Race, Ethnicity, and the Patient-Caregiver Relationship

Abstract

Shortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at Massachusetts General Hospital (MGH), founded The Kenneth B. Schwartz Center at MGH. The Schwartz Center is a non‐profit organization dedicated to supporting and advancing compassionate health care delivery, which provides hope to the patient, gives support to caregivers, and encourages the healing process. The center sponsors the Schwartz Center Rounds, a monthly multidisciplinary forum where caregivers reflect on important psychosocial issues faced by patients, their families, and their caregivers, and gain insight and support from fellow staff members. Racial discrimination is a pervasive problem with multiple damaging effects. It is naïve to believe that medicine is somehow immune to race‐based practices, but there is a growing literature detailing poorer disease‐specific outcomes in minority populations for a range of illnesses. A recent study in the New England Journal of Medicine has implicated physician prejudice as a significant contributing factor. The March 1999 Schwartz Center Rounds sought to explore the influence of ethnic bias on the patient‐provider interaction and the quality of health care delivery. Using a different format with a current affairs video clip and an interactive panel discussion, participants were encouraged to identify the often subconscious racial prejudices which may undermine their relationships with patients. Staff members were challenged to think creatively about how institutions and individuals might promote “cultural competence” and a more equitable health care environment.

The influence of patient race on the use of diagnostic imaging in United States emergency departments: data from the National Hospital Ambulatory Medical Care survey

“…The interplay of race and ethnicity may affect the patient/physician relationship in multiple ways, tipping the balance of diagnostic decision making. This may be a result of the well-known phenomenon of implicit/unconscious bias [ 41 – 43 ] or may be more indirect resulting from other identifiable impacts of racial and ethnic identity on the patient/provider relationship including levels of trust, willingness to communicate, and perceived cultural differences [ 44 – 46 ]. Strategies used to overcome the disparities observed in our study must account for these potential pathways.…”

Ethnic variation in cancer patients’ ratings of information provision, communication and overall care

“…Alternative methods of information provision, tailored to specific needs and preferences of minority ethnic groups may prove effective, such as audio or video information in Sylheti for Bangladeshi patients who find understanding written information challenging (Thomas et al 1999 ). The education of healthcare professionals, from students to consultants, should address ethnic bias (Dedier et al 1999 ) and the need to understand patients as individuals (Kai et al 1999 ) so as to ensure the best possible care and patient experience.…”

Emergency Medical Practice: Advancing Cultural Competence and Reducing Health Care Disparities

“…Similarly, when providers do not carefully traverse cultural obstacles, patients may not receive the full benefit of medical treatment. These barriers arise when providers overlook the importance of culture and view it as something only relevant for the lives of “others.” 9–12 In reality, culture enriches one’s identity and provides a link to family and community through a common bond which informs “actions, expectations, and assumptions.” 9,11 For example, by allowing family members to be involved in decision‐making, a cultural preference can be respected to maximize beneficence. Cultural accommodations may enhance the practice of distributive justice through their ability to reduce barriers to care.…”