A Guide for Physicians on Building Relationships With BIPOC Patients
by India El
Distrust in the healthcare system has been America’s hard pill to swallow especially for the Black, Indigenous, and People of Color (BIPOC) community. Whether examples are from infamous scientific experiments or personal accounts, it has been made apparent there is space for major reform. But where do we begin? Changes start from the top to the bottom; so how can members of healthcare, like physicians, regain the trust of their BIPOC patients?
I’ve interviewed a few patients to receive their viewpoint on healthcare experiences and how physicians can regain trust of BIPOC patients. Our candid discussion includes honest experiences from patients, including myself; where these issues may stem from in history, and recommendations on how physicians can help change the narrative.
In this discussion, we’ve received feedback from some BIPOC patients on their healthcare experiences and how they feel physicians can regain trust of these patients.
Patient Perspective
I’ve interviewed a few BIPOC patients and healthcare professionals, male and female, between 26 to 33 years of age. Their recollection of their healthcare experience as adults has varied from positive and negative experiences. I asked the patients the following questions:
1. How has your healthcare experience been; negatives and or positives?
2. Do you have any examples of negative or positive experiences? Do these examples involve your medical issues or symptoms being disregarded by a physician?
3. At any point in your healthcare experience, do you feel you were denied services possibly due to your ethnicity, gender, or sexual orientation?
4. How do you think physicians can build trust with their BIPOC patients?
How has your healthcare experience been; negatives and or positives?
The overall consensus for these patients is that, at some point, their experience was positive. However, a common generalized theme was related to timing and convenience. For example, James (33 years old, male, Black) mentioned that his healthcare experience has been difficult due to the inconvenience of seeking care through his insurance and setting appointments in his area. He stated, “The current pandemic has not made the situation any better, and at the moment I’ve had to schedule telemedicine appointments but prefer in-person.”
As a new resident to Maryland, I can relate to the problem surrounding inconvenience. Learning to establish care, in a new state, has been a bit difficult. Finding consistent medical professionals, whether physicians or even dentists, has been tough. Additionally, I believe living in a busy area plays a major role. There are many urgent care facilities in the DC, Maryland, and Northern Virginia or DMV area; more than likely placed out of convenience. It is much easier to obtain an appointment at these facilities compared to primary care practices, however, the quality of care is not the same.
Do you have any examples of negative or positive experiences? Do these examples involve your medical issues or symptoms being disregarded by a physician?
Four patients; Lex (25 years old, female, Black), Ravin (25 years old, female, Black), Yolanda (26 years old, female, Black), and Dom (28 years old, female, Afrolatina), all gave accounts on memorable negative experiences in their healthcare journey. The following are testimonies of their experiences.
“They don’t take the time to get to know you and your concerns. They’ll diagnose you without running any test,” Lex mentioned. This statement highlights her adult experience with care after transitioning from pediatric care. Lex provided the following example:
“I went to my OBGYN for concerns of constant pelvic pain. My doctor performed a quick pelvic exam and tells me it “seems” like endometriosis. I later find out that you have to be tested for this diagnosis. Doctors will tell you what they think rather than show you exactly what it is. I’d be scared for months over something that’s not even going on in my body and having to request certain testing or procedures myself because my doctor is not an advocate for my health.”
