Peer Responses – Bias and Equity in Patient Care

Peer Responses – Bias and Equity in Patient Care

Response 1

Hello Krizelle,

Thank you for the informative and comprehensive post on the principle of justice and its application in healthcare. This is helpful in eradicating prejudice in offering health care services for every person since it tackles inequality in the provision of the services. Based on the statistical data mentioned earlier regarding higher mortality and morbidity rates among African American women during childbirth, it is possible to note that numbers like these are appalling and give evidence of systemic issues in healthcare.

From the CDC report, Petersen et al. (2019) found out that African American women are three to four times more likely to die from pregnancy-related causes than White women, irrespective of income status. Such statistics help portray why it is important to fight racial inequality in the healthcare sector. Such attempts to omit bias and equal treatment to all the patients are laudable. Yet other long-term changes require structural modifications as well.

Notably, the negative attitude of doctors and nurses can significantly impact the patients. For example, a cross-sectional study by Knoebel et al. (2021) showed that Black patients remain undertreated for pain compared to White patients due to racial inequality. This is not a problem specific to pain relief but is evident in many aspects of medicine, including maternal care.

In addition to the steps taken to enhance the quality of care, Nair and Adetayo (2019) suggest that healthcare professionals should engage in culturally sensitive and bias-free education on a constant basis. Such measures include instituting training interventions to overcome unconscious prejudice with the aim of promoting parity of treatment of patients. Furthermore, promoting policies that are consistent with the principles of diversity and inclusion in healthcare facilities may play a role in reducing health inequalities.

References

Knoebel, R. W., Starck, J. V., & Miller, P. (2021). Treatment disparities among the black population and their influence on the equitable management of chronic pain. Health Equity, 5(1), 596–605. https://doi.org/10.1089/heq.2020.0062

Nair, L., & Adetayo, O. A. (2019). Cultural competence and ethnic diversity in healthcare. Plastic and Reconstructive Surgery – Global Open, 7(5). https://doi.org/10.1097/gox.0000000000002219

Petersen, E. E., Davis, N. L., Goodman, D., Cox, S., Syverson, C., Seed, K., Shapiro-Mendoza, C., Callaghan, W. M., & Barfield, W. (2019). Racial/ethnic disparities in pregnancy-related deaths — United States, 2007–2016. MMWR. Morbidity and Mortality Weekly Report, 68(35), 762–765. https://doi.org/10.15585/mmwr.mm6835a3

Response 2

Hello Nathalie,

Great work with your post! The scenario described highlights a significant issue within healthcare: the two concerns of language interpretation and discrimination of the providers. The way the physician treated the Spanish-speaking patients as if they were not intelligent is an example of how biases affect positive communication and trust. Shah and Bohlen (2023) note that implicit biases are not unique to encounters between physicians and patients. Still, they also influence decisions in patient management as well as patients’ compliance with their physicians’ advice. As you rightly pointed out, when patients feel that they are treated differently based on their racial status or language, they are more likely to practice suboptimal health behaviors. In line with this, a study by Rivenbark and Ichou (2020) identified perceived discrimination as a significant predictor of delayed/ skippable care.

To reduce such biases, healthcare providers should adopt practices that enhance cultural receptiveness and appreciation. One of them is the utilization of medical translator applications or involving professional interpreters in healthcare institutions. A study by Kwan et al. (2023) has established that professional interpreting reduces language barriers and improves the interactions between patients and clinicians while also providing consoling to the patients and their families. Furthermore, there is a need to train healthcare providers on bias blind spots and how to avoid them. This can be done through regular sessions and training in culture awareness and eradicating bias.

Notably, this implies valuing and accepting the patients in the healthcare setting to enhance their health status and gain their trust. It brings to mind the importance of patient care and compassion in healthcare, as well as the importance of clear communication. Doctors should understand that prejudices and language barriers can be an issue and should, therefore, avoid prejudice and ensure that all patients receive equal and quality treatment.

