BackgroundHealth services research of Latinos with limited English proficiency (LEP) have largely focused on studying disparities related to patient-provider communication. Less is known about their non-provider interactions such as those with patient registration systems and clinic front office staff; these interactions precede the encounter with providers and may shape how comfortable patients feel about their overall health services experience. This study explored Latino patients with LEP experiences with, and expectations for, interactions with patient registration systems and front office staff.MethodsWe conducted 20 in-depth interviews with Latinos with LEP (≥18 years of age) who seek health services in the Piedmont Triad region, North Carolina. We analyzed participants’ quotes and identified themes by using a constant comparison method. This research was conducted by a community-academic partnership; partners were engaged in study design, instrument development, recruitment, data analysis, and manuscript writing.ResultsQualitative analysis allowed us to identify the following recurring themes: 1) inconsistent registration of multiple surnames may contribute to patient misidentification errors and delays in receiving health care; 2) lack of Spanish language services in front office medical settings negatively affect care coordination and satisfaction with health care; and 3) perceived discrimination generates patients’ mistrust in front office staff and discomfort with services.ConclusionLatino patients in North Carolina experience health services barriers unique to their LEP background. Participants identified ways in which the lack of cultural and linguistic competence of front office staff negatively affect their experiences seeking health services. Healthcare organizations need to support their staff to encourage patient-centered principles.
Catholic medical professionals face increasing challenges to adhering to the faith in the exercise of their professional functions. Growing opposition to traditional Church teaching—particularly with regard to issues of human sexuality and end-of-life care—threaten faithful Catholic clinicians with a form of “white martyrdom,” characterized by loss of professional standing. Threats to rights of conscience come from various segments of contemporary society, including professional medical societies and publications that increasingly resemble strident activists rather than dispassionate and measured consensus-builders. Reflection on the relationship between counter-culturalism and joy can be a source of strength for those Catholic physicians facing opposition based on their adherence to the faith in their practice. A review of the historical developments of Christian medicine highlights its counter-cultural stance in contrast to the ancient Greco-Roman traditions that preceded it. Counter-cultural figures such as Ss. Cosmas and Damian, St Basil, and St Philip Neri serve as examples of courageous Christian counter-cultural witnesses in their times. Additionally, St Philip Neri’s cheerful ministry in Rome also exemplifies Christian joy as a means of evangelizing in the midst of a culture in decline (as was the Eternal City in the 16th century). The lives of saints who suffered for the Faith remind us that being counter-cultural has consequences. While being called to “speak the truth in love” (Ephesians 4:15), Catholic medical professionals are to show compassion in words and actions as the singular signs of a faithful Christian.
In our family medicine program, applicants' personal statements largely speak to the value of trusting, continuous doctor‐patient relationships. They give poignant examples of patient interactions that have allowed the applicants to experience the privilege of the intimacy with which patients relate to their doctors. Whatever their true motivations for choosing family medicine, the relational values expressed in the personal statement are the ones we celebrate and incentivize in the residency selection process. However, after donning their freshly pressed white coats, new interns in family medicine hear different definitions of value applied to their chosen specialty.
To the Editor The Viewpoint by Dr Adashi and colleagues 1 raised several criticisms of direct primary care (DPC) that ignored the context in which DPC has emerged. Direct primary care has evolved in affirmation of the primacy of the patient-physician therapeutic relationship and rejection of bureaucratic and economic burdens on clinicians.The authors' suggestion that DPC practices promote adverse selection biases favoring wealthy, healthy, and nonminority patients relies on a false conflation of DPC and concierge practices. Unlike the dominant third party-based model or concierge practices that bill insurance, DPC practices relying on a flat monthly fee are not financially motivated to select patients based on health or socioeconomic status. In fact, DPC practices aim to provide as broad a scope of care as possible on the premise that individuals have the capacity to vote with their feet.The authors suggested that DPC would exacerbate gaps in the cost of care. However, out-of-pocket costs for mandated insurance products have ballooned for US households. 2 For many uninsured and underinsured persons, DPC practices are an economically feasible option that provides access to longitudinal primary care.The claim that DPC "lacks the necessary oversight needed to hold physicians accountable for data reporting as well as individual and population health outcomes" 1 is at odds with the central tenet of the clinician's fiduciary responsibility 3 -to place the patient's interests above others, including data reporting and population health outcomes.
Western medicine developed as an expression of Christian charity and played a large role in the growth of the early church. Despite its original foundation in Christian moral principles, modern medicine has deviated from its origins. The principles of human dignity, solidarity, and subsidiarity have been subjugated to a materialist and transactional construct that forms the basis of the contemporary medical delivery and financing systems. The dehumanization of both healthcare practitioners and patients by the partnership of governmental and corporate entities, and the use of health care as a political instrument, has debased the original mission of the medical profession and represents an affront to the principles of Catholic social teaching (CST). This essay explores the ways in which the US medical delivery and financing systems violate the principles of CST by means seldom recognized due to the inurement of the public and medical professionals. By examining the prevailing healthcare model through the lens of CST, the author illustrates the ways in which CST principles are systematically violated. This analysis serves as the foundation of a Catholic response to the question of how faithful Christians might live out their calls to holiness through the exercise of their professional vocations. A vision of an invigorated model of medicine as vocation, along with illustrative examples, is presented. By exemplifying the principles of human dignity, solidarity and subsidiarity in health care, Christians can seize a golden opportunity for evangelization by rearticulating the historical spiritual mission of Western medicine.
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