Impacts of racism on First Nations patients' emergency care: results of a thematic analysis of healthcare provider interviews in Alberta, Canada

Abstract

Background First Nations people experience racism in society and in the healthcare system. This study aimed to document emergency care providers’ perspectives on care of First Nations patients. First Nations research partner organizations co-led all aspects of the research. Methods Sixteen semi-structured interviews were conducted with Alberta emergency department (ED) physicians and nurses between November 2019 and March 2020. Results ED providers reported that First Nations patients are exposed to disrespect through tone and body language, experience overt racism, and may be neglected or not taken seriously. They described impacts of racist stereotypes on patient care, and strategies they took as individuals to address patient barriers to care. Recognized barriers to care included communication, resources, access to primary care and the ED environment itself. Conclusions Results may inform the content of anti-racist and anti-colonial pedagogy that is contextually tailored to ED providers, and inform wider systems efforts to counter racism against First Nations members and settler colonialism within healthcare.

Exploring paramedic care for First Nations in Alberta: a qualitative study

“…[9][10][11] Authors of previous sociological studies of emergency medicine have argued that ED care is not simply medical but also involves moral judgments of patients. 12,24,25 Our results show that this dynamic extends to paramedicine. Paramedics in our study were deeply invested in defining their role and describing which types of patients they should be seeing, although there was disagreement on definitions.…”

Leaving emergency departments without completing treatment among First Nations and non–First Nations patients in Alberta: a mixed-methods study

“… 63 Indeed, in a previous publication, a physician participant noted how substance-using patients can be led to leave care by ignoring them. 60 This reflects a long-reported tendency for emergency departments to see patients who present with substance use as problems for their department’s operations, rather than presenting with medical issues pertinent to the emergency department. 64 Several of our qualitative examples of patients leaving related to mental health and substance use, while our quantitative data showed higher proportions of leaving without being seen or against medical advice among patients presenting for substance use and mental health problems (compared with injuries, infections, and women’s health issues) among both First Nations and non–First Nations patients, but with higher proportions among First Nations patients.…”

“… 63 First Nations patients whose first language is not English may have language barriers, and communication issues can arise when providers and paperwork use unfamiliar, English-language medical terminology. In our previous study, some emergency providers in Alberta reported frustration with the communication style they perceived First Nations patients to use and made judgments about patients because of their First Nations “accent.” 60 Such factors put First Nations patients at a greater risk of poor communication and interactions with providers.…”

“…Our previous research showed that First Nations patients received less-acute triage scores than comparable non–First Nations patients, 65 and that providers made judgments about whether a patient deserved emergency care based on their perceptions of the patient’s place in society. 60 Racial stereotyping, discrimination, and biased provider judgments may lead to under-triage, longer wait times, and abbreviated care for First Nations patients, and therefore increased motivation to leave the care environment. Furthermore, First Nations members have described how they cannot generally know whether a negative experience in the emergency department (such as a long wait) is related to racism or not, but that racism is always a stress-inducing possibility.…”

Informing critical indigenous health education through critical reflection: A qualitative consensus study

“…The resulting gaps in health outcomes between Indigenous and non-Indigenous populations are a product of intertwined structures, power imbalances that reinforce social vulnerabilities, unfair distribution of economic and political goods and refusal to recognise or challenge the mechanisms and ideologies that target Indigenous peoples (Czyzewski, 2011). Moreover, research has evidenced that anti-Indigenous racism within Canadian healthcare systems is operationalised between and across multiple levels (Allan and Smylie, 2015;McLane et al, 2022;Roach et al, 2022Roach et al, , 2023Turpel-Lafond, 2021). Repeatedly, health service providers overlook, deny or disregard the distal determinants of health of Indigenous people as well as the structural barriers they endure (Czyzewski, 2011).…”