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D
Racial Disparities in Healthcare:
Highlighis from Focus Group Findings
Meredith Grady
Tim Edgar
Wes tat
1650 Research Boulevard
Rockville, Maryland
June 2001
STORIES OF RACIAL DISCRIMINATION
IN HEALTHCARE PRACTICE
Racial discrimination occurs on many levels, in a variety of contexts,
intertwined with income, education level, and other sociodemographic
factors. It can be subtle or disturbingly overt. During the eight focus
groups, participants were asked to talk about their own personal experi-
ences with racism in healthcare. When asked whether discrimination ex-
ists in receiving quality healthcare, one African-American participant
summed up the collective response in this way: "The medical world just
reflects the real world." Throughout the following section, participants'
stories and opinions are presented in their own words, providing evi-
dence of healthcare inequity that participants attributed directly or indi-
rectly to racial or ethnic discrimination, their lack of English-language
proficiency, or both.
Effect of Stereotyping
Participants often felt that the quality of health care services they re-
ceived stemmed from misperceptions and stereotypes, not the reality of
who they are. They said they often feel that health care providers treat
them differently and assume they are less educated, poor, or deserving of
less respect because of their race or culture. A Hispanic physician, speak-
ing of the perceptions of his colleagues, corroborated participants' opin-
ions that health care providers make assumptions about their patients
based on race or ethnicity. "As soon as they look at the patient and see
392
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D: RACIAL DISPARITIES IN HEALTHCARE
393
he's African American or Latino, they assume automatically that he
doesn't have insurance at all."
The following quotes provide examples of encounters that partici-
pants had with healthcare providers who made stereotypical assumptions
about their education or culture.
My name is . . . [a common Hispanic surname] and when they see that name, I
think there is ... some kind of a prejudice of the name.... We're talking about
on the phone, there's a lack of respect. There's a lack of acknowledging the
person and making one feel welcome. All of the courtesies that go with the
profession that they are paid to do are kind of put aside. They think they can get
away with a lot because "Here's another dumb Mexican. " (Hispanic participant)
I've had both positive and negative experiences. I know the negative one was
based on race. It was [with] a previous primary care physician when I discov-
ered I had diabetes. He said, "I need to write this prescriptionfor these pills, but
you'll never take them and you'll come back and tell me you're still eating pig's
feet and everything.... Then why do I still need to write this prescription."
And I'm like, "I don't eat pig's feet." (African-American participant)
My son broke my glasses so I needed to go get a prescription so I could go buy a
pair of glasses. I get there and the optometrist was talking to me as if I was like
10 years old. As we were talking, they were saying, "What do you do," and as
soon as they found out what I did [professionally], the whole attitude of this
person changed towards me. I don't know if they come in there thinking, "Oh
this poor Indian does not have a clue." I definitely felt like I was being treated
d i ff e r e n t l y . ~ N a t i v e - A m e r i c a n p a r t i c i p a n t ~
One participant spoke about a relative who did not want to take her
husband's name after marriage for fear of being negatively stereotyped.
My granddaughter, she's a doctor herself. She graduated in Mexico and then
she came here. She [studied here] so she could become a doctor here. She married
a Mexican guy named [a common Hispanic surname]. You know what she did ?
She took off [a common Hispanic surname] and kept [another surname], her
father's name. (Hispanic participant)
Language Barriers
Many participants in the Chinese- and Spanish-speaking focus groups
voiced concern about being treated unfairly because of their lack of
English-language proficiency. As a result, they perceived that healthcare
providers treat them differently and were concerned that they receive
lower quality care.
If you speak English well, then an American doctor, they will treat you better. If
you speak Chinese and your English is not that good, they would also kind of
look down on you. They would [be] kind of prejudiced. (Chinese participant)
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UNEQUAL TREATMENT
When they see he can't explain himself, they look at him as if [they are] belittling
him. They treat him with a lot of inferiority. . . the doctor, nurses, receptionists.
You can tell when the person is not liked by the doctors or the staff. I have seen
a lot of discrimination in that manner. (Hispanic participant)
I have a desire to improve my English so I can go to an American doctor and get
better treatment. (Chinese participant)
Healthcare providers were also concerned about not being able to
communicate adequately with their patients because of a language bar-
rier. One African-American nurse spoke of "seeing the fear in their eyes"
and knowing how upset and frustrated patients were in trying to commu-
nicate what was wrong with them. A Hispanic nurse acknowledged the
language problem, stating that for "new immigrants that do not speak the
language properly . . . it is the biggest obstacle they encounter."
