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I just got finished reading the admissions for minorities thread and honestly I’m disappointed. It seems there a quite a few people who don’t take racism seriously or believe in it at all. So my question is, how do you expect to treat certain patients if you don’t take their backgrounds and struggles seriously? I was taught that when thinking of a care plan for a patient you must consider their backgrounds and where they come from as that might affect their treatment and recovery. If you don’t believe in your patients struggles (whatever they may be) how do you expect to properly treat them? As someone pointed out, there is a good amount of distrust between the public and the medical community. How will you handle this as a medical professional?  These are legitimate questions, not asking to be sassy. And please keep your answers PA related because I’m genuinely curious about this. 

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Its people like those as to why Ethics classes are part of the PA school curriculum unfortunately. 

For our summer semester we had an "intro to PA" class that dealt with legislation and had a section dedicated to patient ethics.

This coming semester we have a whole class dedicated to Medical Ethics and Issues. 

 

 

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PA students are likely a microcosm of the societies they came from, with blind spots about life in general. Many of us were raised in isolation as far as not being exposed to the full spectrum of life.

The program where I teach — besides Ethics etc — has a Diverse and Vulnerable class where students are exposed to more of the spectrum of life, and an Experiential Learning class where they work with these patients outside of the classroom.

When you’re 22-25 and have grown up around people just like you, it is not surprising that you might have a distorted view of the world. It is one of the many jobs of PA school to broaden your life view and give you opportunities to make connections with people who are different than you.

By the way, this is also an objective of your HCE and PCE. We often ask questions about that during the admissions process.


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Not necessarily in a race way, but in a SES/background/life way, this came up often in my ER rotation.

I would present the 'textbook' treatment plan and my attending would say 'Yes.  That's what SHOULD happen.  But this patient won't come back or follow up with a PCP so we treat it in the here and now or it won't get done'.

Have faith, people are doing the best they can.  I'm a big believer in leading by example; you can't control how someone else practices but you can control what you do, so do it well.

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4 hours ago, BlackCatWhiteCat said:

It seems there a quite a few people who don’t take racism seriously or believe in it at all.

I don't think anyone on this forum doesn't think racism is a problem or that it can't some how affect patients.  White-coat syndrome is a real thing and have seen it more often within black patients. 

5 hours ago, BlackCatWhiteCat said:

I was taught that when thinking of a care plan for a patient you must consider their backgrounds and where they come from as that might affect their treatment and recovery.

If you know their backgrounds and they are open enough to tell you, but you can't make assumptions about people because of their race.

4 hours ago, BlackCatWhiteCat said:

Also if there is anyone who has already encountered a situation like this please feel free to answer. It would be great to know how you handled a situation like that

I was working in a clinic before PA school where a black patient did not want his white CCHT taking care of him, so because I was in the adjacent MOD they asked me to take care of him.  He felt that a latino would be a better fit for him and that is fine.  During the time I talked to him about his life in Chicago and he told be about being a former Black Stone Ranger, he shared his story.  I later reassured him that everyone working at the clinic was awesome and would do a good job taking care of him.  He kept me for about a week, but after continuing to reassure him that everyone was competent in their position, he allowed the white technicians to take care of him.  

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5 hours ago, BlackCatWhiteCat said:

I just got finished reading the admissions for minorities thread and honestly I’m disappointed. It seems there a quite a few people who don’t take racism seriously or believe in it at all. So my question is, how do you expect to treat certain patients if you don’t take their backgrounds and struggles seriously? I was taught that when thinking of a care plan for a patient you must consider their backgrounds and where they come from as that might affect their treatment and recovery. If you don’t believe in your patients struggles (whatever they may be) how do you expect to properly treat them? As someone pointed out, there is a good amount of distrust between the public and the medical community. How will you handle this as a medical professional?  These are legitimate questions, not asking to be sassy. And please keep your answers PA related because I’m genuinely curious about this. 

