hce_nchu
112年
英文
第 21 題
📖 題組：
Questions 21-25 refer to the following passage. PASSAGE 1 Indigenous social determinants of health, including the ongoing impacts of colonization, contribute to increased rates of chronic disease and a health equity gap for Indigenous people. Globally, type 2 diabetes disproportionately affects Indigenous populations, with documented rates in Canada 3–5 times higher in Indigenous compared with non-Indigenous populations. Indigenous people tend to acquire diabetes at younger ages, have complications sooner, and have poorer treatment outcomes. In Canada and other countries that share a colonial history, health inequities arising from the effects of colonization include deeply rooted disparities in the social determinants of health, social exclusion, political marginalization, and historical trauma. Researchers undertook a qualitative examination of Indigenous patients’ stories emanating from a sequential focus group method that concerned diabetes care experiences. They found that interactions and engagement with health services were influenced by personal and collective historical experiences with health care providers and contemporary exposures to culturally unsafe health care. Indigenous patients related such experiences to specific health policies and systemic discrimination in health care systems. Specifically, Indigenous patients reported that rushed appointments, writing prescriptions or medicating complaints, not listening, and negative judgments regarding Indigenous customs and communities created a lack of confidence in the health system and provider. These experiences led to Indigenous patients not disclosing all of their symptoms or health behaviors. Mistrust emerged as a substantial subtheme that stemmed from historical experiences. Some Indigenous patients suspected that during the mid-20th century, Indigenous patients with tuberculosis “were used as guinea pigs”, presumably observed or tested upon without access to the same interventions provided to non-Indigenous patients. On the other hand, other Indigenous patients acknowledged that, increasingly, hospitals set aside spaces for the Indigenous ceremony but noted that access to these is not always possible for patients confined to a bed. Likewise, it is not uncommon for Indigenous extended families to come to hospitals in support of a patient. A considerable challenge identified by Indigenous patients was that each visit to a clinic off-reserve could lead to interacting with a new provider, retelling one’s history, and leaving with yet another care plan. A shortage of on-reserve physicians threatened the continuity of care. Consequently, some Indigenous patients questioned doctor–patient ratios for Indigenous people across Canada, arguing that concern over doctor shortages should be amplified for populations with disproportionate rates of diabetes. In addition, the physical space in which clinical interactions took place was important. Indigenous patients often wanted services provided in their communities or in Indigenous health centers. Examination rooms could stir mistrust before a clinical interaction even began. Health care relationships are central to addressing the ongoing colonial dynamics in Indigenous health care and play a role in mitigating past harms. The positive therapeutic relationships described by Indigenous patients involved physicians who showed empathy and patience, and who took a genuine interest in the patient. Attention to antiracism education, structural competency and advocacy for working with Indigenous populations holds great potential to address issues identified, as physicians are also health advocates and should promote health equity.
Questions 21-25 refer to the following passage. PASSAGE 1 Indigenous social determinants of health, including the ongoing impacts of colonization, contribute to increased rates of chronic disease and a health equity gap for Indigenous people. Globally, type 2 diabetes disproportionately affects Indigenous populations, with documented rates in Canada 3–5 times higher in Indigenous compared with non-Indigenous populations. Indigenous people tend to acquire diabetes at younger ages, have complications sooner, and have poorer treatment outcomes. In Canada and other countries that share a colonial history, health inequities arising from the effects of colonization include deeply rooted disparities in the social determinants of health, social exclusion, political marginalization, and historical trauma. Researchers undertook a qualitative examination of Indigenous patients’ stories emanating from a sequential focus group method that concerned diabetes care experiences. They found that interactions and engagement with health services were influenced by personal and collective historical experiences with health care providers and contemporary exposures to culturally unsafe health care. Indigenous patients related such experiences to specific health policies and systemic discrimination in health care systems. Specifically, Indigenous patients reported that rushed appointments, writing prescriptions or medicating complaints, not listening, and negative judgments regarding Indigenous customs and communities created a lack of confidence in the health system and provider. These experiences led to Indigenous patients not disclosing all of their symptoms or health behaviors. Mistrust emerged as a substantial subtheme that stemmed from historical experiences. Some Indigenous patients suspected that during the mid-20th century, Indigenous patients with tuberculosis “were used as guinea pigs”, presumably observed or tested upon without access to the same interventions provided to non-Indigenous patients. On the other hand, other Indigenous patients acknowledged that, increasingly, hospitals set aside spaces for the Indigenous ceremony but noted that access to these is not always possible for patients confined to a bed. Likewise, it is not uncommon for Indigenous extended families to come to hospitals in support of a patient. A considerable challenge identified by Indigenous patients was that each visit to a clinic off-reserve could lead to interacting with a new provider, retelling one’s history, and leaving with yet another care plan. A shortage of on-reserve physicians threatened the continuity of care. Consequently, some Indigenous patients questioned doctor–patient ratios for Indigenous people across Canada, arguing that concern over doctor shortages should be amplified for populations with disproportionate rates of diabetes. In addition, the physical space in which clinical interactions took place was important. Indigenous patients often wanted services provided in their communities or in Indigenous health centers. Examination rooms could stir mistrust before a clinical interaction even began. Health care relationships are central to addressing the ongoing colonial dynamics in Indigenous health care and play a role in mitigating past harms. The positive therapeutic relationships described by Indigenous patients involved physicians who showed empathy and patience, and who took a genuine interest in the patient. Attention to antiracism education, structural competency and advocacy for working with Indigenous populations holds great potential to address issues identified, as physicians are also health advocates and should promote health equity.
Based on the information in the passage, which of the following is true?
- A Physicians who paid no attention to antiracism education, structural competency and advocacy emanated from the shortage of on-reserve physicians and space set aside in hospitals for the Indigenous ceremony.
- B A health equity gap for Indigenous people is evidenced by documented rates of type 2 diabetes in the world approximately a quarter higher in Indigenous compared with non-Indigenous populations.
- C Doctor–patient ratios for Indigenous people across Canada did not reflect doctor shortages, based on reports of physicians who took a genuine interest in Indigenous patients with disproportionate rates of diabetes.
- D Rushed appointments and negative judgments regarding Indigenous customs created a lack of confidence in the health system and led to Indigenous patients not disclosing all of their symptoms.
- E Indigenous patients wanted services provided in their communities or in the examination rooms of hospitals for clinical interactions, as Indigenous families always came to hospitals in support of a patient.
思路引導 VIP
若一位病患在就醫時感到醫師並不關心他，甚至感受到對其背景的偏見，這可能會如何改變他在診間裡對醫師分享健康資訊的意願？
🤖
AI 詳解
AI 專屬家教
醫療信任的崩解與溝通障礙
恭喜你精準地鎖定了文章的核心細節！這題你能答對，代表你準確捕捉到了文中關於「醫病關係」的因果邏輯。在文章第二段中，作者詳列了原住民病患在醫療體系中所遭遇的負面經驗，包括匆促的診程（rushed appointments）以及醫護人員對其文化習俗的負面評價。這些負面互動並非只是單純的不愉快，而是會直接導致病患對醫療體系產生不信任感，進而選擇隱瞞病情或健康行為。你選擇選項 (D)，正是抓住了這一關鍵的臨床後果。
文本細節的精確辨析
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