Brief Summary:

Giesbrecht argues that differences in social and personal factors can have significant impacts to one’s life and health, but research only tends to group people into general populations, which can cause important health data to get lost or overlooked. Other names for this are diversity based analysis, which focuses on differences between and within groups and how that affects life, and intersectionality, which is about relating two or more inequalities as they are experienced simultaneously. Sex, referring to anatomy, and gender, referring to personalities, social constructs, or behaviors, are the main categories that research typically uses, but there are also other social determinants of health like socioeconomic status, education, sexual orientation, race, ethnicity, and more. Recognizing and acknowledging the diversity of individuals can help to rectify inequity in health spheres, as treating an entire population equally is ineffective due to the unique lived experiences within smaller populations.

Hausman argues that egalitarians in regards to social policy are currently using a form of data collection about health inequalities that is ineffective, because they are unable to accurately find whether there is an injustice at hand that needs resolving. Having a health inequality can impact overall life prospects, and therefore be unjust, but not all inequalities result in injustice, and that’s where the lines get blurry. Quality adjusted life years of a certain demographic can help egalitarians pinpoint which groups of people tend to suffer more health issues, and therefore can lead to inferences about which populations have more injustices–but this system of using QALY isn’t that good because it leaves out whether the health inequality is compensable. When a health inequality is incompensable, it can be said that there is an injustice because that person is on an uneven playing field against the rest of society. Finally, Hausman gives an example for why basing injustice and general inequality on health inequality is in poor judgement: one can be poor but healthy, while another is wealthy but unhealthy. There are many inequalities between these two people, but going off of health would proclaim that there is little to none.

Discussion Questions:

• When would generalities about health be permissible, if at all?

• Is QALY a good way to measure inequality, and therefore injustice?

• When would an inequality constitute an injustice? 

• If a health inequality was compensable, would the person still face an overall (life prospects) inequality?

• Health inequalities differ throughout a life, so would we/how would we divide life into stages/age groups?

• Do SDH factors or sex/gender impact health more?

Summary of Discussion:

For question 1, the majority of the class agreed that generalities are permissible but only in certain amounts and for specific circumstances. For example, in the case of a 40 year old and an 80 year old with the same condition, it can be assumed that the 40 year old is better off because younger patients are generally healthier. Another perspective raised is that generalities are only justified when multiple ones are layered together or used as building blocks to help define the patient, rather than just using one big generality and fitting the patient in that box. Similarly, it was said that while generalities can help on a larger scale, it’s not as useful when dealing with individuals as everyone is different. A shared sentiment within the class was that generalities are permissible when not much is known about the patient, such as when first meeting them or having an unconscious patient. One person brought up the idea that generalities can be used in combination with statistics such as certain populations generally being more at risk for conditions, but the generality shouldn’t be taken as 100% certainty. On the other hand, generalities also shouldn’t be used to completely close out the possibility of a patient having a condition just because they aren’t in the population most at risk.

Question 2 opened up with people saying that the idea that someone can live a full year of perfect health is flawed, so QALY is inherently impaired. Even if someone were to not be in perfect health, it usually isn’t so bad that it would affect quality of life significantly like QALY suggests. It was brought up that a lot of health issues arise from treatable problems, so would it be correct to call something like a diabetic purposely eating sugar an injustice or just a bad choice? The class agreed that QALY is not appropriate or applicable to use because there is a diverse range of health issues while QALY is vague and incalculable. “Quality” is a generality because everyone has a different benchmark for what “good quality” means to them–according to QALY, disabled people are suffering, even when they themselves may be fully functional and happy. On a larger scale, like WHO reports, QALY is helpful, though not perfect, but when it comes down to individuals and their life choices, like a cancer patient rejecting treatment to be with family, QALY is not helpful.

The class began question 3 by defining injustice as a person having no control over their circumstances and the differences in their life cannot be rectified. Alternatively, if a person is able to do something about their situation it would be called an inequality. Inequalities and injustices are not the same, with an example being given of not having money to buy a salad vs. not being allowed to buy the salad (regardless of funds available). Injustices are systemic problems that aren’t within the scope of a physician because it involves greater social injustices, though those societal problems are a leading cause of health injustices. The conversation at this point then pivoted to talking about intersectionality and how it’s not very useful because it becomes so specific, and that intersectionality, though it intends to be less vague, it’s still susceptible to generalities about people with X and Y because multiple people can share X and Y but still be different, which just goes back to grouping people.

Response: 

Based on the discussion, I realized that a lot of reporting methods about health are very general, but that there’s no concrete way to rectify the problem. Adding onto the fact that if it was difficult for all people in our class to agree on definitions and treatments of inequalities, it would be near-impossible to find and execute a national or worldwide standard for what is acceptable in healthcare. I also noticed from the discussion that the class puts a lot of value on individual and patient-centered care, and while I also agree that it’s important to focus on each patient, I believe a paradox is at hand. The more a physician spends time giving top quality care to a patient, the busier a physician will be, leading to longer wait times before a patient will be attended to, resulting in lower care satisfaction. I bring this up to make the point that no physician and no treatment plan will ever be perfect, so instead of trying to make guidelines for what is or is not a generality, quality of life, or an injustice we should let doctors find out what works best for them and the community they serve.