Non-English-speaking participants, especially those in the Hispanic
group, recounted many examples of personal situations in hospitals and
other settings where they were forced to deal with serious health condi-
tions without the benefit of interpreters or patient healthcare staff willing
to assist them. They said they encountered healthcare staff who ignored
them and avoided trying to help them. Others pointed out instances
where they or their family members have received poor quality healthcare
services and have been treated disrespectfully because they speak little or
no English.
A long time ago my husband was in pain. I had to call an ambulance and they
took him to the hospital. We waited three hours. I would ask the nurse to please
treat him because he could not stand the pain. She would say, "We're going to
call him, we're going to call him." I saw black people being called in, but they
never called him back. I askedfor some medication in the meantime. They never
came out with the medicine.... Well, we left. [My husband] told me it must
have been because we are Hispanic and don't speak English. They would call and
call in black people.... I think if we would've been black or American we would
have been treatedfaster. (Hispanic participant)
[My wife] was treated badly. They wouldn't take care of her. They were chang-
ing her IV and the nurse was very rough in the way she would take the needle
out and put it back in. Ifelt bad. I had to go and tell them with the little English
I speak what was happening. So, they changed the nurse. That's the way it is. All
the situations we are experiencing are because we can't communicate in English.
(Hispanic participant)
My son was in a bed and another boy was with his mother. Of course, they
didn't speak English. The lady didn't know . . . she wanted to know where they
were taking the boy. She askedfor the girl who was interpretingfor her. One of
the nurses said, "I don't know why they send these people here without any-
body to interpretfor them. We'll come back later," and they left . . . but they
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D: RACIAL DISPARITIES IN HEALTHCARE
didn't do anything about finding out where the interpreter was. (Hispanic
participant)
I had eye surgery two or three years ago. The specialist was black. There were
Hispanics out front. I told them I had an appointment with the doctor. They
asked me if I spoke English . . . one said to the other in Spanish, "Go inside with
her." "No, you go." I asked them who was going to go with me because the
doctor was waitingfor me. Once we were inside, he would speak [only to the
interpreter] directly. Ifelt rejected. (Hispanic participant)
Five years ago my son got double pneumonia. The doctors wanted to operate
[on] him.... They called my husband and he said he had to talk with the special-
ist who was treating my son to see what he had to say about the surgery. We
called . . . and the specialist said my son would not be able to resist that type of
surgery. My husband called the hospital and told me not to sign any papers. I
didn't speak English. I didn't know anything. They put the paper infront of me
to sign. They insisted I sign the paper. My husband told me not to sign anything
and [that] he was on his way [to pick us up]. In the end my son didn't have the
surgery and he didn't die like they said he would. Three days after they said he
needed the surgery he got better. The surgery was not necessary. (Hispanic
participant)
I called a pharmacy to see if my daughter's medicine was ready and they put me
on hold. They put the phone down and said, "She's a Spanish speaker," and they
put me on hold. She left me waiting a long time until I hung up. (Hispanic
participant)
The Role of Economics
395
Oftentimes, participants noted, a person's perceived or actual socio-
economic status can be an obstacle to obtaining quality healthcare ser-
vices. Participants were concerned that they may receive a lower stan-
dard of care because healthcare providers make assumptions about the
type of treatment or medication that they can afford because they are ra-
cial or ethnic minorities.
I know there have been a couple of times the doctor wanted to prescribe a
certain medication but because of how much it was, he prescribed some-
thing else. Not what was best, but what I could afford. (African-American
participant)
Often times, the system gets the concept of black people off the 6 o'clock news,
and they treat us all the same way. Here's a guy coming in here with no insur-
ance. He's low breed. (African-American participant)
A lot of black people don't have money so Iguess you would say that it's hard [to
get quality healthcare.] A lot of black people don't have any insurance. (African-
American participant)
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UNEQUAL TREATMENT
Lack of Respect
Many participants unequivocally believed that the lack of respect
healthcare providers have for them leads to lower quality healthcare ser-
vices than persons of other ethnicities, especially whites, receive. They
spoke of instances where the office staff would not "look them in the eye"
when they spoke to them or greeted other patients with a more pleasant
attitude. Others felt a lack of respect when they were rushed during ap-
pointments and sensed that providers or their staff did not want to take
the time to help them, answer their questions, or explain medical proce-
dures to them.
.
They wouldn't accept the appointment over the phone; they just put me on hold.
I went in there and she looked at me and I told her I'd been calling trying to make
an appointment. She said, "Well, you see this stack of paper, you think you're
the only one? " She either thought I was Mexican or she recognized I was Indian,
but she would not make that appointment. She just got smart with me and all.
