We all want our patients and their families, when they leave our offices, to be satisfied with the care that they received and how they were treated. But are they? And are families of color and with low income as satisfied?
This week, Pediatrics is early releasing an article by Donna Luff PhD and colleagues at Boston Children’s Hospital and Baylor College of Medicine, entitled, “Understanding Racial, Ethnic, and Socioeconomic Differences in the Ambulatory Care Experience” (10.1542/peds.2021-056001).
The authors conducted a large qualitative study, in which they interviewed 80 parents with diverse backgrounds. They included Asian, Black, Hispanic (English- or Spanish-speaker) and White parents; they also purposefully included families with both public and private insurance.
What were the major themes heard from families?
- There are often a lot of systems issues (difficulty making appointments, parking problems, wait times), and there are often a lot of work-arounds. Parents are frustrated by these systems issues, but are appreciative of staff efforts to work around these issues.
- The personal interactions with the clinician can mitigate many of the frustations that families face.
- Parents appreciate clear explanations of what is going on and what the plan is. Interestingly, while some patients appreciate the opportunity to have input in a shared decision-making process, others find this to be stressful and too much responsibility.
Importantly, there was an overriding theme of discrimination and disrespect by staff and clinicians throughout the interviews. Families reported instances where staff or clinicians made incorrect assumptions about them, and this was more commonly reported by families of color and with public insurance.
These findings are sobering, and everyone who comes into contact with families should read the entire article. The quotes are enlightening, and I suspect that every reader will recall similar incidents which, no matter how well-meaning, could be perceived by the family as being judgmental, discriminiatory, or disrespectful.
How can we do better? In an invited commentary, Drs. Kevin Fiori and Suzette Oyeku at Albert Einstein College of Medicine note that “these experiences of bias, discrimination, and racism can be mitigated by clinicians acknowledging their personal biases, and interrupting patterns of discrimination and disrespect that clinicians observe in healthcare institutions (10.1542/peds.2022-058243).”
We need to remember that our words matter. We can get better at not making assumptions based on someone’s appearance. And we can provide feedback to others when we observe interactions that can be perceived by a family as disrespectful.