Can we talk race and healthcare?

As we have discussed in other class sessions and reading, racism often occurs unintentionally potentiated by unconscious prejudice and stereotypes. To the extent that many people are unaware of their biases, there is little motivation for change.

As a healthcare provider, I have worked in predominately white owned practices privately and publicly and have found that not only do minorities and others marginalized groups receive among other treatments, substandard medical and nursing care, but that often time racism is the fuel motivating the delivery of such care. Often times patients of color are unable to effectively voice these sentiments due to stereotypes threats, and healthcare providers often becomes offended that they are in essences being accused of being a racist.

The current research article we are reading for class: Race, Race-Based Discrimination, and Health Outcomes among African Americans, the authors wrote: “persistent and vexing health disadvantages accrue to African American despite decades of work to erase the effects of racism.” They hypothesized that African Americans’ continuing experiences with racism and discrimination may lie at the root of many well documented race-based physical health disparities.

Since we understand from the readings that racism often occurs unintentionally, the discussion regarding disparities in healthcare delivery for African Americans and other minorities, place both patients and healthcare providers in defensive positions.

So I believe if there is an approach of openly acknowledging stereotypes and other ideologies that influence our behaviors and subsequent fueling of healthcare disparities, perhaps the sensitivities and defensiveness can be reduced improving Doctor-Patient relationship. I further think that open acknowledgement of these structures, will have several benefits. First this can help to enhance understanding of the psychological ills of bias and how negatively healthcare outcomes are impacted for all, not just some. Secondly, this will also help to reduce colorblind ideology /colorblind racism as I believe that suppressing conversation about stereotypes in healthcare can lead to many unintentional consequences such as social distance between patients and providers, and reduced quality of interaction during doctor’s visits. Last week we discussed Apfelbaum and Dovido’s articles that suggested that trying to not appear racist or functioning with colorblind ideology actually took so much effort and cognitive resources, that not only did whites appear racist after all, but that they were rendered ineffective during a particular task. The same is can be true for the effective delivery of healthcare. If a Doctors is preoccupied with colorblindness or stereotype suppression, he or she may render ineffective care in the end, which results in him or her being labeled a racist. Thirdly, open discussions can lead to reduction in external pressures to “appear” not racist and actually enhance internal motivation to reduce biases, based on the awareness of the need for equitable healthcare delivery. Fourth, open discussion can further serve to improve providers’ confidence in their ability to interact and treat African American and other marginalized groups. Just my thoughts, what do you think?

8 thoughts on “Can we talk race and healthcare?”

  1. I’m not how this fits in or not with what you are talking about, but I have noticed that a lack of cultural awareness can impact delivery of health care hugely. For example, the Diabetes Center here in town (run out of our University hospital) has had dismal failure in getting diabetes patients or at-risk diabetes people (often black, asian or native american) to come to the center for educational classes. The “no show” rate is high. Two years ago, a grant was given to the center to allow the certified educators to conduct a train the trainer program which allowed the people of those communities to provide the education in the target population’s churches, beauty salons, barber shops and other local gathering places. The two year grant was a huge success. Unfortunately when the funding ran out the program ended. I think of this as an important example of providers needing to understand how important it is to be aware of cultural differences in how people use (or don’t use) health care, especially if we want to move toward a model that emphasizes prevention.

  2. I, too, agree that diversity training is something that is very important for anyone that works in the healthcare field. It is important for those people that want to help others to be able to effectively communicate with others. However, many white people don’t know how to communicate people of other races or cultures. Most likly because most whites abide by a colorblind ideological mindset and believe that they don’t see race so they don’t talk about race. However, as we have learned it is important to discuss race when it is relevant to the situation. I believe that it is relevant in healthcare because healthcare provides an opportunity for the implicit biases and attitudes of whites nurses or doctors to emerge. If white healthcare providers are trained in diversity, they may be able to better communicate ith people of different races and cultures. As we have discussed all semester in my Interpersonal Communication class, communication is the most important aspect of any relationship. Healthcare providers need to be able to communicate well with their patients and also need to understand that not every person communicates the same way. If healthcare providers are required to have diversity training, they may learn how to communicate with people of all races and cultures in an efficient manner.

