Health care providers urged to create 'culturally safe medical home' for patients
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Understanding the parameters of bias, race and racism is critical to creating an environment in which patients of all backgrounds feel comfortable, according to the keynote speaker at the 2021 Rheumatology Nurses Society annual conference.
“Racism in itself is a huge concept,” Lynn C. Smitherman, MD, assistant professor of pediatrics at the Wayne State University School of Medicine, told attendees.
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Smitherman opened her presentation with a number of definitions, including those for bias, race and racism.
She encouraged attendees to understand the difference between their explicit biases — those that are overt, or that they acknowledge openly — and their implicit biases, which may “operate unconsciously.”
While race “originally started off as a category of kinship or affiliation,” slave trade and the slaughter of native populations in North America resulted in the strictly defined categories that drive much of racism today, according to Smitherman. She added that the two main components of racism include racial prejudice and social power.
Digging deeper, Smitherman discussed how systemic racism and institutional racism can create whole systems of power that disenfranchise certain populations. These types of racism can have a number of far-reaching impacts. They are seen in educational and financial systems and drive disparities in rates of incarceration.
Moreover, systemic and institutional racism can impact individuals and their own interpersonal racism. “Interpersonal racism is how we act upon our racial beliefs when we interact with others,” Smitherman said.
With all of this in mind, throughout 2020, medical societies including the AMA, the American Academy of Pediatrics and the American Public Health Association took a hard look at issues pertaining to bias and racism. “If we are going to improve the public health of our entire population, we are going to need to take this seriously,” she said.
Smitherman was forthright about the role of every health care practitioner in battling bias and racism of all types in this effort. “One of the things we have to look at as medical professionals is that we have to recognize that there is implicit bias among ourselves,” she said. “Health care providers are human. We are going to have implicit biases.”
She encouraged attendees to assess their communication style and word choice with patients and whether race impacts clinical decision-making. “We have to challenge our own biases and prejudices,” she said, and encouraged education on relevant topics as a way of meeting these challenges.
Clinicians should ask themselves hard questions on the subject of race, according to Smitherman. “Am I doing the best for each patient that I see or will this contribute to the unequal playing field that each of our patients faces?” she said.
Smitherman acknowledged that none of this will be easy. “It is a marathon, not a sprint,” she said. “There are going to be stops and starts, there is going to be gaps and mistakes. Just keep trying to do better.”
One simple way to achieve these goals is to simply ask patients about their lives, their stress levels and whether they need mental health services or support. Small things can help, like a diverse array of magazines in the waiting room, or reading books by different types of authors, according to Smitherman.
“Try to create a culturally safe medical home,” she said.
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Smitherman LC. Keynote Presentation: The Impact of Bias, Discrimination and Racism on Health Care. Presented at: Rheumatology Nurses Society annual conference; August 4-7, 2021 (virtual meeting).
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