“I knew something was wrong with my body…Due to the fact that I was in my early 20s I believe he did not think it was anything too serious...I felt unheard,” Ravin stated as she explained a primary care visit due to a drastic change in her health. Although she felt her physician did not take her symptoms seriously, she did mention the physician ran blood work. When the results were received the physician stated she had a vitamin D deficiency, prescribed her vitamin D, and instructed her to revisit in a month. After this visit, Ravin still felt something was wrong and stated her health began to worsen. She detailed the following:
“I then went to a Patient First where I felt they at least tried and knew that something was wrong with my body. I was given an X-ray, some crutches, and a leg brace. After looking at the X-ray, the doctor didn’t see anything alarming but referred me to a podiatrist. After that experience I regained hope that a doctor could help me with my problem. The foot doctor had me do some mobility tests. After these tests, the podiatrist said nothing was wrong with my legs, but something was probably wrong with my brain. That appointment only took about 10 minutes, but he did refer me to a neurologist. At that point, I felt scared, nervous, and thought that I was possibly getting the run-around or just being told anything. He then referred me to a neurologist in the area. I had numerous visits with that neurologist, but he didn’t know how to treat or stop the problems I had going on. During our last visit, he finally referred me to a neurologist at University of Virginia or UVA. My first visit with this neurologist was, and has been, a positive experience. I felt welcomed, heard, and actually cared for. Ever since, I have been visiting UVA, I was confident that everything was going to be okay! I’ve had a positive experience since then!”
Yolanda’s experiences with healthcare involved a long journey of numerous physicians, specialists, and surgeries. A key account in her journey was when she had to visit a nephrologist for her kidneys malfunctioning. The following is her recollection of this experience.
“I had to meet with a nephrologist about the malfunctioning of my kidney, scarring, and how we were to proceed. This doctor was negligent in understanding my symptoms and listening to my concerns. This was a highly recommended doctor, and I couldn’t grasp how or why she was suggesting something so out of the norm. The doctor insisted that she would take skin grafts from my legs in order to take care or subsidize the deformity, which was not needed – all because this was something that she had done in the past but was not needed in this current situation. I will never forget that moment because as a woman who has endured countless surgeries and has battle wounds to show for it, I was opposed to adding unnecessary incisions to my body. Long story short, I was no longer pleased with the healthcare that she was to provide and sought another professional who put me first. I have since been with this physician for the last 15 years.”
Dom’s negative experiences with healthcare were another account of a physician being unreceptive to her wants and concerns. It had been a little while since she sought out primary care so when she did, she scheduled a physical. During her examination, she explained to the physician that she wanted to receive full STD testing. Though she was not sexually active, she still wanted the testing done for a peace of mind. Her physician questioned why she’d want the testing performed and stated, “It’s a pandemic, how much fun were you having?”.
The above instances from these patients highlight the importance of physicians listening to their patients’ concerns and requests, whether big or small. Additionally, these experiences emphasize the need for a complete quality experience for patients to build a sense of comfort during each visit.
At any point in your healthcare experience, do you feel you were denied services possibly due to your ethnicity, gender, or sexual orientation?
While the patients I interviewed did not feel they were denied healthcare services due to their ethnicity, gender, or sexual orientation; these are only a few and do not represent the entire BIPOC community. Additionally, it is important to note that all individuals live above the poverty line and completed higher education. Income and education are key determinants in one’s healthcare experience. (Baciu, et al., 2017).
Denial of services is a regular event that has happened throughout history, and now, for BIPOC groups, which we’ll discuss later. It is important to understand that there have been instances where healthcare has not been equal for individuals of this community compared to their white counterparts.
There are commonalities in the mentioned experiences; being unheard and not receiving a proper diagnosis. Is there a possibility of prejudices in these situations? I believe systemic racism has been a barrier in receiving adequate care for BIPOC individuals.
Origins of Distrust
When we discuss being unheard and not receiving proper diagnoses associated with people of the BIPOC community, we must understand where this may stem from in efforts to dismantling a system rooted in inequalities. Baciu et al., describes the root causes to be based on two factors: inequalities in how powers and resources are apportioned, and the mechanisms that organize powers and resources across different identity groups (sex, gender, race, etc.) (Baciu, et al., 2017). Socioeconomic, education, public policies, and environmental policies have all played their role in the way healthcare is organized and distributed in BIPOC communities.
