News of police brutality toward minorities in urban centers has become so commonplace that it seems to echo indifference over anger. Yet, protesters and other activists across the country, including ones in Baltimore, Maryland, this past May, embody a visceral discontent with the breach of the social contract between law enforcement and the communities they serve. These episodes of violence only fuel the fire of mistrust among underserved, minority groups and are painful reminders of generations of poor social investment and the chronic failure of social institutions to engage with their communities.
Health care providers have a similar social contract as law enforcement: to provide effective, timely services to individuals and create equitable systems that safeguard society. However, evidence suggests that bias and substandard services define health care for many minority communities. The public outcry toward law enforcement should be a cautionary tale to those of us in the health sector. Amid myriad initiatives to preserve faith in health care providers, two tangible interventions stand out: engage trainees in the communities they serve and address implicit biases head on.
During medical student selection, community service is an indicator that a candidate can exhibit empathy and understand that medicine is a service-based profession. Although service helps trainees understand the social determinants of their patients’ health, it is rarely a formal part of medical school or residency training. Immersing trainees in the culture of a community can provide invaluable perspective and clinical acumen. Learning about religion and culture at faith-based institutions and community centers exposes us to leaders and allies in the community, as well as cultural traditions surrounding health. Visiting patients at home allows us insight into their family and community support structures, and improves our understanding of functional limitations, such as safe stairwells and fire hazards. Walking to local grocery stores gives palpable meaning to the term “food desert” by recognizing both the obstacles of transportation and healthy food availability. In the aftermath of the Baltimore protests, The Johns Hopkins Bloomberg School of Public Health unveiled a plan to “Engage Baltimore,” by informing students of issues in the community, encouraging participation in service opportunities, and fostering a vital dialogue between students and their neighboring community. Efforts like this can create better-educated and more thoughtful providers.
Within health care, implicit bias affects both clinical decision-making and community allocation of resources. These stereotypes, often surrounding race and class, unconsciously inject negative associations with ethnic minorities and disenfranchised patients. More worrisome, the bias seems to be deep seated, having been identified even in medical students. Although implicit bias is difficult to change, we must normalize the discussion to allow trainees and experts alike to reflect openly about the role bias may play in their own clinical management. More concretely, group reflections, mindfulness training, and honest debriefing can help us recognize and manage our underlying prejudices. The impact of bias within patient care should not be understated; variations in clinical care rooted in prejudice break down the foundation of the social contract that we strive to uphold.
As three trainees who have been deeply invested in Baltimore City, we have seen and felt the mistrust felt toward both law enforcement and health care. Health care providers are often the front line and the safety net for those in our society most likely to experience prejudice. We propose two pivotal steps: to immerse our trainees in communities through service and to look within ourselves to recognize and mediate the biases that are undermining our relationship with our patients. Before we can be an ally and an advocate, we must take fundamental steps to identify and connect with the communities we serve.
Articles from American Journal of Public Health are provided here courtesy of American Public Health Association
