Moving on to strengths

IT CAN NO LONGER BE in doubt: a quarter of the women who physicians see every day have had some experience of sexual abuse, and fully a third have sustained physical abuse. The article by Sansone et al in this issue of the ARCHIVES confirms the commonality of past abuse experiences among middle-class women in the health maintenance organization setting. Their finding of a 25.8% rate of prior sexual abuse among women seeking Papanicolaou tests at a health maintenance organization in Tulsa, Okla, is comparable to the frequency of prior sexual abuse among women seen in family practice settings across the country. Without statistically validated instruments, the Tulsa data are not strictly comparable with other research; nevertheless, their results are consistent with the rate of prior sexual abuse of 22.1% that was found among women attending a rural clinic in Wisconsin and of 26.0% at a Michigan family .

How turning a QI project into research almost sank a great program

The article discusses the author\u27s experience of establishing a program involving the purchase of institutional memberships to a local Young Women\u27s Christian Association for the low-income patients and staff of a health center in the U.S. The program faced many problems, including the need for more Spanish-speaking interpreters. Approval by the Institutional Review Board was also required for the program

Ways of knowing in family medicine: contributions from a feminist perspective. 1988

Reprint of Dr. Candib\u27s article originally published in 1988, re-published in 1998 for Family Medicine\u27s Classics from Family Medicine series. Original abstract:Feminist psychologists have recently drawn a distinction between separate and connected knowing, two different ways of finding out about the world. Family medicine practice uses connected knowing to discover, through empathy, what another person may be experiencing; in contrast, family medicine research, in order to gain academic credibility, relies on separate knowing, typical of scientific thinking. These two ways of knowing have been variously described by Bruner as paradigmatic vs. narrative, by Kuzel as rationalistic vs. naturalistic, and by Stephens as seeing vs. hearing. The two ways of knowing vary in their use of context, time span, believability, and empathy. Family medicine, in a parallel with women who are finding their voice in a world which has not respected them, must come to blend the two ways of knowing. We can begin reframing our research questions by drawing on knowledge of our intimate, long-term connections with patients, thus underscoring the importance of the knower and the relationship with the known

Obesity and diabetes in vulnerable populations: reflection on proximal and distal causes

Around the world obesity and diabetes are climbing to epidemic proportion, even in countries previously characterized by scarcity. Likewise, people from low-income and minority communities, as well as immigrants from the developing world, increasingly visit physicians in North America with obesity, metabolic syndrome, or diabetes. Explanations limited to lifestyle factors such as diet and exercise are inadequate to explain the universality of what can be called a syndemic, a complex and widespread phenomenon in population health produced by multiple reinforcing conditions. Underlying the problem are complex factors-genetic, physiological, psychological, familial, social, economic, and political-coalescing to overdetermine these conditions. These interacting factors include events occurring during fetal life, maternal physiology and life context, the thrifty genotype, the nutritional transition, health impact of urbanization and immigration, social attributions and cultural perceptions of increased weight, and changes in food costs and availability resulting from globalization. Better appreciation of the complexity of causation underlying the worldwide epidemic of obesity and diabetes can refocus the work of clinicians and researchers to work at multiple levels to address prevention and treatment for these conditions among vulnerable populations

Culture, language, and the doctor-patient relationship

BACKGROUND: This review\u27s goal was to determine how differences between physicians and patients in race, ethnicity and language influence the quality of the physician-patient relationship. METHODS: We performed a literature review to assess existing evidence for ethnic and racial disparities in the quality of doctor-patient communication and the doctor-patient relationship. RESULTS: We found consistent evidence that race, ethnicity; and language have substantial influence on the quality of the doctor-patient relationship. Minority patients, especially those not proficient in English, are less likely to engender empathic response from physicians, establish rapport with physicians, receive sufficient information, and be encouraged to participate in medical decision making. CONCLUSIONS: The literature calls for a more diverse physician work force since minority patients are more likely to choose minority physicians, to be more satisfied by language-concordant relationships, and to feel more connected and involved in decision making with racially concordant physicians. The literature upholds the recommendation for professional interpreters to bridge the gaps in access experienced by non-English speaking physicians. Further evidence supports the admonition that majority physicians need to be more effective in developing relationships and in their communication with ethnic and racial minority patients

Episode 6: Asylum Body Work

Divya Bhatia and Dr. Hugh Silk sit down with Dr. Lucy Candib to talk about the importance of medical-legal partnerships in advocating for individuals who are victims of abuse or torture in their home countries seeking asylum in the US. Content warning: physical and sexual abuse, homophobia, and torture. Recorded March 2020. Dr. Candib\u27s poem Asylum Body Work was first published in The Journal of the American Board of Family Medicine. The transcript for this episode is available for download as an additional file

Inquiring into our past: when the doctor is a survivor of abuse

BACKGROUND: Health care professionals like other adults have a substantial exposure to childhood and adult victimization, but the prevalence of abuse experiences among practicing family physicians has not been examined. Also unclear is the impact of such personal experiences of abuse on physicians\u27 screening practices for childhood abuse among their patients and the personal and professional barriers to such screening. METHODS: We surveyed Massachusetts family physicians about their screening practices of adult patients for a history of childhood abuse and found that 33.6% had some experience of personal trauma, with 42.4% of women and 24.3% of men reporting some kind of lifetime personal abuse, including witnessing violence between their parents. These rates are comparable to or higher than those reported in prior studies of physicians\u27 histories of abuse. RESULTS: Physicians with a past history of trauma were more likely to feel confident in screening and less likely to perceive time as a barrier to screening. CONCLUSIONS: Given the high prevalence of prior childhood and victimization of both men and women physicians with the associated effects on their clinical work, we recommend that educational and training settings adopt specific competencies to provide safe and confidential environments where trainees can safely explore these issues and the potential impact on their clinical practice and well-being

Care that Matters: Quality Measurement and Health Care

Barry Saver and colleagues caution against the use of process and performance metrics as health care quality measures in the United States