Mapping out epistemic justice in the clinical space: using narrative techniques to affirm patients as knowers

AbstractEpistemic injustice sits at the intersection of ethics, epistemology, and social justice. Generally, this philosophical term describes when a person is wrongfully discredited as a knower; and within the clinical space, epistemic injustice is the underlying reason that some patient testimonies are valued above others. The following essay seeks to connect patterns of social prejudice to the clinical realm in the United States: illustrating how factors such as race, gender identity, and socioeconomic status influence epistemic credence and associatively, the quality of healthcare a person receives.After describing how epistemic injustice disproportionately harms already vulnerable patients, I propose a narrative therapy intervention. This intervention can help providers re-frame their relationships with patients, in such that they come to view patients as valuable sources of unique knowledge. Though I identify this intervention as a valuable step in addressing clinical epistemic injustice, I call upon medical educators and practitioners to further uplift the voices, perspectives, and stories of marginalized patients.

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Association of patients’ perception of quality of healthcare received and colorectal cancer screening uptake: An analysis of two national surveys in the United States

Medical Principles and Practice ◽

10.1159/000512233 ◽

2020 ◽

Author(s):

Karan Chawla ◽

Angesom Kibreab ◽

Victor & Scott ◽

Edward L. Lee ◽

Farshad Aduli ◽

...

Keyword(s):

Colorectal Cancer ◽

United States ◽

Healthcare Delivery ◽

Quality Of Healthcare ◽

Healthcare Services ◽

The United States ◽

Crc Screening ◽

Fair Poor ◽

National Trends

Objective: It is unknown whether patients’ ratings of the quality of healthcare services they receive truly correlate with the quality of care from their providers. Understanding this association can potentiate improvement in healthcare delivery. We evaluated the association between patients’ ratings of the quality of healthcare services received and uptake of colorectal cancer (CRC) screening. Subject and Methods: We used two iterations of the Health Information National Trends Survey (HINTS) of adults in the United States. HINTS 2007 (4,007 respondents; weighted population=75,397,128) evaluated whether respondents were up-to-date with CRC screening while HINTS 4 cycle 3 (1,562 respondents; weighted population=76,628,000) evaluated whether participants had ever received CRC screening in the past. All included respondents from both surveys were at least 50 years of age, had no history of CRC, and had rated the quality of healthcare services that they had received at their healthcare provider’s office in the previous 12 months. Results: HINTS 2007 data showed that respondents who rated their healthcare as good, or fair/poor were significantly less likely to be up to date with CRC screening compared to those who rated their healthcare as excellent. We found comparable results from analysis of HINTS 4 cycle 3 data with poorer uptake of CRC screening as the healthcare quality ratings of respondents’ reduced. Conclusion: Our study suggested that patients who reported receiving lower quality of healthcare services were less likely to have undergone and be compliant with CRC screening recommendations. It is important to pay close attention to patient feedback surveys in order to improve healthcare delivery.

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Recruiting Racially Minoritized Students to Optometry School

The Advisor ◽

10.47578/0736-0436.41.4.7 ◽

2021 ◽

Vol 41 (4) ◽

Author(s):

Christian Alberto ◽

Guilherme Albieri

Keyword(s):

Best Practices ◽

Career Paths ◽

Health Professions ◽

Quality Of Healthcare ◽

The United States ◽

Cultural Wealth ◽

Professional Career ◽

Admissions Process

Abstract Enrollment inequities among racially minoritized (RM) students is an ongoing challenge facing health professions programs in the United States, including optometry schools. Consideration of RM students’ representation in health professions programs is essential for long-term improvement in access to and quality of healthcare for RM patients. Prehealth and undergraduate advisors assist students in navigating graduate and professional career paths. Data collected by ASCO on the nationwide matriculation survey reveal prehealth advisors rank third most important in navigating the admissions process for optometry after practicing optometrists and admissions representatives. Prehealth advisors, therefore, are central to generating the optometry school pipeline, inclusive of students from RM backgrounds. This article therefore explores the question “How can prehealth advisors help attract their RM students to optometry?” by approaching best practices in prehealth advising utilizing Yosso’s (2005) Community Cultural Wealth theoretical framework. The recommendations offered in response to the question center on the lived experiences of RM students and identify/acknowledge the strengths inherent among recruiting them to optometry school. The empowering nature of the approach has positive implications on strengthening aspiration, application, and enrollment in optometry schools or health professions broadly.

