.” A real curious look came across this man’s face. He was initially sure that I was someone he used to know now he isn't so sure.Mistaken idChapter 9Race and the ICUErrington c. ThompsonI'm standing in line at a relatively crowded local restaurant. My stethoscope is around my neck because, Ebook The itensivist''s challenge: Part 2hite medical jacket in the hospital, it was relatively common for someone to say. “Hi Dr. So-and-So.” Dr. So-and-So is a black physician and I am also a black physician. Il isn't that we look the same. We do not. I am relatively tall at 6’ 2” and Dr. So-and-So is short and stocky. For the most part. Ebook The itensivist''s challenge: Part 2 I would like to think that these people are trying to be friendly but don't take the lime to really focus on facial features.In 2OƠ2. the Institute oEbook The itensivist''s challenge: Part 2
f Medicine released Unequal Treatment [2]. This was a critical indictment of the medical community with regard to race and ethnic disparities. There wChapter 9Race and the ICUErrington c. ThompsonI'm standing in line at a relatively crowded local restaurant. My stethoscope is around my neck because, Ebook The itensivist''s challenge: Part 2many cases, are unacceptable.•Finding 2-1: Racial and ethnic disparities in healthcare occur in the context of broader historic and contemporary social and economic inequality and evidence of persistent racial and ethnic discrimination in many sectors of American life.E.c. Thompson. MDDepartment of Ebook The itensivist''s challenge: Part 2Surgery. Marshall University.1600 Medical Center Dr. Suite 2500. Huntington. wv 25705. USAe-mail: thompsoner@marshall.edu: erringtonthompson@gmail.comEbook The itensivist''s challenge: Part 2
© Springer International Publishing Switzerland 201675D. Crippen (ed.). The Intensivist’s Challenge: Aging and Career Growth...M.-.J,Í/,nni in inni/mcChapter 9Race and the ICUErrington c. ThompsonI'm standing in line at a relatively crowded local restaurant. My stethoscope is around my neck because, Ebook The itensivist''s challenge: Part 2ization managers - may contribute to racial and ethnic disparities in healthcare.•Finding 4-1: Bias, stereotyping, prejudice, and clinical uncertainty on the part of healthcare providers may contribute to racial and ethnic disparities in healthcare. While indirect evidence from several lines of rese Ebook The itensivist''s challenge: Part 2arch supports this statement, a greater understanding of the prevalence and influence of these processes is needed and should be sought through researEbook The itensivist''s challenge: Part 2
ch.•Finding 4-2: A small number of studies suggest that racial and ethnic minority patients are more likely than white patients to refuse treatment. TChapter 9Race and the ICUErrington c. ThompsonI'm standing in line at a relatively crowded local restaurant. My stethoscope is around my neck because, Ebook The itensivist''s challenge: Part 2s.Several years ago. I was sitting in an ethics committee meeting. We were receiving a lecture on healthcare disparities. One of my colleagues raised his hand to ask why we were listening to this lecture. He stated clearly that he had never discriminated against a patient nor anyone else in his life Ebook The itensivist''s challenge: Part 2. He actually said that this lecture was a waste of his time.Now. 1 am not sure if my colleague was being facetious or not. He seemed to be serious. REbook The itensivist''s challenge: Part 2
ace and ethnicity are touchy subjects in American society. Nobody wants to be called a racist. Nobody wants to be labeled as a physician, healthcare pChapter 9Race and the ICUErrington c. ThompsonI'm standing in line at a relatively crowded local restaurant. My stethoscope is around my neck because, Ebook The itensivist''s challenge: Part 2that supposes prejudice may actually have a survival advantage. When we were living in small clans, it was critically important for US to be able to recognize the members of our clan. Think about it. If a stranger comes up to your group, more bad things can happen than good things. A stranger can ta Ebook The itensivist''s challenge: Part 2ke your food. A stranger can take your women. A stranger can injure or murder your men. All of these bad things can be avoided by recognizing strangerEbook The itensivist''s challenge: Part 2
s and avoiding them. On the other hand, clans are excellent at spreading tradition. In a small clique, you can tell your cousins, your offspring, and Chapter 9Race and the ICUErrington c. ThompsonI'm standing in line at a relatively crowded local restaurant. My stethoscope is around my neck because, Ebook The itensivist''s challenge: Part 2 clear that we all have prejudices. Whether we are prejudiced when it comes to race or hair color or obesity or whatever, we do have prejudices and those prejudices can color our judgment.The trauma literature has tons of articles which correlate the severity of injury to mortality. The Injury Sever Ebook The itensivist''s challenge: Part 2ity Score [5], which has been used for years, basically takes injuries and scores them. The higher the injury severity score, the higher the likelihooEbook The itensivist''s challenge: Part 2
