hce_nchu
112年
英文
第 23 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.
Which of the following instances of unsafe health care is not discussed, either directly or indirectly, in the passage?
- A Physicians coming and going from community
- B Denied ability to practice ceremony
- C Frustration with the daily challenges that affect coping with long queues
- D Past experiences influenced faith in health care
- E What used to be hemochromatosis is now the epidemic of asthma and tuberculosis
思路引導 VIP
在面對這類詢問「文中未提及（NOT discussed）」的題目時，如果你在某個選項中看到了一個非常具體、甚至帶有專有名詞的醫學診斷或描述，你會採取什麼樣的「回頭定位」策略，來快速確認這個細節是否真的屬於作者討論的範疇呢？
🤖
AI 詳解
AI 專屬家教
恭喜你答對了！這顯示你對於長篇學術文章的資訊擷取相當精準。這類題目考驗的是對文本細節的過濾能力，你能不被看似專業的醫學名詞誤導，代表你的閱讀穩定度很高。
文本資訊的篩選與辨析
在文中，作者詳盡地列舉了原住民在醫療體系中所面臨的各種結構性挑戰，例如醫生流動率高導致缺乏連續性照顧（對應選項 A）、受限於醫院環境而無法進行傳統儀式（對應選項 B）、以及過去歷史創傷（如將病患視為實驗對象）所造成的體制不信任感（對應選項 D）。雖然文中確實提到了「結核病（Tuberculosis）」作為歷史實驗的背景，但完全沒有提及「血鐵沈著症（Hemochromatosis）」或「氣喘（Asthma）」的流行演變。選項 (E) 刻意混入了文章未出現的具體病名，是典型的「無中生有」干擾項。
▼ 還有更多解析內容