Recently, a close family member was rushed to the hospital after suddenly becoming ill. After a basic evaluation in the emergency room, he was transported to the intensive care unit for further testing and treatment. Upon receiving the call from his significant other, whom accompanied him to the hospital, not-surprisingly my immediate questions were: What do they think is going on? What tests and treatments are they administering?
Her reply was: Well they haven’t told us anything yet. They’re running some tests and giving him some medication for pain, but that’s all I know at this point. We haven’t spoken to a doctor since he’s left the emergency room.
As a family member who happens to be a physician, conversations like this are extremely frustrating because I know better. I know that physicians and other health care providers are taught to routinely formulate an Assessment and Plan for each patient encounter that they have. Sometimes referred to as an Impression, the Assessment consists of a differential diagnosis, which is a list of potential causes of a patient’s problem in order of perceived certainty. The Plan is exactly that – what the care team plans to do to confirm and then treat the cause of the problem.
I know that the lead physician on the care team should have briefed my loved ones as to what the Assessment and Plan was. I know that not only is this good “customer service,” it is humanistic decency to give patients complete, up-to-date information as to what is going on and to assure them that the care team is diligently working on their behalf. Unfortunately however, this is often times not the case in health care settings, particularly for patients of color.
As in many other industries, overt and unconscious racial bias is a big issue in health care and has been getting a lot of attention as of late. There have been a myriad of studies that show that such biases lead to unfavorable experiences and poor health outcomes for black patients. The good news is that racial bias is gradually being recognized and acknowledged on our end as providers, and medical schools and other health care training programs are implementing educational exercises to uncover and confront it. The bad news is that the system is still wrought with inequity, and there remains a lot of work to do.
The best thing you can do as a patient during a care experience is ask questions and make sure that your health care providers consistently give you appropriate, detailed, real-time information. When you go to a car dealership or a local body shop for car trouble, you expect the mechanic or representative to tell you what he thinks the problem could be and what he plans to do to confirm and fix the problem. The same expectation should be had in matters of your health and the health of your loved ones. Each time you leave the doctor’s office or hospital without being provided with at least some type of Assessment and Plan from the provider, a disservice has occurred. I know better. Now, so do you.
Kenneth G Poole, Jr, MD, MBA is a senior associate consultant at Mayo Clinic Arizona in the Division of Community Internal Medicine, and he is the Chair of Diversity and Inclusion for Mayo Medical School in Rochester, MN and Scottsdale, AZ. He previously practiced internal medicine in St. Louis.
