Medical Overtesting and Racial Distrust

Golemon, Luke

doi:10.1353/ken.2019.0025

Cited by 5 publications

(4 citation statements)

References 71 publications

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“…As seen in the Tuskegee Study, historical extreme medical racism and more subtle medical racism that has persisted to the present have resulted in distrust in the medical community (especially non-Black caregivers) in some Black communities [ 63 , 64 ]. This can potentially impact individuals’ knowledge, attitudes, and behaviors regarding the transmission of COVID-19, proper social distancing and containment measures, testing, and therapeutic interventions, resulted in an increased risk of exposure and a decreased chance of survival.…”

Section: Discussionmentioning

confidence: 99%

Socioeconomic and Racial Segregation and COVID-19: Concentrated Disadvantage and Black Concentration in Association with COVID-19 Deaths in the USA

Khanijahani

Tomassoni

2021

J. Racial and Ethnic Health Disparities

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Introduction This study's objective was to examine the association of the percentage of county population residing in concentrated disadvantage and Black-concentrated census tracts with county-level confirmed COVID-19 deaths in the USA, concentrated disadvantage and Black concentration at census tract-level measure socioeconomic segregation and racial segregation, respectively. Methods We performed secondary data analysis using tract (N = 73,056) and county (N = 3142) level data from the US Census Bureau and other sources for the USA. Confirmed COVID-19 deaths per 100,000 population was our outcome measure. We performed mixed-effect negative binomial regression to examine the association of county population's percentage residing in concentrated disadvantage and Black-concentrated tracts with COVID-19 deaths while controlling for several other characteristics. Results For every 10% increase in the percentage of county population residing in concentrated disadvantage and Black-concentrated tracts, the rate for confirmed COVID-19 deaths per 100,000 population increases by a factor of 1.14 (mortality rate ratio [MMR] = 1.14; 95% confidence interval [CI]:1.11, 1.18) and 1.11 (MMR = 1.11; 95% CI:1.08, 1.14), respectively. These relations stayed significant in all models in further sensitivity analyses. Moreover, a joint increase in the percentage of county population residing in racial and socioeconomic segregation was associated with a much greater increase in COVID-19 deaths. Conclusions It appears that people living in socioeconomically and racially segregated neighborhoods may be disproportionately impacted by COVID-19 deaths. Future multilevel and longitudinal studies with data at both individual and aggregated tract level can help isolate the potential impacts of the individual-level characteristics and neighborhood-level socioeconomic and racial segregation with more precision and confidence.

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Section: Discussionmentioning

confidence: 99%

Socioeconomic and Racial Segregation and COVID-19: Concentrated Disadvantage and Black Concentration in Association with COVID-19 Deaths in the USA

Khanijahani

Tomassoni

2021

J. Racial and Ethnic Health Disparities

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“…The most prone to such practices are doctors with a history of complaints [ 2 , 33 ], who have suffered significant emotional disorders [ 2 ] and who are afraid to go through all the suffering caused by the investigation process in the event of a new complaint [ 5 ]. However, looking at the phenomenon of defensive practices as a whole, it can be noticed that the implications of the complaints extend in multiple directions and target the accused doctor and also the patients, the medical system [ 10 , 38 , 39 ], the colleagues of the doctors involved in complaints [ 5 , 27 ] and even the training of future doctors [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

The Personal and Professional Impact of Patients’ Complaints on Doctors—A Qualitative Approach

Hanganu

Ioan

2022

IJERPH

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Background: Complaints regarding medical practice represent a harsh reality of the current world. Patients have the right to receive explanations and compensation when they are injured during the medical act, but the increased potential for exposure to complaints determines personal and professional consequences for the doctors, with significant impact on their health and practice. Thus, the aim of our research was to analyze in depth the impact of complaints on the doctors involved. Materials and methods: The authors conducted a qualitative study, using a semi-structured interview, addressed to doctors who had complaints from patients. The participants in our research were identified using an adapted version of the snowball method. Results: After the analysis of the interviews using the inductive method, nine themes resulted, seven of which are addressed in this paper: injustice, personal impact, professional impact, difficulties, supportive factors, the attitude of the hospital management and the attitude of colleagues. At the personal level, the doctors were overwhelmed by insomnia, nightmares, stress and anxiety, and at the professional level by doubts about medical decisions, fear, anxiety and the tendency to avoid patients with severe diseases. Conclusions: The study revealed that physicians who had complaints from patients are deeply affected by the complaint itself and the associated investigation procedure, even if, to a lesser extent, some of the participants found motivation for a better management of the situation. The study also showed the need for changes in the legal and medical systems in order to create mechanisms to support the doctors during the investigation process.

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“…In contrast, SBPP combats brittleness by taking a more pluralistic approach, eliciting a broader set of data about users and contexts to generate an understanding how heterogeneous populations may perceive or be unequally affected by interventions while hypotheses are still being formed (Grand, 2020). For example, historically unequal treatment and access to healthcare has contributed to US Black and Brown populations' skepticism of public health officials, suggesting that Covid-19 vaccination messages delivered by trusted community leaders may prove more persuasive (Poteat et al, 2020) than those delivered by medical professionals (Meng et al, 2016;Cotrau et al, 2019;Golemon, 2019;Laurent-Simpson & Lo, 2019) or government officials (Wilkinson, 2013;Galizzi, 2014). Although addressing contextual brittleness remains distinct from achieving generalizability, gaining heterogeneous insight across user contexts through generative research methodologies can also contribute to the development of abstracted principles, or decision rules, that indicate how desirable characteristics of solutions might apply elsewhere without resorting to formula (Bohlen et al, 2020;Ho et al, 2020;Supplee & Kane, 2020).…”

Section: Expand Potential Sources Of Datamentioning

confidence: 99%

Behavioral brittleness: the case for strategic behavioral public policy

Schmidt

Stenger

2021

Behav. Public Policy

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Despite widespread recognition that behavioral public policy (BPP) needs to move beyond nudging if the field is to achieve more significant impact, problem-solving approaches remain optimized to achieve tactical success and are evaluated by short-term metrics with the assumption of stable systems. As a result, current methodologies may contribute to the development of solutions that appear well formed but become ‘brittle’ in the face of more complex contexts if they fail to consider important contextual cues, broader system forces, and emergent conditions, which can take three distinct forms: contextual, systemic, and anticipatory brittleness. The Covid-19 pandemic and vaccination rollout present an opportunity to identify and correct interventional brittleness with a new methodological approach – strategic BPP (SBPP) – that can inform the creation of more resilient solutions by embracing more diverse forms of evidence and applied foresight, designing interventions within ecosystems, and iteratively developing solutions. To advance the case for adopting a SBPP and ‘roughly right’ modes of inquiry, we use the Covid-19 vaccination rollout to define a new methodological roadmap, while also acknowledging that taking a more strategic approach may challenge current BPP norms.

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Medical Overtesting and Racial Distrust

Abstract: The phenomenon of medical overuse in general and specifi cally medical overtesting is well-known and harmful to both the patient and the health-care system (

Cited by 5 publications

References 71 publications

Socioeconomic and Racial Segregation and COVID-19: Concentrated Disadvantage and Black Concentration in Association with COVID-19 Deaths in the USA

Socioeconomic and Racial Segregation and COVID-19: Concentrated Disadvantage and Black Concentration in Association with COVID-19 Deaths in the USA

The Personal and Professional Impact of Patients’ Complaints on Doctors—A Qualitative Approach

Behavioral brittleness: the case for strategic behavioral public policy

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