Equity, NOT equality

I went to a really informative meeting last night.  A group of 6 doctors sat around a table to discuss equity and what that means for our patients.  Though I've known that there's a difference between equity and equality, I haven't processed through it before this meeting.
Here's a helpful illustration:

Equality = sameness.  Equity = fairness.

I think most of us are really thinking about equity when we say equality, especially when it relates to health care.  As humans, we all need a bit of help, some need more than others.  Providing the same care for everyone won't help each individual reach their goal.  If we can't recognize this discrepancy, we'll miss the mark most of the time.
So, medicine is not one size fits all.  Again, I've known that.  But somehow, I still try to treat people "the same".  I really want every hypertensive patient to understand their disease and take the steps to get it under control.  But not all high blood pressure is equal.  Some patients just need to calm down and overcome "White Coat Hypertension".  Others need to eat better and exercise (I would argue all need this).  Others do great on medication.  So what looks like a simple diagnosis can involve a myriad of factors that aren't easily addressed in the 15 minutes allotted.
Of course, we can't always address all of the problems a complex patient may bring in during their visit.  That doesn't mean their symptoms aren't all important.  But it's often helpful to see patients back regularly and chip away at the problems, rather than tackling everything all at once and leaving each problem incomplete.
I have struggled with the idea of healthcare disparities.  I've thought that if patient A and B both live near a clinic, they both have equal access to care.  However, because of the disparities that exist, there are barriers to access beyond just location.  If we don't acknowledge things like education, income and culture, we're missing the bigger picture.  Some patients have problems they would rather see a particular gender for.  Some had a bad experience last time and don't want to be treated that way again.  Others can't afford their copay and choose to tough it out instead.  Healthcare is tricky business!
I still plan on trying to offer "equal" care, but will hopefully be more cognizant of offering a fair opportunity to attain each patient's health goals.

Cars and Bodies

I brought my car to the shop the other day.  The drivers side door wasn't closing easily.  I was finding that I would often shut the door and start driving before I realized the light on the dash was indicating the door wasn't fully shut.  Then I'd have to either try to open and re-shut it while driving, or sometimes pull over and get it shut right.  It always latched the 2nd time so for a while, I thought the problem was the way I was closing the door.  Like maybe if I took a bit more time and wasn't in a hurry, it would shut fine.  But after months of this happening, I finally decided that it wasn't right and booked in with a mechanic.

Sure enough, there was something wrong!  Apparently there was so much pressure build up (built up where??) that when the door was shut, it would just bounce off and wouldn't latch.  So they fixed that along with some other tune ups.  Now things work perfectly, I don't even give shutting the door a second thought.

It occurred to me that a lot of my patients come in with the same desire for their bodies.  They present with a complaint and want me to figure out what's wrong and fix it.  Often, that's exactly what happens.  However, there are also situations where patients have a concern that I consider "normal" and no additional evaluation or solution is offered.  Because of my personality, I tell them this, no sugar coating.  But after this recent experience with my car door, I realize that giving a little more time and attention might do a patient good.  For my car, I thought something was wrong but I was prepared to be told it was fine and that something I was doing was causing the problem.  However, in the case of their body, I'm not sure patients are as prepared to be told they're OK without a bit more effort.

So, when a patient comes in and says that they have a stomach ache every time they eat X, I have a decision to make.  I can tell them that they should avoid eating X, don't let the door hit you on the way out.  Or, I can try and ask a few more questions to see if there could be an underlying problem that is contributing to this pain and would warrant further evaluation.  I will always be tempted to tell them to "STOP IT".  But that doesn't offer the satisfaction the patient is after.

For a laugh, check out this skit:

https://youtu.be/4BjKS1-vjPs

I think the underlying desire of each patient is validation of their concern.  Even if I think they're OK, being willing to listen and asking questions is warranted.  Cutting them off or not giving them a chance to explore the problem often leads to frustration.  People use the term "bedside manner" and I think listening is key.  Other helpful things I've learned over the years is to offer a smile, make eye contact and when possible, bring up something you remember from your last interaction.

I do my best to give patients the time and attention they deserve.  Time is really tricky in this day and age, but attention is something I have more control over.  Even though 15 minutes can go by quickly, I'm sure my patients are more satisfied if I spend a bit of time in discussion without distraction.  Typing while we talk is better for time management, but the connection gets lost.

So, my take home is to try and listen the next time someone comes in complaining of something that I don't consider a big deal.  I'll try to remember how I felt with my car door, second guessing if it was worth bring it in for evaluation.  Our bodies are way more important than a car and being flippant about my patients' complaints won't accomplish either of our goals.