Equity, Newspeak and the AMA

AMA Logo, Image: Pixabay

Using a fictional vignette, Jim Dillon shows how the AMA’s guide for “Advancing Health Equity” might shape a physician-patient interview.

Recently the American Medical Association (AMA) and the Association of American Medical Colleges (AAMC) released a document entitled “Advancing Health Equity: A Guide to Language, Narrative, and Concepts.” John Stossel and Matthew Yglesias have critiqued the guide, but the original is well worth reading, if only because, like vintage Sci-Fi movies, it is so bad that it is hilarious.

In the following vignette, I show how this guide might shape a physician-patient interview. Boldface identifies language that is taken directly from the guide. Explanations appear in brackets.

Background: The patient is a 22 y/o Black [black, lower case, is a color, not a race or a person] person, identifying as a male (assigned at birth) who was shot by a rival gang member. The consultant has been asked to see the patient the day after surgery because of uncooperative behavior.

Patient: [groaning, holding his belly]

Psychiatrist: Good morning. Are you Betty Penfiel?

Patient: F—- No! Do I look like a b—- to you?

Psychiatrist: No, no, not at all, let me check here…. Aha. My error. What is your name?

Patient: My homies call me “Mac the knife.”

Psychiatrist: My, what an interesting name. Would that be Mr. “Mac the knife,” Ms. “Mac the knife,” Miss “mac the knife” ….

Patient: Get the f—- out of here. Didn’t I tell you I ain’t no girl?

Psychiatrist: Sorry, sorry, please forgive me. I’m Caucasian – oops, forgive me – I’m not Caucasian [this is a forbidden word, according to AMA]– I mean, I am white [not upper case White]– and I sometimes say the wrong thing with people from an economically/socially marginalized community. Sorry, sorry. I’m working on my cultural humility to give you a sense of cultural safety in this healthcare space.

Patient: A what?

Psychiatrist: So, what pronouns would you like me to call you?

Patient: S— man, is this a freakin’ grammar test or do you have something to say to me?

Psychiatrist: May I refer to you as “he” and ‘him?”

Patient: I don’t need no jack-off referral. Are you gonna leave or what?

Psychiatrist: Just a few questions, please. So, what happened [pointing to patient’s belly].

Patient: Read the chart. You the pain plug? Can you get me some blues? And I been on sub for lonnnggg time, need some a that or I get very hard to deal with.

Psychiatrist: I’d hate for that to happen, you seem like such a natural charmer. So, are you a person from a gay, cis gender, trans gender, queer, or non-binary group?

Patient: What you talkin ‘ about you limp-d—– honky?

Psychiatrist: Let me ask that in a different way. Do you have a girlfriend?

Patient: Yeh, man lots of ‘em, what’s it to you?-

Psychiatrist: Just curious. So tell me how you became a person with a bullet in your abdomen [avoiding direct reference to violence]?

Patient: Man, I be K.O.S. out there a long time.

Psychiatrist: Huh?

Patient: You know, K.O.S. – kill on sight.

Psychiatrist: My goodness. Where do you live?

Patient: 127th, West Side…. Can I have my blues now?

Psychiatrist: Please be patient.

Patient: I am the patient, as-h-l-! You be the doc and find me some blues.

Psychiatrist: It seems you are from a community that is historically underserved with limited access to healthcare resources.

Patient: Damn right.

Psychiatrist: So, you said someone was out to bring your life to a rapid and premature termination?

Patient: If you don’t get me some blues real soon, I may bring your pathetic existence to a rapid and premature termination.

Psychiatrist: Just a couple more questions….

Patient: [big sigh]

Psychiatrist: So how did it happen that someone wanted to put you to your final rest [avoiding “blaming” language].

Patient: I could use some rest, maybe you can leave me alone.

Psychiatrist: Have there been other disagreements with people?

Patient: You mean, like, other people wanting to shoot me?

Psychiatrist: Yeh, something like that. Do you belong to a group of young people who battle day-to-day oppression by racist cops?

Patient: I did man, but the Car-rips, they kicked me out.

Psychiatrist: I understand. Sounds like you grew up historically and intentionally excluded. That can make you feel quite disinvested.

Patient: Yeh, too many bounce checks.

Psychiatrist: No social justice there. You must be wondering what kind of public collective action is necessary to confront health inequity across identifiable populations?

By the way, are you a “returning citizen”?

Patient: What?

Psychiatrist: You know, a person with a history of incarceration?

Patient: You talkin’ ‘bout jail? Yeh, my jacket pretty thick.

Psychiatrist: Did you receive any psychiatric treatment while you were there?

Patient: Yeh, they gave me total mind fog. Druggin’ up another Black man.

Psychiatrist: Social injustices including racism or class exploitation, e.g., social exclusion and marginalization, should be confronted directly, so that they do not influence health outcomes.

Patient: It is difficult to just survive where I be from.

Psychiatrist: Decisions by landowners and large corporations, increasingly centralizing political and financial power wielded by a few, limit prospects for good health and well-being for many groups.

Patient: Huh?

Psychiatrist: Well, I guess that’s enough for now. You’ve really made me think about what are the ways public health, with their allies, can organize for social change directed to meeting human need for health and well-being?

[offering a piece of paper] Here’s a form for your feedback on this consultation.

Patient: You get me those strips and you be dawgg.

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