‘Get out of the clouds:’ What we need from providers to build health equity
As a patient advocate and a patient of color, I challenge physicians to take the small steps and the big steps to dismantling the current medical landscape to pave the way for health equity.
Physicians, in my experience, tend not to understand the historic nature of fear within communities of color when discussing medicine and medical research. A physician recently said to me, ‘Is Henrietta Lacks still a thing?’
It’s more than a thing and it goes far beyond one woman. The medical and research community tends to land on Tuskegee or Henrietta as if they were the beginning of medical atrocities. They weren’t. It started in 1619 and still persists today. How do you achieve equity in a health care system that was never designed to treat you?
Our current system is akin to the Constitution, constantly amended without changing the source of contention. We add to the health care system without resolution. We are always going to have health care inequity until we destroy and deconstruct and build a new system that does not factor skin color into treatment.
You, as physicians, need to get out of the clouds and realize this is an actual problem across the board and you are part of that problem.
Acting as if it’s not there does not change it. We need help within and outside the institution to affect change for health care equity. That means we are going to need physicians to affect change by speaking up and speaking out against the institutions for which they work. Otherwise, those who make the decisions default to existing inequity.
Fight the institution from within the confines of the institution. Make the grand gesture through bold statements. And then remember the small steps you can take each day to dismantle your own implicit bias.
Know Your Patients
One way to dismantle your own bias is to take the time to know your patient and help them choose the right treatment for their lives. Do not prejudge them based on race, socioeconomics or even habits formed.
We must realize there are certain treatments and treatment programs and options that don’t fit the lives of the current working environment. That is what puts patients in financial jeopardy, not only choosing between treatment and employment but also treatment and taking care of their families. When you look at your patients, does the treatment match the life?
Understanding what’s going on at home makes a big difference. They might be a single parent; they might be a caregiver for elderly parents. Families now in the working class are not 9-to-5 anymore. They can’t make 9-to-5 hours. There needs to be accommodations for people who work part time at McDonalds and Walmart.
Traditional medicine is not traditional anymore and we need to remove that traditional thinking from medicine. Patients are not one-size-fits-all. They never have been.
No one ever asked me: are you a single parent? What work do you do? Does this treatment plan match what you do? Can you do this or that?
There needs to be a true partnership and true empathy for the patient and the lives that they lead outside of the medical institution. This is a starting point. It shows your patients that you are actually concerned for their overall wellbeing.
Some physicians may say they are not those people, that this is not within their training. But medicine today is a bottle bursting at the seams. Trying to stay within that bottle is futile. Everyone is doing more than one duty now. It is no longer ok to pass the patient along to an assistant. I’m not seeing your assistant. I’m seeing you.
It makes me feel better that the doctor I’m coming to see regularly knows my personal situation, that they try to work with me, to benefit me and not put me in a position to choose between treatment and living.
That doesn’t happen often because we only have 13 minutes to talk. Before you take those 13 minutes and walk into that room, know who you are seeing. Know something about my life. Having a doctor who is empathetic and understanding and says, ‘Let’s work this out to benefit you and also doesn’t hurt you at the same time’ is the key to building trust.
Guide Your Patients
The next step after knowing your patient is guiding them through the system weighted against them.
Every patient needs to have a navigator and every doctor needs a relationship with the navigation team. These patients are dealing with things at home that a physician cannot handle but knowing who to send a patient to – especially a patient who is guarded – can make a huge difference. Your patients may be more comfortable with you, so don’t send them through hoops when it is truly out of your realm.
Be knowledgeable and consider what your patients are managing. That could be a make-or-break moment. They might be embarrassed, but if you can do the handoff to a patient navigator, it helps the patient. Don’t put the patient through that unnecessary trauma of bouncing through the system.
In the case of colorectal cancer and other conditions that may have a genetic tie-in, don’t just ask about family history as a patient may not know. Guide the patients in gathering their family history. And then give clear, concise directions after it is determined if there is a family history. Connect your patients with genetic counseling, genetic testing but be prepared to discuss the innate fear of those instructions.
A lot of times, it is left open. Patients fear what you’re saying and may also harbor fears about the family history and family secrets. These are real-life situations that will prevent a patient moving forward. Counseling needs to go hand-in-hand with physician instruction.
I was diagnosed in 2003 and didn’t hear until more than 10 years later that I should undergo genetic testing. After I was diagnosed, no one told me what to say to my children even though my diagnosis is now their family history.
Remove Implicit Bias, Medical Paternalism
I implore you to look at your own implicit bias, recognize it and work on dismantling it. Do not look at a patient without knowing more. We tend to judge people without knowing why they’ve made these decisions – why they smoke, why they drink, etc.
Put all of those aside. Don’t pre-judge. Just because a person does these things doesn’t mean they don’t care about their own lives. We need to talk to them differently.
Remove implicit bias and look at people as people.
Often, conflict arises when patients are pre-judged, especially when we discuss how Black men and Black patients are treated in relation to pain. Stop equating race with pain tolerance.
When it comes to certain medical equipment, providers are still inputting if a patient is Black or white. That is no longer valid. It’s been proven that those are historically inaccurate as it relates to minorities as a way to show we are different, more impaired, more susceptible.
I would love to see the removal of equipment created centuries ago, when Black people were research subjects. We are still using equipment that measures blood pressure differently due to race. Just living in a racist environment can cause stress and, therefore, higher blood pressure. I would love to see race-based equipment gone and health be based upon a person for themselves.
There is a lot of medical paternalism and that comes with physician expertise. I ask you to remember the patient knows their living conditions, their bodies and what they can, can’t or want to tolerate. Allow your patients to voice their concerns and then work within those concerns. Do not just automatically assume you know better than the patient telling you they are fearful.
Additionally, physicians must understand some patients will never ask you questions because they have been reared in ‘the doctor is always right’ mentality when physicians are only human. This brings us back to understanding your patients when choosing treatment options and recommending certain medications. You should ask the right questions to lift the weight of fighting for medical equity from the shoulders of your patients.
It’s ridiculous the amount we have to fight just to receive adequate health care. It’s amazing how I can receive wonderful care and, in the same city, another patient may not receive any of it. We don’t have the same treatment across the board. It wasn’t until I became an advocate and connected with other patients that I discovered what I didn’t know.
Don’t make your patients fight that fight. Do better. Give the best care for each patient.
- For more information:
- Candace Henley founded The Blue Hat Foundation, a colorectal cancer organization whose mission is to educate, raise awareness and provide resources to free screenings for minority and medically underserved communities. She can be reached at firstname.lastname@example.org.