Largely your claim is based off that your assumption of race and minorities in PA admission is correct and that everyone that disagrees with you is wrong. With that, everyone who disagrees no longer take racism and discrimination seriously. The way I am interpreting what you have said is that anyone who disagrees with that assumption cannot look at a patient as a whole and be able to treat them. 

As @MT2PA has said, on my ER rotation or even my rural IM rotation, we took into account SES for each patient and treated them accordingly. We prescribed certain drugs to be affordable, explained their diagnosis, and helped as much as we could at the site of care.

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I've found that the best way to connect with patients of diverse backgrounds is to ask questions and listen to the answers.  I have minority patients who won't go to certain providers, but will see me: "you're allright, doc" (it's always doc. I never correct veterans, because I know they know what they mean by that).  Do I need to live in an inner city to truly understand the situations urban patients experience? Absolutely.  But that's not who I am, not who I am going to ever be, so I focus on letting the patients tell me about themselves and their relevant experiences. A few minutes per visit, to let them know you care about each one as a human being. It's really not that much different than "shared decision making" conversations.

 

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On 8/9/2018 at 1:56 AM, BlackCatWhiteCat said:

It seems there a quite a few people who don’t take racism seriously or believe in it at all.

And there are many people who find racism everywhere they look.  Let's make a pact:  If you find TRUE RACISM, then I will stand arm-in-arm with you to fight back against that.  Meanwhile, let's not call out everyone who disagrees with the leftist ideologies of affirmative action or poor data as racists.  Okay?

On 8/9/2018 at 1:56 AM, BlackCatWhiteCat said:

So my question is, how do you expect to treat certain patients if you don’t take their backgrounds and struggles seriously? I was taught that when thinking of a care plan for a patient you must consider their backgrounds and where they come from as that might affect their treatment and recovery. If you don’t believe in your patients struggles (whatever they may be) how do you expect to properly treat them?

This has nothing to do with race.  I try to take seriously the backgrounds and struggles of ALL my patients, no matter where their ancestors came from or how much melanin they have in their skin.  Lots of poor and uneducated Americans of every skin type and color.
 

On 8/9/2018 at 1:56 AM, BlackCatWhiteCat said:

As someone pointed out, there is a good amount of distrust between the public and the medical community. How will you handle this as a medical professional?  

By treating their medical condition.

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Guest thatgirlonabike
On 8/11/2018 at 11:44 AM, Boatswain2PA said:

And there are many people who find racism everywhere they look.  Let's make a pact:  If you find TRUE RACISM, then I will stand arm-in-arm with you to fight back against that.  Meanwhile, let's not call out everyone who disagrees with the leftist ideologies of affirmative action or poor data as racists.  Okay?

 

I'm not exactly sure how far your head has to be in the sand to be able to deny institutional racism exists on a daily basis for POC in the US.  I'm never really sure how to react when people tell me this.  It's like someone coming up and telling me the sky is orange when we can all clearly see it is blue.  How do you argue against that?

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9 hours ago, thatgirlonabike said:

I'm not exactly sure how far your head has to be in the sand to be able to deny institutional racism exists on a daily basis for POC in the US. 

Who denied institutional racism exists?  Of course, the definition of institutional racism, the extent to which it exists, and what we can (or should) do about it is up for discussion.

The social battles against personal racism, which we used to just call "racism" has been won.  For example - despite being WIDELY publicized, the largest white-power event in the country just took place and about thirty people showed up.  Thirty.  Yup, 30.  In a nation of 300,000,000.   Like I said before, I will stand arm and arm with you against people like this.

So, with these battles won, the terminology has changed.  Now it's institutional racism.  Does it exist?  ABSOLUTELY!  The Democrat-sponsored Jim Crow laws certainly led to many generations of people facing inequality, and there is absolute evidence that children raised in lower socio-economic strata have more difficulty in breaking into higher strata than those who were born/raised in that strata.

