Health Equity

Prioritizing Equity video series: Culturally Responsive Communication Strategies for Equity


In this episode of the Prioritizing Equity series, panelists share the importance of teaching, implementing and adapting culturally responsive communication models for addressing health inequities. Physicians will reflect on and share examples from their personal and professional experiences of designing curriculum, developing screening practices, and investigating barriers and facilitators of culturally responsive communication utilizing health justice frameworks.

  • Leon McCrea II, MD, MPH, senior associate dean of diversity, equity and inclusion, Drexel University College of Medicine
  • Lalit Narayan, MD, MBBS, MA, primary care internist, GW Medical Faculty Associates and assistant professor of medicine at George Washington School of Medicine and Health Sciences
  • Chavon Onumah, MD, MPH, MEd, associate professor of medicine, General Internal Medicine Division at George Washington School of Medicine and Health Sciences
  • Maranda C. Ward, EdD, MPH, Two in One Model, assistant professor and director of equity in the Department of Clinical Research and Leadership, George Washington University School of Medicine and Health Sciences
  • William Jordan, MD, MPH, director of health equity policy and transformation, American Medical Association

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Dr. Jordan: Hello, everyone. Welcome to a new episode of the Prioritizing Equity series. I am Bill Jordan, the director of health equity policy and transformation at the American Medical Association Center for Health Equity, and I have the pleasure of being your moderator for today's discussion. In this episode of the Prioritizing Equity series, panelists will share key learnings and insights for teaching, implementing and adapting culturally responsive communication models in the prevention and treatment of HIV and COVID-19 for historically minoritized and marginalized patients.

Routine screening and early detection of HIV and COVID-19 are critical to ensure patients receive treatment and lower their risk of transmitting these infectious diseases. Ultimately, routine screening saves lives, increases health equity and reduces health care costs. Medicine should aim to ensure that people feel understood, respected and valued as they are more likely to stay in care under these conditions.

Our AMA also encourages physicians to develop cultural safety and more culturally aligned communication practices when screening patients. The AMA encourages medical schools and residency program directors about activities and resources related to assisting physicians in providing structurally competent care to patients throughout their lifespan. In addition, AMA suggests that physicians include the topic of culturally effective health care in their curricula to support research into the utility of training and cultural humility using existing mechanisms such as the annual medical education surveys.

Today, physicians and experts will reflect on and share examples from their personal and professional experiences of designing curriculum, developing screening practices, and investigating barriers and facilitators of culturally responsive communication. We will also explore abilities to translate values, equity and health justice into inclusive patient engagement and communication.

Please join me in a warm welcome to our panelists. Maranda Ward, Two in One Model and assistant professor and director of equity in the Department of Clinical Research and Leadership at George Washington University School of Medicine and Health Sciences. Lalit Narayan, primary care internist, GW Medical Faculty Associates and assistant professor of medicine at GW School of Medicine and Health Sciences. Leon McCrea, senior associate dean of diversity, equity and inclusion at the Drexel University College of Medicine and Chavon Onumah, associate professor of medicine, General Internal Medicine Division at GW School of Medicine and Health Sciences.

As a family doctor who worked and taught in the Bronx for many years, I'm particularly honored to welcome these dynamic leaders for their conversation today. I'll start with an opening question for everyone. Tell us a little bit about how you're coming into this conversation today and why health professionals should focus on HIV and COVID-19 testing strategies.

Dr. Ward: I'll go ahead and get started. Thanks so much for that introduction, Dr. Jordan. So I also, like you mentioned, I'm the PI on the 211 model. And when we say Two in One, we're making the case that we should really be pairing HIV and COVID vaccines screening in the one primary care setting because both HIV and COVID are highly stigmatized, both HIV and COVID disproportionately impact the same patient populations, and so I'm coming to this from this research-based educational intervention that I've been leading over the last 18 months where I actually performed key informant interviews with minoritized patients and PTP to really supplement and explain what I was learning about the factors that really do influence HIV screening, prep screening, COVID vaccine screenings through some targeted scoping reviews.

