Doctor, Can You See Me Now?
Whether you are a physician, surgeon, nurse, or technician, being a health care or wellness practitioner is a stressful and taxing state of being. With strenuous demands and pressures created by the medical and insurance industries, balancing the incredible burn-out while still providing quality care is a constant battle for professionals in that arena.
Recent studies and media coverage have brought to the forefront the prevalence of errors in diagnosis, treatment, and management of women of color, with a high percentage of those cases resulting in death. Literature suggests that these errors can be prevented or at least reduced, if the symptom and impact of implicit bias were to be recognized and addressed.
How inclusive is your medical practice? Are you aware of how your implicit bias influences how you approach a patient? Based on female industry experts and patients of color, the suggestions below are a starting point for a more diversity-conscious and inclusivity-led approach to health care and wellness provision.
1. Have People On Staff Who Do Not Look Like You
The simple truth is that we all come from our own perspectives as individuals. On a basic human level we are who we are based on our upbringing, family setting and history, and our personal life experiences, which are impacted by our sex, race, and other factors. Those dynamics do not check out at the door when we walk into our offices and we have to recognize that our preferences, prejudices, and perceptions will color how we see and engage with other people. No matter how “woke,” “bias-conscious,” or “progressive” we deem ourselves to be, at some level we will still fail to be the mystical unbiased human being we want to be. One simple way to address this is to ensure that staff and your colleagues “do not look like you,” meaning having a diverse team which can analyzed and assessed a patient from different perspectives, identifying factors that you did not consider because of your own blind spots. This is not a judgment on you as an individual or your expertise. This should be seen not as an issue of lack in one but rather the power of many.
2. Listen to the True Expert …Your Patient
Time to check the ego at the door! When one becomes an expert or experienced in one’s field, the tendency is to know better than your patient/your client/your customer. The problem with such a position is that this often leads to us not fully listening or hearing what is being said to us. As professionals, especially in the medical field, hearing your patient out and actually understanding what she/they/he are telling you can be the difference between life and death. There has to be a resistance to “know better” and already making up one’s mind about what the patient is presenting, which diagnosis to give, and what treatment to employ before all the facts are in. Not to hurt your feelings, but your patient – not you – is the expert in the room. Only she/they/he can truly explain to you what feels out of the norm for their mind or body. Just as you do not like to have your emotional or physical experience dismissed or discounted, so thou shall not do onto your patient. And just like you want your expertise believed, so should medical professionals believe the words of their patients.
3. Your Patient’s Best Advocate Might Not Be You
The second part of this ego-check is understanding and being comfortable with having an advocate for your patient other than yourself. Again, this is not a reflection of your skill or expertise level but rather ensuring that your patient is surrounded by the best team possible. Make patients aware of “patient advocates” in your hospital, clinic, or center, if your facility has them. If your agency does not have any, share other advocacy resources with your patient.
A note on accompanying family members. If your patient comes with a family member, keep in mind possible cultural dynamics that may render that family member not the ideal representative for your patient, especially if the patient identifies as a woman or is a child. As a health care or wellness professional having an inclusive practice with a diversity-based approach means being mindful of gender dynamics and historical oppression of individuals of certain demographics. Having cultural, ethnic, and linguistically diverse advocates would be a great practice in this field to identify and address any cultural dynamics which may cause your patient not being able to communicate with you as freely and fully as necessary.
4. Go Beyond the Script
A lot of us have the experience of waiting for our appointed time with our physician for several minutes, maybe hours, only to be examined for five short minutes before the white coat disappears out the door and you are already checking out and paying your co-pay. While the pressures of health care systems and the allotted time per patient are a nightmare, going beyond the script, meaning, asking more than just the basic questions and only in regards to the symptoms presented can have a major impact on outcome. Especially with women of color there is a tendency of “not making a big deal” out of pain or the body “acting not as usual.” Additionally, where a patient presents with symptoms but has no medical history, or perhaps communicates that they have felt like this before and this is the umpteenth time this has happened, that should prompt you to ask more questions to look for the bigger picture that sits in front of you. Just because your patient may minimize (or just not know any better or, possibly, doubts themselves in what they are experiencing) should not be an absolution for you to ask more questions and put the pieces of the puzzle together. As an inclusive health care practitioner, you will need to give additional time, consideration, and identify additional resources that may be outside the “presenting symptoms,” especially with patients with limited health literacy or access to care.
Some medical and nursing schools have started to give more space to the conversation of diversity and inclusion in training future medical professionals. But that alone will not move the needle. The medical industry and the health insurance systems must and should put positive patient outcomes over profit in order to allow medical professionals to do what they set out to do when deciding to join this crucial line of work. A health care practice based on diversity, equity, and inclusion can save lives…literally.
The authors of this article are Carla M. Kupe, Esq., is the founder and principal of The Impact Alliance NFP, a DEI consulting firm, and the creator of Speak Truth, a platform giving voice and visibility to issues uniquely and particularly impacting women of color, former Illinois MCH Title V Director Andrea Palmer, MPH, MBA, CHSM, University of Chicago faculty and trauma surgeon Priya Prakash, MD, and Founder of Mganga Midwifery Jeanine Valrie Logan, CNM, MSN, MPH.