Seeing Race in Healthcare

Today as we celebrate a great man, Martin Luther King, Jr., I want to take a moment to discuss why color blindness is not a skill to be used when providing care to patients.  Martin would have never wanted that.

Access to healthcare should be colorblind but we fall far short of that ideal.  That is a long and heated debate that we should have soon; but not today.  Today, I am going to talk about why we should look at race and cultural backgrounds in healthcare.

If your patient is black, they have:

• 60% greater chance of diabetes but their legs are amputated 2.5 times more often and they have 5.6 times more kidney disease related to diabetes.
• Three times greater chance of dying of an asthma attack.
• 16 times more likely to die from scarring of the lungs secondary to sarcoidosis
• 50% greater risk of lung cancer despite the fact that they smoke less than their white counterparts
• Younger black people die 4 times more often from stroke than blacks and suffer twice the number of first time strokes.
• Black people develop high blood pressure at a much earlier age. Over 40 percent of the black population over the age of 20 has hypertension.

If your patient is Hispanic, they have:

• Heart disease at a rate of 35% less than the general population
• A lower death rate from the top ten killers in the US but….
• A 50% higher death rate from diabetes
• 23% more obesity
• 24% higher poorly controlled hypertension

Patients of Jewish descent have several genetic diseases.  The one that would most likely affect patients in the Medicare population is Gaucher’s disease.   They also have dietary restrictions.  Being Kosher is about more than not eating pork.

Islam

I cannot find any specific diseases or conditions common to Muslims but to be effective, clinicians should be aware of some of their customs and rituals.

• Privacy and modesty should be respected always. If a female patient chooses to be covered, respect her wishes to the degree possible.
• Use your right hand when handing an object to the patient, feeding the patient and administering medications as the left hand is considered dirty.
• Do not be insulted if a Muslim patient or family member does not shake your hand or make eye contact. This is part of their culture and is not an indicator that they are not listening to what you are saying.
• Muslims are specifically forbidden to eat pork and its byproducts, alcohol, animal fats and meat that has not been slaughtered according to Islamic rites. While most of you had no intention of cooking dinner for your patients consider that many medications contain gelatin, alcohol, or magnesium stearate which is an animal byproduct.  Although any medication can be given in an emergency, the patient should be made aware of these ingredients in non-emergency situations and told about the possible consequences if not taken.  Ultimately, it is their decision to make.

There are so many more races, ethnic groups and religions that require special knowledge to be effective in our care of these patients.  There may be smaller groups within your community that require knowledge of their customs and heritage.  Learn them.

Ask questions.  “What time does your family say prayers?  I can schedule visits before or after.”  “What are your favorite foods? How do you cook that?”  (Did you know that ‘greens’ are best cooked with bacon fat?)

An elderly Cajun man from down the bayou was explaining to a doctor about his nature as I walked in to check his pedal pulses following a heart cath.  I might should have listened more and spoke less because I blurted out, ‘I’m a nature lover, too.  I love taking pictures of nature.”  The cardiologist, very shy and usually expressionless doubled over laughing.  It seems a certain population down the bayou refers to their sexual desire as their ‘nature’ and I was a self-proclaimed nature lover who took photos.

The moral of that story is to learn the local lingo.  If you don’t understand what your patient is telling you because it doesn’t make sense or because of a thick accent, be patient and persistent.  Had I listened more, I would have realized there was something off about changing the topic to nature in the middle of a blood pressure medication conversation.

It is not racist to tell a patient that he has a greater chance of losing his leg because he is black.  It is useless information unless you use it in a context that explains your apparent foot fetish or motivates the patient to be compliant to diabetic foot care; but it is not racist.

In every situation, it is critical that you gain the trust of the patient and their caregiver and you can’t do that unless you see the patient for who they are.  You may be their strongest tie to the healthcare community for rural patients and immigrants.  Be approachable.  Make it a priority for every person in your agency to be warm and welcoming so that patients feel more comfortable calling you.  Being politically correct does not mean pretending a person isn’t black or a Muslim or Jewish.  They already know that.  I promise.