And let me tell you, patients told us that they would be offended if their clinicians asked them to get an HIV test. Why? Well, because they know clinicians aren't asking all patients to get tested, so they rightfully feel profiled. And so this is why we've been calling for a routinization of screening questions about sexual history, about COVID vaccine history for all patients, just like it's done for depression. You come in and see a PCP, you may be there for a physical, you may be there to talk about birth control, whatever brought you in that day, but a set of questions around depression are going to be posed to you, and that's the way you eliminate mental health stigma.

Similarly, we need to do that for sexual health screening. We need to do that for COVID vaccine screening. And we recognize that it's easier said than done because again, not only did I talk to patients, but PCPs told me that they don't always feel comfortable talking about sex with older patients, for example. Yes, that very well may lend to an age bias, but we know that these patients are still alive. These patients are very much sexual beings and their age doesn't protect them from HIV, so they need to have those conversations too.

Same thing for marital status bias. Marriage doesn't protect you from HIV. So really we want to eliminate stigma and we know stigma is attached to social identity. Stigma is attached to sex. Stigma is attached to COVID. So this is why we want to have these conversations be the standard of care that's really going to normalize these conversations as part of prevention, as part of health.

And in this way, clinicians don't necessarily need to rely on their perception of risk, which is basically assumptions and bias, but instead they should just rely on what the patients are telling them when they pose a set of questions and that's going to determine their eligibility for prep, for HIV testing, for administering the vaccine or the boosters. So that's basically all of us are connected through the 211 model of really coming to having this conversation for other clinicians to join us in making this the standard of care.

Dr. Jordan: Thanks, Dr. Ward. Would one of the other panelists like to jump in on this initial question on why health professionals should focus on this testing strategy?

Dr. Onumah: Well, I will say Dr. Ward put it so eloquently so I don't have much to add. I'm an HIV specialist. I have been for over a decade, and I think just to echo her thoughts on really just normalizing the way that we speak about HIV as we do any other illness, hypertension, diabetes, depression, what have you, and then standardizing the screening processes. And I think once we come to the conversation after having removed any stigma or feeling uncomfortable about these questions in the conversation, that our patients feel comfortable.

For instance, I tell all of my patients that, "You know what? I screen everyone, I don't care if you're married, if you're straight, same sex, it doesn't matter. I screen everyone." And very, very seldomly do I have anyone that says, "Oh no, don't do that. If this is something that you do for everyone, why wouldn't you do it for me?"

So I think that that is one of the big pieces and something that was lost a bit in the pandemic as we were focusing on COVID-19―rightfully so―but we need to bring it back so we don't end up with more inequities than what we already had to begin with.

Dr. Jordan: Thanks, Dr. Onumah.

Dr. McCrea: Dr. Jordan, the one thing I may want to add is the lens. One, as a clinician, I'm a family physician as well, and you mentioned your years in practice in the Bronx and how important it is to be at one with your patient and actually trying to make sure you're providing this culturally sensitive care, eliminating bias, and clearly we have bias as providers and also patients have bias and how do we meet and have that intersection in between? And part of that is open and clear communication and sometimes putting your cards on the table as a provider and saying, "These are the things that I believe. These are the reasons why I'm asking you these questions. These are the reasons why I'm hoping that you will consider us coming together with shared decision making."

I think the other part of that though as an educator is that it is our responsibility to also prepare the next generation of health care providers who are going to be watching us in terms of how we interact with patients, what things we normalize, what things we routinize. As Dr. Ward mentioned earlier, in terms of our care of just not vulnerable populations but all populations. And so if the standard of care is that everyone gets a certain set of questions, if we normalize the way in which we approach these issues, then the expectation is that that is the new normal. Oftentimes we are transmitting our biases to our learners and they gravitate towards those things. They adopt those as their own behaviors down the road. And so it's really important, I think, that we talk about these principles and that we teach these principles to our learners today who are going to be our providers of tomorrow.

Dr. Narayan: This is a wonderful conversation. I really like what Maranda started off with is that it's actually a very multilayered skill, relating to patients in America because they're different ages, different backgrounds. Where I come at it is, I'm an Indian citizen and I trained and worked in India prior to coming here for medical graduation and is relevant for two reasons. One is actually when foreign medical graduates come over here, they disproportionately become PCPs, especially of Medicaid and Medicare patients.

