In March 1966, Martin Luther King Jr., delivered a speech at a convention of the Medical Committee for Human Rights. He said, “Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane.” At the time, King was conducting direct action to bring hold-out hospitals in line with the legal desegregation requirements of the Civil Rights Act passed one year earlier.
Though all hospitals were eventually required to allow all patients through their door regardless of race and ethnicity, disparities in health outcomes still exist between white and nonwhite patient populations. This has been evident in the COVID-19 pandemic, where Black, Hispanic and Native American individuals and communities continue to be more likely to contract and die from the virus, and less likely to receive a vaccine.
In recent years, efforts around population health have focused on social determinants as the root cause of these disparities. However, this analysis makes up only one piece of the complex problem. Among Black Americans in particular, we see health disparities crossing socioeconomic boundaries. One particularly pointed example: an April 2020 article in The Washington Post demonstrated that Prince George’s County Maryland, one of the wealthiest predominantly-Black communities in the country, had one of the highest COVID-19 death rates in the state.
How Assumptions and Biases Interfere With Care
A lack of patient engagement and empathy, as well as conscious and unconscious biases, are contributing factors to the current crisis. Often the English-speaking Black population is left out of current discussions devoted to improving cultural sensitivity. A culturally sensitive patient engagement approach designed to value the Black population overall and Black patients individually is essential.
During my time in the public hospital system, I worked closely with individuals with sickle cell disease to improve their care and experience. Whether the result of conscious or unconscious biases, this population is often perceived by healthcare institutions and providers as “drug seekers.” In fact, they are among the least addicted of any group with chronic pain. This assumption can lead to patients with sickle cell disease being under-medicated, resulting in unnecessary suffering. Being referred to as a “drug seeker”—rather than being treated with compassion and empathy by healthcare workers—also causes mental and emotional pain for patients.
In the words of leading pain researcher William T. Zempsky, MD, “Difficult patients are not just born, they are in part created by their passage through the medical system. Not only has this system failed to cure, it may have done unpleasant things to make matters worse.” Time and time again in my long career, I’ve come across patients who were labeled as “noncompliant,” “frequent flyers” and “drug seekers.” When “noncompliant” is written in the medical records or used in conversation, rarely if ever has the “why” question ever been asked.
Improving Patient Care by Asking “Why?”
Providing healthcare in a nonjudgmental manner, coupled with cultural competence inclusive of the English-speaking population, can reduce the gap between perception and reality. This is the motivation behind the SPOT Check Methodology©, a patient engagement and cultural competency training program I’ve developed, which uses the acronym to help providers determine the why for each patient:
- Speak to the patient and family to find out who that person is.
- Pacify fears, as fear can lead to noncompliance.
- Outline what is important to the individual.
- Take into consideration the time it takes to accept a disease or diagnosis.
The successful implementation of this protocol at one hospital resulted in significant positive outcomes for congestive heart failure patients. Following the change in Medicare reimbursements for readmission, we began “SPOT checks” prior to discharge to help identify and overcome barriers to patient participation in treatment plans. Following intervention, readmission was reduced from 30% to 18.7% based on data from the central office. The population makeup remained the same—race, wealth and ZIP codes did not dramatically shift. But the simple act of ensuring that every patient received nonjudgmental, engaged and patient-centric care made a measurable difference.
I’m always looking for opportunities to partner with health systems to implement and track impact of culturally sensitive care. “SPOT checks” and another useful methodology I’ve developed, CHANGE©, rely on the simple step of asking why to help reduce health disparities.
Understanding the Human Experience and Leading With Empathy
The common thread—the human experience—is the recognition that individuals come to our institutions and are sometimes given a diagnosis they did not want and cannot give back. Once a disease is accurately diagnosed, the disease is nonnegotiable and no culture, economic status, race, ethnicity or country of origin can change the circumstances. This aspect of the human experience has the potential to be unifying. Furthermore, when we accept the concept of a “nonnegotiable disease diagnosis,” then empathy toward all patients must be the chosen patient engagement approach. After all, at any point in time, we may be the patients ourselves and would want the same.
Healthcare leaders across the care continuum are uniquely positioned to create an empathetic culture. When the drive to understand the human experience comes from the top, our front-line teams will feel empowered and energized to look beyond negative perceptions. This approach may require a little more time—a precious commodity in the midst of the pandemic, to be sure. But the benefits are both tangible (reduced readmissions, higher patient satisfaction scores and more) as well as morally imperative. It is time worth giving, for if we can improve the health of the most vulnerable, we can improve the health of anyone.
Mauvareen Beverley, MD, is the president of Mauvareen Beverley MD, PLLC, and the senior consultant for patient engagement and cultural competence.