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Assignment Two

How are Our Healthcare Providers Affected by the Various Characteristics of

Discrimination?
Samantha Sealey

Assignment Two

Introduction
I am sure you have been to a hospital, doctors office, an outpatient clinic, or
some place to seek medical attention at some point in your life. When you visited at least
one these places Im sure you noticed that not all of the medical providers were of the
same race, gender, or ethnicity as you. Sitting there, observing this, have you ever once
thought or felt that the quality of your medical care would be any different because of
those factors or others? What if you are seen by a physician assistant or nurse practitioner
rather than a doctor? Would these discriminative factors of our healthcare providers make
you think less of them or assume they were not qualified enough to do their job?
As we go through our everyday lives, we never really realize the importance of
our healthcare or the problems that go on with it. Our healthcare field is surrounded by
numerous of doctors, nurse practitioners, physician assistants, and registered nurses that
are in various specialties; these occupations are also known as our healthcare providers.
As a society, we also generally do not understand the complexity of our healthcare
providers and how each differs or relates to one another. A nurse practitioner and
physician assistant both work underneath a doctor which arouses some patient skepticism
of their work and intelligence. This is one of the many factors that are discriminated upon
to our healthcare providers. Other factors may include ethnicity, gender, race, spoken
language, visual appearance, etc. Throughout this paper I will be researching patient
skepticism and how they discriminate upon our healthcare providers.
Before progressing further into this paper it is necessary that I state my
relationship to this topic I have chosen to research and I should also include any biases
that I may have with it as well. This topic does have a significant importance to me

Comment [SS1]: Flip the last and third paragraphs-right now, your intro ends with your bias and leaves
the reader hanging as to your "thesis." I know your
thesis is embedded in the third paragraph, but we
need to see that as kind of a conclusion to the
introduction.

Assignment Two

because I am wanting to eventually pursue a career in the health field, specifically a

Physician Assistant. With this being such a personal interest could also bias my research
of the other healthcare providers. I grew up being introduced to the medical field when I
was young. With my mother being Registered Nurse, at times she would allow me to tag
along with her at work and I enjoyed every minute of it. Seeing what she did at work and
helping people in ways others could not really inspired me. Looking up to her motivated
me to eventually become a Physician Assistant. For a couple of my sources used in my
inquiry, I included an interview with Wendy Wrenn, RN and an observation of Amy
Berry, PA. This is where another bias could step in. Wendy Wrenn, RN is my mother and
Amy Berry, PA is my godmother; my connections with these people is what could also
bias my research. With my research involving patients and peoples opinions of their
healthcare providers and discriminations upon them could cause some readers to believe I
have written in favor of my chosen career path rather than proportionately to the
occupations discussed.
The focus for my research will involve gathering opinions from people inside and
outside of medical facilities. Reasons why I plan to gather opinions from random people
outside of a medical facility is to discover if prejudice acts and judgments are still made
upon society to our medical professionals than just patients. This research I am interested
in conducting is in seeing how patients in various medical treatment situations respond to
the health care providers treating them. The average person may not think a topic like this
is important but as you continue to read, you will learn the similarities and differences of
our healthcare providers and how people judge them whether their inside or outside of a
medical facility from the study .

Comment [SS2]: The third paragraph of your intro, you

mention that you are trying to determine "if prejudice
or judgement acts upon society...", and I think you
need to rephrase your proposed focus a bit. There is
no question that every person makes judgements day
in and day out about the people that are around them,
and these not necessarily prejudicial
judgements. Example: I often have to determine or
"judge" whether a student is truthful in submitting work
that is his/hers and not someone else's, but this
doesn't necessarily mean that I am being
prejudiced. What I would recommend you revise this
statement/focus to is something like "I am interested in
seeing how patients in various medical treatment
situations respond to the practitioners treating
them. How are patients making certain judgements
that may affect how they take the practitioner's advice,
whether or not they receive follow up care, etc."

