Cultural complications affect clinical outcomes

Social determinants of health are as much risk factors as a patient’s physical status.

Tracy M. Downs, MD, FACS, and Linda L. McIntire, MD
Tracy M. Downs, MD, FACS, and Linda L. McIntire, MD

Urologists are all familiar with clinical complications following urological surgery. Morbidity and mortality (M&M) conferences focus on complications as a key learning tool to help urologists improve the quality of care that is being provided to their patients. Cultural complications are just as important.

“We always talk about the importance of high-volume centers and high-volume surgeons in outcomes, but we don’t talk about where our patients come from and who they are,” said Tracy M. Downs, MD, FACS, professor of urology and chief officer of Diversity & Community Engagement for the University of Virginia Health in Charlottesville. “We have good data showing that your outcomes are equally determined by where your patients come from as by your skill and experience.”

Dr. Downs will moderate a panel discussion exploring “Cultural Complications in Urology” during today’s afternoon Plenary from 4:30 to 4:55 p.m. in Hall B1. Just as stratifying patients by clinical risk factors can improve outcomes, so can eliminating bias and identifying health care barriers for specific patient populations.

“As surgeons, we are all accustomed to M&M conferences where patient case complications are presented and potential solutions discussed,” said Linda L. McIntire, MD, president of the R. Frank Jones Urological Society, and author of the plenary session. “We have a series of cases presenting different barriers to health care with a discussion of how we, as urologists, can change our attitudes and behavior to help eliminate disparities in urological care and more broadly in health care.”

The problem, she explained, is that although urologists receive years of training in recognizing and mitigating clinical barriers, cultural barriers have long been ignored. Implicit bias, the unconscious and unrecognized attitudes and beliefs about groups of individuals, is universal. These unconscious stereotypes can affect attitudes toward age, sex, gender, race, weight, sexual orientation, ethnicity, religion and many other factors.

One potential result of implicit bias might be to ignore resources that are available to help specific populations mitigate specific health risks. Urologists might not think to inquire about a patient’s financial status or place of residence when making referrals or recommending treatment, yet finances and living situation can have dramatic impacts on treatment outcomes.

“Financial status is outside our purview as urologists,” Dr. McIntire said. “The urologist doesn’t have to assume the patient’s financial burden, but we do have an obligation to be resourceful in helping patients find the assistance they might need and to refer them to places where they can get the appropriate help. If we are treating patients with sexual fluidity, for example, we need to be aware of the resources locally that will allow us to help these patients more effectively.”

Social determinants of health are as much risk factors as the patient’s physical status and lifestyle, Dr. Downs noted.

“You can’t control your patient’s insurance status, but your outcomes are going to be affected if you don’t think upstream enough about neighborhood resources and strategies to mitigate poor outcomes in the post-surgical setting,” he said. “We can improve patient care delivery and patient outcomes if we consider these kinds of cultural complications before surgery. It is our professional responsibility to get these things right just like it is our responsibility to get the technical aspects of our surgery right.”

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