INTEREST GROUP REPORT SOCIAL EM & POPULATION HEALTH
Respect: A Driver of Empathy and Equity Shanna S. Strauss, MSc MS4; Megan Healy, MD FAAEM; and Sara Urquhart, MA RN
the main social determinants of our patients’ health outcomes, especially those drivers that impact the most marginalized patients.
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n 1967, Arethra Franklin created “Respect,” a song that not only stayed at the top of the charts for months, but also became a civil rights anthem (Brown, 2018). Respect was central to creating equality in the 1960s and it is just as important today as we strive to create health equity for our patients. This important end cannot be achieved without fair work environments for clinicians. In many ways, we have seen how public admiration doesn’t translate to workplace respect. On one hand physicians are admired as health care heroes by the public, on the other hand some are also being retaliated against for speaking out about lack of PPE during a pandemic (Carville et al., 2020). Physicians are not immune to the experiences of dehumanization, devaluation, and exploitation in the workplace. These are commonly experienced as unfair employment contracts, punitive policies, and incentives that drive us away from the bedside and our patients.
Many of our patients experience the direct effects of criminalized poverty (Yungman, 2019) and institutionalized classism (Scambler, 2019). These social factors are foundational to the health inequities contributing to our patients presenting illness. To compound the problem, most medical centers do not have robust systems in place to address issues like homelessness, food insecurity, and violence. At minimum, emergency physicians need to be empowered to speak out about issues that impact patient safety. Work environments that lack transparency, threaten physician autonomy, or place profit above patient care are unsafe. In challenging work environments like these, physicians face substantial barriers to providing equitable care. We must also recognize that our patients experience independent hardships when they seek treatment in the emergency department. Just as
Is there a connection between the systems eroding the physician-patient relationship and our patients’ health outcomes? • Hostile work environments contribute to burnout and high physician attrition rates (NunezSmith et al., 2009). • Physician attrition affects patient care. Not only does it limit clinical research but it also sequesters funds for hiring that could be invested in employee satisfaction and patient outcomes (Meurer et al., 2013). • Burnout is not only expensive for physicians and employers; it is also contributing to the significant rise in physician suicide. “Burnout has widespread consequences, including poor quality of care, increased medical errors, patient and provider dissatisfaction, and attrition from medical practice, exacerbating the shortage and maldistribution of EPs” (Stehman et al., 2019). • As physicians become more burned out, their self-reported empathy levels decline (Wolfshohl et al., 2019). In the pioneering article “Reframing Clinician Distress,” (Dean et al., 2019) the authors argued that moral injury lies at the heart of physician burnout. Moral injury “describes the challenge of simultaneously knowing what care patients need but being unable to provide it due to constraints that are beyond our control.” Medicine at large is ill equipped to address
we AAEM members scrutinize the systems and cultures that threaten our ability to practice good medicine, we must also turn a critical eye to the systems and culture that disempower our patients. Part of the answer to addressing these inequities lies in the same core value: respect. Often patient mistreatment is institutionalized and disproportionately affects patients based on their socioeconomic status, their racial categorization, sexual identity, mental health conditions, and/or addiction. We
Physicians are
not immune to the experiences of dehumanization, devaluation, and exploitation in the workplace.”
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COMMON SENSE MARCH/APRIL 2021
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