Responding to Discriminatory Patient Requests.

Autor:	Moore R; Division of Developmental and Behavioral Health, Section of Psychology, Children's Mercy Kansas City, Kansas City, MO.; Department of Pediatrics, UMKC School of Medicine, Kansas City, MO., Loe IM; Stanford Maternal and Child Health Research Institute, Stanford, CA.; Department of Pediatrics, Stanford University School of Medicine, Stanford, CA., Whitgob E; Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.; Santa Clara Valley Medical Center, San Jose, CA., Cowden JD; Department of Pediatrics, UMKC School of Medicine, Kansas City, MO.; Office of Equity and Diversity & Division of General Academic Pediatrics, Children's Mercy Kansas City, Kansas City, MO., Nyp SS; Division of Developmental and Behavioral Health, Section of Psychology, Children's Mercy Kansas City, Kansas City, MO.; Department of Pediatrics, UMKC School of Medicine, Kansas City, MO.
Jazyk:	angličtina
Zdroj:	Journal of developmental and behavioral pediatrics : JDBP [J Dev Behav Pediatr] 2021 Jun-Jul 01; Vol. 42 (5), pp. 429-431.
DOI:	10.1097/DBP.0000000000000971
Abstrakt:	Case: Julia is a 13-year-old White adolescent girl who was referred for psychological counseling given concerns related to mood, nonadherence, and adjustment secondary to her new diagnosis of type 1 diabetes. The family lives in a rural town located several hours from the academic medical center where she was diagnosed. After several months on a waitlist, the family was contacted to schedule a telehealth appointment with a predoctoral psychology trainee. When the scheduler informed the mother that her daughter would be scheduled with Ms. Huang, the mother abruptly stopped the conversation stating, "I do not want to waste everyone's time" and initially declined the appointment offered. When the scheduler asked about her hesitance, the mother disclosed previous interactions with doctors at the hospital who were "not born in the United States" that she felt were "textbook" (e.g., smiling even when discussing a new chronic medical condition) and "hard to understand" (i.e., because of different dialect/accent). The mother shared that she found these experiences to be stressful and felt the interactions had negatively affected Julia's care. When informed about the length of the waitlist for another clinician, the mother agreed to initiate services with the trainee.The supervising psychologist shared the mother's concerns and comments with Ms. Huang. After discussion, Ms. Huang agreed to provide intervention services, "as long as the family was willing." During the initial telehealth sessions, Ms. Huang primarily focused on building rapport and strengthening the therapeutic alliance with the family. During this time, Julia's mother was reluctant to incorporate suggested parent management strategies at home. Julia also made minimal improvement in her medical management (i.e., A1c levels remained high), had difficulty using behavioral coping strategies, and experienced ongoing mood symptoms (i.e., significant irritability, sleep difficulties, and depressive symptoms). Ms. Huang began to wonder whether the family's resistance and inability to implement recommendations were in some part because of the family's initial concerns and reluctance to engage in therapy with her as a clinician.Should Ms. Huang address the previously identified concerns with the patient and her family? What should be considered when determining how to approach this situation to ensure provision of both the best care for this patient and support for this trainee? Competing Interests: Disclosure: The authors declare no conflict of interest. (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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