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Patient Centric Healthcare InformationSystems in the U.S.

Encyclopedia of Information Ethics and Security ◽

10.4018/978-1-59140-987-8.ch074 ◽

2011 ◽

pp. 498-506

Author(s):

Nilmini Wickramasinghe

Keyword(s):

Quality Of Healthcare ◽

The United States ◽

Final Report ◽

Institute Of Medicine ◽

High Quality ◽

Quality Healthcare ◽

Improving Patient Care ◽

The U.S ◽

Patient Centric

Healthcare expenditure is increasing exponentially, and reducing this expenditure (i.e., offering effective and efficient quality healthcare treatment) is becoming a priority not only in the United States, but also globally (Bush, 2004; Oslo Declaration, 2003;Global Medical Forum, 2005). In the final report compiled by the Committee on the Quality of Healthcare in America (Institute of Medicine, 2001), it was noted that improving patient care is integrally linked to providing high quality healthcare.

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If Roth Were a Doctor: Physician Reputation under the HCQIA

American Journal of Law & Medicine ◽

10.1177/009885880403000104 ◽

2004 ◽

Vol 30 (1) ◽

pp. 85-100 ◽

Cited By ~ 3

Author(s):

Guillermo A. Montero

Keyword(s):

United States ◽

Peer Review ◽

Health Care Quality ◽

Data Bank ◽

Quality Of Healthcare ◽

The United States ◽

Care Quality ◽

Disciplinary Action ◽

Health Care Quality Improvement

Hospitals in the United States rely on peer review committees to make credentialing decisions and to conduct ongoing evaluations of all medical care, thereby ensuring the quality of the physicians they employ. Physicians, however, may be reluctant to serve on peer review committees for fear of retaliatory litigation. In response, and in an effort to improve the quality of healthcare in the United States, Congress passed the Health Care Quality Improvement Act of 1986 (“HCQIA”).Congress designed the HCQIA to improve the quality of healthcare in two ways. First, it increased the effectiveness of peer review by providing review committees with immunity from lawsuits filed in response to professional review actions. Second, it authorized the Secretary of Health and Human Services (“HHS”) to create the National Practitioner's Data Bank (“NPDB”). Any disciplinary action taken by a review committee must, as a condition to immunity, be reported for listing in the NPDB.

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The Nature and Role of Perceived Threats in User Resistance to Healthcare Information Technology

International Journal of Healthcare Information Systems and Informatics ◽

10.4018/ijhisi.20210701.oa2 ◽

2021 ◽

Vol 16 (3) ◽

pp. 21-45

Author(s):

Madison N. Ngafeeson ◽

Joseph A. Manga

Keyword(s):

Information Technology ◽

Quality Of Healthcare ◽

The United States ◽

United States Government ◽

Healthcare Information ◽

User Resistance ◽

Reactance Theory ◽

Psychological Reactance Theory

The efforts of the United States government in the past 15 years have included harnessing the power of health information technology (HIT) to improve legibility, lessen medical errors, keep costs low, and elevate the quality of healthcare. However, user resistance is still a barrier to overcome in order to achieve desired outcomes. Understanding the nature of resistance is key to successfully increasing the adoption of HIT systems. Previous research has showed that perceived threats are a significant antecedent of user resistance; however, its nature and role have remained vastly unexplored. This study uses the psychological reactance theory to explain both the nature and role of perceived threats in HIT-user resistance. The study shows that perceived helplessness over process and perceived dissatisfaction over outcomes are two unique instances of perceived threats. Additionally, the results reveal that resistance to healthcare information systems can manifest as reactance, distrust, scrutiny, or inertia. The theoretical and practical implications of the findings are discussed.

