C L O S L E R
Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

On Discrimination, Transparency, and Mutual Respect

Takeaway

Patients' past experience with discrimination may influence how they interact with you. Acknowledging this may improve communication and patient care.

Discrimination at health clinics

A recent article posted by NPR reported that 92 percent of Black Americans believed that discrimination against Black Americans exists in the US today. In a survey of Black Americans in the US, approximately 1/3 of individuals reported experiencing discrimination specifically within the context of going to a doctor or a health clinic.

Unconscious bias may affect patient care

While we can agree that most clinicians aim to provide the best, most equitable care possible, it is only human nature that biases may unconsciously creep into encounters with patients despite best intentions. A provider may not purpose to discriminate against a patient based on his or her race, education, or socioeconomic status, but if left unchecked, unconscious biases may affect patient care in disparate and tangible ways.

According to the healthcare literature, black patients have a history with healthcare wrought with mistrust and low patient-provider rapport. It seems simple enough that the solution to addressing discrimination in healthcare starts with building patient trust and rapport, but how? You’re already doing this, right?

Acknowledging lived experiences

Well, within the nation’s currently tense social climate, we could all bear to do a better job with human-to-human encounters–to be kinder and more empathetic, not only in clinical interactions.

Acknowledging lived experiences, including those (especially those) that may make us uncomfortable, may help us bridge the gap. In the hustle and bustle of the day, it’s easy to take the fundamentals of good communication for granted. Here are a few basic notes that apply regardless of to whom we’re speaking.

  1. Listen first. Listen actively. Listen for understanding, not just to respond.
  2. Build rapport. View the patient as a person–a sum total of their life’s experiences, not just their health conditions or health behaviors.
  3. Ask questions. Don’t assume.
  4. Acknowledge your own humanity. You’re a person, too. The patient-provider encounter is ultimately an exchange of information between one person with expert medical knowledge and another person with their expert life experience. Leveling the playing field is the easiest way to avoid the pitfalls of bias.

As a health equity researcher, eliminating health disparities, including addressing discrimination in healthcare and elsewhere, is my priority. Moreover, understanding the ways in which providers and the healthcare system at-large can help to lighten the burden of disease on disproportionately affected populations is the path that I have chosen for my career. I believe that transparency and respect are at the core of our solutions. Being honest about racism and discrimination sets us on that path.

Equity is not a single individual’s burden to carry, but it is everyone’s responsibility.

When we see it that way–that everyone benefits from equity–the task of addressing discrimination and eliminating disparities is not only feasible, but worthwhile.

Learning to acknowledge the personal experiences of others, not just racial discrimination, improves practice by not only encouraging empathy, but by clearing the path for more patient-engaged and informed medical decision-making.