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.
Race and culture can significantly impact your 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 Crowe south, if someone has, you know, lived experiences where they felt marginalized, where their voices have not been heard, or they feel persecuted, they are going to bring those expectations to the clinical encounter. So, it is important for us, as physicians, to not only see the diseases that someone brings into the office, but that 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 that they can try to address those mistrust issues that may lead to non-adherence down the line.
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.”
