Promoting Inclusive Care at the Patient Bedside

Creating a clinical environment that is inclusive, welcoming and comfortable for individuals of all backgrounds is an important component of the patient experience.

Why Inclusive Patient Care Matters

Inclusive care—or care that embraces patients of all sexual orientations, abilities, ethnicities and economic levels—is not a new concept. However, recent work that highlights continuing disparities and inequities in healthcare point to a need for greater focus on this approach. For example:

·      A recent Stanford Medicine Scope Medical Blog by Helen Santoro reports that members of the LGBTQ community experience higher occurrences of cancer and lower survival rates than heterosexual patients.

·      According to the Centers for Disease Control and Prevention, adults with disabilities are three times more likely to have heart disease, stroke, diabetes or cancer.

·      Research published by the National Academies of Sciences, Engineering and Medicine indicates African Americans are “30% more likely than whites to die prematurely from heart disease, and African American men are twice as likely as whites to die prematurely from stroke.”

Additionally, this Stanford Department of Medicine Annual Report feature underscores the prevalence of hypertension, diabetes, obesity and cardiovascular disease among Black patients.

In the article, Meharry Medical College student Matthew Burke points out that this disease burden, coupled with a lack of trust for healthcare providers, “is common among the underserved.”

How Physicians Can Help Promote an Inclusive Care Environment

Although physicians alone cannot eliminate healthcare disparities, they are in a unique position to build trust and develop relationships with patients. Cultivating an inclusive environment at the bedside is one of the first steps to effect change. Following are strategies to employ during future patient interactions.

·      Listen intently to the patient’s story and tune into emotional cues. As outlined by the Presence 5 for Racial Justice curriculum, it’s important to give your patient undivided attention, avoid interruptions and use open body language.

·      Be mindful of your words and tone. In an article on helping people with disabilities feel welcome, Psychology Today’s Joshua Wilder recommends avoiding words and tones that belittle or infantilize people. “This mostly occurs when people who genuinely mean no ill intent simply speak without thinking,” he says. “A desire to fill an awkward silence is typically the main culprit. Some people simply don’t know what to say, and fear appearing rude, so they say the first words that come to mind.” The National LGBTQIA+ Health Education Center places similar emphasis on word choice. The organization recommends healthcare providers make an effort to stay up to date with the language preferred by the LGBTQIA+ community.

·      Ask, don’t assume. Be aware of how you phrase questions and avoid any assumptions.  For example, ask patients about their sexual orientation and gender identity, which can guide further conversation and screenings. Or, if you’re struggling to pronounce a patient’s name, ask them how it should be pronounced. When interacting with patients with disabilities, don’t make assumptions about their lifestyle. “Focus on talking to people with disabilities like they have serious careers, families and talents – because they do,” Wilder explains.

·      Remember patient preferences. Make note of patient pronouns and inquire about a preferred name, as it may differ from insurance- or government-issued documents.

·      Provide all patients with routine and inclusive health histories. According to the National LGBTQIA+ Health Education Center, it may help to open the conversation by stating that all patients are asked these questions. This should help normalize the process.

·      Expand your personal education. Improve your personal level of cultural competence by becoming familiar with your local patient community, refining awareness of your own beliefs and participating in trainings on cultural sensitivity.

·      Remember that all patients—regardless of their ethnicity, gender identity, sexual orientation and physical and intellectual abilities—are unique individuals and should be treated as such.

Providing inclusive care requires awareness of the unique circumstances each patient faces, as well as a commitment to personal growth. We hope that these tips provide a jumping-off point for further exploration. We also look forward to engaging in future conversations about this important topic!