Jonathan M. Metzl, MD, PhD and Dorothy E. Roberts, JD
The call for structural competency encourages medicine to broaden its approach to matters of race and culture so that it might better address both individual-level doctor and patient characteristics and institutional factors.
In the September 2014 issue on physicians as agents of social change, Dr. Audiey Kao, editor-in-chief of Virtual Mentor interviewed Dr. Rajiv Shah, administrator of the United States Agency for International Development or USAID.
Asymmetry in knowledge and power between (1) physicians and patients and (2) physician educators and their students creates a climate for possible abuse in both sets of relationships.
Physicians need to manage expectations and clearly explain the prognosis of ICU patients to their families, particularly when the outcome is a negative one.
Physicians should be aware of the level of emotional distress and suffering that a patient is experiencing as a result of his or her illness and incorporate that into the patient's treatment plan.
Physicians should demonstrate compassion when the parent of an ill child asks the physician for his or her personal opinion regarding the parents' choice to continue experimental treatment when the prognosis is not good.