The Mount Sinai journal of medicine, New York
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Physicians licensed to practice medicine have enjoyed socially endorsed, legally underwritten status-trust to a remarkable degree. However, such trust is not endorsed equally by all segments of American society, most notably, by African Americans. ⋯ On the other hand, overinterpretation of this fact needlessly risks despair. A theory of trust provides guidance in resolving clinical conflicts.
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There is a serious, continuous and increasing shortfall of organs, especially kidneys, for the purpose of transplantation. This shortfall is especially remarkable in African American populations. Because the incidence of hypertension (HTN) and associated end-stage renal diseases (ESRD) is 17 times greater in African Americans, this minority group, which comprises only 12% of the U. ⋯ Also, because they get more poorly matched organs, their kidney transplant graft survival is 10-20% lower than that for other racial groups. The African American community is unaware of the special needs in members of their own race. Steps must be taken to increase minority awareness of the need for well-matched transplant organs and their involvement in the donation process.
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The African American community's response to the AIDS epidemic has reflected the profound mistrust of the medical establishment which many African Americans feel. Among African Americans, the belief that the epidemic originated in a genocidal plot is widespread. ⋯ If we look at African Americans' historical relationship to the medical establishment from the era of slavery to the recent past, the suspicious attitudes which make such beliefs possible can be seen as an intelligible response to a new disease which disproportionately affects African Americans. Successful medical and public health responses to the epidemic have depended and will continue to depend upon overcoming the historical legacy of suspicion and gaining the trust of the community.
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Having a small sick baby in a neonatal intensive care unit can be an extremely difficult experience for any family. A minority family brings to this setting the additional burden of a concern that racism may affect the care their child receives. ⋯ In some cases, these parental perceptions lead to a charge of experimentation. An increased understanding by health care providers of the cultural differences and life experiences that families bring to stressful situations can improve communication.
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Successful outcome from a traumatic cervical spinal cord injury (SCI) depends heavily upon the quality of the acute care rendered to the affected individual. In recent years, there have been significant advances in the acute management of SCI. We discuss current management strategies in the areas of prehospital care and transport, emergency room management, surgical considerations and pharmacotherapy.