d of death. Yet. Cornwell et al. investigated the National Trauma Databank, and their results were published in 2008 [6Ị. The authors looked at insuraChapter 9Race and the ICUErrington c. ThompsonI'm standing in line at a relatively crowded local restaurant. My stethoscope is around my neck because, Ebook The itensivist''s challenge: Part 2 8.2 %. The mortality rate for Hispanics was 9.1 %. When whites were compared to blacks or Hispanics, they had a statistically significant lower mortality rate. The mortality rate was almost twice9 Race and the ICU77for uninsured patients versus insured patients (4.4 % and 8.6 %). This was statistic Ebook The itensivist''s challenge: Part 2ally significant (/?<0.005). Even when the authors adjusted for injury severity, blacks and Hispanics with insurance had a higher mortality rate thanEbook The itensivist''s challenge: Part 2
did white patients with insurance. This data clearly suggests that insurance status and race play a very important role in mortality. Here’s the crazyChapter 9Race and the ICUErrington c. ThompsonI'm standing in line at a relatively crowded local restaurant. My stethoscope is around my neck because, Ebook The itensivist''s challenge: Part 2er the trauma system in the field, patients are being placed in one protocol or another. If the patient is hypotensive and a victim of blunt trauma, we have one protocol. If the patient is normotensive with penetrating trauma, they are in a different protocol. How can patients who are being taken ca Ebook The itensivist''s challenge: Part 2re in extensively researched evidence-based protocols have racial disparities?Over the last 20 years, protocols have sprung up in the ICƯ. The SurviviEbook The itensivist''s challenge: Part 2
ng Sepsis Campaign is one such protocol. This protocol is fairly simple and is supported by the Society of Critical Care Medicine and the Centers for Chapter 9Race and the ICUErrington c. ThompsonI'm standing in line at a relatively crowded local restaurant. My stethoscope is around my neck because, Ebook The itensivist''s challenge: Part 2ocess, and to adequately resuscitate the patient early and aggressively. Again, much like in the trauma population, there really should not be any healthcare disparities in patients with sepsis.A.M. Esper and colleagues investigated patients who were entered into the National Hospital Discharge Surv Ebook The itensivist''s challenge: Part 2ey from 1979 through 2003 (the majority of these patients probably were not included in any nationwide sepsis protocol) 19]. There were over 12 millioEbook The itensivist''s challenge: Part 2
n reported cases of sepsis during the 25-year study timeframe. The main hospital length of stay for sepsis was higher for blacks than for whites. The Chapter 9Race and the ICUErrington c. ThompsonI'm standing in line at a relatively crowded local restaurant. My stethoscope is around my neck because, Ebook The itensivist''s challenge: Part 2he Journal of Critical Care Medicine, Dombrovskly et al. studied all patients with a diagnosis of sepsis in New Jersey in 2002 [10]. Although their data set was significantly smaller than Esper’s, they still identified over 24,000 patients who were admitted with a diagnosis of sepsis. The authors fo Ebook The itensivist''s challenge: Part 2und the relative risk of sepsis in black patients was greater than that of white patients. There was a difference in the relative risk in different agEbook The itensivist''s challenge: Part 2
e categories, but the risk remained larger for blacks than whiles for all age groups. The age-adjusted fatality rates for blacks and whites were not sChapter 9Race and the ICUErrington c. ThompsonI'm standing in line at a relatively crowded local restaurant. My stethoscope is around my neck because, Ebook The itensivist''s challenge: Part 2sis of sepsis. The length of stay both in the hospital and in the ICƯ was greater for blacks than for whites.Exactly what are we try ing to do with this data anyway? With most investigations, the researchers are trying to improve outcomes. Are we really trying to improve outcomes for a specific mino Ebook The itensivist''s challenge: Part 2rity group? Are we really trying to improve care for blacks and Hispanics alone? By studying these discrepancies, can we improve care for all patientsEbook The itensivist''s challenge: Part 2
? My somewhat sheepish answer is. “I do not know.” If. on the other hand, our goal is to simply point out that these discrepancies exist. I am not surGọi ngay
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