References

Kwan, M., Jeemi, Z., Norman, R., & Dantas, J. A. R. (2023). Professional interpreter services and the impact on hospital care outcomes: An integrative review of literature. International Journal of Environmental Research and Public Health, 20(6), 5165. https://doi.org/10.3390/ijerph20065165

Rivenbark, J. G., & Ichou, M. (2020). Discrimination in healthcare as a barrier to care: experiences of socially disadvantaged populations in France from a nationally representative survey. BMC Public Health, 20(1). https://doi.org/10.1186/s12889-019-8124-z

Shah, H. S., & Bohlen, J. (2023, March 4). Implicit bias. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK589697/

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PEER RESPONSE 1

The principle of justice is the ethical right of all individuals to receive equal and unbiased care. Fortunately, I have not personally experienced unfair, prejudiced, or biased care from healthcare professionals. However, an instance in which an individual may experience prejudiced, biased, or unfair care in the healthcare setting may be in women of color, especially African American women. For example, the rate of mortality and morbidity in African American women giving birth is substantially higher than all other ethnicities of women. In May 2019, the Centers for Disease Control and Prevention (CDC) issued a report “that included data demonstrating that pregnant or postpartum women of color die at a staggering rate of 3 to 4 times greater as compared with their White counterparts, regardless of socioeconomic factors” (Minehart et al., 2021, Introduction).

This statistic personally affects me because I am a woman of color and can empathize with other women who fear that they will not be properly cared for during pregnancy and childbirth, which is a time of increased vulnerability. As a nurse practitioner and a woman of color, I plan to approach other women of color as I would every other individual, regardless of race or gender. I would reflect on all my personal biases and beliefs that may interfere with my ability to provide equal care to all individuals and work towards eliminating these personal biases so that I may be a better healthcare provider to all patients. Furthermore, researching and immersing myself in various other cultures and advocating for systems-wide provider bias training may help me and other healthcare providers become more open to other cultures so that fewer personal biases may be formed when practicing care (Minehart et al., 2021).

PEER RESPONSE 2

During a recent visit as a nurse case manager, I encountered troubling bias. While accompanying a Spanish-speaking client to an specialist appointment, I observed the physician’s dismissive attitude and reluctance to communicate effectively. Despite my efforts to facilitate communication, the doctor rushed through the consultation, using complex medical jargon without explaining. Fortunately, my basic Spanish language skills and understanding of medical terminology allowed me to bridge the communication gap for the patient. I was deeply unsettled when the doctor avoided eye contact with the patient and directed his attention solely towards me. This experience shed light on the biases and injustices in the medical field. As providers, it is integral that we embody trustworthiness and empathy. This experience has prompted me to ponder my potential biases, as I am determined never to become like him.

Implicit bias reaches beyond mere stereotyping to encompass favorable or unfavorable evaluations of groups of individuals. Evidence demonstrates the pervasive influence of biases on healthcare delivery, public health outcomes, and the learning and working environments within the healthcare profession. Furthermore, biases harm patient-provider interactions, treatment decisions, and patient adherence to medical advice. Notably, a study revealed that patients who perceived differential treatment based on their race were significantly less likely to undergo optimal chronic disease screening and more prone to disregarding medical advice or delaying necessary care (Vela et al., 2022). This experience underscores the urgent need for healthcare professionals to address cultural and language barriers with empathy and competence.

The first action the provider should have taken is to acknowledge the patient’s existence and treat her as an equal. This can be achieved by initiating direct contact, asking if the patient has any questions, and effectively communicating the plan of care. The next crucial step is ensuring that each healthcare clinic has a medical translator app or account. Studies in the US have proven that having professional interpreters in healthcare settings can effectively diminish language barriers, enhance patient-clinician interactions, and offer crucial emotional support to patients and their families (Suarez et al., 2021). Those are two simples examples that could assist on preventing and reducing bias.

Peer Responses:

Number: A minimum of 2 peer posts, at least one on a different day than the main post
Length: A minimum of 250 words per post, not including references
Citations: At least one high-level scholarly reference in APA per post from within the last 5 years

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