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 American and Hispanic patients, receive unequal c
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 American and Hispanic patients, receive unequal care compared to white patients.
How does race or ethnicity influence clinical decision-making? We explored the complex 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.
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 likely to adhere to recommended medical care. Therefore, she was less likely to send her patients to specialists.
A black 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 is 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 issues. 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. In addition, fear of procedures may apply more to minorities.
One doctor spoke of the benefits of accepting a patient’s beliefs. “I have a patient who is Hispanic who really doesn’t want to come to terms with his diagnosis of diabetes. He’s a young guy and he’s trying all kinds of herbs, and I had to put aside my scientific thinking to come to an agreement with him that he could do that as long as he also monitored his blood sugar.”
How do minority patients move forward to get the best possible care? We cannot focus on just one factor. Here are several starting points.
- Find common ground. Ideally, physicians should think of the person in front of them as a family member. A doctor who walks in the patient’s shoes provides better care. If your doctor does not attempt to understand your cultural concerns, be prepared to tell your doctor about your background and beliefs.
- Ask for help to overcome barriers to accessing care. This is particularly true for immigrants and the underinsured. Ask your doctor if a social worker or community liaison can help you navigate the system, especially if your doctor talks about treatments and specialists that seem overwhelming or out of reach.
- Find a facility that has what you need, if your doctor’s office or hospital lacks the support or care you need.
- Take charge of your modifiable risk factors. Learn about the American Heart Association “Life’s Simple 7” lifestyle recommendations. These can reduce your risk of heart disease (and other health problems). Monitor and control blood pressure, cholesterol and blood glucose levels, engage in an active lifestyle, eat healthful meals, lose weight and stop using tobacco products. Do not be overwhelmed by a list of seven. Start working on the lifestyle change that would give you the biggest health benefit. No. 1 – If you smoke, stop!
- Vote for your health. Learn about political candidates and programs focused on expanding access to health care and funding health research.
Recognizing racial/ethnic differences is the first step to overcome these disparities. Working together will help us bridge this gap!
About the Author
Khadijah Breathett, MD, MS, assistant professor of medicine at the University of Arizona College of Medicine – Tucson, is board-certified in internal medicine, cardiology and advanced heart failure and transplant cardiology. Her research focuses on reducing racial/ethnic and gender disparities in advanced heart failure and preventing populations that experience disparities from developing advanced heart failure. Her published research appears in journals such as Circulation Heart Failure and the Journal of American College of Cardiology Heart Failure. She also is the lead author of the chapter, “Review of Heart Failure Management in African Americans” in Management of Heart Failure.
Factors that affect physician bias: From “Factors Related to Physician Clinical Decision-Making for African-American and Hispanic Patients: A Qualitative Meta-synthesis,” Journal of Racial and Ethnic Health Disparities, March 5, 2018