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Feature: Between the lines

10-10-2016 11:49

How IRs can support diversity in their specialty and patient populationtlGFIjJrQ5u1AnwFb6OB_Twitter_Bird2.png

By Melanie Padgett Powers  Fall 2016

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While talk of the United States one day becoming a majority-minority country dominates the news cycle from time to time, it’s already happening. Today’s Caucasian first graders are already a minority in their age group, according to the U.S. Census Bureau. For the first time in 2014, 50.2 percent of children younger than five were part of a racial or ethnic minority group. And four states—Hawaii, California, New Mexico and Texas—and Washington, D.C., are already majority-minority.

As our country’s diversity continues to grow, what does this mean for the physician workforce, the patient population, interventional radiology and individual practices? 

Although 13 percent of people in the United States are black or African American, they make up only 4 percent of the physician workforce, according to the Association of American Medical Colleges (AAMC). In addition, only 4 percent of doctors are Latino, while 12 percent are Asian and 49 percent are white. Furthermore, IR is among the medical specialties with the least amount of gender or ethnic diversity when compared to gender and ethnic percentages of AAMC-certified medical schools and all ACGME-certified residencies and medical fellowships.

Increasing diversity and inclusiveness in interventional radiology is an SIR imperative and is critical to the future of recruitment, innovation, leadership, professionalism and patient-driven care. 

“I’m not sure we should be focusing as a specialty on working with diverse populations until we look at ourselves in the mirror, meaning I think [SIR] itself has to be more diverse, has to be more inclusive of women and underrepresented minorities,” says Harjit Singh, MD, FSIR, chair of the SIR Diversity and Inclusion Committee. 

The committee is developing initiatives to recruit more minority and female medical students into the specialty. As the specialty itself becomes more diverse, “working with a more diverse population naturally follows,” Dr. Singh says. 

It’s important to have a diverse physician workforce to mirror a diverse patient population, in part, because studies show that patients are more comfortable with doctors who look like them and have similar backgrounds and cultural experiences as them, says Derek L. West, MD, co-chair of the Diversity and Inclusion Committee.

However, that’s not always possible. While the specialty strives to increase its number of women and underrepresented minorities, current IRs and practices can focus on improving their own awareness of diversity, no matter their race or ethnicity. 

Examine your implicit bias

Before you can make changes in how you treat and respond to patients, it’s important to know where you’re starting from. Dr. West recommends examining your own implicit bias, which “refers to the attitudes or stereotypes that affect our understanding, actions and decisions in an unconscious manner,” according to the Kirwan Institute for the Study of Race and Ethnicity at The Ohio State University. Implicit biases can be positive or negative and are activated without a person’s awareness or control. A related term is “microaggressions,” which are subtle, everyday offensive or derogatory statements or actions toward a person in a minority group. Patients can experience microaggressions-based on stereotypes of their minority group—every day in the health care system.

Individuals can test their implicit bias anonymously online through Project Implicit at Harvard University: implicit.harvard.edu/implicit. Different tests focus on race, religion, gender, sexuality, age and more.

Once acknowledged, implicit biases can be corrected and microaggressions prevented. Research has shown that mindfulness meditation reduces implicit bias. Another approach is to teach empathy skills, starting in medical school.

Dr. West explains that while he will never experience a uterine fibroid, empathizing with a female patient’s experience (listening carefully to and acknowledging patients’ questions and experiences, using an active listening technique to ensure that patients understand the instructions given, etc.) can improve communication and the patient’s compliance with medical instructions. He points to another example: Patients with end-stage renal disease are disproportionately black or Hispanic. “One of the things physicians can do is to learn about the population, learn about the cultural differences, learn about the things that affect patients who are underrepresented minorities who are also on dialysis and to empathize with and understand their situation,” he says.

In implicit bias training, Dr. West, who is an African-American male, might examine his beliefs about white female patients. “What is it that I bring to the table when I am interacting with a white female? All of my life experiences that I have when interacting with white females come to the table,” he explains. “Part of implicit bias training is to move that aside, or at least to be aware of and acknowledge your biases.” Then, the unconscious bias becomes conscious and the doctor can work to eliminate it.

“What this allows is a more honest and open approach to your patients and allows you to see things through their eyes. That’s a step in the right direction,” Dr. West continues. “It opens the door to you understanding better what the cultural differences are and how to address them. At least be aware of the cultural differences you bring and examine the ones someone else may bring.”

Dr. Singh adds, “The idea is shifting from ‘what do I have to learn about others?’ to ‘what do I have to learn about myself?’ It’s really about learning how we feel about things and then, once we realize we have a bias, how we can overcome it. It puts the onus on us.”

A shift to cultural humility

The focus on cultural competency of the past few decades is starting to take a backseat to the concepts of implicit bias, microaggressions and “cultural humility,” Dr. Singh says. Cultural competency is the ability to interact with people from any culture.

“There’s no way you can teach one person about 200 cultures and about their dietary needs, their views on death—the things you’re going to see in a hospital. It’s impossible,” Dr. Singh says. “We shifted to this idea of cultural humility that you approach your patients, and even your colleagues and people you work with every day, with this idea that you may not know about them, but if you come to them in an open fashion and you’re willing to learn about them, that it would move you forward as a person.”

Dr. Singh points to a medical practice that aimed to better understand the needs of patients who were disabled. Instead of only offering handicapped parking or an accessible entrance, the practice posted a sign at the registration desk that asked, “How can we enable your visit today?”

To develop a more diverse specialty and one that cultivates cultural humility, IRs at all levels must get involved, Dr. Singh said. “This has to be an organic process for our society. That means membership participation, buy-in and education,” he says. “If members of the society work with the Diversity and Inclusion Committee and take ownership of some part of the effort, we will succeed. And with that support, we will be a stronger society.”

SIR diversity projects

The Diversity and Inclusion Committee is dedicated to developing critical initiatives to recruit women and underrepresented minorities into the specialty. The two-year-old committee has three subcommittees focusing on these efforts:

  1. Annual Scientific Meeting—This subcommittee is examining ways to expand programming for and about women and underrepresented minorities and about overall diversity topics. The subcommittee is also aiming to increase the diversity of meeting presenters.
  2. Strategic plan—The current five-year strategic plan ends in 2017 and SIR will embark on the development of its next five-year plan. This subcommittee is developing principles of diversity and inclusion that it aims to weave into the strategic plan.
  3. Outreach and pipeline—Now that IR has its own residency program, it is a valuable opportunity to develop programs to reach out directly to medical students about the benefits of becoming an interventional radiologist. Individual IRs can work with clerkship directors to include IR in didactic lectures. They can also connect with medical students by allowing them to observe procedures or get them involved in an IR research project.
Melanie Padgett Powers is a writer/editor in the Washington, D.C., area. She specializes in health writing and has also written for the American Optometric Association, Cleveland Clinic, American College of Ob-Gyns, American Public Health Association and National Hemophilia Foundation.

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