Advancing DEI in health care

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In today's diverse and multicultural society, the healthcare sector is crucial in providing equitable and inclusive care for all patients. Diversity, equity, and inclusion (DEI) are essential principles that physicians must embrace to enhance rapport with patients, increase patient compliance with suggested treatments and medications, improve patient outcomes, increase patient satisfaction, and build trust. Effective communication is the cornerstone of providing culturally competent care. Yet, misunderstandings and mistakes can occur when physicians need to recognize and address their patients' unique backgrounds. In this article, we will explore instances where doctors have encountered challenges communicating with patients while offering suggestions for improving DEI with patients, staff, and colleagues.

Let us begin with two examples from one of the authors (NB) that demonstrate what NOT to do and demonstrate a lack of DEI sensitivity.

#1 The doctor enters the exam room, and a much younger woman accompanies an older man. The doctor inquires if the younger person is the older patient's daughter. The older patient replies, "No, that's my wife."

#2 A senior physician is accompanied by a resident who has a protuberant lower abdomen. NB met the two in the hallway. The senior physician introduces the resident, and I ask, "When are you expecting?" The senior doctor waved me off and gave me the "cut" sign with the flat of the hand against the neck, indicating that was not appropriate and that she wasn't pregnant.

These are two examples of severe "hoof and mouth disease" that must be avoided. It is incumbent on doctors to be sensitive to more than pronouns. We must acknowledge differences in age, gender, cultural background, and how the LGBTQ community wishes to be referred to.

In modern healthcare, Diversity, Equity, and Inclusion (DEI) is not just a buzzword but a core principle that seeks to create an inclusive and welcoming environment for all patients. As physicians and healthcare personnel, it is crucial to recognize the significance of sensitive management when providing care to DEI patients. By fostering an atmosphere of empathy, respect, and understanding, we can bridge the disparities and inequalities in healthcare and deliver patient-centric care to all. In this article, we will explore the importance of sensitive management in DEI healthcare, along with some practical examples to implement these principles in daily practice.

Mistakes in communication

In the diverse healthcare landscape, doctors may inadvertently overlook the impact of cultural factors on a patient's health. For example, assuming a patient understands a medical condition without considering language barriers or cultural beliefs can hinder effective communication and treatment outcomes.

Implicit biases can affect how physicians perceive and interact with patients. These biases may influence the level of care provided, leading to disparities in diagnosis and treatment. For instance, a physician may dismiss or, more commonly, not understand a patient's symptoms based on preconceived notions about their socioeconomic background, gender, or race.

Physicians who fail to display DEI sensitivity may unintentionally create an environment discouraging open communication. Dismissing a patient's concerns, emotional state, or cultural preferences can erode trust and impede effective care. DEI is crucial in understanding a patient's unique experiences and needs. There's no better method to develop trust between a patient and their physician than to demonstrate concern and understanding of the unique differences between the patient and the doctor.

Three suggestions for improving DEI with patients:

1. Never make a patient feel uncomfortable. When you see a patient assume a defensive posture like crossing their arms or correcting you on your use of pronouns, this is a time to apologize or ask what verbiage they prefer.
2. Educate your staff on DEI and cultural differences. Doctors can demonstrate cultural sensitivity by acknowledging and respecting the diverse backgrounds and beliefs of their patients. They take the time to learn about cultural practices, traditions, and beliefs that may impact healthcare decisions and incorporate this understanding into their approach.
3. Cultural sensitivity is essential in delivering patient-centered care to diverse populations, including DEI patients. Physicians should educate themselves about various cultures, ethnicities, and backgrounds, as well as the associated health beliefs and practices. A sensitive approach involves acknowledging and accommodating these differences while ensuring that all patients receive equitable care for the non-DEI population.

Example: A physician encounters a patient from a different cultural background who prefers traditional remedies for a particular ailment. Instead of dismissing these practices outright, the physician takes the time to understand the patient's beliefs and incorporates them into the treatment plan when safe and appropriate.

There may be language barriers between you and your patient. These barriers can be easily overcome. Doctors can show empathy by ensuring language access for patients with limited English proficiency. Today, it is easy to provide interpretation services or work with trained medical interpreters to facilitate clear and effective communication.

An example of breaching a language barrier is I would like to learn more about your perspective so we can work together to find the best healthcare approach that aligns with your values. We have interpreters available who are fluent in your native language. They can assist us during your appointments to ensure we understand each other accurately. Would you like to use this service?"

For example, "I understand that your (cultural) background may influence your beliefs about certain medical treatments. I want to learn more about your perspective to work together to find the best healthcare approach that aligns with your values."

Doctors can show empathy by ensuring language access for patients with limited English proficiency. There are readily available interpretation services of trained medical interpreters to facilitate clear and effective communication.

Example: "We have interpreters available who are fluent in your native language. They can assist us during your appointments to ensure we understand each other accurately. Would you like to use this service?"

Find ways to make patients and their families feel comfortable in the practice. This might be as simple as having your newsletter, educational material, or answering service provide material in the patient's native language.

Find ways to demonstrate your understanding. This can be as easily as nodding your head up and down to convey that you are listening to the patient and understanding the situation.

Use language that makes patients feel you understand. This means avoiding medical jargon whenever possible or making sure you define the term.

If errors are made, it is necessary to learn how to apologize. (Baum N. The Art of the apology, J Med Prac Mgmt, Sept-Oct 2022)

Ask patients for their advice. It is only possible to understand some of the nuances of the DEI patient. A DEI patient will appreciate your inquiring about their unique differences, especially if your inquiry is meant to enhance your understanding of their background and situation.

