Vol. 13 Issue 2

Washington University Review of Health Spring 2020
Back to the Basics
Writer: Alicia Yang | Editor: Daniel Berkovich | Illustrator: Lucy Chen
References
Bryant Scholars Pre-Admissions Program.
(2020). Retrieved from https://medicine.missouri.edu/education/admissions/bryant-scholars-pre-admissions-program
Gill, E., Dykes, P. C., Rudin, R. S., Storm, M.,
McGrath, K., & Bates, D. W. (2020). Technology-facilitated
care coordination in rural
areas: What is needed? International Journal
of Medical Informatics, 137. doi: https://doi.
org/10.1016/j.ijmedinf.2020.104102
Kahn, C., & Morgan, A. (2019, November 16).
Rural healthcare needs innovation, policy
changes to survive. Retrieved from https://
www.modernhealthcare.com/opinion-editorial/rural-healthcare-needs-innovation-policy-changes-survive
Kelley, T. (2020, January 14). Despite Decades
of Initiatives, Rural Physicians Grow Scarcer.
Retrieved from https://www.managedcaremag.
com/archives/2019/11/despite-decades-initiatives-rural-physicians-grow-scarcer
Mareck, D. G. (2011). Federal and State
Initiatives to Recruit Physicians to Rural Areas.
AMA Journal of Ethics, 13(5), 304–309. doi:
10.1001/virtualmentor.2011.13.5.pfor1-1105
Missouri Population 2020. (2020). Retrieved
from https://worldpopulationreview.com/
states/missouri-population/
NRHA. (2020). Retrieved from http://www.
ruralhealthweb.org/advocate/medicare-cutshurt-rural
Peterson, L. E., & Fang, B. (2018). Rural Family
Physicians Have a Broader Scope of Practice
than Urban Family Physicians. Rural & Underserved
Health Research Center Publications, 5,
1–5. Retrieved from https://uknowledge.uky.
edu/cgi/viewcontent.cgi?article=1004&context=ruhrc_reports
Rosenblatt, R. A. (2000). Physicians and rural
America. West J Med., 173(5), 348–351.
Retrieved from https://www.ncbi.nlm.nih.gov/
pmc/articles/PMC1071163/
Warshaw, R. (2017, October 31). Health Disparities
Affect Millions in Rural U.S. Communities.
Retrieved from https://www.aamc.org/news-insights/health-disparities-affect-millions-rural-us-communities
Tumor. Cancer. Surgery.
Disorder. Disease.
Treatment. Doctors have
the responsibility to tell their
patients “bad news” all the time.
The “news” is not some abstract
story that can be simply watched
out of boredom or skimmed over
with glazed eyes. The “news” is
about one’s future of living or
dying. Far more difficult to swallow
than prescribed pills is the fear of
dying and suffering. Doctors
possess special vocabulary reserved
for delivering “news” beyond
medical terms. “Best”, “try”, “everything”,
“understand”, “support”,
“sorry”. They aren’t big words, but
they somehow take on greater
importance in the context of a
fluorescent, sterile, Purell-scented
doctor’s office.
Doctors are the communicators of
truth about bodies and well-being.
Clear patient-directed communication
is a way to restore some
control in the midst of what could
be a dehumanizing and undignified
circumstance. A patient being
examined in a gown that exposes
their imperfect nakedness to the
whims and waits of the healthcare
system—it is an experience that
could be forever ingrained in
memory. Paul Kalanithi, a neurosurgery
resident at Stanford who
became a patient and passed away
before finishing his book, When
Breath Becomes Air, learned the
true role of a physician after he lost
the power of the role.
He learned “something not found in
Hippocrates, Maimonides, or Osler:
the physician’s duty is not to stave
off death or return patients to their
old lives, but to take into our arms a
patient and family whose lives have
disintegrated and work until they
can stand back up and face, and
make sense of, their own existence”
(Kalinithi 166).
Kalanithi eloquently characterizes
the patient-physician relationship.
It is inherently unbalanced. The
physician’s job is to enter into the
patient’s existence and personal life.
The physician is the safeguard of
sensitive, HIPAA-sheltered information.
Doctors communicate advice
on how to live better. They ask very
personal questions about our lives,
prescribe medications, write
directives and tell us what to eat
and how much to move. All of these
actions require clear and compassionate
communication.
Health literacy is the term given to
describe the ability to acquire and
make sense of information and
resources regarding health. A
displaced immigrant or refugee may
be familiar with different foods and
traditions; they may come from a
different culture with its set of
medical practices and beliefs; they
will almost definitely not speak the
same language or have the same
mannerisms as their providers in
the United States. In these situations,
health literacy is not just a
matter of knowledge and implementation
as language and culture
become major barriers to access.
The Center for Immigration Studies
gathered information regarding the
prevalence of foreign languages
spoken in the United States in 2018
(Zeigler & Camarota, 2019). The
representation of almost all languages
has steadily increased. The
most prevalent languages spoken in
the U.S. following English are
Spanish, Chinese and Tagalog.
While much energy is wasted on
debating whether or not healthcare
is a right, no energy is needed to
realize the fact that all people need
access to healthcare services. Title
VI of the Civil Rights Act of 1964
ensures that federal money given to
hospitals must not discriminate on
the basis of race, color or national
origin (“Title VI of the Civil Rights
Act of 1964”). This means that
healthcare providers that receive
federal funding must provide equal
access to healthcare for all of its
patients by providing professional
medical interpretation. Even with
policy protection, the reality for
non-native English speakers is
bleak. In order to receive federal
funds, hospitals must comply with
the law and “provide adequate
language services, but virtually
everyone agrees that too many
32 33