Putting nonverbal communication under a lens: An examination of the dynamic interplay of patient-provider interactions between Black patients and non-Black physicians

Experiences of Black Women With Pelvic Floor Disorders-A Qualitative Analysis Study

IMPORTANCE

Disparities research in Black women with pelvic floor disorders (PFDs) has primarily focused on epidemiology or surgical outcomes, but little is known about the patient perspective on seeking PFD care.

OBJECTIVE

To provide quality and equitable care to Black women with PFDs, we conducted a qualitative study to hear their perspectives and lived health care experiences.

STUDY DESIGN

Black women seeking care for PFDs at a tertiary care institution were invited to participate in qualitative interviews. Open-ended questions explored participants' knowledge, attitudes, and health care experiences. Interviews were transcribed verbatim and coded line-by-line. Inductive content analysis was performed to identify key themes, and consensus was achieved among the research team.

RESULTS

Eight Black women aged 21-83 years consented to participate. Patients noted a stigma surrounding PFDs, both among health care professionals and their community. They noted several barriers to care: financial, logistical, and racial bias. They cited difficulties in patient-health care professional communication, including not feeling heard or treated as an individual. They preferred gender and racial concordance with their physicians. These women expressed both a desire for more knowledge and to share this knowledge and advocate for other women.

CONCLUSIONS

Black women expressed distinct obstacles in their PFD health care. They reported not feeling heard or treated as a unique individual. The themes derived from this study identify complex patient-centered needs that can serve as the basis for future quality improvement work and/or hypothesis-driven research. By grounding health disparities research in patient perspectives, we can improve the health care experiences of Black women.

Prosopagnosia (face blindness) and child health during the COVID-19 pandemic

Prosopagnosia or 'face blindness' is the inability to recognise people's faces. There are two types: congenital or developmental prosopagnosia, which is the most common, and acquired prosopagnosia, which may occur secondary to brain tumours, stroke or other brain disorders. The authors of this article explored if mask wearing as a result of the restrictions imposed by the coronavirus disease 2019 (COVID-19) pandemic may affect social and developmental outcomes in children, including the development of prosopagnosia. Limited research on this topic is available and, although some relevant publications were found, no definitive evidence of mask-induced prosopagnosia in children was identified. However, nurses should be aware of this issue and discuss coping strategies to support children with the condition. Longitudinal studies on outcomes in children from different age groups who grew up during the COVID-19 pandemic will provide further insight.

Black (patients') lives matter: Exploring the role of identity-safety cues in healthcare settings among Black Americans

Two online experiments investigated whether hypothetical physicians' use of an identity-safety cue acknowledging systemic injustice (a Black Lives Matter pin) improves Black Americans' evaluations of the physician and feelings of identity-safety. Across studies, findings showed that when a White physician employed the identity-safety cue, Black Americans reported stronger perceptions of physician allyship and increased identity-safety (e.g. trust). As predicted, use of the identity-safety cue produced smaller or non-significant effects when employed by a Black physician. These benefits emerged regardless of physicians' perceived motivation for employing the cue (e.g. whether the physician was personally motivated to employ the cue or his medical practice encouraged use of the cue; Study 2). Furthermore, analyses revealed that exposure to the identity-safety cue promoted a greater sense of identity-safety for Black Americans due to increased perceptions that the physician is an ally for Black individuals. Implications of identity-safety cues for racially discordant medical interactions are discussed.

Time to Reflect and Take Action on Health Disparities and Health Inequities

The United States healthcare system underperforms in healthcare access, quality, and cost resulting in some of the poorest health outcomes among comparable countries, despite spending more of its gross national product on healthcare than any other country in the world. Within the United States, there are significant healthcare disparities based on race, ethnicity, socioeconomic status, education level, sexual orientation, gender identity, and geographic location. COVID-19 has illuminated the racial disparities in health outcomes. This article provides an overview of some of the main concepts related to health disparities generally, and in orthopaedics specifically. It provides an introduction to health equity terminology, issues of bias and equity, and potential interventions to achieve equity and social justice by addressing commonly asked questions and then introduces the reader to persistent orthopaedic health disparities specific to total hip and total knee arthroplasty.