About six years ago, I received an abnormal Pap smear during an annual physical exam with my primary care physician. I went to a gynecologist, who was highly recommended in my local town. My first red flag came up while completing paperwork and I saw the “Check your racial background” section. For the first time, I noticed the category of “Asian” was not listed. When I asked the front-desk team about it, they said, “the physician believes Asians don’t get cancer, so we leave that race out.” As a biracial Korean Asian American chief administrative officer of the hospital, I did not accept that answer. It motivated me to have a serious talk with the provider. When I approached her with a questioning attitude, as we should do in a high-reliability organization, I was dismissed with a stereotypical response, saying “Asian people eat healthier than other races, are in a higher socioeconomic status and have the highest education.” The entire Asian community flashed before my eyes and I felt the need to stand up for all of them, especially since I was living in an area where 30% of the population was of Asian background. How many patients had received suboptimal care from this physician because of the color of their skin? How many patients didn’t speak up and just accepted what this physician had told them?
In college, as a student majoring in health promotion disease prevention, I often wondered why the Asian racial/ethnic group was often left out of studies on smoking cessation, sexually transmitted diseases, cardiovascular diseases, childbirth deaths, childhood asthma, mental health and diabetes. When I questioned this, I was told there were not enough Asians included in these studies to be statistically significant to be reported. Even worse, the health data on Asian Americans and Pacific Islanders are often lumped into one category, limiting the data on the subgroups coming from 30 or more countries. Do you have a dashboard in your organization that includes all ethnic groups, and if so, who sees it and how often is it reviewed? Is it questioned or just looked at? How do we measure the fidelity of the data we receive? As we transition to more value-based care and away from illnesses and diseases, it is important we focus on equitable whole person care. The need to advance social justice occurs in our physician offices every day through every conversation that takes place between a patient and a provider who “should” be trusted.
Consider these statistics of Asian American and Pacific Islanders, compared to other racial and ethnic groups. They are least likely to report having a primary care physician, less likely to receive blood pressure monitoring and Pap smears, and have a higher incidence of breast cancer. Contributing factors to these statistics include infrequent medical visits, language and cultural barriers, and lack of health insurance.
The impact of racism in healthcare must become real to cultivate change. We need to achieve health equity, instill cultural competence and earn trust. What is the health equity road map at your hospital? Does your community trust your healthcare providers? What cultural competency training do your healthcare providers receive? We need to promote equitable clinical protocols. We need to attract and retain healthcare professionals who are true reflections of the communities they serve. Our collective voices, knowledge and experience will help create positive change.
Sitting in that doctor’s office, I was vulnerable. This physician said, “I’m going to cut a cone out of your cervix and oh, by the way, you most likely will never be able to have children.” I stood up, with tears in my eyes, and swore she would never touch my body. I got a second opinion from a fellowship-trained gynecologist, received a minimally invasive procedure and had my first child a year later. I challenge you to have serious conversations with your physicians who are affiliated with your facility, no matter where your hospital or practice is located. They have the power in what happens to your patients in your community, and not all patients will push back when they should. We in the healthcare industry should push for advocacy at the state level, partner with our departments of public health, and use it to educate both providers and community members. Our patients deserve it, and one day, we could all be one of those patients.
Bonnie J. Panlasigui, FACHE, is vice president/COO, Dignity Health/St. Mary Medical Center, Long Beach, Calif.