So when you are imagining the thing in the world, it's people who are coming in from a very different learning point. Like me, most people didn't have any significant contact with the U.S. aside from pop culture, until you're about 25. But then when come in at 25, you're very intentional about the way you start learning about people because you're seeing patients almost from the get-go. And I feel like we hence have useful things to contribute to.

One of the things I would like to foreground is just the importance of history, especially if you come into a place where we are not. For example, to understand fully why, for example, certain communities, minority communities, react in a particular way to the notion of being targeted or being defined as a high risk.

You sometimes have to look outside of medicine, for example. There are many other situations like we could say New York in the broken windows theory and the stop and frisk policing, which was targeting high criminal areas. That did not end up well for the people over there. And if you look back further, if you look at financial institutions with redlining and denying Black homeowners financial instruments like mortgages. Again, being seen of as Black from the system, it sometimes does not end well. So once you understand that history, then I feel like it's easier to understand people's unspoken fears. As an educator that's sometime also for like in the foreground. This idea that you have to understand everything that's happening in its historical context.

Dr. Jordan: Thanks for sharing that, Dr. Narayan.

I would like to get into some of our questions for some of our panelists and I'll start with Dr. Ward. As we know, many health institutions, including the AMA, are building and releasing toolkits to assist physicians and other health professionals with increasing screenings. One major tool is culturally responsive communication. Could you walk us through the difference between culturally safe communication and culturally responsive communication?

Dr. Ward: I sure can. And actually culturally responsive communication relies on the literature around cultural safety so it's an extension. So as part of the 201 nine-part live training series, three of those lectures focus squarely on culturally responsive communication because the way that patient culture shapes health is just very well documented. So I will say that oftentimes when we talk about the culture of the patient, that gets described as cultural competence. And I'm intentionally using air quotes to explain the ethnocentric shift away from cultural competence to cultural safety.

So one, the reason why I'm describing as ethnocentric is because culture is dynamic. So it really can't be mastered in the way that competence implies, which is why we're moving away from that language. It's really a lifelong iterative process of learning, unlearning and then also you have to think about how the traditional cultural competence got positioned as understanding someone else's difference. Which not only others patient, but it doesn't really allow for clinicians to turn the mirror on themselves and their own cultural attitudes and then build empathy for how someone else landed where they did because now they can actually understand and explain their own taken-for-granted attitudes and cultural beliefs.

So culturally responsive communication allows for an understanding that clinicians have culture too. So when we talk about culture, we're not just talking about the culture of patients. Dr. McCrea talked about that, thinking about you as a clinician, bringing all of your world positions and values in that clinical encounter. So the culture of a clinician does have a measurable impact within the clinician and patient relationship. And so when clinicians are introspective and reflecting on their deeply held health beliefs and biases, it does really remove that value that gets placed on health beliefs as right, instead of really recognizing that a range of health beliefs exist. So removing those values, and really allowing for the interrogation of clinician culture. That's going to call into question concepts of power and expertise because as we know, historically clinicians are deemed as all-knowing and the one with sole decision-making power.

So yes, we have patient culture; yes, we have clinician culture; but as we know, culture from an ecological perspective is not just interpersonal. So we're steeped in subcultures. We have a culture of medicine. And so as an example, a patient may share their preference to rely on prayer before resorting to the recommended therapeutics. And so they could be viewed as refusing treatment or being non-compliant rather than someone who just doesn't wholly subscribe to westernized medicine or maybe they just don't prioritize it. But that's the thing, because traditionally clinicians do get trained in what is right, what is effective, what counts as evidence. Sometimes those attitudes can be at odds with their epic of care. And so we also have to talk about the culture of medicine. So culture of patients, culture of clinicians, culture of medicine, and then the culture of racism. And so when it comes to minoritized patients, there are attitudes and assumptions that do exist discursively for why they face the health outcomes that they do.

