By: Roberto Rentería
I was attending one of my first Grand Rounds in clinical practicum at a family medicine clinic. It was an exciting opportunity to listen to physicians present complex medical cases and conceptualize their treatment approach. And it was such an exciting opportunity to be a part of the behavioral health team as a psychology practicum student. It was remarkable when my psychological knowledge and expertise was not just welcome but requested to help in formulating a treatment plan for patients.
During one of the first Grand Rounds, I was caught off guard. – The attending physician interrupted the resident’s presentation to state, “Remember, the psychology practicum students like to know about race.” It struck me that physicians had to be prompted to include the racial identity of their patient. Later, I came to find out that this was primarily due to previous practicum students frequently eliciting this question during Grand Rounds. Coming from a scientist-practitioner program (and especially in a counseling psychology program), race and ethnicity are arguable the major “diversity” factors considered when discussing multicultural practice.
A few weeks later, after another prompt from the attending physician to state the patient’s race, one of the residents finally expressed their curiosity: “Why do you like knowing about race?”
The resident looked at me with earnest curiosity. She was genuinely curious why it mattered in my conceptualization. It seemed odd to receive a question on why race would matter in conceptualizing a patient in healthcare. It was evident she and the family medicine team were committed to culturally-competent healthcare. I wondered if it was due to applying different approaches to healthcare. The resident’s question prompted a conversation between the physicians and the psychology practicum students. I discussed the significant health disparities across racial/ethnic groups as a foundational reason. I pointed to the evidence on how diagnoses, treatment, and medical care is disparate across racial/ethnic groups. I also stated that knowing race/ethnicity helped me integrate potential experiences of systemic and interpersonal discrimination into my conceptualization.
The conversation was brief, and it seemed that the physicians were genuinely interested in learning more. I felt content for the opportunity to share a bit of my understanding on why race matters. Yet, it made me wonder how I could advance this conversation with other providers. As a psychologist, how could I facilitate this conversation to improve patient care?
Addressing inequities in healthcare will require systemic change in healthcare curricula and training. Nonetheless, we can begin a conversation now, and this can have significant impacts on patient well-being. I want to validate that these conversations can be challenging to initiate, even with providers who are wanting to learn.
So, I hope to provide resources on how behavioral health practitioners can promote these conversations within their healthcare teams. This resource list is NOT exhaustive. My hope is to provide a few resources to encourage our own path towards better understanding why race/ethnicity and other cultural identities matter in the provision of healthcare.
Why Race Should be Discussed in Healthcare
Scientific American: What role should race play in medicine? https://blogs.scientificamerican.com/voices/what-role-should-race-play-in-medicine/
Vyas, D. A., Eisenstein, L. G., & Jones, D. S. (2020). Hidden in plain sight—reconsidering the use of race correction in clinical algorithms. New England Journal of Medicine, 383(9), 874-882. https://www.nejm.org/doi/full/10.1056/NEJMms2004740
Snipes, S. A., Sellers, S. L., Tafawa, A. O., Cooper, L. A., Fields, J. C., & Bonham, V. L. (2011). Is race medically relevant? A qualitative study of physicians’ attitudes about the role of race in treatment decision-making. BMC health services research, 11, 183. https://doi.org/10.1186/1472-6963-11-183
Anti-Racism Practices in Medicine & Healthcare
Health Affairs: Making Anti-Racism a Core Value in Academic Medicine. https://www.healthaffairs.org/do/10.1377/hblog20200820.931674/full/
University of Hawai’I at Manoa – John A. Burns School of Medicine. Resources for Confronting and Discussing Race in the Classroom. https://hslib.jabsom.hawaii.edu/c.php?g=1051064&p=7659239
White Coats for Black Lives (https://whitecoats4blacklives.org/)
Exploring Racism and Health: An Intensive Interactive Session for Medical Students. https://www.mededportal.org/doi/10.15766/mep_2374-8265.10783
Cultural Competence in Medical Education
Feinberg Academy of Medical Educators – Anti-Racism Medicine Collection. https://www.feinberg.northwestern.edu/sites/fame/educator-training/Anti-racism-in-Medicine-Collection.html
Nieblas-Bedolla, E., Christophers, B., Nkinsi, N. T., Schumann, P. D., & Stein, E. (2020). Changing how race is portrayed in medical education: recommendations from medical students. Academic Medicine, 95(12), 1802-1806. https://doi.org/10.1097/ACM.0000000000003496
Krishnan, A., Rabinowitz, M., Ziminsky, A., Scott, S. M., & Chretien, K. C. (2019). Addressing race, culture, and structural inequality in medical education: a guide for revising teaching cases. Academic Medicine, 94(4), 550-555. https://doi.org/10.1097/ACM.0000000000002589