Systemic racism doesn’t rely on the presence of people who are racist. Rather, this brand of racism is often unintentional & results from established—& unquestioned—policies, procedures & workflows.
Partner with your patients. Another important element to successful outcomes is including patients in shared decision making. Dr. Rose gives the example of a Black woman with SLE who was frequently late to her appointments. Her physician recommended increasing her steroid treatment, with the intention of alleviating her pain quickly and avoiding a situation in which the patient would be late to physical therapy (PT) appointments. The patient was upset by the care decision because of the side effects and, after working with her physician and Dr. Rose, was able to successfully complete a PT course—to which she showed up on time because she adjusted her schedule to ensure it.
“Part of the problem-solving process is engaging the individuals in front of you in their own care, and valuing them as a person who is autonomous to make a decision along with [the rheumatologist’s] guidance, help and support,” Dr. Rose says. “That’s really half the battle of addressing racism in healthcare.”
Other ways to help disadvantaged patients include thinking beyond the exam room toward things like patient assistance programs, pharmacy payment plans, and calling in a social worker or psychologist when warranted.
Get involved. Physicians and healthcare providers are leaders in their community and have the power to effect change toward diversity, inclusion and equity. Dr. Rose recommends clinicians get involved by reviewing their community health needs assessment, serving on a council to advocate for community needs or mentoring someone who aspires to be a clinician.
“As clinicians we have power in our community,” Dr. Rose says. “We can write social prescriptions for people, whether it’s to attend support groups, go to a food pantry, seek housing advocacy or go swimming at a local YMCA. Social prescriptions not only tell someone that you are interested in their well-being, but [that] you’re creative about the resources and opportunities you see them having access to.”
Kimberly Retzlaff is a freelance medical journalist based in Denver.
Addressing Systemic Racism in Medical Education
The effects of systemic racism in medical education are multifaceted, and a plethora of research articles, op-eds and news stories have been written on the subject. Seemingly benign things, such as using photos and examples of white patients during training courses, contribute to the continued disparate outcomes between white patients and people of color. (Think of diagnosing dermatologic conditions and how that differs when the patient’s skin color is light or dark.) Medical programs are starting to evolve with this in mind. For example, the ACGME Program Requirements for Rheumatology that went into effect July 1, 2020, specify education in quality improvement with specific focus on addressing health disparities.1
