Creating Safe Spaces

Every patient has a story. Asking them to share may improve care. Listen to Monica Peek, MD, MPH, discuss how race, culture and life experiences can create barriers to communication.
To learn more, visit and subscribe to the NIDDK Diabetes Discoveries & Practice blog: www.niddk.nih....
Transcript:
DR. PEEK: Race and culture can significantly impact shared decision-making.
If someone is coming from a racial background, or an ethnic background, or social-cultural experience where sharing information with your provider is frowned upon, where we don’t trust that sharing information about ourselves or our family is something that is safe or doable, if we have differential expectations for care than the average population, then we are not going to be as effective, as patients, in sharing that information. And so, if someone has lived through the Holocaust, if someone has lived through Jim Crow south, if someone has, you know, lived experiences where they felt marginalized, where their voices have not been heard, where they feel persecuted, they’re going to bring those expectations to the clinical encounter.
And so it’s important for us, as physicians, to not only see the diseases that someone brings into the office, but they see the whole person and understand how their lived experience - through history and current events - shapes people’s impressions, not only of the past, but of current healthcare experiences.
If the population has historically been mistrustful of the healthcare institution, that may be something that providers need to be aware of so they can try and address those mistrust issues that may lead to non-adherence down the line.
Many populations have had to develop survival strategies over time in order to survive, and some of those strategies they bring with them to the clinical encounter. So, for some communities, being very deferential to institutions of power is a way that they can survive in the world. That means, as physicians, if we’re asking them to be empowered and to be more vocal, that may feel counter to what their cultural experience has been.
We need to understand as providers the role that we play, the very important role that we play, in encouraging patients and supporting them and providing safe spaces for them to fully engage in shared decision-making. And so, I always, when I first meet someone, go through the steps of stating the obvious. "My job is to do the very best I can to take the very best care of you and your loved ones."

[@Smithl325749]

And only if most doctors see patients as human beings, regardless of race or ethnicity. I am a nurse and honestly, I see medicine as a lucrative business. I work for Veteran Health Affairs and patients complain constantly that their voices are barely audible. I assure them that I am a patient within the private sector and much of the same problems exist whether it’s federal healthcare or private executor care. Upon meeting most doctors I don’t reveal that I am a nurse. I have come to expect the worse and find few exceptions of “good doctors”. I am often rushed through my appointments, talked down to as if I Have no brain capable of understanding my own care, and finally, have just run into doctors who just don’t give a crap anymore. So a safe space would be ideal in an ideal world. I walk into a space I expect to be hostile.