So what do we do about it now?  What works?  For almost 3 generations we have been trying to fix this through affirmative action, welfare, etc.  Has any of it worked?  There is lots of data showing that it hasn't, and all our good intentions have brought great harm to families/neighborhoods/culture of our minorities.  The thriving black business districts of the 1950s and 1960s are gone, and black families have enormous rates of children born out of wedlock (the #1 predictor of poverty in America).

So what do we do now?  I don't know what the answer here.  It certainly seems reasonable to allocate resources to recruit heavily from minority neighborhoods, and I can't see any harm coming from that.  But what else should we do??

Should we follow what South Africa is considering doing and allow the forceful seizure of white people's lands as compensation for wrongs generations ago?  Do you think that would make things better for anyone?  No, I don't think so.  Civil Wars have generally ruined things for just about everyone.

As for me...when I see racism I will stop it.  But I won't look for it everywhere.  Instead, I will treat everyone with respect, regardless of their skin color.

8 hours ago, mcclane said:

Also impossible to change an individual's mind through argumentation. Only gets worse when they are relatively intelligent. When smart people hold ignorant opinions, there is no "winning" by verbal engagement. What are the odds that, through conversation, a racist will argue you into suddenly becoming a racist? Zero, right? So why would it be possible to argue a racist out of their racism?

Discussions, and even disagreements, don't need to be an argument.  Instead of trying to change someone else's mind, you could seek understanding of their points, and conversely seek them to understand your points.  Maybe all those racists you see out there aren't really racists, so you don't need to argue them OUT OF their racism? 

 

8 hours ago, mcclane said:

I recommend - dwarf them in counter protests, report them to HR and push for termination, out them on social media, and remove their safe spaces. Then watch them cry about the first amendment that doesn't protect them in those locations, whine about "just wanting to talk," and other such inconsistent nonsense.

PS - PAF is a "safe space".

Oh look everyone...we have a social justice warrior who wants to become a PA!  Goody for you!!  Do you have your black face mask, pepper spray, and sticks??

It's funny how the "antifa" use the same tactics as the actual fascists of history.  Yet they are all socialists, the movement which led to the rise of the actual fascists.  History is funny....

PS - There is no "safe space" there cupcake.  That feeling of safety you get in your moms basement is an illusion provided to you by men who are willing to do violent things to keep the wolf at bay.

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On 8/9/2018 at 2:44 AM, UGoLong said:

PA students are likely a microcosm of the societies they came from, with blind spots about life in general. Many of us were raised in isolation as far as not being exposed to the full spectrum of life.

The program where I teach — besides Ethics etc — has a Diverse and Vulnerable class where students are exposed to more of the spectrum of life, and an Experiential Learning class where they work with these patients outside of the classroom.

When you’re 22-25 and have grown up around people just like you, it is not surprising that you might have a distorted view of the world. It is one of the many jobs of PA school to broaden your life view and give you opportunities to make connections with people who are different than you.

By the way, this is also an objective of your HCE and PCE. We often ask questions about that during the admissions process.


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Why I hold a very strong bias against admitting young recent college graduates into a previously "adult" profession!

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8 hours ago, mcclane said:

It's easy to argue against anything. That's the root of the problem. Also impossible to change an individual's mind through argumentation. Only gets worse when they are relatively intelligent. When smart people hold ignorant opinions, there is no "winning" by verbal engagement. What are the odds that, through conversation, a racist will argue you into suddenly becoming a racist? Zero, right? So why would it be possible to argue a racist out of their racism?

I recommend - dwarf them in counter protests, report them to HR and push for termination, out them on social media, and remove their safe spaces. Then watch them cry about the first amendment that doesn't protect them in those locations, whine about "just wanting to talk," and other such inconsistent nonsense.

PS - PAF is a "safe space".

You forgot to list wear black masks to cover your face, shout  them down , spray others with bear repellent!

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11 minutes ago, CAdamsPAC said:

You forgot to list wear black masks to cover your face, shout  them down , spray others with bear repellent!

S/he (or whichever of the 32 sexual or asexual identifiers this person self-identifies as) also doesn't realize that many of us received training to face people wearing black masks shouting at you, and were trained to continue operating while exposed to "bear repellent".