For example, "I understand that your cultural background may influence your beliefs about certain medical treatments. I want to learn more about your perspective to work together to find the best healthcare approach that aligns with your beliefs and values."

DEI and empathy

A doctor practicing active listening engages fully with the patient, giving them their undivided attention and demonstrating genuine interest in their concerns. They maintain eye contact and do not spend most of their time looking at a computer. They nod in acknowledgment, demonstrating that the doctor is paying attention to the patient. They use verbal and non-verbal cues, such as nodding in agreement, to show they are listening and understanding.

For example: "I can see you're anxious about the upcoming procedure. I understand your concerns, and I'm here to answer any questions or fears you may have."

Doctors can use empathetic language to convey their understanding and validate their patients' emotions. They choose words to provide reassurance and support.

An example might be: "I understand how difficult this diagnosis must be for you and your family. Please know that we'll do everything possible to provide you with the best care and support throughout your treatment."

Empathetic doctors create a safe and non-judgmental environment, allowing patients to express their thoughts, concerns, and worries without fear of judgment. They maintain a compassionate and accepting demeanor.

With this patient in mind, you might say, "I want you to feel comfortable sharing information. We aim to provide you with the best care possible, creating an open and non-judgmental opportunity to express yourself."

Doctors can acknowledge and empathize with the emotional impact of a patient's illness or medical condition. They offer support and provide resources to help patients cope with their emotions.

Consider this response: "I understand that receiving this news can be overwhelming. Please know that our team has resources available, such as support groups, appropriate educational material, or counseling services, to help you navigate the emotional aspects of your condition."

Empathetic doctors respect their patients' autonomy and involve them and their families, if appropriate, in decision-making regarding their healthcare. They provide information, discuss treatment options, and consider the patient's issues, concerns, and preferences.

Based on the information we have, there are several treatment options available. However, I want you to actively decide which is right for you. Let's discuss the benefits and risks of each option together. Let's you, your family, and I form a team approach to managing your situation."

The benefits of DEI

There's a benefit for your practice when you learn how to communicate with a DEI patient. DEI patients have a tight-knit community. If a DEI patient has a positive experience with you and your practice, they will likely share that experience with others in their community. As a result, the word-of-mouth spread will undoubtedly enhance your reputation. It will increase the number of DEI patients in your practice.

Empathetic doctors use inclusive language that avoids assumptions or stereotypes about their patients' backgrounds. They communicate in a way that makes patients feel respected, valued and understood. You might open a discussion with a DEI patient by stating, "Please feel free to share any specific cultural or religious considerations that may impact your treatment plan. We want to provide care sensitive to your individual needs and beliefs."

One of us (NB) provided care for a Jehovah's Witness patient with a kidney tumor. The surgery had a reasonable risk of requiring a blood transfusion. The patient was steadfast about not receiving a transfusion regardless of the risk. The patient signed a release indemnifying the surgeon if the patient needed blood but opted out for religious reasons not to accept the transfusion. Fortunately, the patient did not require a transfusion. However, because of the communication within the Jehovah's Witness community that a doctor was willing to accept patients and respect their decision not to receive any blood products, the number of Jehovah's Witness patients entering the practice increased. The same is likely to be the case with DEI patients. The other side of the reputation-building coin is that failure to demonstrate sensitivity to a DEI patient will negatively impact your practice. If there is a lack of respect or compassion for a DEI patient, they will share that negative experience with their community, and their reputation may suffer.

Empathetic doctors are aware of health disparities that affect marginalized communities, such as the indigenous communities, and take proactive steps to address them. They are knowledgeable about social determinants of health and work towards providing equitable healthcare.

Consider this trial balloon, "I'm aware that certain communities like Native Americans face higher rates of certain health conditions such as diabetes, hypertension, and obesity. Let's discuss strategies and resources to help you manage your condition effectively, considering any unique challenges you may face."

Take home message: Doctors can show empathy by working collaboratively with DEI patients, empowering them to make informed decisions about their healthcare and working as a team to achieve optimal healthcare results. These sensitive doctors advocate for their patients' needs and support them in navigating the complicated healthcare system.

The empathic physician is sensitive to gender identity and sexual orientation. LGBTQ+ patients often face unique challenges in healthcare settings. A sensitive and inclusive approach involves providing a safe and non-discriminatory environment where patients' gender identity and sexual orientation are respected.

For example, when a transgender patient visits a practice for a routine check-up. The physician ensures that the patient's preferred name and pronouns are used, and they discuss any health concerns while being sensitive to the potential impact of gender-affirming care.

Bottom Line: These are a few examples that illustrate how doctors can demonstrate empathy towards their patients. By showing empathy, doctors can establish trust, improve communication, and enhance patient experience. With this approach, the patient is likely to be more compliant and will have improvement in their outcome. The sensitive management of DEI patients is not only a professional responsibility but also an ethical imperative for physicians and their staff. By cultivating DEI sensitivity, addressing unconscious biases, empowering informed decision-making, and accommodating patients' diverse needs, physicians can create an inclusive healthcare environment where every patient feels valued and respected. Through small but significant changes in our approach to patient care, we can pave the way for a more equitable and compassionate healthcare system. Ultimately, by acknowledging and embracing diversity, we strengthen the foundation of healthcare and improve health outcomes for all. If doctors can demonstrate empathy with their patients, there will be no worries about AI replacing a caring physician.