Headlines hit last summer about Black nursing home residents being neglected and left unbathed, without clothing, and sometimes without the medications they needed at an Alabama nursing home after a lawsuit was filed. What it outlined was an allegedly discriminatory environment at a facility toward both patients and staff, who were called “n****,” “slave girls” and “little Black girls.”
It’s one instance among many that have made national headlines, putting a spotlight on a trend that health care workers have been speaking up against for years — how the discrimination of Black patients within facilities is a serious problem that, ultimately, affects care delivery and outcomes. It’s adding stress for health care providers, and disproportionately burdening Black health care workers. The amount of research, anecdotes, and lawsuits noting everything from the dismissal of patients’ pain and mistreatment to overall lack of empathy for Black patients is piling up.
A new report released this month by the Commonwealth Fund reveals that nearly half of health care workers witness racial disparities against patients, and even more say racism is a crisis or major problem. Additionally, 70% of those working in facilities with mostly Black patients said they have witnessed discrimination — more than those with mostly white or mostly Latino patients.
Three thousand health care professionals nationwide took part in the survey.
“If we are going to build truly equitable health care systems, we have to start by listening to voices of those on the front lines,” said Dr. Laurie Zephyrin, the report’s co-author and senior vice president for advancing health equity at the Commonwealth Fund. “Understanding what health care workers are experiencing, and what they want and need from their employers and colleagues to address discrimination, is critical to successful and sustainable change.”
While the report focused on patients, it also found that more than 40% of respondents had seen their co-workers endure racism in the workplace. Nearly 60% of Black workers reported being discriminated against in the facilities where they work because of their race. Many are worried about retaliation if they speak up about their discrimination concerns.
For this to come from those working within the health care system is profoundly disappointing and sad, said Dr. Aletha Maybank, who is chief health equity officer at the American Medical Association. It indicates that the medical system is failing to create safe environments for patients and workers. She wants them to not only survive, but thrive, she said.
Racism is a barrier to high quality, equitable care, advocates say. It seeps into misdiagnosis, symptom dismissal, and delayed care, which in turn contribute to myriad health disparities that are disproportionately burdening Black Americans, like high risk for stroke, heart disease, maternal mortality, and cancer.
Included among the findings was that 48% said medical providers were more accepting when white patients advocated for their needs than when Black patients did the same, and Black workers were much more likely to agree with this statement than white workers.
The report quoted a Black male doctor who works in Maryland who said while white patients are often seen as wanting the care they deserve, patients of color are “seen as aggressive or belligerent.”
There’s also a generational divide between health care workers and how they view discrimination in the workplace. Those ages 18 to 39 were much more likely than those over 40 to say racism against patients was a major problem or crisis. In addition, nearly 70% of mental health care workers said the same, indicating that a worker’s specialty also plays a role in perceptions.
Solutions, experts say, might include creating systems for workers to autonomously report instances of discrimination and require classes on the topic in schools. In the report, some are also suggesting training staff to spot racism and examine current policies.
One director of medical education from a hospital in California said, “We treat our patients to recognize the signs and symptoms of stroke, but why can’t we pretreat our own internal staff on the signs and symptoms of discrimination?”
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