1
|
Wolfe BH, Gunning JN, Boateng SN, Hintz EA, Cardwell ME. Disenfranchising Talk Mediates the Relationship Between Social Determinants of Health and Wellbeing Outcomes for Women of Color Patients with Autoimmune Disease. JOURNAL OF HEALTH COMMUNICATION 2024; 29:548-555. [PMID: 39136415 DOI: 10.1080/10810730.2024.2384888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
Autoimmune disease disproportionately afflicts women of color (i.e., Black/African American, Hispanic/Latina, Multiethnic-racial) of childbearing age. Social determinants of health (SDOH) and dismissive healthcare provider (HCP) interactions exacerbate these disparities in health outcomes for women of color with autoimmune disease. Guided by the theory of communicative (dis)enfranchisement, this study assesses whether disenfranchising talk (DT) mediates the relationship between SDOH (i.e., race/ethnicity, insurance status, income, employment, education, and sexual orientation) and health outcomes including patient satisfaction, overall well-being, and tangible social support for women of color with autoimmune disease. Findings affirmed the mediating role of DT, such that Multiethnic-racial patients and those with less insurance coverage and lower household income reported less tangible social support, poorer overall well-being, and lower patient satisfaction when they experienced HCP DT. We offer theoretical and practical implications.
Collapse
Affiliation(s)
- Brooke H Wolfe
- Department of Communication, Michigan State University, East Lansing, MI, USA
| | | | - Sarah N Boateng
- Department of Communication, University of Connecticut, Storrs, CT, USA
| | - Elizabeth A Hintz
- Department of Communication, University of Connecticut, Storrs, CT, USA
| | - Megan E Cardwell
- Department of Communication, Villanova University, Villanova, PA, USA
| |
Collapse
|
2
|
Waltz M, Foreman AKM, Canter C, Cadigan RJ, O'Daniel JM. Reflections on 'common' genetic medical history questions: Time to examine the what, why, and how. PATIENT EDUCATION AND COUNSELING 2024; 122:108190. [PMID: 38340501 PMCID: PMC11289763 DOI: 10.1016/j.pec.2024.108190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/18/2024] [Accepted: 02/02/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE A central goal of patient-centered care is to establish a therapeutic relationship. While remaining in tune with patient emotions, genetics providers must ask questions to understand medical histories that will inform the differential diagnosis, evaluation plan, and potential treatments. METHODS 195 audio-recorded conversations between providers and caregivers of pediatric patients with suspected genetic conditions were coded and analyzed. Coders identified sensitive history-taking questions asked by providers related to exposures and complications during pregnancy; ancestry and consanguinity; educational attainment of the caregiver; and family structure. RESULTS We highlight examples of providers: using stigmatizing language about conception or consanguinity; not clarifying the intent behind questions related to caregivers' educational attainment and work history; and making presumptions or assumptions about caregivers' race and ethnicity, family structure, and exposures during pregnancy. CONCLUSION Some questions and phrasing considered routine by genetics providers may interfere with patient-centered care by straining attempts to establish a therapeutic, trusting relationship. Additional research is needed to assess how question asking and phrasing impact rapport building and patient experience during genetics encounters. PRACTICE IMPLICATIONS Review of the purpose and need for medical history questions common to genetics practice could serve to improve patient-centered care.
Collapse
Affiliation(s)
- Margaret Waltz
- Department of Social Medicine, University of North Carolina, Chapel Hill, NC, USA.
