The Clinical Examination and Socially At-Risk Populations: The Examination Matters for Health Disparities

Karly A Murphy; Alejandra Ellison-Barnes; Erica N Johnson; Lisa A Cooper

doi:10.1016/j.mcna.2017.12.013

The Clinical Examination and Socially At-Risk Populations: The Examination Matters for Health Disparities

Med Clin North Am. 2018 May;102(3):521-532. doi: 10.1016/j.mcna.2017.12.013.

Authors

Karly A Murphy¹, Alejandra Ellison-Barnes², Erica N Johnson³, Lisa A Cooper⁴

Affiliations

¹ Department of Medicine, Johns Hopkins Hospital, 2024 East Monument Street, Suite 2-500, Baltimore, MD 21287, USA. Electronic address: kburke34@jhmi.edu.
² Osler Medical Residency Training Program, Department of Medicine, Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD 21287, USA.
³ Johns Hopkins Bayview Internal Medicine Residency, Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, Mason F. Lord Building, Center Tower Suite 381, 5200 Eastern Avenue, Baltimore, MD 21224, USA.
⁴ Department of Medicine, Johns Hopkins Center for Health Equity, Johns Hopkins University School, 2024 East Monument Street, Suite 2-500, Baltimore, MD 21287, USA; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Center for Health Equity, Johns Hopkins University, 2024 East Monument Street, Suite 2-500, Baltimore, MD 21287, USA.

PMID: 29650073
DOI: 10.1016/j.mcna.2017.12.013

Abstract

Data from the United States show that persons from low socioeconomic backgrounds, those who are socially isolated, belong to racial or ethnic minority groups, or identify as lesbian, gay, bisexual, or transgender experience health disparities at a higher rate. Clinicians must transition from a biomedical to a biopsychosocial framework within the clinical examination to better address social determinants of health that contribute to health disparities. We review the characteristics of successful patient-clinician interactions. We describe strategies for relationship-centered care within routine encounters. Our goal is to train clinicians to mitigate differences and reduce disparities in health care delivery.

Keywords: Cultural competency; Health care disparities; Patient-centered care; Shared decision making; Social determinants of health.

Publication types

Review

MeSH terms

Cultural Competency*
Decision Making
Delivery of Health Care / methods
Health Status Disparities
Healthcare Disparities* / ethnology
Humans
Minority Groups
Patient-Centered Care / standards*
Physical Examination / psychology
Physical Examination / standards*
Physician-Patient Relations*
Risk Factors
United States