When we think about improving minority health, we rarely think of clinical trials and research. But we should. To move closer to health equity, we must increase the participation of diverse communities in clinical trials.
Clinical trials are essential in determining whether a drug is ready for mass consumption, as well as revealing important information for doctors and patients about prevention, diagnostic and treatment methods. They can also help shed light on whether there are unique bio-markers across the different groups the product is being provided to.
As the ancient Roman poet Virgil wisely observed, “The greatest wealth is health.” However, health is an issue that usually is approached reactively—not proactively— by Hispanic older adults because they simply face too many competing basic needs. This presents a challenge when it comes to health promotion among Latino seniors. Telling them to “eat healthy” or “do more exercise” is meaningless when food insecurity, hunger, chronic disease and transportation are top of mind.
Analysts doing quality assurance exercises generally ask questions such as “Were the right tests ordered? Were the right drugs or other treatments prescribed?” And, of course, “Did the patient get better?” But a different question usually goes unasked, because it is so hard to answer from medical records: “What is the quality of the doctor-patient relationship?” In many cases, the doctor-patient relationship may be the most important element in identifying and treating the patient’s problem. Is the patient depressed? Are there stressors in the patient’s life that are causing symptoms?
My best clinical shifts are the ones where I know that I am on the same page as my patient and I make clinical decisions incorporating principals of shared decision-making. Emergency medicine presents a unique challenge to the doctor/patient relationship. The first challenge is that patients almost never “want” to be in the emergency department (ED). They typically come reluctantly because they are in need of help for their acute medical problem. The second challenge is the ED is a chaotic environment.
A strong doctor-patient relationship can make all the difference in a patient’s treatment and quality of care. In my experience, abiding by a few key principles goes a long way in building a relationship that enables a more successful diagnostic and therapeutic regimen.
The first, and arguably most important principle for me, is to see each patient as a person rather than a patient with cancer. Making them feel comfortable that I’m concerned about their disease process and ready to get through it as a team helps build trust from the beginning.