Very few physicians or patients enter an exam or hospital room with the intent of racially alienating the other person in the room, but research demonstrates that minority populations, particularly African-Americans and Hispanic patients, receive unequal care compared to Caucasians.
How does race or ethnicity influence clinical decision-making? The causes are complex, but include an interloping combination of factors, namely differences in characterizing the importance of race, patient-level and system-level issues that may be more common among racial and ethnic minorities, bias and racism, patient values, and communication. We explored these issues in “Factors Related to Physician Clinical Decision-Making for African-American and Hispanic Patients: A Qualitative Meta-synthesis,” published in Journal of Racial and Ethnic Health Disparities, March 5, 2018.
In the published studies we reviewed, one white physician shared how she had not sent her racial/ethnic minority patients to see specialists when indicated because the patients were underinsured. Another white physician described that racial/ethnic minority patients were less adherent to medical regimens. Therefore, she was less likely to send her patients to specialists.
An African-American physician observed a colleague empathizing more for the White patient because he has more of a connection with him. “Most doctors who are very good doctors, and otherwise nice people, are simply doing less for the black patient because they have this unconscious racism. I guess it’s kind of hard to swallow, but you almost don’t want to accept it,” he said.
It’s hard to have this discussion without appearing to single out white physicians, but the reality is most health-care providers are white. Patients also come to clinical settings with their own baggage —both real and those perceived by health-care providers. Minority patients may have lower levels of trust in the health-care system related to historical disservice. Many minority patients hold spiritual beliefs that guide decisions, at times to their doctors’ discomfort. And, fear of procedures may apply more to minorities.
How do we move forward to provide equal access to evidence-based patient care for minority patients? We cannot focus on just one factor. Here are several starting points.
- Cultural training and communication – physicians and patients must find commonality. Think of this person as a parent or grandparent and treat the patient as a family member. Take a moment to understand the patient’s culture without forming stereotypes. This process of perspective-taking and individualizing care has been associated with improved patient outcomes and reduced bias. Patients, if your doctor does not ask about your cultural concerns, be prepared to tell your doctor about your background and beliefs.
- Patient-level issues – physicians must understand the patients’ barriers to accessing care, especially for immigrants and the underinsured. Engage a social worker or community liaison to address socioeconomic issues. Seek support from your health-care administrators. Small investments in this process have reduced long-term costs for the patient and health-care system.
- System issues – if a facility lacks adequate support and time for indigent care, where can the patient obtain needed care? This will require health system adjustments to provide increased time to see patients who require well-rounded care, which addresses health and other social needs. Quality improvement initiatives that address systematic differences in care has been associated with more equitable care. In addition, physicians need to stay up to date on patient-care guidelines.
- Racial/ethnic minority patients often have more modifiable risk factors for disease. Adopting the American Heart Association “Life’s Simple 7” lifestyle recommendations can reduce risk of heart disease: monitoring and controlling blood pressure, cholesterol, and blood glucose levels, engaging in an active lifestyle, eating healthier meals, losing weight, and stopping usage of tobacco products.
- Reducing structural inequalities will require political change. Vote to address health-care issues that impact patients and health-care providers.
Recognizing racial/ethnic differences is the first step to overcome these disparities. It will take a concerted effort by patients, providers, and the health system to ensure equitable health care to all. So let’s bridge this gap together!
“Drs. Breathett, Merchant Spotlight DOM Research at 2nd Innovations & Inventions Fair” | Posted Oct. 18, 2018
“Racial/Ethnic Disparities in Heart Failure Care Focus of NIH Award for Dr. Khadijah Breathett” | Posted Aug. 13, 2018
“Drs. Breathett, Ramos Pen ‘Healthy Dose’ Blogposts on Medical Bias, Precision Medicine” | Posted May 9, 2018
“UA Sarver Heart Center and Banner – University Medical Center Welcome Three Cardiologists” | Posted Oct. 5, 2017