Physician Perspectives on Responding to Clinician-Perpetuated Interpersonal Racism Against Black Patients with Serious Illness

Crystal E Brown; Cyndy R Snyder; Arisa R Marshall; Kristine L Cueva; Sandra Y Jackson; Kemi M Doll; Sherita H Golden; Bessie Young; Abby R Rosenberg

doi:10.1007/s11606-023-08377-z

Physician Perspectives on Responding to Clinician-Perpetuated Interpersonal Racism Against Black Patients with Serious Illness

J Gen Intern Med. 2023 Aug 24. doi: 10.1007/s11606-023-08377-z. Online ahead of print.

Authors

Crystal E Brown^{1

2

3}, Cyndy R Snyder⁴, Arisa R Marshall⁵, Kristine L Cueva⁶, Sandra Y Jackson⁷, Kemi M Doll⁸, Sherita H Golden⁹, Bessie Young¹⁰, Abby R Rosenberg^{11

12

13}

Affiliations

¹ Cambia Palliative Care Center of Excellence at UW Medicine, Seattle, WA, USA. crysb@uw.edu.
² Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA. crysb@uw.edu.
³ Department of Bioethics and Humanities, School of Medicine, University of Washington, Seattle, WA, USA. crysb@uw.edu.
⁴ Department of Family Medicine, Center for Health Workforce Studies, School of Medicine, University of Washington, Seattle, WA, USA.
⁵ Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
⁶ Department of Medicine, University of Washington, Seattle, WA, USA.
⁷ United States Army, Center for Army Analysis, Fort Belvoir, VA, USA.
⁸ Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA.
⁹ Division of Endocrinology, Diabetes, and Metabolism, John Hopkins University, Baltimore, MD, USA.
¹⁰ Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA, USA.
¹¹ Cambia Palliative Care Center of Excellence at UW Medicine, Seattle, WA, USA.
¹² Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, USA.
¹³ Department of Pediatrics, Harvard Medical School, Boston, MA, USA.

PMID: 37620725
DOI: 10.1007/s11606-023-08377-z

Abstract

Background: Racism negatively affects clinical outcomes in Black patients, but uncertainty remains among physicians regarding how to address interpersonal anti-Black racism incidences involving them to facilitate racial healing and promote accountability.

Objective: Elicit physician perspectives on addressing concerns from Black patients about interpersonal racism involving them or their team.

Participants: Twenty-one physician subspecialists at an urban academic medical center.

Approach: We conducted one-on-one semi-structured interviews to help inform the development of a clinician-facing component of a program to address the distress of racism experienced by Black patients with serious illness. We asked clinicians to describe experiences discussing racism with patients and identify additional resources to support these conversations.

Main measures: Physician perspectives, including barriers and facilitators, to promote racial healing and clinician accountability when discussing clinician-perpetuated interpersonal racism with Black patients.

Key results: Of the 21 participating physicians, 67% were women with a mean age of 44.2 years and mean of 10.8 years of experience as an attending physician. Four identified as Asian, three identified as Black, and 14 identified as White. Participants largely felt unprepared to discuss racism with their patients, especially if the harm was caused by them or their team. Participants felt patients should be given tools to discuss concerns about racism with their clinicians, but worried about adding additional burdens to Black patients to call out racism. Participants believed programs and processes with both patient- and clinicians-facing components had the potential to empower patients while providing resources and tools for clinicians to engage in these highly sensitive discussions without perpetuating more harm.

Conclusions: Addressing and improving communication about interpersonal racism in clinical settings are challenging. Dual-facing programs involving patients and clinicians may help provide additional resources to address experiences of interpersonal racism and hold clinicians accountable.

Abstract

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