Abstract
The US Census Bureau projects that, beginning in 2045, non-Hispanic Caucasians will no longer make up most of the US population. 1 With the changing landscape of medicine, we need culturally sensitive health care more than ever. Diagnostic medical sonographers and vascular technologists not only play an integral role in the diagnostic process by acquiring high-quality images but also work intimately with patients to provide a high level of compassionate patient care. Part of this commitment to excellent patient care is cultural awareness. Over the last few years, we witnessed that COVID-19 ravaged racial and ethnic minorities as well as socioeconomically disadvantaged populations, at disproportionately higher rates than non-Hispanic Caucasians and those of higher socioeconomic status. In the wake of the pandemic, the existing deep-rooted historical mistrust of health care institutions among these groups has only further deepened. 2 Now, as the pandemic’s effect is receding from the medical workplace, there is a need to become aware of its lingering effects and provide culturally sensitive health care.
Diversity and Determining Risk Factors for Disease
Cardiovascular disease is more prevalent in the US African American population than in other groups. They are 30% more likely to die from heart disease and 40% more likely to have hypertension. 3 This is even more concerning considering that they are 10% less likely than non-Hispanic Caucasians to have their hypertension under control. 3 One unfortunate consequence of uncontrolled hypertension is kidney damage and subsequent kidney failure, which, according to the National Kidney Foundation, “is the second leading cause of kidney failure in the United States.” 4 There is no cure for kidney failure, necessitating the patient to receive dialysis or a lifesaving kidney transplant. 4 However, those of racial and ethnic minorities are much less likely to receive kidney transplants compared with their Caucasian counterparts. 5 These patients pass through sonography departments all the time, though the systemic barriers they face are not always apparent. It is not immediately obvious that the African American AV fistula patient you scanned last Thursday will be on dialysis far longer than their Caucasian counterpart, as they await a kidney donation. Additionally, it is no coincidence that your third renal sonography patient of the day also comes from a disadvantaged socioeconomic background or is a racial or ethnic minority. The first step in providing culturally sensitive care, to patients in the community, is to first identify and understand the risk factors and challenges they may be facing.
Distrust and Avoidance After the Pandemic
Medical mistreatment of racial and ethnic minority groups in the past has led to distrust of the health care system among these patients. This sentiment spans generations and is still alive and well today. One of the most well-known instances of medical mistreatments in recent history is the “Tuskegee Study of Untreated Syphilis in the Negro Male,” wherein for 40 years beginning in 1932, the US Public Health Service allowed syphilis to run its course untreated in hundreds of poor African American men in Tuskegee Alabama. This was done to understand the progression of the disease until the egregious acts were exposed in 1972. 6 While it can be easy and convenient to attribute medical mistrust of African Americans strictly to historical atrocities, inequalities in today’s hospital systems can still be to blame. Recent studies have revealed that African American mothers have a higher birth-related mortality compared with Caucasian mothers, and African American infants have a higher mortality rate when cared for by Caucasian physicians compared with when they are cared for by African American physicians. 7 In the era of COVID-19, several social determinants of health led to varying rates of vaccine hesitancy among African American, Asian, and Latinx communities. One study theorized that, of the three groups, Asian participants were the least hesitant to receive the vaccine due to xenophobic fears, and African American participants were most hesitant to receive the vaccine due to group-based medical mistrust. 8 The pandemic has reignited these same concerns among these groups and resulted in extrinsic social factors that influence their perception of health care. As they walk through our departments, on the heels of the pandemic, we need to deliver culturally sensitive care to begin rebuilding our broken health care system.
Moving Forward
A recent article exploring institutional distrust among African Americans outlines four recommendations for the best way forward. 2 The first step is acknowledging injustice and reconciliation. While it is one thing to admit to a wrongdoing, it is another to follow through and make amends. For instance, we discussed how uncontrolled hypertension prevalent among the African American community exacerbates a need for kidney transplants, but there is a systemic hurdle to obtaining them due to injustices in the transplant criteria. As of January 2023, some African American kidney transplant candidates who were previously disadvantaged by the old race-inclusive kidney function calculation will have modifications made to their waiting times. In this instance, the Organ Procurement and Transplantation Network not only acknowledged an inequity but also worked to resolve it.
The second recommendation was to engage communities most affected by the pandemic. Disadvantaged and vulnerable communities have been disproportionately impacted by the virus, and there is additional effort needed to support these communities in a way that fits their culture and perception of the health care system. On an individual level in our workplace, this may look like asking more detailed history questions or giving clear and concise explanations of the exam you are performing and why it is important.
The third recommendation is to elevate trusted sources. With the constant flow of information, based on social media, from a plethora of sources (trusted or not), it can be easy for misinformation to spread. Increasing the visibility of trustworthy sources, such as the World Health Organization and the National Institutes of Health, provides a better circulation of factual information. Rotating through several environments as a sonographer, I have seen breast clinics with dozens of informational brochures detailing cancer treatments to breast biopsies. You were hard-pressed to see a patient leave without at least one. In a vascular lab, where I worked, the walls were adorned with posters detailing the progression of plaque buildup. While, on the surface, it does not seem like much, it builds foundational knowledge for the patient from a trusted source.
The last recommendation is to leverage intergenerational communication. Younger African American adults already act as conduits for health information and translation for the older generation. Communication strategies that shield older African Americans from COVID-19 and other health risks are imperative. Engaging the younger community to relay information and strengthen information flow among families is the best way to solidify factual information. Health care systems can do this by spreading awareness with community events and even on social media. Keeping diverse communities informed on health issues can assist in increasing their general health.
Overall, we have a duty to our patients to deliver culturally sensitive care. By understanding the systemic barriers they may face, acknowledging potential hesitancies toward care, and mapping out steps forward, our workplaces can be more readily equipped to provide equitable patient care. A change to providing more inclusive health care starts on an individual level, and it can start with you.