| | | | - Courtney Canter
- Department of Anthropology, University of North Carolina, Chapel Hill, NC, USA
| | - R Jean Cadigan
- Department of Social Medicine, University of North Carolina, Chapel Hill, NC, USA
| | | |
Collapse
|
3
|
Kornblith E, Diaz-Ramirez LG, Yaffe K, Boscardin WJ, Gardner RC. Incidence of Traumatic Brain Injury in a Longitudinal Cohort of Older Adults. JAMA Netw Open 2024; 7:e2414223. [PMID: 38819822 PMCID: PMC11143459 DOI: 10.1001/jamanetworkopen.2024.14223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/29/2024] [Indexed: 06/01/2024] Open
Abstract
Importance Traumatic brain injury (TBI) occurs at the highest rate in older adulthood and increases risk for cognitive impairment and dementia. Objectives To update existing TBI surveillance data to capture nonhospital settings and to explore how social determinants of health (SDOH) are associated with TBI incidence among older adults. Design, Setting, and Participants This nationally representative longitudinal cohort study assessed participants for 18 years, from August 2000 through December 2018, using data from the Health and Retirement Study (HRS) and linked Medicare claims dates. Analyses were completed August 9 through December 12, 2022. Participants were 65 years of age or older in the HRS with survey data linked to Medicare without a TBI prior to HRS enrollment. They were community dwelling at enrollment but were retained in HRS if they were later institutionalized. Exposures Baseline demographic, cognitive, medical, and SDOH information from HRS. Main Outcomes and Measures Incident TBI was defined using inpatient and outpatient International Classification of Diseases, Ninth or Tenth Revision, diagnosis codes received the same day or within 1 day as the emergency department (ED) visit code and the computed tomography (CT) or magnetic resonance imaging (MRI) code, after baseline HRS interview. A cohort with TBI codes but no ED visit or CT or MRI scan was derived to capture diagnoses in nonhospital settings. Descriptive statistics and bivariate associations of TBI with demographic and SDOH characteristics used sample weights. Fine-Gray regression models estimated associations between covariates and TBI, with death as a competing risk. Imputation considering outcome and complex survey design was performed by race and ethnicity, sex, education level, and Area Deprivation Index percentiles 1, 50, and 100. Other exposure variables were fixed at their weighted means. Results Among 9239 eligible respondents, 5258 (57.7%) were female and 1210 (9.1%) were Black, 574 (4.7%) were Hispanic, and 7297 (84.4%) were White. Mean (SD) baseline age was 75.2 (8.0) years. During follow-up (18 years), 797 (8.9%) of respondents received an incident TBI diagnosis with an ED visit and a CT code within 1 day, 964 (10.2%) received an incident TBI diagnosis and an ED code, and 1148 (12.9%) received a TBI code with or without an ED visit and CT scan code. Compared with respondents without incident TBI, respondents with TBI were more likely to be female (absolute difference, 7.0 [95% CI, 3.3-10.8]; P < .001) and White (absolute difference, 5.1 [95% CI, 2.8-7.4]; P < .001), have normal cognition (vs cognitive impairment or dementia; absolute difference, 6.1 [95% CI, 2.8-9.3]; P = .001), higher education (absolute difference, 3.8 [95% CI, 0.9-6.7]; P < .001), and wealth (absolute difference, 6.5 [95% CI, 2.3-10.7]; P = .01), and be without baseline lung disease (absolute difference, 5.1 [95% CI, 3.0-7.2]; P < .001) or functional impairment (absolute difference, 3.3 [95% CI, 0.4-6.1]; P = .03). In adjusted multivariate models, lower education (subdistribution hazard ratio [SHR], 0.73 [95% CI, 0.57-0.94]; P = .01), Black race (SHR, 0.61 [95% CI, 0.46-0.80]; P < .001), area deprivation index national rank (SHR 1.00 [95% CI 0.99-1.00]; P = .009), and male sex (SHR, 0.73 [95% CI, 0.56-0.94]; P = .02) were associated with membership in the group without TBI. Sensitivity analyses using a broader definition of TBI yielded similar results. Conclusions and Relevance In this longitudinal cohort study of older adults, almost 13% experienced incident TBI during the 18-year study period. For older adults who seek care for TBI, race and ethnicity, sex, and SDOH factors may be associated with incidence of TBI, seeking medical attention for TBI in older adulthood, or both.