Micaela Bravo

Dr. Emerson

IDMD 101

October 10, 2023

Half the Population, Half as Respected

Source Summary:

It is being found in research that women are statistically less likely to be taken seriously in medical settings compared to men complaining of the same ailments or showing the same symptoms. Due to the fact that women are more sensitive to pain and more expressive than their male counterparts, a lot of doctors–especially male ones–take their pain as an overexaggeration and lead to severe issues like women being 25% less likely to be given pain meds for the same affliction as a man. Many women have failed to even get past the diagnoses stage, as a significant amount have stepped forward with similar stories about their doctors not listening to them, insisting on not running tests, and some were even sent to psychiatrists for an illness that, when finally meeting a competent doctor, was found to be a severe disease of the body like cancer or a tumor.

Significance of the Phenomenon:

When leaving the doctor’s office, no one should ever feel worse than when they came in, yet somehow a woman was “told ‘shut up’ by a nurse because [she] was screaming too loud while [she] was in pain” (Bever). Empathy is a monumental part of healthcare and should be used in every patient interaction because creating a safe space where they feel heard can mutually benefit both physician and patient. Rather than the doctor having to read the mind of a closed-off patient in order to have enough information to make a diagnoses and begin treatment, it would be much easier if they just allowed the patient to feel they can share things without feeling judged or invalidated, leading to more information that may be relevant to their healthcare plan. 

Paying attention to a patient can also avoid situations where their physical condition gets to a point of no return, like when a woman was screaming in agony during a labor where she was supposed to be getting epidural, but after multiple times of her healthcare team dismissing her pain and assuring she was getting the max dose, it was found out that the epidural slipped out which led to needing an emergency C-section. An entire room of medical professionals failed her. Had they listened, really listened, to what she was telling them, that she could feel everything and was in severe pain, they would’ve realized their mistake before her body gave out, which in the end costed the medical team more time and effort and the woman more money than originally needed. 

Additionally, being empathetic means to not discredit someone based on their appearance, but “research found that half of white med students and residents were more likely to underestimate black people’s pain,” leading to situations like a black woman with a chronic illness needing to change into her “Sunday best” in order to not be prejudiced or portrayed “as a drug seeker” (Bever). To immediately cast-off the pains of a human being just for wearing more worn-out clothes, or for having darker skin, or for being a woman is terrible and should not be as common as it is. 

Yes, in more recent times there have been steps forward in understanding female experiences of pain, but one would think “recent times” refers to the past hundred years. It was only in 2016 that the National Institutes of Health required most medical research to consider sex as a biological variable. Only 7 years ago. Half of the world population is female, and yet only 43% of medical students said their curriculum taught sex and gender differenes in medicine. Being taught to be understanding of people’s differences is surprisingly not as present in medical spheres as it should be. It all comes back to having empathy and being able to truly listen to patients when they keep coming back to their physician in indescribable agony. “[Empathy is] not enough for someone to have a sympathetic manner or use a caring tone,” as a doctor must actually take the time to listen and understand what their patient is going through (Jamison). Women may be more sensitive to pain, but that does not negate the fact that they are still feeling pain, and should not be cast away and told “it was all in [their] head” (Bever). 

A worse act though, more than not properly treating a patient, is to refuse to even run tests when asked multiple times by a patient with severe symptoms. If a patient has reasonable suspicion that they are ill and has no qualms with any risks involved in the process of running an exam, they should not be turned away because the physician thinks the patient is overexaggerating their condition. In other words: “you treat the pain that the patient has, not the pain that you think the patient should have” (Bever). It is wrong to decide that a patient is not suffering severely enough to have a severe disease, and keep them from proper diagnoses and treatment. Exams may also be refused due to paternalism and the doctor worrying about the patient’s well-being if they receive either a false negative or positive, and though this case is better than the ignorance case, it is still not right. 

The Effect:

The terrible stories of women who went through years of being denied proper medical care having been published through a massive publication such as The Washington Post is bound to make waves. Women with similar experiences can read those of other women in the submission board of the article and find that they are not alone, and they are not crazy. A lot of doctors chalk up female pain to be hormones, dramatization, mental illness, or a combination of the three, when in reality the patients who go to health offices seeking treatment or answers for their ailments are valid concerns that should be respected as such. After experiencing being shut-out by the person who is supposedly there to help you, many women “start to doubt [themselves]” and may be less averse to going back to seek medical attention until the pain becomes “unbearable,” and by then their illness may have permanent effects. Women should take back the reigns as “the owner of [their] health” and “go with their gut” when they feel something is wrong, and “if [their] provider does not appear to be listening to [them] or believing what [they’re] saying,” instead of feeling like their concerns are unimportant, they should get “a new provider” (Bever).

Works Cited

Bever, Lindsey. “From Heart Disease to Iuds: How Doctors Dismiss Women’s Pain.” The Washington Post, WP Company, 13 Dec. 2022, www.washingtonpost.com/wellness/interactive/2022/women-pain-gender-bias-doctors/. 

Jamison, Leslie. “Empathy Exams.” Https://Alabama.App.Box.Com/s/Kukl2jf235eikdd5x8tjcgq2tuot5ejk, Box.