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9 hours ago, thatgirlonabike said:

I'm not exactly sure how far your head has to be in the sand to be able to deny institutional racism exists on a daily basis for POC in the US.  I'm never really sure how to react when people tell me this.  It's like someone coming up and telling me the sky is orange when we can all clearly see it is blue.  How do you argue against that?

The most rampant and disgusting "institutional racism" that I fought for most of my life is ,the lower expectations for "POC" and actions of Liberals that assume that I as a Black man owe my success or any opportunities to excel are due to their largesse! Somehow non White people in America can't obtain government identity cards and need to be coddled and herded into polling places by Liberals because evil White people are out there blocking access to voting. The mass murder of Black people in utero by the offspring organization of a eugenicist somehow is acceptable to the point more Blacks are aborted in some settings than born. Yeah the Liberals have firmly implanted lesser values on those of color and successfully avoided be labeled the racist they are! That's truly "Institutional Racism" Black, & Brown people must labor under.

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8 minutes ago, Boatswain2PA said:

S/he (or whichever of the 32 sexual or asexual identifiers this person self-identifies as) also doesn't realize that many of us received training to face people wearing black masks shouting at you, and were trained to continue operating while exposed to "bear repellent".

And to inflict serious bodily harm on them in the process of "Charlie Mike"!

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4 minutes ago, CAdamsPAC said:

And to inflict serious bodily harm on them in the process of "Charlie Mike"!

Wasn't it Von Clauswitz who said "War is politics by other means?"

Virtually everything, especially health care now that it is mostly paid for by government, is political.  What people fail to recognize is that by making health care political, it puts it in THE SAME CATEGORY as warfare....politics.

So while these boards strive to be apolitical, they cannot be as we all work in healthcare (well....except for some SJWs who haven't quite made the cut yet), therefore we are all now political.

Some SJW politicians are already willing to go to "war" for their political views.  Fortunately for them, but unfortunate for everyone else, they have no idea what actual warfare is, how how wars really start.  

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Thanks for your posts so far! I now have a follow up question. I took a class on medicine and law and in this course we dealt with several ethics issues. My question is, what happens when the values of a provider conflict with the treatment of a patient? I know abortion is a common issue but are there other situations where this happens? Such as a provider who may be anti-lgbt but treating an lgbt patient? How are they resolved? And if you’re in a position where you can’t refuse this patient, can they still trust you to provide adequate care?

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48 minutes ago, BlackCatWhiteCat said:

Thanks for your posts so far! I now have a follow up question. I took a class on medicine and law and in this course we dealt with several ethics issues. My question is, what happens when the values of a provider conflict with the treatment of a patient? I know abortion is a common issue but are there other situations where this happens? Such as a provider who may be anti-lgbt but treating an lgbt patient? How are they resolved? And if you’re in a position where you can’t refuse this patient, can they still trust you to provide adequate care?

#1 provide care appropriate for the patient's needs/condition. Should any provider be unable or unwilling to properly care for any pt presenting , they IMHO need another profession. In a reverse vein a pt expresses skepticism about the ability of a minority PA based on that fact how should the PA react?

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Question:  How do you know when you have reached the intellectual and emotional limits of an socialist idiot living in their mommy's basement?  
Answer:  They call you a racist.

 

7 hours ago, BlackCatWhiteCat said:

I took a class on medicine and law and in this course we dealt with several ethics issues. My question is, what happens when the values of a provider conflict with the treatment of a patient?

In addition to taking the same classes, I have 20 years of military operational experience, and 6 years of PA experience...so let me answer your question:  You treat the patient to the best of your ability.
 

 

7 hours ago, BlackCatWhiteCat said:

 I know abortion is a common issue but are there other situations where this happens?