  3. I think Simone brings up a number of good points; I think diversity training is absolutely necessary in the healthcare field. As Simone’s presentation demonstrated this week, racism has a pervasive effect on an individual’s mental and physical health, as well as the ability to seek help. Because of incidents such as Tuskegee, there remains a historical distrust of doctors and the medical field; without the tools and ability to understand why this relationship exists and ways to improve inter-racial relations and build trust, there will continue to be a discrepancy in health care treatment—assuming that it’s equally provided. One of the first things I learned about treatment in Multicultural Psychology was that because different ethnic and racial groups may communicate differently, it’s important to be culturally competent and learn how to effectively communicate, despite these barriers. As Simone mentioned, diversity training could enable better communication between doctors and patients and allow individuals to better communicate their symptoms. If doctors are culturally competent, they will be able to not only encourage a greater degree of communication, but they should be able to understand how different cultures express symptoms and emotions—enabling them to successfully communicate cross-racially.

  4. I truly think that this problem is the one that should be used the most in the fight against social injustices. Healthcare is one thing in our society that truly tugs at people’s heartstrings. Put simply, humans generally don’t want other humans to die.

    If we can prove that (and we can) minorities are receiving worse healthcare from the same doctors that white people are receiving better healthcare from, people may be moved to accept that their truly is an institutional, systematic racial problem within our society.

    I believe, that although these injustices are not purposeful, they may be perceived by the general public as more overt and blatant than, for example, the general problem of white privilege. With an understanding of this in the general public, people may be more open to understanding the wider, more generalized problem of modern forms of racism.

  5. I see your point Simone and I especially agree with what you said about needing to have this training because it will help the quality of interaction between caregiver and patients. I think this demonstrates what we talked about earlier in the semester about how topics such as this can be difficult to talk about because we often times don’t know how. Diversity training for health care professionals would be an excellent way to educate them/provide them with the tools to discuss issues they may emerge with various types of patients and in turn make them more comfortable with caring for diverse patients.

  6. I wonder, and perhaps you are best suited to answer this question Simone, are doctors required to take a diversity course? I ask this because, as those of us who have been/currently are employed, we all are required to take a sexual harassment course (or 2 or 10) in our professional life. I wonder if there would be a way to incorporate something along those lines with regard to multicultural awareness/diversity training? And if so do you think that this would lead to an improvement in how communications occur or do you think it would be passed over as “just another requirement” and then carry on with the status quo? I know that teachers in the state of Pennsylvania are required to read a mandate regarding race and cultural differences and how to effective communicate/teach in a diverse classroom. I am not certain how much of an effect (if any) that this has on teachers but it is better than nothing at all I suppose. What do you think; can we begin the process of integrating diversity classes in the professional realm like we have the sexual harassment and/or “sensitivity” training?

    • I think that integrating diversity classes in the professional realm is a great idea, as awareness in my opinion is one of the first small steps that can be taken towards solving the problem of inequality in healthcare. I also thought it would be interesting to share this while we are on the topic of healthcare: I was telling my mom the other day about our class discussion regarding the inequalities in healthcare today since my grandfather (her father) is now a retired surgeon. As much as I hate to put him in a negative light, he has always been one at the dinner table to crack a joke saturated with racism. My mom then went on to tell me that as much as he says these comments, he used to operate on people of many different races who did not have insurance and would either let them pay him a small portion of the cost of the operation over time or pay nothing at all. She said how he always had to be discrete about these incidents because other surgeons would look down on him for doing what he did. What do you guys think about this? I get confused about the gap between the jokes he makes and then his actions that don’t match what he says sometimes. I admire him very much for what he has accomplished in his career in medicine and often times get the impression from his stories that it was a very difficult road for him. By this I mean that he always had to follow the the pack, such that if he stepped out of line from what other doctors were doing or spoke up with an idea, he would be frowned upon. Granted, I realize he has been retired for almost ten years now, but I wonder how much as really changed in the world of medicine?

    • I do believe Diversity training is an important aspect of healthcare management. Training healthcare providers in cultural competency–providing effective treatment to individuals of various cultures, religions, ethnicities and native languages–is a main component in bridging the disparities gap in healthcare. I recall the very first class I had as a Nursing Student was “diversity in the patient population –what’s your role”. Surprisingly this was the first time many of my fellow student nurses ever thought of the possibility of having to care for someone that is not look like him or her and the resulting conversations were astounding. Many in my first years class voiced their discomfort caring for someone of a different race who may also have different views on healthcare and prefer practices such as , homeopathic remedies ,for example. The bottom line is that diversity training for healthcare providers and patients is immediately beneficial . Without the training/ discussions, the quality of interaction between the caregiver and patients can be negatively affected by the cultural diversity that exists. This diversity can affect the patient’s ability to discuss symptoms, stick to treatment plans or his beliefs regarding the respect he receives from caregivers and the healthcare system.

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