And then so we can really just think about how the explanations of scientific racism―yes, they've been discredited but the cultural narratives remain intact. And that prejudice actually shows up for racially and ethnically minoritized patient populations in how they get characterized in research, in medical charts, in health policies. And so speaking of medical charts, there was a study that was published in Health Affairs that reported how coded language―being difficult, non-compliant, at-risk―was actually more often used for Black patients in their electronic health record. And so not only does that further marginalize them, but it contributes to how they're viewed in disempowering ways and pathologizing ways that other clinicians who access the chart…it's going to proceed them and literally follow them around. And so this is why I really love that the AMA addresses discursive inequities in your language and narrative guide. That really helps us be very intentional in how we frame and use language to describe the patient populations that we engage with and serve.

Dr. Jordan: Thanks, Dr. Ward for spelling all of that out, and I really appreciate both the prior comments about history and these comments about cultural understanding and understanding our own culture as clinicians that we come from. And thanks for the mention of the narrative guide as well.

I think one of the challenges that we often face is that a lot of medical students don't necessarily come into medical school having learned some of these things beforehand and the extent to which medical school curricula deal with these concepts is still very variable. So I wanted to pitch the next question to Dr. McCrea. In thinking about the development of competency-based evaluations and cultural responsiveness, can you talk more about the concept of culture and why we should also consider institutional culture alongside patient culture?

Dr. McCrea: Yeah, absolutely. I mean, for anyone who's becoming increasingly steeped in medical education, at almost every level now we're moving towards competency-based evaluation and assessment instead of time-based assessment. Meaning we should be able to actually determine one's readiness for practice or readiness to progress, not just based on being on a rotation for a month or completing two or three years or seven years of training, but the accumulation of a set of skills. And each person will attain those skills in a different timeline.

But part of that is actually and speaking to cultural responsiveness and how we incorporate that into that competency-based assessment is how are you actually able to negotiate the care of all types of patients? How do we assess that? How do we assess a person's success in managing patient populations in terms of getting toward decision-making and ultimately outcomes? One of the really hard things and I'm going to jump around a little bit, one of the things for any provider to understand is that sometimes the best outcome for the patient is not necessarily the best outcome that you perceive as a physician.

Sometimes the patient defines success as having come into the office. Success isn't defined by starting a new medication, by moving their A1C from 9 to 7. It is just that they have had an opportunity to talk about the challenges in their lives and that is what they define as success. And so sometimes repivoting what it is that we have to embrace in terms of a successful patient-physician relationship or patient-provider relationship is constantly an evolution. But so many of our traditional metrics for success are how well, and I'm putting well in air quotes, are you taking care of your patient population? And those are defined by what percentage of your patients have gotten colonoscopies, what percentage of your patients have certain metrics at a certain level? And those are important metrics. Don't get me wrong. I would not be doing my job as a provider if I did not make sure I moved the needle in that way, but it does not fully define success for each and every patient. And so we have to really think more broadly about how it is that we train tomorrow's providers about how they define success in that provider-patient dyad.

Now, the other piece though is that culture, especially health care culture and institutional culture happens at so many levels. And often the patient feels that impact long before they get into the provider's room. How do they engage with the EMR? How do they engage with the front desk? What messaging is available when you go into the office or you see the websites that our health systems provide? Do you have an ability to determine what your name is in your EHR? Is that a binary way of doing it? Are we able to actually have secured locations to put information in? There are pros and cons to a patient having full access to all of their information and while we absolutely agree and think that the transparency through which patients now have access to their information is incredibly empowering, we have to make sure that we are partnering with our patients to make sure that they understand what that access means.

I also think though that when we think about that lens of culture and what it is that our responsibility is as contributors to medical culture, how we have to challenge each other. And I'm going to say it again, challenge each other as health care providers to actually be better. We are not doing each other favors by standing on the sidelines and watching as our colleagues provide what we may determine to be suboptimal care. And I don't mean that there's suboptimal care and that they're not actually doing things by the book, but it means that there are opportunities for us to support each other in doing and being better because it is not just the patient who is watching individual interaction. It's often them saying, "Oh my God, a community of providers," or "A health care system has watched me ping pong around and no one stepped up to make sure that my mother was heard, my grandfather was heard, my uncle was heard, my cousin was heard."

