Health Equity in Hospital Medicine: Foundations, Populations, and Action

Health Equity in Hospital Medicine: Foundations, Populations, and Action pdf

Hospital-based physicians witness some of the most profound moments in people’s lives, including life-altering diagnoses, crucial medical procedures, complex decisions, and critical end-of-life choices. However, there is currently no structured approach for hospitalists to incorporate the various social factors affecting care, such as race, gender identity, cultural background, immigration status, sexual orientation, primary language, housing status, and poverty, into clinical decision-making. While hospital physicians might occasionally use interpreters for patients with limited English proficiency, ask about cultural practices during patient admissions, or inquire about the impact of racism on their care, these efforts are inconsistent and lack a systematic approach to ensuring equitable care.

In my own practice as a hospital-based physician, I can recall numerous instances where, despite our efforts to provide equitable care, we fell short. I remember a Spanish-speaking patient with multiple comorbidities who had undergone neurosurgery and was recovering well on an acute care unit. On the third day, he complained of vague abdominal pain and ultimately died from a perforated bowel; the team hadn’t used an interpreter to fully understand his pain symptoms. I remember a young Black patient with terminal cancer who repeatedly declined hospice care until a physician was able to discuss hospice in the context of historical racism in clinical care, presenting it not as a way to hasten death but rather as an opportunity to live his remaining days in comfort. I remember an elderly Pakistani woman whose son, though essential to her emotional well-being, was banned from visiting due to aggressive behavior toward staff, causing her deep distress as she felt deprived of the unique support only he could provide.

Imagine if hospital physicians in these cases had access to a resource to help them provide culturally respectful care—not just by speaking the patient’s primary language, but by actively listening and genuinely considering the life experiences and culture that shape the individual before them. This is what this book aims to offer hospital medicine physicians: a framework for deeply integrating social factors into the care they provide.