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A Multicase Study Exploring Women’s Narratives of Infertility: Implications for Counselors

The Qualitative Report ◽

10.46743/2160-3715/2018.3510 ◽

2018 ◽

Author(s):

Staci Born ◽

Christin Carotta ◽

Kristine Ramsay-Seaner

Keyword(s):

Quality Of Healthcare ◽

Healthcare Services ◽

The United States ◽

Women’S Experiences ◽

Personal Variables ◽

Women's Experiences ◽

Women's Narratives ◽

Biological Health ◽

Multicase Study

Infertility affects 6.7 million women in the United States (Chandra, Copen, & Stephen, 2013). Women’s experiences with infertility are not only influenced by biological health factors, but also by social, cultural, and personal variables. Given the prevalence and complexity of infertility, additional research is needed to further examine the nuances of women’s experiences. The purpose of this multicase study, as informed by four individual cases, was to explore how women construct their infertility narratives. Review of reflective journals found five common elements: (1) Emotional Rollercoaster, (2) Mind-Body (Dis)Connection, (3) Secret Identity, (4) Supportive vs. Constrained Communication Patterns, and (5) Fatalistic- vs. Agency-Oriented Coping. Increasing our understanding of the whole experience of infertility, beyond the biological diagnosis, is essential to decreasing stigma and increasing the quality of healthcare services available for women.

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Sentinel Amenable Mortality: A New Way to Assess the Quality of Healthcare by Examining Causes of Premature Death for Which Highly Efficacious Medical Interventions Are Available

BioMed Research International ◽

10.1155/2018/5456074 ◽

2018 ◽

Vol 2018 ◽

pp. 1-15 ◽

Cited By ~ 1

Author(s):

Montse Vergara-Duarte ◽

Carme Borrell ◽

Glòria Pérez ◽

Juan Carlos Martín-Sánchez ◽

Ramon Clèries ◽

...

Keyword(s):

Causes Of Death ◽

Healthcare Quality ◽

Premature Death ◽

Quality Of Healthcare ◽

The United States ◽

Extensive Literature ◽

Medical Interventions ◽

Amenable Mortality ◽

Premature Deaths

Background. Amenable mortality, or premature deaths that could be prevented with medical care, is a proven indicator for assessing healthcare quality when adapted to a country or region’s specific healthcare context. This concept is currently used to evaluate the performance of national and international healthcare systems. However, the levels of efficacy and effectiveness determined using this indicator can vary greatly depending on the causes of death that are included. We introduce a new approach by identifying a subgroup of causes for which there are available treatments with a high level of efficacy. These causes should be considered sentinel events to help identify limitations in the effectiveness and quality of health provision.Methods. We conducted an extensive literature review using a list of amenable causes of death compiled by Spanish researchers. We complemented this approach by assessing the time trends of amenable mortality in two high-income countries that have a similar quality of healthcare but very different systems of provision, namely, Spain and the United States. This enabled us to identify different levels of efficacy of medical interventions (high, medium, and low). We consulted a group of medical experts and combined this information to help make the final classification ofsentinel amenable causes of death.Results.Sentinel amenable mortalityincludes causes such as surgical conditions, thyroid diseases, and asthma. The remaining amenable causes of death either have a higher complexity in terms of the disease or need more effective medical interventions or preventative measures to guarantee early detection and adherence to treatment. These included cardiovascular diseases, diabetes, hypertension, all amenable cancers, and some infectious diseases such as pneumonia, influenza, and tuberculosis.Conclusions.Sentinel amenable mortalitycould act as a good sentinel indicator to identify major deficiencies in healthcare quality and provision and detect inequalities across populations.

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