I told my husband about it. He's big and white. She got to him just like that. No
problem. She got the appointment and got him through. She wouldn't do itfor
me. (Native-American participant)
If elt that because of my race that I wasn't serviced as well as a Caucasian person
was. The attitude that you would get. Information wasn't given to me as it
would have [been given to] a Caucasian. The attitude made mefeel like I was less
important. I could come to the desk and they would be real nonchalant and
someone of Caucasian color would come behind me and they'd be like, "Hi, how
was your day?" (African-American participant)
I don't have a problem with taking more time to be able to understand each other,
but they get really annoyed when you don't understand them. Basically, they
get really annoyed if you talk too much because they know they don't under-
stand your language. When Igo to the doctor Iask a lot of questions, so they can
get really aggravated with me. I don't know if they would do the same thing to
a white person. (African-American participant)
Others felt they must wait for long periods of time before receiving
medications and other medical assistance, while whites are cared for first.
I would call [for the nurse] when I was feeling pretty bad. They wouldn't come
until Ifinally had to yell, "Help me, I'm in pain! I need something to calm the
pain!" They had to call someone and she gave it to me. There were American
[patients] there. They would even close the curtains for them. (Hispanic par-
ticipant)
If your bell was on and the Caucasian lady, she doesn't even have to have her bell
on. She was being attended to because they knew they better . . . do a certain
quality [of service]. Whereas the same quality should have been given to the
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D: RACIAL DISPARITIES IN HEALTHCARE
black people, but their bell would be on and they still would have to wait.
(African-American participant)
397
Improper Diagnosis or Treatment
More troubling are instances that participants mentioned where the
quality of medical treatment was compromised by discriminatory atti-
tudes or practices that participants believed led to either misdiagnosis or
improper treatment.
When I was growing up, my parents didn't have health insurance. We would go
to the Indian Health Service. You'd go there to the clinic and I think sometimes
you wonder about the quality of the medical personnel that was examining you.
My younger sister had appendicitis. It burst, and they told her she had a stom-
achflu. I don't know how they were hiring the medical personnel at that time.
It's changed now, but back then I don't think we had some of the best medical
officers or nurses. (Native-American participant)
Being in a group practice seeing predominantly African-American patients, I
have patients who have seen mainly white physicians in the past. When they
come in to visit with us and speak with us, something as simple as [asking them
to] sit up on a table and they got a question. "What are you going to do?" "I'm
going to examine you." "Oh, my other doctor never did that." (African-
American physician)
Of course, in psychiatry we see this [discrimination]. One area we see is in
terms of diagnosis. Patients are inappropriately diagnosed and medications
prescribedfor the patients. We see errors in that. Minority patients will often
be diagnosed inappropriately as being schizophrenic. (African-American
physician)
When I ask [my Hispanic patients] if the other doctor ever examines you, they
say, "No, they give me a prescription." It's amazing. A lot of times these
patients have these problems that are missed by the other doctors. (Hispanic
physician)
In some instances, participants noted, racial and ethnic minority pa-
tients have difficulties gaining access to the specialists they need. One
physician noted that specialists mistreat racial and ethnic minority pa-
tients to avoid having to provide treatment for them.
I'm in private practice and we refer a lot. We kind of know what specialists to
avoid because we hear the patients coming back and telling about what type of
treatment they're gettingfrom these specialists. A lot of the specialists in these
institutions act like they don't want to see the minority patient at all. When the
minority patient ends up there maybe because they're on [a particular] plan...
they are mistreated. (African-American physician)
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UNEQUAL TREATMENT
In contrast to situations described by participants in which healthcare
providers sought to limit their access to healthcare services, two female
participants described being pressured to have surgical procedures that,
in retrospect, were deemed unnecessary by other doctors.
The first thing they wanted to do was a hysterectomy. I was 36 years old and
they never really examined me. I was just telling them the symptoms and it
scared me and I left.... I guess they were trying to stop the population birth,
whatever, because [the hospital] back then wasfor people who didn't have insur-
ance. (African-American participant)
My Ob-Gyn is Caucasian. I havefibroid tumors and the doctor I've been going
to, he's been my Ob-Gynfor 14 years andfor the last 2 years he told me I have
to have this hysterectomy. I had a girlfriend at the office recommend me to a
female African-American physician.... A week later she called me at home and
said to me, "There's nothing wrong with you. Thefibroid is there but if it's not
bothering you, if it's not broke, don'tfix it. You don't need to have a hysterec-
tomy." (African-American participant)
To overcome discriminatory attitudes from healthcare providers, one
participant suggested that it is necessary for minorities to be "strong" and
not "humble in your voice and tone" to have a better chance at getting the
care they wanted.
