We must be aware of our own biases and prejudices in order to give excellent care to every patient.
Lifelong Learning in Clinical Excellence | December 17, 2020 | 4 min read
By Kristal Brown, PhD, MSPH, Johns Hopkins Medicine
When I was a doctoral candidate, I gave a presentation on my upcoming study to a room full of young Black women, hoping they would enroll. It was on the role of racial discrimination and subsequent behavioral reactions among young Black women living in larger bodies. At the end of the presentation their interest and eagerness to participate was more than I’d expected. After many agreed to participate, we scheduled times for them to come in for their assessment.
Individually, I reminded them about the particulars of the assessment. It required them to fast before their arrival and have their weight, height, waist circumference, and blood pressure measured. I then asked, “Do you prefer to have a female or male assessor?”
In response, one participant asked me a question I hadn’t anticipated, “Is the man Black or white?”
This response was atypical, as people normally said something like, “Girl, I don’t care, whoever is available,” or “I definitely want a woman.” I wondered about the root of this different answer.
“He’s white,” I replied.
She shook her head from left to right, and said, “No, I can’t have him as my assessor. That would be triggering for me. I consider myself a Black woman, but I’m mixed. The racial discrimination that I’ve had to continuously endure regarding my body from the white side of my family is a lot. I’ve also had to hear my grandmother talk negatively about my father, a Black man. Having a white assessor would be stressful and triggering for me.”
My colleague, a white man and a skilled assessor, had completed cultural competency training and was a consummate professional. To be clear, I’m not at all saying a cultural competency workshop makes you a resident expert in all things Black women. But I am saying that on paper he was qualified for the task. However, in that moment none of that mattered. What mattered was ensuring my participant felt safe and comfortable.
This participant was responding based on her lived experiences. She experienced personal discrimination from her white family who attacked the features of her Black body. Some patients might not be able to recognize racial discrimination, experience it vicariously through social media, or choose not to verbally acknowledge their experiences. Compounded by this, minority patients living in larger bodies are impacted by the intersection of race, size, and racial discrimination.
Expand how you think about stress to include various types of discrimination and understand the impact this stressor has on minority populations, particularly the intersection of size and race. Although this moment was captured with one Black woman, these experiences and feelings aren’t isolated to Black women alone. Minorities as a whole have been subjected to these experiences. We are not okay.
For my study, I was afforded the opportunity to match participants with assessors of the gender/race they felt most comfortable with. However, physicians may not have the option to ask patients who they prefer to see.
Here are 6 things you should know:
1. Stress for Black and Brown patients always includes racial discrimination.
Ask your patients if it’s okay for you to talk about some of the unique stressors they might be facing, which could be interfering with their eating habits, physical activity, and motivation. Understand that everyone won’t want to talk with you and that’s okay. What’s important is that you create space. Be prepared to provide a list of referrals to patients that might need additional support from someone that looks like them and/or has had similar experiences.
2. Every patient won’t be comfortable with assessments that include showing their bodies, especially those who have been historically ridiculed and degraded for their Black and Brown bodies.
Check out “Fearing the Black Body,” by Sabrina Strings. It’s not enough to just see your patients. You must SEE your patients. SEE their Black and Brown bodies. SEE their larger bodies. SEE their pain. Be empathetic. You can do all of these things while simultaneously promoting health and long-term behavior change.
3. Check yourself.
When we enter a room, we come in with our own beliefs and biases that shape the patient-clinician relationship. Many have preconceived ideas about the behaviors of people living in larger bodies, specifically Black and Brown bodies. Check yourself. Implicit biases, preconceived notions, attitudes, and beliefs about people and groups are inescapable—it’s critical to be aware of them.
4. Do the work.
We’re tired of explaining why being a person of color comes with its own set of challenges. Make it a lifelong practice to take time to read articles and books that address sociocultural factors that impact minority health. Sign up for workshops that go beyond the standard departmental cultural competency training.
5. Be you.
Being knowledgeable and culturally competent is a must. However, it’s equally as important for you to BE YOU. Although race and discrimination are hot topics right now and everyone wants to be an expert, patients are smart and can see right through a person trying to be someone they are not. Be genuine. Be candid. Be your authentic self—even if that means sharing that you’re learning and taking the necessary steps to be informed.
6. Be brave enough to stand up to your colleagues.
Stop allowing—yes allowing—your colleagues to dismiss racial discrimination as a thing of the past or a figment of imagination. If you’re not correcting your colleagues, friends, and family, your silence means complicity. Stand up. Speak up. Be anti-racist.