In the blog titled, Food Outcry: Dismantling Food Inaccessibility in BIPOC Communities, there was mention of structural influences that affected access to food for BIPOC individuals such as redlining which added in the creation of food insecurities and access to proper care. When communities are structurally limited to the quality of life they deserve, this can create a downward spiral in health leading to contracting preventable illnesses and decreased life expectancies. This falls under one of the factors described by Baciu et al, mechanisms that organize powers and resources; prime example, structural inequalities (Baciu, et al., 2017). Social and structural influences have proved to place the health of BIPOC individuals at a disadvantage. When comparing their health to those of the white community, theirs has revealed to be dramatically worse. Lacking the proper resources (education, economic, nutrition, etc.) varies amongst these communities (Smedley, 2001).
When having conversations about BIPOC groups and healthcare, the ultimate takeaway is that the cause is systemic. Dismantling the inequalities is not an issue we in the BIPOC community can solve. Can we advocate for quality healthcare, yes. But the significant changes must begin at the top; starting with policies. Geographic segregation of BIPOC groups and immigration policies are heavy hitters in the ability to access adequate care (i.e. regular doctors visits, urgent care access, access to better physicians or specialists for specific illness/diseases, regular pediatric care for children, etc.).
So where do we go from here? How can we as a community gain better care for our families? How can we build confidence to seek the care we deserve? How can physicians help advocate for us along the way?
Guide to Regain Trust
In this guide for physicians to regain trust with their BIPOC patients, we will continue with statements from the interviewed patients. Additionally, we’ll provide some suggestions for physicians to implement in their practice.
How do you think physicians can build trust with their BIPOC patients?
In a conversation held with Ley (33 years old, female, Afrolatina), a Licensed Practical Nurse or LPN, she stated “Building trust with minority patients starts with building the physician-patient relationship. Having candid conversation with patients to get to know them and build that rapport.” In another conversation with Angela (25 years old, a Clinical Nurse in Trauma Surgery, she stated the following:
“Our trauma patients are predominately Black, and a lot of times I find myself having to explain to my patients what the doctor said to them or advocate for my patients by asking questions they are afraid to ask. I've also had abused patients who have had panic attacks when male doctors go in their room to talk with them alone. I've had to be the voice of reason to make their situation or preference known. I feel like the nurses are the safety net between a patient and doctor. The very minimal times I've seen a doctor build trust is when it's a younger medical resident, a nurse practitioner, or a doctor who is BIPOC themselves.”
Her statements were key to the point we are driving, building, or regaining trust in order to benefit from the healthcare experience. While it should not solely be the nurse’s job to build the relationships with patients, Angela went on to describe another key point, “I think what doctors miss is empathy. Nurses are trained to be empathetic, while doctors are just trained on the science aspect of healthcare.” Ravin mirrored these sentiments by stating, “Showing empathy and knowing it’s okay to say, ‘I do not know but I’m going to reach out to different doctors to see if they’ve ever had a patient with a problem similar to yours.’”
Timing is an aspect both nurses and previously mentioned patients noted as significant issues in their experiences. “Taking the time to listen to your patient's concerns and questions makes them trust you. They will be more comfortable with teaching prior to discharge, wound care, taking medication, etc.” Angela stated. Lex stated, “I believe physicians can build trust with patients by simply taking their time. Yes, I know they have a busy schedule. However, as a doctor whose job is to help alleviate health issues/concerns, that should be the priority.”.
Latrell (25 years old, male, black) whom has had a fairly positive healthcare experience, however, shared the following remarks based on experiences:
“I believe that physicians can build trust with their patients by listening to them. If a patient expresses that they’re experiencing symptoms, then they need to be heard, as opposed to having their feelings invalidated. In addition to that, physicians need to be more culturally competent when working with individuals within the Black community. For example, research shows that the maternal mortality rate for African American women is high, but what are physicians doing to work to improve these disparities?”
What do we have so far; empathy, timing, communication, cultural competency, and education. These are our five keys for physicians on regaining trust with their BIPOC patients.
