The Existence of Racial Profiling in Hospitals and its Effects on Patient Care

[This is a paper I wrote in 2015 for an upper level intercultural communications course I took.]

Intro:

The topic of this theory paper is the existence of racial profiling in hospitals and its effects on patient care. The issue of racial profiling in healthcare professions although many may feel that it is far behind us is still an issue that very much exists today and continues to be a struggle for healthcare providers. Now racial profiling from the physicians point of involvement (which is where I will be speaking from and to) can be analyzed using theories and concepts such as: body politics, cultural identity, marginalization, intercultural praxis and positive health communication; all of which I will be going into detail about.

Body politics:

Racial profiling can be based on many things but one of the most prevalent to base this type of categorization of people is the perception of appearance which is heavily affected by body politics. Appearance meaning the way a patient dresses, if they have body art or piercings, or even how their hair or makeup looks. Many things influence how people perceive others, such as racial hierarchy which affects socioeconomic politics which is behind body politics. Let’s start from the beginning with race, the concept of racial differences is something that is quite controversial in many ways, such as biological differences between races, but according to evolutionary biologist Joseph Graves (2005) he stated” The traditional concept of race as a biological concept is a myth.” There is evidence on both sides of this spectrum that in most cases is extreme in opposition. Science in many ways has been the normalizing factor in this debate of racial differences stating that there is no biological basis for the racial differences theory and that it all leads back to historical social constructs. Social constructs exist because many people agree on an idea, such as race. Historically several racial hierarchies have been established; most notably can be seen in colonization of people around the world, slavery, and historic power constructs. In most cases this involves a separation of minorities and majorities the majority being white people with white privilege putting them at the top of the power structure while the minorities such as African Americans, Asian, Mexicans, Native Americans, etc. are left at the bottom. This concept is something that can affect the way you treat a patient or even what is taken into consideration when diagnosing a patient. For example an article written approximately four months ago and briefly mentioned in the New England Journal of Medicine detailing the way a patient was restrained forcefully without causation due to racial profiling mentioned this unseen aspect of racial profiling in hospitals. In the article the mother of the patient stated that her son, a black male, twenty two years old with a medium build, woke up from sedation after surgery and was panicked so he went to sit up and take out his intubation tube and IV and was restrained with unnecessary and excess force due to his appearance (race and body art). The New England journal also mentioned a study done with pharmacy and medical school students to see if the students could identify any racial prejudices they may have through answering a series of medically based scenario questions. The study showed that most students were unaware that they had any prejudices. One student of an ethnic minority was quoted as saying that out of everyone she didn’t think she would have a racial prejudice against people of her own ethnic background; this shows how prevalent racial hierarchies are and how even someone from a minority can share poor views of their own ethnic group. Although physicians are supposed to be scientifically based in their diagnosis and treatment of patients a great deal of the time personal biases are taken into account not only in diagnosis but also in communication and views of a patient. This can affect the way patients feel when communicating with their healthcare providers in a negative way.

Cultural Identity:

Cultural identity not only addresses the way a patients may identify themselves, but also the way a physician identifies his/her self which can change the way they view others. The identity of a physician (both ascribed and avowed) can change their position as well as their framing as they communicate with patients which in-turn affects their treatment of a patient. Avowed identity is the identity that one forms of oneself but your views of yourself don’t escape the influence of the views others hold of you or your ascribed identity. As a physician ascribed identity plays a large role in the way communication occurs between you and the patient. Physicians are normally viewed as being powerful, knowledgeable, but then you have to take into account the ascribed and avowed identities of the individual, this includes the way they identify socioeconomically, ethnically, linguistically, etc. This is a very complicated process that affects the way a physician or any healthcare provider cares for a patient, showing that although in western medicine being scientific and not personally involved is praised and enforced through power structures, it isn’t the only set of glasses that a physician looks through. A blind spot in hospitals today is the fact that in medical ethics having cultural awareness and sensitivity toward patients in required/recommended yet it isn’t mentioned as a requirement for the physician to evaluate him/her self in this way. According to the Journal of Medical Ethics the reason that cultural awareness and sensitivity is important is because "The United States of America demographic profiles illustrate a nation rich in cultural and racial diversity.” Yet in some way the article seems to imply that this doesn’t apply to the diversity of physicians. An example of how this is a large flaw can be seen in the way that anyone communicates with an individual on the street. Now although you may not think that the way you identify affects the way you view others, the way that you culturally identify yourself attributes to your framing of a situation and person which in turn affects the way you communicate with those around you. For example if as a physician you identify as a white, homosexual, male and go in to see a patient that is a straight, black, male; you would not only have to be culturally sensitive to the patient but you would have to evaluate how you identify and the ascribed identities that you may have which will affect the way the patient views you and how you will have to communicate with them from your frame of reference as a physician and a culturally diverse person. All of these things can better the way a physician cares for a patient with more efficiency and clarity.

