New study supports the value of medical humanities in illuminating the root causes of health care disparities in Washington, DC

WASHINGTON -- A new study analyzing dozens of published papers over five decades focusing on health care disparities in Washington, DC, found that those that employed medical humanities approaches identified crucial barriers and opportunities for intervention that quantitative studies often miss.

Lead author Sweta Ghatti, a fourth year student at Georgetown School of Medicine, began the study as part of a Mitchell Summer Research Scholarship project addressing health challenges in the District. Ghatti worked closely with senior author Lakshmi Krishnan, MD, PhD, assistant professor of medicine and director of the Georgetown Medical Humanities, on the project for almost two years.

Their findings are described in the article, “Mapping DC Inequities: A Scoping Review Comparing Scientific and Medical Humanities Approaches” and was published Dec. 2 in the journal Humanities and Social Sciences Communications.

“We know that people living in the District face multiple challenges in accessing health care and that some segments of the population have significantly poorer health profiles,” Ghatti said. “For example, predominantly Black areas of the District experience higher rates of chronic diseases such as asthma, hypertension, diabetes and poor maternal health outcomes than White neighborhoods. Our goal was to systematically map the literature of health disparity in DC and to examine the strengths and weaknesses of these methodologies in understanding barriers to care and potentially opportunities for intervention.”

Medical humanities is a dynamic, interdisciplinary field that explores the ethical, historical, literary, philosophical and religious dimensions of health and illness. Medical humanities includes history of medicine, narrative medicine and other storytelling approaches, social sciences, communications and the use of the arts to identify issues that are important to patients, caregivers and providers.

“In our efforts to advance health equity and improve population health, this human-centered approach should be normalized in health professions education,” says Christopher J. King, PhD, FACHE, co-author and Dean of the School of Health.

Ghatti began by analyzing over 1500 papers, using strict criteria to narrow down the final 119 included for analysis. Studies needed to be localized to the DC area and address specific health conditions and issues. Of those, 51 were tagged as medical humanities papers. The analysis revealed that the medical humanities papers were significantly more likely to identify systemic information gaps (78.4% vs. 30.9% p<0.001) and stigma-related barriers (27.5% vs. 5.p%  p=0.002) compared to more quantitative scientific papers.

“Medicine and health care don’t begin and end at the hospital or clinic doors. Medical humanities really bring a contextual approach to understanding how individuals and communities experience health care. “In these studies, we are looking at both specific factors and the enduring things that connect us,” said Krishnan, who is also co-executive director of the Georgetown Howard Center for Medical Humanities and Health Justice. “We see these qualitative and quantitative studies as complementary, providing different lenses and more texture without breaking the health care experience into components.”

“We find that quantitative studies don’t provide a complete picture of disparities,” says Ghatti. “In the medical humanities studies, we hear about issues like language barriers, stigma, mistrust of the health care system and lack of communication that makes navigating the health care system difficult for some patients.”

Ghatti says the findings can have a direct impact on medical and public health education, medical practice and research.

“We need research that captures both measurable obstacles and those that resist quantification,” she adds. “In this country, where health care disparities have persisted over the five decades we studied, the stakes are too high to rely on a single lens or intervention.”

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The authors report having no personal financial interests related to the study.

In addition to Ghatti, Krishnan and King, authors include Scott Dorris and Xue Geng, both of Georgetown University Medical Center.