Assignment Two

Literature Review
In todays society, we depend on healthcare for various reasons. Whether we are
getting a cold, yearly check ups, prescription refills, emergency needs, etc. We always go
to some type of clinic or hospital to find answers to resolve our medical problem. In order
to receive these answers, we must rely on a doctor, physician assistant, nurse practitioner
or a nurses decision of diagnoses. With such a developing field, there are also a diversity
of races, ethnicities, religions, genders, spoken languages, body appearances, etc. All of
the factors can play a role with each other in the opinion of patients and people. There are
going to be people who are would rather been seen by a doctor as their healthcare
provider versus a nurse practitioner or a physician assistant; and theyre are some who
simply do not have a preference. Also, there are going to be patients or people who are
going to questions ones ability and qualities of their profession because they are a
difference race, ethnicity, gender, religion, etc as themselves.
Majority of the time when we go to the clinic, we normally are seen by a nurse
first then a doctor or sometimes a physician assistant or nurse practitioner. The
expectation is that the substitution of PAs or NPs will reduce costs and doctor's workload
while maintaining quality of care (Van Vught, Hettinga, Denessen, Gerhardus,
Bouwmans, Van Den Brink, & Postma 2015). This is one of the many important factors
of a physician assistant and nurse practitioner. They are both very qualified professionals
that not only help increase the quality of care of patients but to help doctors. With the
idea of substituting a doctor is the thought that inclines people have judgments of
distrusting PAs and NPs.

Comment [SS3]: Great work overall summarizing your

sources, BUT there needs to be some
restructuring/adding of paragraphs throughout the lit
review.
Comment [SS4]: There needs to be some sort of brief
introduction to the literature review. Tell your readers
what the main topics are for the lit review and what
you intend to provide background on. For example, an
intro could start something like this, "Before analyzing
some of the potential biases patients can have
concerning their healthcare providers, it is necessary
to trace the where this conversation is being. In short,
we need to understand some basic key principles:
(and then list the main topic themes that you have
divided up your source materials by).

Assignment Two

A physician assistant and nurse practitioner are similar but are also different. Both
occupations require a masters degree but while in school, a nurse practitioner is allowed
to alter his or her clinical experiences to their chosen specialty while a physician assistant
just requires a clinical rotation through all specialties without a chosen specialty (Freda
2000). This is also a factor that could cause people not to want to substitute a doctor. If
people choose to believe a PA or NP arent as specialized as a doctor, then they choose
not to trust their judgments. This is one reason why we need to teach society the
importance of a physician assistant or nurse practitioner and how significantly qualified
they are to make medical decisions with or without a doctor. These occupations are very
helpful in our healthcare field. From observing a physician assistant, I learned what they
do during the day. Physician assistants normally work with doctors and have patients like
they do. They also refill prescriptions, diagnose patients, provide care and can receive
help from their supervising doctor if need be (Berry 2016).
This is where a physician assistant and nurse practitioner can begin to differ. A
nurse practitioner is an academically advanced and experienced registered nurse and is
not required to work under a doctor like a PA but they are allowed to (Cresswell 2013).
Thus, nurse practitioner programs are based off of a nursing foundation, which makes
them similar to a registered nurse in certain ways. Each of these occupations strive to
ensure better patient outcomes, as so do other medical professions.
A registered nurse is only a two year accredited nursing program (Wrenn, 2016).
Registered nurses only require two years of nursing school because they are not of a
higher level like the other careers mentioned. Since registered nurses are at a lower level,
they arent allowed to diagnose their patients but they are skilled to check vitals, fill out

Comment [SS5]: Right after (Berry 16), the sentence

that starts with "This is where PA and nurse
practitioner begin to differ" represents a slight shift in
subject--you need to start a new paragraph here.

Assignment Two

lab requests, calling in prescriptions, and helping assist doctors (Wrenn, 2016). A nurse
practitioner and physician assistant can both be under the supervision of a doctor, which
can make them seem skeptical to their patients. Some might think since they do not have
the label of a doctor could mean they do not have enough experience or education,
especially if the person has no clue what a PA or NP is.
A physician/doctor obviously has the most education out of all of these
professions. In order to become a doctor one must earn their doctorate degree, go through
several years of residency, and take their board exams. This is what allows them to be at
the top because they have more education and experience. This is the main reason for
patient skepticism with healthcare providers. Further more, could there be other factors
that play a role besides their education and experience? On average, a nurse practitioner
or physician assistant will spend about 12 minutes face to face with there patient which is
more than the averaged 7.5 minutes from the doctor, they also spend more time
diagnosing and filling out prescriptions (Venning, Durie, Roland, Roberts, & Leese
2000). Although patients tend to prefer a doc tor, they often do not know that PAs and
NPs spend more one on one time with their patients than a doctor. This is one major
characteristic in receiving positive patient outcomes.
It is likely for healthcare providers to gain trust if they spend more attentive time
with their patient. This will also lead to less confusion with patient diagnosis and
treatment, which indicates positive feedback. Patient treatment is a very important quality
in healthcare. How and what the patient are treated with is very important among their
diagnosis. For instance, a registered nurse could have a patient with specific symptoms of
a sickness. The RN is allowed to make assumptions but are not allowed to diagnose them;