Patients don't expect us to perfectly heal them. Patients understand that there are components of their disease processes that are beyond our control. What they want is to feel as if they are treated as a human in their life journey. We're all not going to be here one day. That is one of the truisms of life is that it is going to end at some point. But how did we partner with our patients as a component of that journey? And so embracing the fact that we need to understand what a patient's expectation is for what their journey's going to be through life with what our expectation is as health care providers and how we do that, that's where I think that that cultural piece is incredibly important. So I'll turn it back over to you.

Dr. Jordan: Thanks Dr. McCrea for both calling us in to really support our colleagues in doing better and also for really grounding us in the humanity of our patients and talking about how we really need to understand what our patient's priorities are and have our care be driven by that. I'm going to shift over to Dr. Onumah. As someone with expertise in preventive medicine, HIV prevention and treatment and relationship-centered care, could you talk a little bit more about why clinicians need to value the historical role, impact of racism and how we talk to patients?

Dr. Onumah: Absolutely. Thank you for that question. And I just have to say I just love being here in this conversation and hearing my colleagues here, and I'm just, I almost wanted to say, "Preach, amen." But so I'm a HIV specialist and primary care physician, but also a medical educator. I direct our residency internal medicine residency training program and also work with the medical students. And so many things are hitting home here. And so I think when I think about us as clinicians, but also medical educators as Dr. McCrea talked about how we role model what care looks like for learners, I think when we think about this whole concept of achieving health equity collectively, what we're trying to do is we want to help each individual patient reach their full potential. In order to do that, you have to build these trusting relationships and partnerships with your patients, and that requires us to be able to relate to our patients and learn from them, learn with them. That's this whole concept of cultural responsiveness that Dr. Ward was just speaking about.

So honestly, I don't know how you can relate to anyone or really learn or try to understand more about people without understanding the experiences, the history that shapes them, their lives, their decisions. If we're being honest as a community, as clinicians we know that racism is embedded in all aspects of American society, including health care. This is true. That's a fact. So we know that people from marginalized communities continue to experience structural violence or harm from the historical and present day exclusion of individuals by our institutions, our structures. It's everywhere―social, economic and what have you. So not only are we really charged with being aware of these harms, we really need to be intentional about practicing structural humility. And I think that means that you have to acknowledge the history and the impact of racism.

If we use HIV, for example, how can you not look at the inequities and the large or higher rates of HIV in Black men and women and not think about the redlining, mass incarceration rates and things that have shaped those communities, have decreased the sexual pool and what have you, and all the multiple impacts of that. So when we think about...Dr. Ward was already alluding to this competency and now really moving towards humility. And so when I think about structural humility, I was really based on, if you remember, Dr. Melanie Tervalon and Dr. Jann Murray-García, that the cultural competence, I mean, I'm sorry, cultural humility concept and that there's always an ongoing engagement, life-long learning process where we are learning about patients, communities, colleagues and ourselves, and that we never stop that learning. And so structure of humility just takes that a little bit further.

We use the structure of humility lens. We are not just making ourselves aware of racism and its impact, but we also aren't making assumptions about the role that these play in our patients' lives. So instead, it's more of a collaboration with our patients, the communities, and trying to develop that understanding and how they actually respond to the structural violence that is happening on a daily basis and has happened historically.

So one way that I think we can do this is through education and through experiential learning. And so for example, and as I mentioned, I am a residency program director, and so in our program―Dr. Narayan has participated in these sessions as well―we host a session called Building Structural Humility Through a Historical Lens. And what that really entails first is a little bit of pre-work. I love Dr. Camara Jones, and so we have them watch the videos on the allegories of race and racism. Just set the stage, as you mentioned; sometimes people are coming from different places with this knowledge, so that sets the stage.