Communication
Communication is key in building any relationship especially regarding one’s health. Getting to know everything there is to know about the patient during each visit will ensure that solid foundation for ease of communication. Getting to know the patient should involve the following: understanding their culture (which we will discuss), things the patient may be involved in like extracurricular activities that may involve requiring a good health standing, following up with patients as often as possible instead of waiting until the 6-month checkup, etc.
Cultural Competency
Gaining a sense of cultural competency will increase the effectiveness of the physician’s work. Even if a physician does not work with a lot of BIPOC patients, it is still important to know that things like religion, cultural beliefs, social beliefs, language, communication, behaviors, and values vary across different ethnic groups. A physician’s job is to serve the community but how would that be possible if the physician is unfamiliar with cultures other than their own? Not all patients are subject to the same care; general care, yes; but individually, no. No one’s patient chart is going to be the same, so the physician must be knowledgeable on how to tailor their care to each specific patient. One patient’s diagnosis is not going to be the same as another when we consider cultural differences. Therefore, communicating thoroughly with the patient to understand WHO they are including their symptoms and illness, will help the physician gain a better understanding of how to treat that specific individual.
Education
Not all patients are educated enough to understand their symptoms, diagnosis, or illness. A physician should ensure the patient is fully educated on their diagnosis and provide resources for that patient to educate themselves. Low socioeconomic status in BIPOC patients like lower income and education resulted in increased levels of distrust in healthcare compared to their white counterparts (Armstrong et al, 2007). The level of understanding is going to vary dependent on education level. Educating the patient should involve first determining preexisting conditions the patient may have, familial history, and how that may play a role in their diagnoses. Additionally, allowing the patient the comfortability in asking questions during their visits.
Timing
Both nurses interviewed described how busy the physicians can get however this should not take away from the quality of care the patient receives. For BIPOC patients, more time may need to be allotted to fully understand the patient’s symptoms and needs. The physician should be giving each patient the time they need to leave their visits fully educated and pleased with their experience.
Empathy
Having an understanding and sharing concerns with the patient is another way to build trust with patients. These visits are moments where patients should be able to be the most candid without feeling unheard. Physicians should be supportive, encouraging, and emote with their patients during visits about their issues. Ways that physicians can become more empathetic to their BIPOC patients is to volunteer in these communities to gain a better understanding of their lifestyle and culture.
The experiences from the interviewed patients and healthcare professionals have only been a few examples of experiences of many within the BIPOC community. Regaining trust with individuals in this community will require physicians to be a bit more vulnerable with their patients to change the narrative of how healthcare is perceived for these people. Educating themselves, becoming culturally competent, taking their time, communicating thoroughly, and being empathetic towards these patients will be the foundation needed to improve the physician-patient relationship.
In retaining editorial control, the information produced by Diverse Health Hub does not encapsulate the views of our sponsors, contributors, or collaborators.
Importantly, this information is not a substitute for, nor does it replace professional medical advice, diagnosis, or treatment. If you have any concerns or questions about your health, you should always consult with a healthcare professional.
India El is a native of Virginia. She has a background in biology and is pursuing a MS in regulatory affairs at George Washington University. India is interested in government policies and regulations regarding clinical research and mental health. She is a health equity ambassador at Diverse Health Hub.
References
Armstrong, K., Ravenell, K. L., McMurphy, S., & Putt, M. (2007). Racial/ethnic differences in physician distrust in the United States. American journal of public health, 97(7), 1283–1289. https://doi.org/10.2105/AJPH.2005.080762
Baciu A, Negussie Y, Geller A, et al., (Eds). (2017). The root causes of health inequity. National Academies Press (US), Washington (DC). https://www.ncbi.nlm.nih.gov/books/NBK425845/
Smedley, B. D., Stith, A. Y., & Colburn, L. (2001). Increasing racial and ethnic diversity among physicians: An intervention to address health disparities? National Academies Press (US), Washington (DC). https://www.ncbi.nlm.nih.gov/books/NBK223632/