Many, many, MANY situations.  I've closed on an abdomen that ACTUALLY HAD the all the KKK/nazi tattoo's across it..you treat the patient to the best of your ability.  I've treated more meth-heads than I can remember....you treat the patient to the best of your ability.  I've treated a guy who shot a cop....you treat the patient to the best of your abiilty.  I've treated the drunk driver who killed the family member of the lady in the next room....you treat the patient to the best of your ability.

There are three thoughts that I rely on when I see someone who exerts a negative emotional reaction in me:  #1)  I don't have the whole story.  Maybe the KKK/Nazi tattoo guy got his tattoos in prison and has since found his humanity, etc.  The criminals I treat may be innocent, or they may have turned their life around.  #2)  If these people HAVEN'T turned their life around yet, then I try to give the more time so that they can.  And #3) God created this person, and loves this person just like I love my children who also have made terrible decisions.

 

7 hours ago, BlackCatWhiteCat said:

Such as a provider who may be anti-lgbt but treating an lgbt patient? 

For this question to be answered we would have to start with clearer definitions of "anti-lgbt" and what treatment this person required.

 

7 hours ago, BlackCatWhiteCat said:

And if you’re in a position where you can’t refuse this patient, can they still trust you to provide adequate care?

Yes.

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11 hours ago, Boatswain2PA said:

Oh look everyone...we have a social justice warrior who wants to become a PA!  Goody for you!!  Do you have your black face mask, pepper spray, and sticks??

It's funny how the "antifa" use the same tactics as the actual fascists of history.  Yet they are all socialists, the movement which led to the rise of the actual fascists.  History is funny....

PS - There is no "safe space" there cupcake.  That feeling of safety you get in your moms basement is an illusion provided to you by men who are willing to do violent things to keep the wolf at bay.

Dude...seriously?  I think your comments have become less constructive the longer you've followed this thread.  Literally, these are insults and seem to be geared more toward a generational shift in political thinking (probably from an unhealthy dose of fox news on your part) and less to do with healthcare.  I'm not disputing your seniority here buddy.  But seriously, you need to calm down.

To get back on topic...

On 8/9/2018 at 1:11 AM, BlackCatWhiteCat said:

Also if there is anyone who has already encountered a situation like this please feel free to answer. It would be great to know how you handled a situation like that

I mean...I've rendered care to racists, drug addicts, people actually attempting to do physical harm to me.  I've witnessed nurses and doctors alike break down and give up care temporarily or even become equally combative with patients.  I've treated alleged murderers (such is the life of a Corpsman).  I'm sure to some degree, every single person involved in direct patient care has faced, at some point early on in their career, this dark, sort of, unconscious decision that follows an encounter with a particularly morally repulsive patient.  Do I let this person suffer?  The answer is no.  No matter what.  There is never a correct rationale to rendering lesser care to someone you don't like or agree with.  HONESTLY, if you ever find yourself trying to rationalize something like this, you need to be in a different job.  Our job as providers is to treat indiscriminately and to the best of your ability.  You should endeavor to treat someone convicted serial rapist the same as anyone else imo.

idk maybe I'm wrong, but this is my philosphy on patient care (largely informed by my own faith and personal beliefs)

 

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2 hours ago, Boatswain2PA said:

Many, many, MANY situations.  I've closed on an abdomen that ACTUALLY HAD the all the KKK/nazi tattoo's across it..you treat the patient to the best of your ability.  I've treated more meth-heads than I can remember....you treat the patient to the best of your ability.  I've treated a guy who shot a cop....you treat the patient to the best of your abiilty.  I've treated the drunk driver who killed the family member of the lady in the next room....you treat the patient to the best of your ability.
 

I think implicit bias doesn't rear it's head so much in emergencies or urgent care maybe even most specialties.  Its with primary care that it becomes a problem.  You label patients non-compliant, uneducated, "they don't care about themselves," pain-seekers.  This person is an addicit-- that person is "illegal" so they don't deserve to be treated here.  You are supposed to be providing care and managing a patient's complex disease processes but it's easier to just give up on them with a little racial bias perhaps?  Definitely a classist bias.....

I see it.  Every. Day.  

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