Collapse
Affiliation(s)
- Erica Kornblith
- San Francisco Veterans Affairs Health Care System, San Francisco, California
- Department of Psychiatry, University of California San Francisco, San Francisco
| | - L. Grisell Diaz-Ramirez
- San Francisco Veterans Affairs Health Care System, San Francisco, California
- Department of Medicine, University of California, San Francisco, San Francisco
| | - Kristine Yaffe
- San Francisco Veterans Affairs Health Care System, San Francisco, California
- Department of Psychiatry, University of California San Francisco, San Francisco
- Northern California Institute for Research and Education, San Francisco, California
- Department of Neurology, University of California, San Francisco, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | - W. John Boscardin
- San Francisco Veterans Affairs Health Care System, San Francisco, California
- Department of Medicine, University of California, San Francisco, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | - Raquel C. Gardner
- Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel
| |
Collapse
|
4
|
Bond C, Datta S, Milne WK. Hot off the press: Microaggressions in the emergency department. Acad Emerg Med 2024; 31:404-407. [PMID: 38465881 DOI: 10.1111/acem.14891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 02/13/2024] [Indexed: 03/12/2024]
Affiliation(s)
| | - Suchisimita Datta
- NYU Grossman Long Island School of Medicine, New York, New York, USA
| | - William K Milne
- University of Western Ontario OH5, Goderich, Ontario, Canada
| |
Collapse
|
5
|
Punches BE, Osuji E, Bischof JJ, Li-Sauerwine S, Young H, Lyons MS, Southerland LT. Patient perceptions of microaggressions and discrimination toward patients during emergency department care. Acad Emerg Med 2023; 30:1192-1200. [PMID: 37335980 PMCID: PMC11075179 DOI: 10.1111/acem.14767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 06/13/2023] [Accepted: 06/13/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Disparities in emergency department (ED) care based on race and ethnicity have been demonstrated. Patient perceptions of emergency care can have broad impacts, including poor health outcomes. Our objective was to measure and explore patient experiences of microaggressions and discrimination during ED care. METHODS This mixed-methods study of adult patients from two urban academic EDs integrates quantitative discrimination measures and semistructured interviews of discrimination experiences during ED care. Participants completed demographic questionnaires and the Discrimination in Medical Settings (DMS) scale and were invited for a follow-up interview. Transcripts of recorded interviews were analyzed leveraging conventional content analysis with line-by-line coding for thematic descriptions. RESULTS The cohort included 52 participants, with 30 completing the interview. Nearly half the participants were Black (n = 24, 46.1%) and half were male (n = 26, 50%). "No" or "rare" experiences of discrimination during the ED visit were reported by 22/48 (46%), some/moderate discrimination by 19/48 (39%), and significant discrimination in 7/48 (15%). Five main themes were found: (1) clinician behaviors-communication and empathy, (2) emotional response to health care team actions, (3) perceived reasons for discrimination, (4) environmental pressures in the ED, and (5) patients are hesitant to complain. We found an emergent concept where persons with moderate/high DMS scores, in discussing instances of discrimination, frequently reflected on previous health care experiences rather than on their current ED visit. CONCLUSIONS Patients attributed microaggressions to many factors beyond race and gender, including age, socioeconomic status, and environmental pressures in the ED. Of those who endorsed moderate to significant discrimination via survey response during their recent ED visit, most described historical experiences of discrimination during their interview. Previous experiences of discrimination may have lasting effects on patient perceptions of current health care. System and clinician investment in patient rapport and satisfaction is important to prevent negative expectations for future encounters and counteract those already in place.
Collapse
Affiliation(s)
- Brittany E. Punches
- The Ohio State University College of Nursing, Columbus, Ohio, USA
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Evans Osuji
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Jason J. Bischof
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Simiao Li-Sauerwine
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Henry Young
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Michael S. Lyons
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Lauren T. Southerland
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| |
Collapse
|
6
|
Vora AS, Grilo SA. The Influence of Identity on Multiracial Emerging Adults' Health and Experiences Seeking Healthcare in the United States: a Qualitative Study. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01785-1. [PMID: 37698751 DOI: 10.1007/s40615-023-01785-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND The Multiracial population, defined as having parents who are of two or more racial groups, increased from 2.9% of the United States population in 2010 to 10.2% in 2020. Existing research focused on monoracial populations shows that racial disparities and discrimination affect health. This study explores how emerging adults ages 18-29, who identify as Multiracial, describe the impact of identity on their health and experiences seeking health care in the United States. METHODS Semi-structured interviews were conducted with 21 participants in May 2021. Interview guide categories were the following: health and wellbeing, racial/ethnic identification, childhood upbringing, family influence, peer engagement, discrimination, forming resilience, language, and demographics. A thematic framework analysis was utilized. RESULTS Overarching themes were as follows: mental health and Multiracial identity-related stress, childhood experiences, healthcare experiences, influences on seeking or not seeking care, and the impact of identity on physical health. Our findings suggest that Multiracial emerging adults perceive their identity to influence mental health more than physical health. CONCLUSION Multiracial emerging adults face challenges with healthcare that are unique (e.g., discrimination based on identity defined or perceived by others) and others that are similar to their monoracial counterparts (e.g., structural racism, access to care). This study illustrates how structural factors trickle down to influence care sought and accessibility via socioeconomic status, insurance, childhood experiences, and racial and cultural beliefs about healthcare. Increased awareness and identification of Multiracial individuals and diversity in the workforce may help the US healthcare system better serve Multiracial emerging adults.
