Health Equity in Hospital Medicine

In my own practice as a hospital-based physician, I can recall scores of hospitalized patients where we tried hard to provide equitable care, but fell short. I remember the Spanish-speaking patient with multiple comorbidities who received neurosurgery and was on the road to recovery on an acute care unit, when on day three, he complained of vague abdominal discomfort and ended up dying of a perforated bowel. No interpreter was used by the team to fully delve into the details of the pain he was experiencing. I remember the young Black patient with terminal malignancy who had multiple repeated conversations with physicians recommending hospice care but refused until he saw a physician who was able to explain hospice within the context of racism that has historically defined clinical care for Black people, and was able to present hospice not as a way to hasten death but rather as a way to live the remainder of his days in comfort. I remember the elderly Pakistani female patient whose demanding son antagonized staff and clinicians alike until he was banned from visiting because of his aggressiveness with staff and whose inability to visit his mother caused her extreme distress as she felt that she had lost the unique voice that only her oldest son could provide.