The Presence 5 for Racial Justice: Promoting Anti-Racism in Clinical Interactions

With racial health inequity exacerbated by the pandemic, Stanford Medicine 25’s Donna Zulman, Abraham Verghese and their Stanford Medicine colleagues evolved the Presence 5 practices to address a longstanding history of racial bias in medicine. The concept, titled The Presence 5 for Racial Justice, adapts the evidence-based strategies to enhance physician presence and foster meaningful connection with patients, while simultaneously promoting antiracism in the clinical setting.

These specific communication strategies, explains Zulman in the 2021 Department of Medicine Annual Report, will help healthcare providers counter “racism that affects their patients’ health and well-being” and “provide a foundation for racially just and equitable care.” Zulman and colleague Megha Shankar presented the approach at the 2021 Stanford Medicine 25 Skills Symposium. Following are highlights from their presentation on employing the anti-racist practices during clinical encounters:

1.     Prepare with intention. Before meeting a patient, familiarize yourself with their history, while keeping an open mind about their perspectives and experiences. Examine your own identity and biases—whether implicit or explicit—and consider their potential influence on caring for the individual. Develop a protocol to recognize and address bias and incorporate this reflection into regular practice.

2.     Listen intently and completely. Studies show that physicians are significantly more likely to have shorter visits, speak faster and dominate the conversation when meeting with Black patients. During interactions, position yourself to receive a patient’s ideas by sitting down, leaning forward and avoiding interruption. Consider broad differential diagnoses for every patient and make treatment recommendations based on efficacy rather than convenience, which can reduce disparities.

3.     Agree on what matters most. Rather than assuming, ask a patient about their care priorities and preferences and then collaborate with him or her to develop a plan focused on those goals. Including the individual in decision-making can build trust and prevent stereotyping.

4.     Connect with your patient’s story. It’s important to acknowledge the social and environmental factors that influence health. If a patient chooses to discuss racial trauma, follow their lead while conveying openness to their beliefs. While conversing, eliminate language such as “noncompliant” or “vulnerable” that reflects preconceptions about minority racial groups. Research shows this improves documentation and understanding of one’s history.

5.     Explore emotional cues. Pay close attention to your patient’s expressions, body language and emotions. It’s helpful to visually or verbally confirm an emotion—and then follow up with an idea to overcome the obstacle. Take particular notes of emotions related to racial trauma and consider how current events may influence mental health or feelings of safety.

We encourage the Stanford Medicine 25 community to answer Zulman’s call for widespread implementation of these practice and continued learning about solutions that ensure equitable care for all patients. Visit the Presence 5 website to learn more.