Collapse
Affiliation(s)
- Anjali S Vora
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA.
- New York-Presbyterian Hospital, New York, NY, USA.
| | - Stephanie A Grilo
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY, USA
| |
Collapse
|
7
|
Wollen J, Rosario N, Kiles TM. Training Student Pharmacists How to Mitigate Racial or Ethnic Microaggressions in Patient Encounters. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2023; 87:100068. [PMID: 37316124 DOI: 10.1016/j.ajpe.2023.100068] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/31/2022] [Accepted: 12/08/2022] [Indexed: 06/16/2023]
Abstract
The experience of interfacing with the health care system is a taxing one for racially or ethnically marginalized patients (REMPs). The seemingly inevitable occurrence of encountering microaggressions is reason enough to avoid the interaction for many resulting in worse health outcomes. Microaggressions result in conflict, loss to follow-up, and reinforcing the unwelcome atmosphere of the health care system to REMPs. Teaching antimicroaggressive content in doctor of pharmacy curricula is critical for reducing strain on the fragile relationship between REMPs and the health care system. Whether it is gathering a patient history, devising a patient-centered care plan, or counseling patients, there is an opportunity for an interaction that could sever the patient's trust in the health care system. Teaching each of these skills-based learning activities should be combined with didactic lessons in nonjudgmental and nonmicroaggressive communication approaches. In addition, lessons regarding the impact of microaggressions on REMPs should also be present so that learners may appreciate the impact of a clinician's actions on REMPs in this regard. To establish evidence-based best practices, more research on teaching antimicroaggressive didactic and skills-based content to student pharmacists is needed.
Collapse
Affiliation(s)
- Joshua Wollen
- University of Houston College of Pharmacy, Houston, TX, USA.
| | | | - Tyler Marie Kiles
- College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, USA
| |
Collapse
|
8
|
Conneely M, Packer KC, Bicknell S, Janković J, Sihre HK, McCabe R, Copello A, Bains K, Priebe S, Spruce A, Jovanović N. Exploring Black and South Asian women's experiences of help-seeking and engagement in perinatal mental health services in the UK. Front Psychiatry 2023; 14:1119998. [PMID: 37077277 PMCID: PMC10109459 DOI: 10.3389/fpsyt.2023.1119998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/06/2023] [Indexed: 04/21/2023] Open
Abstract
Background and aims In the United Kingdom (UK), Black and South Asian women are less likely than White British women to access support from perinatal mental health services, despite experiencing similar, or higher, levels of distress. This inequality needs to be understood and remedied. The aim of this study was to answer two questions: how do Black and South Asian women experience (1) access to perinatal mental health services and (2) care received from perinatal mental health services? Method Semi-structured interviews were conducted with Black and South Asian women (n = 37), including four women who were interviewed with an interpreter. Interviews were recorded and transcribed line-by-line. Data were analyzed using framework analysis, by an ethnically diverse multidisciplinary team of clinicians, researchers and people with lived experience of perinatal mental illness. Results Participants described a complex interplay of factors that impacted on seeking, and receiving help, and benefiting from services. Four themes emerged that captured the highly varied experiences of individuals: (1) Self-identity, social expectations and different attributions of distress deter help-seeking; (2) Hidden and disorganized services impede getting support; (3) The role of curiosity, kindness and flexibility in making women feel heard, accepted and supported by clinicians; (4) A shared cultural background may support or hinder trust and rapport. Conclusion Women described a wide range of experiences and a complex interplay of factors impacting access to, and experience of, services. Women described services as giving them strength and also leaving them disappointed and confused about where to get help. The main barriers to access were attributions related to mental distress, stigma, mistrust and lack of visibility of services, and organizational gaps in the referral process. These findings describe that many women feel heard, and supported by services, reporting that services provide a high quality of care that was inclusive of diverse experiences and understandings of mental health problems. Transparency around what PMHS are, and what support is available would improve the accessibility of PMHS.
