By Abril Corona
The health care field has undergone many changes over the course of history, both scientifically and socially. In the health care field there are several things that have been recognized as important in the past and in the current era. One of the most prominent things includes the relationship between a patient and their provider. Like other relationships in a person’s life, this relationship is crucial and vital to the well-being of a person-especially if they are seeking treatment for an illness. This relationship is highly important because without proper communication between both parties, there are higher chances of miscommunication and error. In the health care field, a lack of proper communication could cost someone their lives. This relationship however, can be impacted on by different factors that are brought on by societal standards and structure. These factors include disparities in race, gender, age, culture, language and even educational attainment all of which put a gap and strain on the relationship. Each of the factors individually impact how efficient a doctor and its patient can communicate. While all factors are incredibly important to this relationship between doctor and patient, an often-overlooked factor is educational attainment.
Statistics on North Carolina Educational Attainment
Educational attainment in terms of a patient/doctor relationship can be defined as the highest educational level achieved by the patient in comparison to the highest level of education in a medical doctor and how it impacts the relationship. Out of these differences, a gap is created. Educational attainment gaps are due to the differences in education, both academically and personally (previous experiences). These gaps reach the healthcare system to the entire U.S system and also to each individual state such as North Carolina. Statistically speaking, North Carolina educational attainment percentage is below the national average of 89.51 with only 87.8% (Educational attainment by State, 2021). What these numbers mean is that 87.8% of North Carolina residents over the age of 18 have graduated from high school, while only 31.3 % of the state’s residents have graduated a university (Educational attainment by State, 2021). While these percentages appear to be higher than other states, that means that 12.2% of the residents have never graduated from high school which roughly estimates to 1 million residents (Educational attainment by State 2021). Typically, educational attainment gaps are seen in the rural areas of North Carolina, which take up 39.8% of the state (Rural Health Information Hub). Rural areas and education are related because in rural areas, education levels are typically lower. Rural areas are also the areas with the weakest relationships between patients and providers. This actively demonstrates that a big part of North Carolina residents does not have a positive relationship with their providers; without the knowledge and education achieved in different educational levels, individuals have a harder time to relate and take control of their own health. To properly observe the influence of educational attainment gap on patient-doctor relationship and how it impacts the physical and mental health of an individual, the Stories to Save Lives project can be used to tell the stories of those who have noticed a change in this relationship due to educational attainment within the North Carolina healthcare system.
Effect of Educational Attainment on Mental Health
The influence of educational attainment and prior experiences with the healthcare system on mental health can be visualized using William Sessions’ interview about his life. William Sessions, an African American man shares his story about moving to North Carolina, his family and his addiction. William grew up with his grandparents that came to the US from Africa with no education background. He was raised not believing in doctors, and having little communication with them in times of illness, that his grandparents taught him home remedies rather than teaching him how to communicate with doctors or anything related to the healthcare system (Sessions, 00:30:44.0-00:32:28.0). William then states that it was not until he was in school that he learned basic health things such as going to the dentist every six months, and decided to take charge of his health at a young age since his mother was absent due to addiction (Sessions, 00:29:25.0-00:30:44.2). As Williams grew older, he recognized the healthcare system in ways his family did not, and states that he “grew a relationship with providers and that it was good” (Sessions, 00:32:50.0). Williams later fell to mental health problems which created chaos in his life before he realized he had to seek treatment. He learned through his therapist that mental health was also vital to his health. He also realized that his feelings who had been present since his childhood were not healthy, and he suspected his family had undiagnosed mental health issues but they did not believe in mental health & seeking professional treatment (Sessions 00:36:18.01-42:01.0) William states his relationship with his doctors helped him overcome his mental health issues and led him to a healthier life. While William never got a bachelor’s degree, his earlier education was what started him on the right path to maintain a constant healthy relationship with his providers which ultimately lead him to get the right treatment for his mental health issues. This story magnifies how important proper education on both mental and physical health can help avoid any additional distress, and how trusting and communicating with providers when help is needed leads to a healthier life.
Rural Areas of North Carolina with Lower Educational Attainment
A story that emphasizes how higher education can correlate to a positive patient/provider relationship can be found through the story of Carol Fields. Carol Fields, is an African- American woman born and raised in Clinton, North Carolina, now retired from aerospace engineering. Carol Fields mentions that her parents had dropped out at a young age and she was the first to attend a university (Fields, 00:04:02-00:06:03). She states that she did not take much health classes and that it was not until she moved to California that she noticed how rural and unhealthy Clinton, NC was (Fields, 00:20:23- 00:23:50). Carol mentions how her high school classmates were sick “some with dialysis” while her university classmates were in better health; this giving us an insight to how different those two educational levels were in Carol’s story. Carol later on states that she had difficulty with her knees, and her back and she was able to see three different doctors before deciding on surgery. She mentions that she chose the doctor who gave her the most information about the procedure, and answered all her questions properly and did not “push” her away from getting proper explanations to her issues (00:46:00-00:49:04). Carol Fields is able to give proper explanation to her chronic pain, and her previous surgeries using medical terminology. While she does not explicitly state that her knowledge was due to her educational level she mentions how she understands these words because of the knowledge given to her from her provider and from previous lectures in chemistry and anatomy in her undergraduate career.
Educational Attainment Gap & Discrimination in Healthcare
Another issue with the educational attainment gap between a patient & their provider is based off discrimination from the provider. This is seen in many areas of the healthcare field. This is one of the reasons lower educational levels are scared of going to a doctor- because they feel less than for not attending higher education. More often than not, patients are discriminated against because of their racial background and assumed to have a lower educational level. While many providers go about this in a discrete way, this was not the case for Mirna Allende. Mirna Allende, a Hispanic-American Commwell Health employee who lost her mother to cancer at a young age, uses her experience with her family and her personal experience with the medical field to explain how medical paternalism arising from providers’ esoteric knowledge lessened the quality of her relationship with a provider. The provider that Mirna Allende went to during a thyroid cancer scare, explicitly told her when she was asking questions “I was the one that went to school for this” (Allende, 00:39:11.0-00:41:23.0). Allende mentions how she quickly switched doctors, and wanted one that could answer her questions and gave her the right information to make a choice about her treatment. She states she did not want a doctor who barely gave her a choice in her own care, and that she had seen similar things happen to migrant workers when she worked in healthcare and she knew it was going to negatively affect her.
All of the statistical analysis and the stories of William Sessions, Carol Fields and Mirna Allende considered it is clear that education attainment & the gap that it creates between a patient and their provider impacts the treatment of the patient & their overall health. If the relationship between a patient & provider is weak then the miscommunication between both parties leads to improper treatment of the patient & an unhealthier life.
Allende, Mirna. Interview with Maddy Kamey. 25 June 2018 (Y-0001). Southern Oral History Program Collection (#4007), Southern History Collection, Wilson Library, University of North Carolina at Chapel Hill.
Educational Attainment by State 2021. worldpopulationreview.com/state-rankings/educational-attainment-by-state.
Fields, Carol. Interview with Shelby Smith. 12 August 2019 (Y-0097). Southern Oral History Program Collection (#4007), Southern History Collection, Wilson Library, University of North Carolina at Chapel Hill.
Sessions, Williams. Interview with Joanna Ramirez. 27 June 2018 (Y-0049) Southern Oral History Program Collection (#4007), Southern History Collection, Wilson Library, University of North Carolina at Chapel Hill.