1. Practicing Medicine in a Multicultural Environment: Will We Have What it Takes? Elizabeth Lee-Rey, MD Co-Director Hispanic Center of Excellence Albert Einstein College of Medicine

2. So what do we understand about health care today?

3. Latinos In The United States Source:Therrien, M.,& Ramirez,RR 2000. The Hispanic Population in the US: March 2000

4. Institute of Medicine Report to Congress Minorities in America even those with private health insurance receive lower quality care than given to whites. Highlighted health care disparities in areas of cardiovascular disease, HIV/AIDS,cancer and diabetes. Other areas of inequities identified: Language barriers, inadequate insurance coverage,bias among doctors and nurses, and lack of minority physicians.

5. Diverse Communities, Common Concerns  Minority Americans do not fare as well as whites.  African Americans, Asian Americans, and Hispanics are more likely that whites to experience difficulty communicating with their physician, to feel that they are treated with disrespect when receiving health care services, and to experience barriers to care, including lack of insurance or a regular doctor.

6. Diverse Communities, Common Concerns

7.  The idea of service, calling and commitment and the importance of preserving a sense of personal meaning in the practice of medicine  Definition -Service is defined as the work of the soul  Recognize that depth of commitment is independent of expertise  Witness the unity of commitment to service that lies beneath the diversity of expertise and experience

8.  Awe is not an uncommon experience in medicine  To develop greater comfort with unanswered questions  To develop greater comfort with not knowing  To differentiate between the study of death and the management of dying

9. The Experience of Awe in Medical Practice  Occur in caring for those at the end of life, and death is often a time when such questions naturally arise and mystery seems closer and more apparent  Sharing grief and honoring loss

10.  What we do instead of healing:Common strategies of responding to loss and disappointment-dysfunctional  These strategies temporarily numb pain but do not heal loss  Grief is presented as a process by which the heart heals after loss, which allows us to remain open-hearted in our work

11.  Many people feel inadequate when faced with the loss of others, most of us have valid instincts about how to be with others in times of disappointment and loss  Reflect on a time of disappointment and remember someone who was of help to them at that time  Remember someone who wanted to be of help tothem at a time of disappointment but was not of help to them

12.  Strategies they have seen others use as physician are those that have been personally counter-productive  Difference between healing and fixing others  Power of sharing and being listened to.  The power of compassionate listening to heal things that cannot be fixed

13. “It is possible to heal, with your listening, things you cannot cure with your science.” -Rachel Naomi Remen

14.  Discovering and Nurturing Your Wholeness  Need and responsibility for self care physical, emotional, and spiritual  Preserve empathy,sensitivity and compassion

15. Tools of self remembering  Contemplation  Rituals  Journaling  Imagery  Poetry