Collapse
Affiliation(s)
- Maev Conneely
- Unit for Social and Community Psychiatry, WHO Collaborating Centre, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
- East London NHS Foundation Trust, London, United Kingdom
| | - Katy C. Packer
- Camden and Islington NHS Foundation Trust, London, United Kingdom
- North East London NHS Foundation Trust, London, United Kingdom
| | - Sarah Bicknell
- Birmingham and Solihull Mental Health Foundation Trust, Birmingham, United Kingdom
| | - Jelena Janković
- Birmingham and Solihull Mental Health Foundation Trust, Birmingham, United Kingdom
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Harpreet Kaur Sihre
- Department of Applied Health Research, University College London, London, United Kingdom
| | - Rosemarie McCabe
- School of Health and Psychological Sciences, City, University of London, London, United Kingdom
| | - Alex Copello
- Birmingham and Solihull Mental Health Foundation Trust, Birmingham, United Kingdom
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Kiren Bains
- Birmingham and Solihull Mental Health Foundation Trust, Birmingham, United Kingdom
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, WHO Collaborating Centre, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
- East London NHS Foundation Trust, London, United Kingdom
| | - Amy Spruce
- Action on Postpartum Psychosis, London, United Kingdom
| | - Nikolina Jovanović
- Unit for Social and Community Psychiatry, WHO Collaborating Centre, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
- East London NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
9
|
Facente SN, Lam-Hine T, Bhatta DN, Hecht J. Impact of Racial Categorization on Effect Estimates: An HIV Stigma Analysis. Am J Epidemiol 2022; 191:689-695. [PMID: 34999778 DOI: 10.1093/aje/kwab289] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 12/13/2021] [Accepted: 12/15/2021] [Indexed: 11/14/2022] Open
Abstract
Suboptimal racial categorization potentially introduces bias in epidemiologic analysis and interpretation, making it difficult to appropriately measure factors leading to racial health disparities. As part of an analysis focused on predictors of experiencing human immunodeficiency status (HIV)-related stigma among men who have sex with men living with HIV in San Francisco, we struggled with the most appropriate ways to categorize people who reported more than 1 racial identity, and we aimed to explore the implications of different methodological choices in this analysis. We fitted 3 different multivariable linear regression models, each utilizing a different approach to racial categorization: the "multiracial," "othering," and "hypodescent" models. We estimated an adjusted risk difference in mean score for reported frequency of experiencing HIV-related stigma on a 4-point scale, adjusting for age, race, gender identity, injection history, housing, mental health concerns, and viral load. Use of a hypodescent model for racial categorization led to a shift in the point estimate through the null for Blacks/African Americans, and it improved precision for that group. However, it obscured the association of increased stigma and race for multiracial people, compared with monoracial counterparts. We conclude that methodological decisions related to racial categorization of participants can dramatically affect race-related study findings in predictor regression models.
Collapse
|
10
|
Doctors’ Perceptions of Multiracial Adolescents. SOCIAL SCIENCES 2022. [DOI: 10.3390/socsci11040146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Perceptions of race influence the way health care is delivered to minority populations, particularly multiracial people. Currently only 11% of American physicians are Black or Latinx, making the chances slim that Black and Latinx patients will be treated by a co-ethnic. White supremacy is well documented in the medical literature—along with efforts to combat it—yet medical education and health care are still largely based on studies by and about white people. This privileging of whiteness is increasingly evident as the COVID-19 pandemic has shone a renewed spotlight on disparities in health and care in the U.S. The current study considers how doctors perceive race and use it to make healthcare decisions. Among the (N = 509) doctors in this sample, few said they considered the patient’s race. Of those who did, many determined race by some method other than asking the patient directly. The most common methods were observing skin tone and observing cultural cues. Doctors perceived nearly half the multiracial targets as monoracial. Targets who followed the norm of hypodescent were significantly more likely to be identified congruently by doctors. Targets who identified at the extremes of the color spectrum (black and white) were easier to identify, while the beige tones in the middle of the spectrum were more challenging. Patient ancestry was the most relevant criterion in explaining the congruence of racial identification between patients and doctors, while characteristics of the doctors were nearly irrelevant.