Then we have a group field trip, if you will, the National Museum of African American History and Culture in Washington DC. So grateful to have that right here in our community. And so after we explore the museum as a group, we come back, we discuss how the museum tells the history of Black people and U.S. history, some painful parts of course, but it also highlights the stories of triumph, perseverance, resilience of Black people through these collaborative efforts. And so after that trip, we sit down, we have some time to reflect personally, but then as a group reflect on our own biases, what we've learned. And we come up of ways as clinicians to really use this historical context and tap into that individual and community-level resilience, the strengths, the assets, the things that we can use to partner with our patients and communities to address and overcome the structural violence.

I think it has been a really powerful tool for our learners, for me personally, and the other clinicians that have participated in this session. And it helps us to inform, bringing it back to your question about the communication piece. It helps us inform how do we rank questions when we're talking to patients, the language we use. When we use terms both in verbal language, but also written language such as refused and comply or compliance, for example, with that very paternalistic historical undertone, how that can impact the relationships and that trust that we're trying to build. And it really limits our ability to identify the barriers, help connect patients to resources and hinder their progress towards health equity.

So I think just to round it all up is that you use that history to help you learn more about the patients. You don't let that define the relationship, but it's to help you connect and build these partnerships and then also help the patients to empower them. And I hate to even use empower because we have power, but sometimes it's helping folks to realize their power. To really overcome some of the factors, the structural inequities that continue to plague marginalized communities. So sorry, that might have been a long answer, but I get really passionate about this.

Dr. Jordan: Well, thank you so much doctor for grounding us in humility and expanding on Dr. Ward's earlier comments about how we're really committed as physicians to lifelong learning, including history.

I guess with that, I'll shift to Dr. Narayan to ask when we're working alongside minoritized and marginalized communities, how do physicians translate values of equity and health justice into inclusive patient engagement and communication? What are some of the strategies that you have used?

Dr. Narayan: I think it's different in different settings. I have the advantage of being in a setting in which I have time to get to know my patients over years because I'm a primary care physician. So what I do find about cultural identity and ethnic identity is especially now in a growing atmosphere of racial tension and so on and so forth, sometimes something which you think of a very benign question can sometimes come off as perhaps a little bit more emotionally charged for the patient. So what I would say is, Dr. Onumah mentioned this, is it's always good to build a conversational style in which you're explaining why you're asking things. For example, if I'm asking about someone's sexual practices, I explain to them I'm trying to figure out how to screen you for sexually transmitted diseases or whether you qualify for certain preventive therapies or so on and so forth.

And then it makes the process of asking it much lesser. And similarly, it's something which I see give it time, open yourself up. And I really feel like it's almost a cliche to say, but the secret to caring for a patient is caring for a patient and a lot of cultural responsibilities is exactly that. It's like people will lead you into their culture once they figure out what your intentions are that you really want to help. They will show you things or explain things or adjust your understanding on something because ultimately you'll have the same common desire.

Dr. Jordan: Thank you. Well, this has been a great conversation. I'm going to wrap up by asking the same question of everybody and just ask for a couple of sentences from each of you to round us out for today. How do you envision these principles that we've been talking about, shaping the future of medical education and health care delivery, particularly for historically minoritized and marginalized communities? And I'll start with Dr. Ward.

Dr. Ward: So I'm an educator by training, and most people on the call are educators too. So I think that it's a combination of really taking a good look at our curriculum and training practices. I will say that for example, in the School of Medicine and Health Sciences, one of the things that we have are a set of curricular guidelines on how to talk about race in clinical cases and to minimize the use of race when you're looking at medical history, because obviously race is not biological, so why would it come up in the medical history? But we know race is still important because it actually infers their exposures to racism and racial discrimination. So you still want to have that come up in the social history. But I think that is so important when we talk about curriculum. Yes, the content is really important, although the things we talked about and having the conversations about how do you facilitate these conversations, how do you support faculty so that they know how to couch and frame these discussions?

And so that's where those set of curriculum guidelines are really important so that as we've been talking about the role of bias, we can make some disassociations. We don't always have to...every time we have a patient who identifies that LGBTQIA, okay, they're coming in presenting with STI. And then we wonder why those associations go together. It's because at every turn in training, in the textbook, in the clinical case, we always say those go together. But we need to start to make some disassociations, have some fuller narratives about the range of patients that come across the hospital or clinical setting, and that would do it justice.