Assignment Two

this is what a doctor, physician assistant, and nurse practitioner is for. The RN could then
send their patient to some type of medical practice where he or she would be seen by one
of those three medical professionals. If this scenario had gone different, the patients
treatment outcome could have been greatly affected. This is one reason why all
healthcare affiliations provide greater quality monitoring (Madison 2004).
Another factor that plays a role in patient skepticism is discrimination. We as
people tend to discriminate people in unmannerly ways. For instance, some patients tend
to discriminate against a healthcare providers race or ethnicity assuming he or she is not
as intelligent as their race, gender, or ethnicity. This tends to be more seen in hospital
settings. Many spoken languages from different cultures surround our healthcare field;
this allows us to have access to people with multiple linguistic abilities. Even though
patients tend to judge a book by its cover at times, these linguistic aspects of cultural
competence have been associated to decreases in racial/ethnic disparities in health and
health care (Johnson 2004). These negative stereotypes and discriminations are deeply
embedded in the culture and institutions of our society (Williams & Mohammed 2008).
Any cultures will more than likely continue to discriminate on others for several decades
because; societies seem to have a natural instinct to judge others. All of these
characteristics of skepticism definitely affect patient gratification. The development of
positive ethical conditions is important to the evolution of quality work environments and
quality patient outcomes (Pauly, Varcoe, & Storch 2009). Whether or not a patient would
be more satisfied with being treated from a doctor versus a nurse practitioner or physician
assistant, their providers race, gender, ethnicity, religion, should not be of any concern
unless it affects their medical tendencies in a negative way.

Comment [SS6]: I'm noticing 3 themes that your

sources fall in to: qualifications for PA, nurse
practitioner, RN, and doc, "who" can do what, and
patient skepticism. I want you to go back and
organize your sources into three distinct paragraphs
according to these themes, and what you can do as is
add these themes to lit review intro where you identify
the key issues associated with your topic.

Assignment Two

Entering the Conversation

Over the past several decades, our healthcare field has seemingly grown in the
amount of people that are becoming physician assistants and nurse practitioners over a
doctor. Even though they are highly qualified healthcare providers, patients seem to
believe that since they do not have as much experience or education as a doctor, there are
not as intellectual as a doctor. Although a doctor does have more education and
experience, a physician assistant and nurse practitioner are both qualified to diagnose,
prescribe medications, perform minor operations, etc. People also tend to discriminate
against their healthcare providers or nurses age, body appearance, ethnicity, hygiene,
gender, race, religion, spoken language etc. What factors do patients tend to discriminate
on more than others? Do patients judge their health providers label more or less than
discriminating their qualities? I would like to propose a study to determine if consumers
would prefer a doctor over a physician assistant or nurse practitioner. I would also
determine if this Also to determine if consumers discriminate and what factors they
discriminate on more than others.
This study will be conducted in three different settings in order to receive
opinionated answers to these questions. These different settings will be various hospitals,
outpatient clinics, and random people outside of the other two settings. In order to gather
answers, interviews must be taken place. There will be 12 different interviewers, four in
the hospital, four in the outpatient clinic, and four in the city outside of the clinic and
hospital. Since we are asking two different questions in this study, two of the four
interviewers in each group will be asking about their opinion on having a physician

Comment [SS7]: In your ETC, I want to know why is

that? How do you know that patients tend to
discriminate based on these criteria? Is this from a
source? I would recommend citing a source here.
Comment [SS8]: You seem to work very hard in the
ETC to not use "I" which is sometimes awkward. For
instance, when you say "A study should be
conducted" instead say something like "I would like to
propose a study that does x, y, and z."

Assignment Two

assistant or nurse practitioner as their healthcare provider and the other two interviewers
will be asking about what they tend to discriminate on with their healthcare provider or
nurse. While we are trying to find these answers, the interviewers will be dressed very
professionally but they will be of various races, genders, ethnicities, body appearance,
etc. since we are asking discriminative questions. Reasons to split the four interviewers
into two groups and have different settings is to avoid biased answers and to receive
different opinionated answers. More specifically:

Each subgroup of two interviewers in the same four-interviewer group must be

man and woman; therefore, there will be a total of six women and six men
interviewing consumers. This is being done to keep track of different facial
expressions to the questions.

Each group of four interviewers has two subgroups of two interviewers. One
subgroup will be asking the Interview Questions A (see questions bulleted below)
about their opinion on having a physician assistant or nurse practitioner as their
healthcare provider versus a doctor and the other subgroup will be asking
Interview Questions B (see questions bulleted below)about the discrimination of
healthcare providers and nurses.