Collapse
|
11
|
Burnett-Bowie SAM, Bachmann GA. Racism: the shameful practices that the medical profession is finally addressing. Womens Midlife Health 2021; 7:9. [PMID: 34727987 PMCID: PMC8561345 DOI: 10.1186/s40695-021-00068-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/14/2021] [Indexed: 11/10/2022] Open
Affiliation(s)
- Sherri-Ann M Burnett-Bowie
- Endocrine Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 50 Blossom Street, Thier 1051, Boston, MA, 02114-2696, USA.
| | - Gloria A Bachmann
- Women's Health Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| |
Collapse
|
12
|
Kaufman JS, Merckx J, Cooper RS. Use of Racial and Ethnic Categories in Medical Testing and Diagnosis: Primum Non Nocere. Clin Chem 2021; 67:1456-1465. [PMID: 34557889 DOI: 10.1093/clinchem/hvab164] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/26/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Use of race and ethnicity is common in medical tests and procedures, even though these categories are defined by sociological, historical, and political processes, and vary considerably in their definitions over time and place. Because all societies organize themselves around these constructs in some way, they are undeniable facets of the human experience, with myriad health consequences. In the biomedical literature, they are also commonly interpreted as representing biological heterogeneity that is relevant for health and disease. CONTENT We review the use of race and ethnicity in medical practice, especially in the USA, and provide 2 specific examples to represent a large number of similar instances. We then critique these uses along a number of different dimensions, including limitations in measurement, within- versus between-group variance, and implications for informativeness of risk markers for individuals, generalization from arbitrary or nonrepresentative samples, perpetuation of myths and stereotypes, instability in time and place, crowding out of more relevant risk markers, stigmatization, and the tainting of medicine with the history of oppression. We conclude with recommendations to improve practice that are technical, ethical, and pragmatic. SUMMARY Medicine has evolved from a mystical healing art to a mature science of human health through a rigorous process of quantification, experimentation, and evaluation. Folkloric traditions, such as race- and ethnic-specific medicine will fade from use as we become increasingly critical of outdated and irrational clinical practices and replace these with personalized, evidenced-based tests, algorithms, and procedures that privilege patients' individual humanity over obsolete and misleading labels.
Collapse
|
13
|
Diop MS, Taylor CN, Murillo SN, Zeidman JA, James AK, Burnett-Bowie SAM. This is our lane: talking with patients about racism. Womens Midlife Health 2021; 7:7. [PMID: 34454618 PMCID: PMC8399735 DOI: 10.1186/s40695-021-00066-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/15/2021] [Indexed: 12/15/2022] Open
Abstract
Racism has significantly impacted communities of color for centuries. The year 2020 is a reminder that racism is an ongoing public health crisis. Healthcare institutions have an important role in dismantling racism because of their ability to implement innovative solutions that advance diversity, address social determinants of health, and promote health equity. Healthcare professionals have the unique opportunity to support patients by discussing patients' experiences of bias and racism. Asking about discrimination, however, can be difficult because of the sensitive nature of the topic and lack of appropriate education. This review highlights the importance of addressing patients' experiences of racism, utilizing the frameworks of trauma-informed care, structural competency, provider bias, and intersectionality. Furthermore, this review provides ways to engage in meaningful dialogue around discrimination and includes important patient-centric resources.
Collapse
Affiliation(s)
- Michelle S Diop
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Christy N Taylor
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Sascha N Murillo
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jessica A Zeidman
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Aisha K James
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Sherri-Ann M Burnett-Bowie
- Endocrine Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 50 Blossom Street, Thier 1051, Boston, MA, 02114-2696, USA.
| |
Collapse
|
14
|
Abstract
BACKGROUND Patient-provider race concordance has been argued as one way to improve patient-provider communication, patient satisfaction, and even patient outcomes. However, much of this literature focuses on or assumes that both patients and providers identify with only one race. OBJECTIVE The purpose of this study was to understand multiracial patients' preferences in choosing a health-care provider. METHODS We conducted 15 interviews and 3 focus groups. We performed a directed content analysis to understand participants' expressed preferences. RESULTS Thirty-one participants shared their health-care preferences. Participants described proximity to their homes or work, convenience in terms of availability, and health insurance coverage as reasons for selecting a provider. The majority articulated preferences related to provider gender and race. However, participants noted key barriers to receiving care from their preferred providers. CONCLUSION This study highlights the preferences for health-care providers and the factors influencing those preferences and decisions among multiracial individuals. Findings illustrate the need to increase health workforce diversity, especially among primary care providers. Findings also show the need for increased empathy and cultural sensitivity among health-care professionals.
Collapse
Affiliation(s)
- Cyndy R Snyder
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Anjali R Truitt
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| |
Collapse
|