INDIANAPOLIS — From the moment Daytheon Sturges, PhD, MPAS, PA-C, took the stage for his session at the American Academy of Physician Associates 2022 annual meeting, his hopes of transforming medicine became clear. Following the announcement that he had no official disclosures, Sturges made an unofficial disclosure of his own: “No medicines will be spoken about here, but I am trying to prescribe heart medicine because I want to change hearts today, if they have room to be changed.”
What Sturges meant is that he wants to bring issues of justice, equity, diversity, and inclusion (JEDI, in his parlance), into the clinic on a daily basis. But to do that, physician assistants (PAs) and other clinicians need to be willing to learn about past and current health inequities people have experienced and consider how today’s patients still bear the brunt of traumas experienced by previous generations, he said.
The session laid the groundwork for understanding the social determinants of health — the nonmedical factors that influence health outcomes — by highlighting notorious episodes in American history. These included the Chinese Exclusion Act of 1882, which implemented a total ban on Chinese immigration to the United States, and the 1955 race-related murder of Black teenager Emmett Till, which helped spark the Civil Rights movement.
“It’s uncomfortable to hear the history, but the only way to clear the stains of the past is to acknowledge them,” Sturges said. “The world creeps into how our patients see us and how we see them. People just want to live and love and be who they are, but when they come into our clinics, they may be afraid to tell us these things.”
Moving Beyond History
For Sturges, an assistant professor at MEDEX Northwest at the University of Washington in Seattle, Washington, family medicine is the perfect specialty from which to understand health equity and work to increase it. “A society still dealing with injustice and inequities leads to adverse health consequences in communities,” he said. “What better specialty to tackle such issues than family medicine, which has been a champion for the community since its beginnings in the social justice movement of the 1960s?”
Sturges emphasized that race is a social construct, not based in biology. “Race is too often matter-of-factly mentioned in medical training and patient care as a biological construct,” he said. “The idea of race as biology does not align with the scientific evidence and is harmful to patients.”
He cited the longstanding misconception that leads doctors to prescribe less pain medicine to patients of color than white patients for the same condition. “This is a health inequity all of us as PAs can and should overcome in our practices,” he said.
Sturges believes that the upheaval caused by the “perfect storm” of the COVID-19 pandemic and the social justice unrest of 2020 presents an opportunity to move the health professions toward a greater focus on achieving health equity. “A mirror was placed in front of the nation and our medical institutions as well,” he said. “We all had to reckon with the legacy of discrimination in society and medicine. We can’t unsee that.”
Recommendations for Change
But how can individual healthcare providers translate awareness and good intentions into actions that actually help their patients? “Apply an equity lens to your practice to see who is being helped and who is being harmed, then unpack and address social drivers of equity,” Sturges suggested in an interview with Medscape Medical News.
That means reviewing your practice’s policies and protocols, he said.
Is your intake form welcoming to and inclusive of all genders?
Do your written materials take into account different literacy levels?
Do any policies penalize low-income patients more than other patients?
“If your appointments are automatically cancelled if a patient is more than 15 minutes late, how will that affect your patient who has to take three buses to see you? If any one of those buses runs late, so will your patient,” Sturges said. “Do you really want to add obstacles for that patient to receive quality care?”
Social Determinants of Health Via EHR
Sturges also suggested reviewing your institution’s electronic health record (EHR) to look for possible roadblocks to providing equitable care. Conversely, your EHR may even be a helpful tool for clinicians seeking to provide more equitable care.
“Did you know that Epic has a social determinants of health module?” Sturges asked. “It can help you document important issues like food insecurity and homelessness among your patients, and then track the outcomes to show tangible benefits from your care.”
This was news to attendee Veronica Coleman, MPAS, PA-C, University of Texas Southwestern Medical Center in Dallas. “That was really a big takeaway for me. I’ve seen [that module] in Epic, but I’ve never used it and I’ve never even encouraged my medical assistant to fill it out,” she said. “That’s actually something we can do to start collecting data, and to start addressing social determinants of health right in our practices.”
Focus on Communication
Sturges suggested that even seasoned PAs should continue to evaluate how they communicate with patients during clinic visits. “Know their pronouns and who they have sex with,” he said. “Know their living situation and their education level. Know the gaps in their care so you can fill them.”
Sturges shared a story in which he learned that one of his patients, newly diagnosed with diabetes, read at only a first-grade level. His solution was to record necessary instructions for monitoring her glucose levels and administering insulin to herself right on her cell phone.
This advice resonated with Maninderpal Sethi, one of Sturges’ students who attended the session. “This is why it’s so important to base your treatment plan on the actual patient in front of you and their situation, rather than relying on your perception of their situation,” he said.