Patient-centered care is as essential to quality healthcare as is technical expertise. A while back I wrote a column explaining the values and actions comprising patient-centered care. Here, I will explore a requisite task to becoming a patient-centered practitioner, regardless of your profession. That task is learning to face the reality that a racial difference between the practitioner and client can affect the work, and that it is our responsibility as professionals to proactively prepare for and respond effectively when working with clients we do not look like. Claiming color-blindness has been demonstrated not to work, so please keep reading.
Do you feel uncomfortable? Join the club. The topic of race is always sensitive and there’s high risk of hurting feelings or being misunderstood even in the most ordinary of times. Current events have inflamed many of us to the point of anguish or anger. However, to look away from the influences of race in the delivery and receipt of healthcare is not an option if one is to be evidence-based and competent.
Research has demonstrated that African Americans as a group have experienced significantly substandard quantity and quality of healthcare in our country. The patterns of disparity are deeply dyed into our systems of care and our national culture. By acknowledging them and by making each professional interaction a good one, we can contribute to their solutions.
As a white woman I have often felt that perhaps I had no right to talk about the issue of race. I cringe to recall how, as a small-town Midwesterner interviewing for my first OT position (a community mental health center in Boston), I explained that my lack of history with people of color and urban settings could be an asset, as I had not formed any biases. Ouch. They ended up hiring me, anyway. My three years in that job were highly educational, as you can imagine, and only the beginning of my quest. I have since been fortunate to have many African-American clients, colleagues and friends who have generously told me about their lives, and helped me to recognize some of my biases and blind spots.
I know I’m a work in progress, which is probably the first step toward becoming the occupational therapist that my patients need me to be. Happily, there are many resources to help me learn to become competent and compassionate practitioners for African-American (and other) patients whose life experiences and worldviews are very different from mine.
The approaches I prefer are those that promote attitudes and skills that are universally applicable and focused on growing a working alliance with each client:
- Acknowledge that we are all prone to stereotyping. Only by recognizing this can I overcome my subconscious cognitive and emotional habits.
- Understand that my good intentions are not the central issue for my patients. My client’s past experiences may bring anxiety and mistrust when they see my white face, even if it’s smiling. That’s neither their fault nor mine, but it’s very real and has an effect on our work.
- It is upon me to prove my worthiness, and this will likely take time and willingness to ask good questions, listen fully, believe in my client and show respect.
- Carefully observe and evaluate my own reactions and assumptions. Step away from automatic intuitions and consider many alternate hypotheses about what is going on with my client.
- Observe my client’s nonverbal responses to what I say and do. Seek feedback, especially if they appear to feel uncomfortable, guarded or offended. Own my errors and ask forgiveness if I have been clumsy or ignorant, then change my behavior.
- Share what I know in ways that work for my client.
- Trust my client to be the best expert in the room when it comes to finalizing decisions on intervention plans and methods.
I hope these ideas resonate with you in a good way, and that they will help you on your own quest toward excellence and making our world a better place.
Increasing Diversity in Occupational Therapy: The Coalition of Occupational Therapy Advocates for Diversity (COTAD) https://gottabeot.wordpress.com/2015/06/01/increasing-diversity-in-occupational-therapy-the-coalition-of-occupational-therapy-advocates-for-diversity-cotad/
Institute of Medicine. 2003. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (full printed version). Washington, DC: The National Academies Press. https://doi.org/10.17226/10260.
Racial and Ethnic Healthcare Disparities; Workforce Diversity http://www.ncsl.org/documents/health/workforcediversity814.pdf
Burris, J. (2012) On enhancing competent work with African American clients: Challenging Persistent racial disparity trends by examining the role of the working alliance. J of Applied Rehabilitation Counseling, 43(3): 3-12.