Dr. Jordan: Thank you. I'll turn to Dr. Narayan next.

Dr. Narayan: I mean, I think one thing, and it's obvious even in this podcast is I say on the global stage, the American medical establishment and clinical educators really are really thinking hard about issues around inclusivity. I have to say that sometimes you don't give yourself enough credit that almost no other national medical association across the world would have as many resources as the AMA has on cultural responsibilities if you just take a look at their website. So I feel like 100% we have a long way to go. There are some disparities and a history which is deeply painful over here for a long time. But I also say the encouraging thing is there's just so much energy around this, probably nowhere else in the world.

Dr. Jordan: Thank you. I'll shift to Dr. Onumah next.

Dr. Onumah: Yeah, I agree. I feel there's hope. There's hope. I think in addition to what my colleagues have already said, also thinking about the abundance of information that people are privy to in this day and age. And sometimes not knowing exactly where that information is coming from, what's behind it, what does it mean, and that can end up perpetuating some fear, especially in marginalized communities or mistrust of medicine and physicians and what have you.

So I'm hoping that as we begin to practice or continue to practice culturally responsive care and really partner and focus on this relationship care and use these skills that the building of the trusting relationship so that when people are coming to us to...“I read about this study, what does that mean for me? How can I prevent this from happening to my family member?” That we're able to dispel whatever myth, we're able to quell some of the fears, but also be very up front and say, "Hey, this is a possibility. These are the things that you can do now or in the future to hopefully prevent this from happening or have a better outcome," if you will. So that's the hope. I hope that we are partnering with patients more using this framework.

Dr. Jordan: Thank you, Dr. Onumah. And I'll give the last word to Dr. McCrea.

Dr. McCrea: Thanks so much. It's so great to be part of this fabulous conversation. And what came to mind is all of us as colleagues thinking about this is Bryan Stevenson, the author of Just Mercy, in many of his teachings, talks about this concept of getting proximate with one's community. And when I hear about the issues that Dr. Ward has brought up in terms of minoritized and disenfranchised and folks that have intersection, and so that means a constellation or combination of factors that can make you feel even more disenfranchised. Often there is a disconnect between patient and provider because there is not true empathy or understanding about the lived experience. And part of that is that we have not taken enough time to just get proximate with the communities that we take care of.

Part of that proximity can actually start in the provider-patient relationship. Being inquisitive, asking questions of your patients with sincerity. I have learned so much about communities from my patients. Just taking that extra 30 seconds to actually sit down and say, "So why do you do this in your cultural practice? Why are you giving me pushback on this? Explain to me how best we can partner on this. This is what's making sense to me; please help me understand what makes sense to you, and how do we come to some version of a middle ground?"

I think our responsibilities as providers of tomorrow is to teach today's learners how to adapt because we have no possible anticipation of what is to come. None of us predicted COVID. But that hit us. Even though we've had pandemics in the past, I sure didn't expect one to happen during my lifetime. And then for that to intersect with all these other conditions and to see communities that were already disenfranchised be more disproportionately hit by COVID, as an example, just further talked about the chasm that we have in our health care delivery model. So my fervent hope as we come together to figure all this stuff out is to actually get proximate to all of these communities so that we can actually understand them better and provide the care that they need.

Dr. Jordan: Thanks, Dr. McCrea, for grounding us in the current historical moment and also linking us back to the patient physician relationship and how important it is for us to stay curious and be proximate to the communities that we're working in and serving.

I just want to thank you all again to our wonderful panelists for this engaging and thoughtful conversation. To continue the larger health equity conversation, I hope that many of you can join us on May 30th for a National Health Equity Grand Rounds webinar, Advancing Health Equity Through Resistance, a State of the Union on Threats and Opportunities.

The National Health Equity Grand Rounds event will serve as a proverbial state of the union for health justice work in the United States. And you can register to join us in this conversation and help us identify strategies to advance equity through resistance while building a stronger multiracial democracy equipped to support health for every individual across the United States. Thank you all for being here with us today.

Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.

Table of Contents

  1. Panel
  2. Moderator
  3. Transcript