All of the patients being interviewed must be ages 18 and up because younger
patients may not understand the questions or why theyre be interviewed. Two
interviewers must ask 50 random patient Interview Questions A and the other two
must ask 50 random patients/people Interview Questions B as well but they
cannot be the same person asked for Interview Questions A.

Comment [SS9]: When you first mention "Interview

Questions A" and "Interview Questions B" put in
parenthesis "See questions below" or some other
similar note referring to the questions.

Assignment Two

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The four interviewers inside the outpatient clinic will be interviewing random
patients that is either waiting in line or leaving the clinic from their appointment.
Two interviewers asking 50 random patients Interview Questions A will be at a
different outpatient clinic than the other two who are asking 50 random patients
Interview Questions B. This is being done so we can have a variety of people and
not asking one person two sets of questions.

The four interviewers inside the hospital will be interviewing random patients that
are just in the general care unit. Two interviewers asking Interview Questions A
will be asking 50 random patients and the other two interviewers asking Interview
Questions will be asking 50 random patients as well but they must be different
from the patients than the ones asked for Interview Questions A.

Lastly, the other four interviewers will be going to other places in the same
county as the clinic and hospital to interview 50 random people Interview
Questions A and 50 random people Interview Questions B that are not currently
being patients inside a facility.

Also, people are going feel very strong about their opinion and some are going to care
but not feel strong on their opinion. When a patient or person states their judgment,
the interviewer cannot change their facial expression or states their opinion. This
could create tension between the interviewer and the applicant. As for the healthcare
provider being discriminated upon should make their statement on how qualified and
determined they are before their patient decides if they want a new provider or not.
Interview questions A:

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1. In todays society our healthcare providers are not just doctors; there are physician
assistants and nurse practitioners. Knowing that nurse practitioners and physician
assistants tend to work underneath a doctor and have less education and less
experience, would you trust having a nurse practitioner or physician assistant as your
healthcare provider versus a doctor?
2. When going to an outpatient clinic and your temporary provider is a doctor, would be
feel less uncertain since he or she is not a physician assistant or nurse practitioner?
3. Now, if you are a patient staying the in hospital and your healthcare provider is a
doctor but you have a physician assistant to come and do check ups, would you feel
like you are not receiving the same level of care?
4. To continue from question three, would you feel any different if you had a nurse
coming to do your check ups and take your vitals even though they are trained to do
so?
5. If you were skeptical to having a nurse practitioner or physician assistant as your
healthcare provider versus a doctor, explain why that is even though they are trained
to do so. Also, if you were uncertain about having a nurse take your vitals or draw
blood, explain why having a nurse to do these duties makes you feel that way.
Interview Questions B:
1. If your healthcare provider were of a different race or ethnicity of you, would you feel
like you are treated with the same level of care as a provider of the same race or
ethnicity as you? If they were not fluent in your language, would you be less trustful
of them?

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2. If your healthcare provider were of a different gender, would you feel like you are
treated with the same level of care as a provider of the same gender as you?
3. If your healthcare provider were apart different religion, would you feel like you are
treated with the same level of care as a provider of your religion?
4. If your healthcare provider had a difference appearance than you, for example is
covered in tattoos and looks different than any other provider youve had before,
would you feel like you were treated with equal level of care?
5. If you answered yes to any of these questions, could you explain why you would
discriminate that factor with their level of intelligence and providing equal care?
After conducting all of these interviews we now compare the results of each
question in each category. First, we will divide the answers to the questions according to
setting where they we interviewed. Next, we will categorize the answers for each
question into sections with the same answers. Then, we will calculate the same answers
in each question and divide that number by the total number of people who answered that
question. Doing this will give us the percentages for each question according to setting.
Lastly, before calculating the percentages, separate the patients interviewed by category
with their age. Dividing the answers according to the interviewees age will determine if
the ages of the patients affect how they respond to their healthcare professionals in
various medical treatment situations. Once the percentages for all of the answers are
found, you can then compare the answers to one another. From this, you can discover the
percentages of which discriminating factor is used more than others. You can also
determine the percentages of how many people prefer a doctor, nurse practitioner, or
physician assistant, or if they simply do not have a preference. Calculating all of these

Comment [SS10]: I still don't know HOW you are

analyzing the data, and what you are doing with the
data. How do you calculate the percentages? And
how will you use the answers that you have found?
Will you create a presentation? Will this be a training
module that healthcare professionals could take to
help with them with patient care? Addressing these
questions as a part of the analysis is key.

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differences will develop a reasoning as to why people discriminate on certain factors, and
why people tend to trust the label of a nurse practitioner or physician assistant less than a
doctor. Once these calculations are finished, a module could be created in various
languages. This module could be kept with the medical professionals to have when the
time is needed, will be at any medical facility for the public, and will be available online
for the public to access.