Marginalization:

Marginalization also plays a large role in the discussion of racial profiling and patient care in the way that marginalization of a specific cultural or ethnic group by our society can affect an individual’s interaction within a setting, such as in a hospital. A physician can affect the perpetuation of marginalization of patients in two ways; they can either stop the hindrance that marginalization can place on a patient by treating them the way that they would treat any other patient or they can perpetuate it and follow the already present social marginalization of the patients cultural or ethnic group. For example a common form of medical marginalization of patients is when a patient without healthcare insurance or who is perceived not to have any due to a high volume of ER visits are marginalized and physicians are encouraged not to invite people “like that” back, because they don’t want their kind clogging up walk in clinics and the ER. An interview on CNN detailing a topic similar to this, said patients with a high volume of walk in visits were most likely part of an ethnic minority, now the reason for this is because due to social constructs if you are in an ethnic minority you are more likely to be of a lower socioeconomic status and take advantage of the ER and walk in clinics more often. This type of marginalization of patients can be detrimental and even fatal in some cases, which is one reason that Dr. Ben Carson now running for US president detailed in an interview 3 years ago at Johns Hopkins that preventative care should be a priority so instead of going along with this type of marginalization the emphasis should be placed on mending patient physician relations and recommending or working on preventative care with this type of patient.

Intercultural Praxis:

Intercultural praxis which is a theory that has been tied into each of the previous topics can also offers a resolution to the problem of racial profiling in hospital settings. The specific aspects of intercultural praxis that can do this include: actions taken to communicate, dialog, and framing. Some flaws in patient physician relationships and there for patient care, stem from these portions of intercultural praxis. A physician can start with taking steps to instigate communication by opening with cultural sensitivity to the patient and the physician him/her self. The second step in this process of removing racial profiling and bettering patient care is dialog; which may be the most important aspect of intercultural praxis between a patient and physician. Dialog has to do with the flow of meaning of words between people in this case a patient and physician. This not only means the meaning of a diagnosis but also the way specific words are perceived negatively or positively by an individual’s culture or if the patient is a high or low context communicator. Lastly we have framing which has been mentioned multiple times framing not only matter when examining the way others may view or listen to the physician but also for the physician to realize their own frame and positionality as a power figure and also a culturally diverse person. Intercultural praxis in medicine is all about bridges, how to make it past barriers which is something that hospitals have tried doing through the use of technology and constructive criticism from outside organizations to better intercultural praxis but all of this starts with the physician and patient relationship. This process is different between each physician and patient which means it can’t be mainstreamed rather it needs to be simply structured and the resources made accessible so that each individual can work on intercultural praxis. One of the reasons I brought up technology as an example is because I found an article that discusses the intercultural praxis process through the use of technology in hospitals, I think that it details the process of intercultural praxis quite well as it mentioned the flow of information that not only goes from physician to patient and vice versa but also between other physicians. In most cases patient care for one patient is handled by multiple physicians which is another reason that cultural diversity and sensitivity of physicians is an important part of patient care. As a society since intercultural praxis is not something that is at the forefront in medicine it is not something that is a powerful social construct for people to follow yet, which is why it has been difficult to propagate it in hospitals.

Positive Health Communication:

According to “Communication in Everyday life: A Survey of Communication” by Steve Duck and David McMahan, in the healthcare field today positive health communication is being implemented for a positive patient physician relationship by using personal cultural narratives as a premise of understanding patients from their cultural perspective. This helps medicine be more effective through the use of the correct patient doctor perspective instead of the incorrect consumer doctor perspective. In positive health communication racial profiling is not tolerated while cultural sensitivity is fostered. This new way of communicating and relaying information between individuals is more analogues to a healthy relationship instead of a strict capitalist perspective which is something that western medicine is built on which is becoming more and more evident even in the selections of medications by physicians and the relationships that hospitals have with one another. Positive health communication is one of the results of the correct use of intercultural praxis in medicine and is a trend that many hope will catch on especially in light of the diversifying society we live in; since patients need to feel comfortable communicating their needs, while physicians need to be able to effectively use that information to treat a patient which can all be made possible through cultural sensitivity.

Conclusion:

In the medical field as it is today racial profiling has a profoundly negative effect on patient care although it may be less evident than it was in previous years and a bit less present it is still a heavy presence that needs to be dealt with. Throughout this paper the analysis of the existence of racial profiling in hospitals and its effects on patient care, has brought us to the conclusion that through the use of intercultural praxis to examine body politics, cultural identity, and marginalization in hospitals. The outcome of correctly using this analysis and putting it into action results in positive health communication, which not only begins the process of diminishing racial profiling and improving patient care but it also opens the door for new and better healthcare practices for the future.

Citations:

A checklist to facilitate cultural awareness and sensitivity. (n.d.). Retrieved December 1, 2015, from http://jme.bmj.com/content/28/3/143.full

Ben Carson: An Extraordinary Life - Conversations from Penn State. (n.d.). Retrieved December 8, 2015, from https://www.youtube.com/watch?v=4-8NRSfk_a8

Brandt, R. (n.d.). MOBILE MEDICINE AS EFFICIENT AND EFFECTIVE INTERCULTURAL HEALTH COMMUNICATION PRAXIS. Retrieved December 8, 2015, from https://connexionsj.files.wordpress.com/2013/05/brandt-rice1.pdf

Duck, S., & McMahan, D. (n.d.). Communication in everyday life: A survey of communication (Second ed.).

Health Care - CNN.com. (n.d.). Retrieved December 8, 2015, from http://www.cnn.com/specials/health-care

Marginalized patients: A challenge for family physicians. (n.d.). Retrieved December 1, 2015, from http://www.researchgate.net/publication/12653647_Marginalized_patients_A_challenge_for_family_physicians

Sorrells, K. (2013). Intercultural communication: Globalization and social justice. Thousand Oaks, Calif.: SAGE.

The Politics of Belonging and Intercultural Health Care. (n.d.). Retrieved December 2, 2015, from http://wjn.sagepub.com/content/25/7/762.short