Health care for the poor—An exploration of primary-care physicians’ perceptions of poor patients and of their helping behaviors

Monnickendam, Menachem; Monnickendam, Shlomo M.; Katz, Chana; Katan, Joseph

doi:10.1016/j.socscimed.2006.11.033

Cited by 26 publications

(25 citation statements)

References 48 publications

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“…Black residents felt more positively about both their clinics and their effectiveness. An Israeli study has looked closely at the role of physicians' international ethnicities, attitudes, and behaviors in caring for poor patients [45], but the moral complexities of interactions between international medical graduates and the diverse poor populations in the United States have received scant attention [46]. Unsurprisingly, patients at risk of moral judgment, including those who are poor, undereducated, and/or African-American, pay significantly more attention to impression management than do other patients [47].…”

Section: Methodsmentioning

confidence: 99%

How clinicians make (or avoid) moral judgments of patients: implications of the evidence for relationships and research

Hill

2010

Philos Ethics Humanit Med

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Physicians, nurses, and other clinicians readily acknowledge being troubled by encounters with patients who trigger moral judgments. For decades social scientists have noted that moral judgment of patients is pervasive, occurring not only in egregious and criminal cases but also in everyday situations in which appraisals of patients' social worth and culpability are routine. There is scant literature, however, on the actual prevalence and dynamics of moral judgment in healthcare. The indirect evidence available suggests that moral appraisals function via a complex calculus that reflects variation in patient characteristics, clinician characteristics, task, and organizational factors. The full impact of moral judgment on healthcare relationships, patient outcomes, and clinicians' own well-being is yet unknown. The paucity of attention to moral judgment, despite its significance for patient-centered care, communication, empathy, professionalism, healthcare education, stereotyping, and outcome disparities, represents a blind spot that merits explanation and repair. New methodologies in social psychology and neuroscience have yielded models for how moral judgment operates in healthcare and how research in this area should proceed. Clinicians, educators, and researchers would do well to recognize both the legitimate and illegitimate moral appraisals that are apt to occur in healthcare settings.

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Section: Methodsmentioning

confidence: 99%

How clinicians make (or avoid) moral judgments of patients: implications of the evidence for relationships and research

Hill

2010

Philos Ethics Humanit Med

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“…The scientific literature provides data on difficulties encountered by health professionals who treat people living in poverty, but there is a serious lack of evidence on overcoming those difficulties (Stewart et al, 2005;Monnickendam et al, 2007). Our study may be the first to describe how some dentists develop a socio-humanistic approach that includes understanding patients' social context, taking time and showing empathy, avoiding moralistic attitudes, overcoming social distances, and favoring direct contact.…”

Section: Discussionmentioning

confidence: 88%

Providing Humanistic Care

et al. 2010

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Communication barriers severely reduce the effectiveness of oral health care provision to people living in poverty. Our objective was to identify specific approaches and skills developed by dentists for more effective treatment of people living in poverty and addressing their needs. We conducted qualitative research based on in-depth interviews with eight dentists practicing in disadvantaged communities of Montreal, Canada. Analyses consisted of interview debriefing, transcript coding, and data interpretation. Results revealed that, over years of practice, these dentists had developed a five-faceted socio-humanistic approach that involved: (1) understanding patients' social context; (2) taking time and showing empathy; (3) avoiding moralistic attitudes; (4) overcoming social distances; and (5) favoring direct contact with patients. This approach is original, and, even though participants found it successful, it should be evaluated in terms of its impact for access to services and patients' experience of care.

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“…An understanding of Medicaid's role as a resource for pregnant women is key in determining how to improve access to care, assess quality of care, and implement effective and lasting maternity care reform [25] . While previous research has indicated that patients of lower socioeconomic status are less likely to receive high quality care, this study does not support those conclusions.…”

Section: Resultsmentioning

confidence: 99%

The effectiveness of providing evidenced-based perinatal practice to low-income populations providing perinatal care: Does patient income influence the delivery of quality care?

Damon

Parrotta

Wallace

et al. 2013

JHA

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Background: This study examines a national perinatal quality improvement collaborative designed to create high reliability through the use of evidence-based perinatal care bundles. The objective of this study is to determine whether hospitals serving low-income patient populations experienced lower compliance with perinatal care bundles than hospitals serving higher-income patient populations.Objective: We investigated the relationship between the rate of perinatal bundle compliance within a hospital and the economic characteristics of the patients and surrounding community. We hypothesized a negative relationship between poverty and care bundle compliance.Methods: Using prospective data from 131,847 births over 34 months within 16 hospitals located in cities across the United States, we examined the relationship between compliance with evidence-based obstetrical care bundles and three measures of the poverty status of the patient population served and the hospital service area: 1) proportion of the obstetrical patients with Medicaid as the primary payer, 2) median income in the hospital service area, and 3) poverty rate in the hospital's service area. Results:The findings indicate no difference in bundle compliance rates in relation to the economic characteristics of the participating hospitals and their patients. Conclusions:While previous research has indicated that patients of lower socioeconomic status are less likely to receive high quality care, the findings in this study indicate that hospital compliance with evidence-based perinatal care bundles did not differ by economic characteristics of the hospital service area. These results indicate uniformity of care across hospitals irrespective of patient economic characteristics.

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Health care for the poor—An exploration of primary-care physicians’ perceptions of poor patients and of their helping behaviors

Cited by 26 publications

References 48 publications

How clinicians make (or avoid) moral judgments of patients: implications of the evidence for relationships and research

How clinicians make (or avoid) moral judgments of patients: implications of the evidence for relationships and research

Providing Humanistic Care

The effectiveness of providing evidenced-based perinatal practice to low-income populations providing perinatal care: Does patient income influence the delivery of quality care?

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