Conclusion
Throughout this paper, I have researched the similarities and differences of our
our healthcare providers they are discriminated upon. These discriminative factors
include diversity of races, ethnicities, religions, genders, spoken languages, body
appearances, etc. All of the factors can play a role with each other in the opinion of
patients and people. I also researched if patients tend to prefer a doctor versus a nurse
practitioner or physician assistant.
I discovered that there are going to be people who are would rather been seen by
a doctor as their healthcare provider versus a nurse practitioner or a physician assistant;
and theyre are some who simply do not have a preference. The results I found for
Interview Questions A, the amount of people who had no preference in their healthcare
provider and the amount who preferred a doctor were fairly even. I also discovered that
younger generations are more likely to not have a preference where as older generations
were more likely to feel more skeptical of having a nurse practitioner or physician
assistant. As for the results from Interview Questions B, I found that patients are more
likely to judge their healthcare providers quality and intelligence if he or she is not fluent

Comment [SS11]: I don't really see how the study

matters in the conclusion. It certainly DOES matter,
but I don't see this connection made in the conclusion
yet. Right now, the first paragraph reads similar to
your introduction, and I think you really need to make a
case for why this research DOES matter.

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in English as their spoken language regardless of their race. This was seen more in the
older generation. The younger generations were not far behind them but, they were more
likely to trust their judgments even if they were not fluent in English. This was the
number one discriminative factor I found at all locations (outpatient care, hospital, and
city). The factor that was discriminated the least was gender. Out of all the locations and
generations interviewed, gender was only mentioned a few times as a factor they
discriminated on.
This research conducted is really important to release to our society. It could be a
major role in leading our society to decrease or stop these prejudice acts within our
healthcare field. It is important for our public to have easy access to this module rather
than having it just at one place. They will be available online, in medical facilities, and all
healthcare providers will have to carry it with them at all times when doing their job. This
way anyone can learn about the results and know why it is important to stop prejudice
acts to our healthcare providers. Our patients who do make these verdicts may come to
realize that they their prejudgment remarks to their healthcare provider treating them are
redundant.
There will always be research involving patient skepticism with medical
professionals and treatment. Further research I would like to propose is if patient
skepticism affects the performance of our healthcare providers. Lets say if a patient
refuses treatment from a physician assistant because he/she wants to be seen by a doctor,
would this affect the PAs performance in a negative way at work? Another question I
would like to propose is how can our societys knowledge of healthcare and medical
professionals be improved so that patent skepticism will decrease? A way I have thought

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to conclude this is for everyone in high school and college to take a mandatory course
about healthcare, medical professionals, and ethics that revolve around them. This could
possibly improve our societys knowledge involving healthcare. The medical field is full
of new opportunities and new technologies and I hope that there will be continuous
research involving the topics I have mentioned.

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Assignment Two
References
Berry, A., PA. (2016, February 5). Observing Amy Berry, PA [Personal observation].
Cresswell, S. (2013, December 23). What's The Difference Between a Physician
Assistant and A Nurse Practitioner and What Should You Choose?
Freda, C. E. (2000). Nurse practitioner versus physician assistant. Nephrology Nursing
Journal, 27(2), 26.
Johnson, R. L., PA. (2004, February 27). Racial and Ethnic Differences in Patient
Perceptions of Bias and Cultural Competence in Health Care.
Madison, K. (2004, April 1). Hospital-Physician Affiliations and Patient Treatments,
Expenditures, and Outcomes. Health Services Research, 39, 2, 257-278.
Pauly, B., Varcoe, C., Storch, J., & Newton, L. (2009, September). Registered Nurses'
Perceptions of Moral Distress and Ethical Climate.
Van Vught, A., Hettinga, A., Denessen, E., Gerhardus, M., Bouwmans, G., Van Den
Brink, G., & Postma, C. (2015, September 17). Analysis of the level of general

clinical skills of physician assistant students using an objective structured clinical

examination. Journal of Evaluation in Clinical Practice, 21(5), 971-975.
Venning, P., Durie, A., Roland, M., Roberts, C., & Leese, B. (2000, April 15).
Randomized controlled trial comparing cost effectiveness of general practitioners
and nurse practitioners in primary care.
Williams, D. R., & Mohammed, S. A. (2008). Journal of Behavioral Medicine.
Discrimination and Racial Disparities in Health: Evidence and Needed Research,
32(1), 20-47.
Wrenn, W. (2016, February 9). Interviewing a Registered Nurse [E-mail interview].