In the ongoing conversation about cultural competency, you’ll run into this term now and then: Clinical discrimination. Did you ever wonder exactly what it means? Wonder no longer, because KFF’s 2023 Survey on Racism, Discrimination and Health lays it all out by the numbers.
These surveyors spoke to more than 6,000 people who’d visited a provider in the last 3 years. What they found is that many Native American, Hispanic, and Black adults go into healthcare appointments bracing for insults and clinical discrimination. Specifically, 52% of Native adults. The only group to rank higher were Black adults at 60%, while Hispanic adults ranked about the same at 51%. To influence providers’ perceptions of them, many patients said they tried to stave off mistreatment by changing their appearance.
Clinical Discrimination: Negative Experiences in the Exam Room
Here’s how an insulting healthcare encounter might unfurl for patients. The provider…
- Makes negative assumptions about them
- Suggests that patients are personally to blame for their medical issues
- Ignores patient questions and requests
- Refuses to prescribe pain medication the patient feels they need
As an example of that last point, 22% of Black women who were pregnant or gave birth in the past 10 years say they were refused pain medication, while only 10% of White women said the same.
Obviously provider-patient interactions are nuanced and subjective. What a provider interprets as a positive or at least neutral interaction might feel quite different to the patient. That’s why cross-cultural communication is such a vital skill.
Witness the difference patients report when they see a provider who shares their cultural, ethnic, or racial background. Survey respondents said these providers were more likely to explain things in a way they could understand, involve them in decisions about their care, and check on their basic needs, like shelter, food security, or transportation. These patients came away feeling respected and engaged in their healthcare treatment plans.
Right away, you can see the disparity here. 73% of White adults say that half or more of their visits were with a provider who shares their racial and ethnic background. But that number drops precipitously for everyone else, particularly Native patients; only .4% of the physician workforce is Native American.
When it came to experiencing discrimination in daily life, Native people also topped the list at 58%. A few examples: harassment and threats, being treated as if they are stupid, or receiving poor service in stores and restaurants. This kind of ongoing treatment influences health too, as the survey found people who experience it are 2-3 times as likely as others to report feeling anxious, lonely, or depressed.
Building Cultural and Clinical Bridges with Communication
We realize these survey findings about clinical discrimination are not fun to read. But to focus on the positive, the answers are right there: patients want respect, trust, and communication from their healthcare encounters.
We often hear about Indigenous patients rushed out the door, their cultural values scoffed at or ignored. As our physician recruiter Pamela Amiotte (Oglala Lakota Sioux) said, “They’re rushing patients out without being sensitive to them and how they’d like their traditions and culture incorporated into their health plan. And that can cause distrust, leading to subpar or poor care. I know several elders who won’t go to the doctor anymore because of a bad experience.”
Our provider network sends hundreds of physicians, nurses, medical assistants, pharmacists, dentists, and specialists to healthcare facilities on Indigenous lands all over the country. Some are Native; many are not. But all of our healthcare workers bring compassion, cultural competency, and experience in Indigenous health to the table. And that includes the awareness that the right approach is everything.
This is a lesson that’s applicable to all facilities, for all patients.
In January, we are releasing complimentary cultural competency training for Native healthcare. Some of the lessons within are applicable to any healthcare encounter where vulnerable patients are nervous about how their providers will treat them. So stay tuned – and let us know how your facility makes sure that all patients feel comfortable, cared for, and respected.