I believe that African Americans do get a lower quality of care. I think if you're
educated, if somebody's not treating you right then you kind of push past some
of the stuff, butfor somebody that doesn't have a goodieeling about themselves,
whether it's because of race or literacy, that makes it very hardfor them to get the
care that they need. (African-American nurse)
CHALLENGE OF IDENTIFYING RACIAL AND
ETHNIC DISCRIMINATION
Some participants found it difficult to identify obvious examples of
discrimination they encountered in their healthcare experiences, although
they were certain that discrimination exists in healthcare settings. As one
African American participant aptly described, "It's hard to identify dis-
crimination because they don't show it. They'll be sweet and smooth, all
the way through it." Participants mentioned experiencing discrimination
in many situations, but because of the subtleties often inherent in dis-
crimination, it was challenging to identify overt examples. They often
said, "You just know," or "You can feel it" when describing incidences of
discrimination.
Overall, participants felt that racial discrimination could not easily be
separated from other forms of discrimination. The quotes that appear in
the following section illustrate participants' concerns about not receiving
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D: RACIAL DISPARITIES IN HEALTHCARE
399
appropriate healthcare services, but they also show that the link between
one's race or ethnicity and poor treatment can be very complex. While the
underlying issues (e.g., economics, improper diagnosis) mentioned here
parallel those discussed in an earlier section, the claims made in the fol-
lowing quotes only suggest that a lower quality of healthcare stems from
racial or ethnic discrimination. The evidence for this causal relationship
tends to be circumstantial.
Patients' Appearance
Some participants hinted that attention to appearance, (e.g., being
well-dressed) might counteract discriminatory tendencies. One Hispanic
participant said he felt it was important to "be presentable," otherwise the
healthcare staff would likely make him wait for hours before helping him.
Another said:
I've noticed that, outward appearance has a lot to do with the rapport that you
have with your provider. They talk to you a little different, they treat you a bit
differently. You can walk in, you're all battered and crummy looking, and their
whole personality changes. You walk in looking half-way decent, and they're
very pleasant, and they react and act completely different. (African-American
participant)
Patients' Economic/Insurance Status
Some participants provided examples of how they or their family
members received poor healthcare services because of their lack of insur-
ance or perceived inability to pay for these services. They believed that
they were being treated differently by the healthcare system, although
they did not make a direct link to race or ethnicity.
I went back [to IHS] after Ifound out everything that needed to be done. I went
back to the clinic and chewed out the doctor. Then she said, "Wait a minute.
Wait a minute. Do you realize how much it's going to cost you? It's like buying
a new car. " I said "I don't care at this point. It's my life. I don't care how much
money I have to pay out of my pocket." Then she says, "Wait a minute. Let's
send you to a specialist." I said, "Why didn't you tell me this to begin with?
Now that I'm making my move, now you're telling me, OK, now you can do
this and thatfor me?" I said, "No thank you. This is it." (Native-American
participant)
My niece went to this hospital and they wouldn't wait on her because she
didn't have insurance. They told her she would have to go to the county hos-
pital. So I had to take her to the county hospital. She was bleeding all the way.
It was just terrible, because she didn't have insurance. (African-American
participant)
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UNEQUAL TREATMENT
It's almost like "Oh well, this person doesn't have insurance. Let's just give
them the IHS treatment." (Native-American participant)
I have a son and he's considered disabled. He had MediCal before. I got it before
I got insurance through my job, and I had to wait 100 days before I got the
insurance through my job. So I noticed there's a longer waiting period. . . other
people are coming in after me and have later appointments, but they have private
insurance, so they're seen before me and my son. And it wasn't just the waiting
period; the treatment was different. Now that I have private insurance, as soon
as I get there, [they see me]. (Hispanic participant)
An Ob/Gyn who had a large Medicaid population, not just black and Hispanic,
but a large Medicaid population . . . they told the doctor they wanted him to have
more deliveries at other hospitals. [He refused.] The hospital then, at that point,
decided they would stop taking all Medicaid period because this doctor would
not leave. For an entire year this hospital wouldn't pay Medicaid just so this
doctor wouldn't deliver there anymore. (African-American physician)
Healthcare Setting
Native Americans, because of their unique access to healthcare through
the Indian Health Service (IHS), spoke often about the poor quality of care
at the IHS clinics. More than participants in the other groups, they defined
their ability to get quality healthcare services by the setting in which they
received care and not by their race. They did not blame poor healthcare on
individual providers as much as they did on the IHS system.
If you go into IHS for a problem, they don't investigate your problem to the
extent that a private place does. [Private offices] go through everything like an
ultrasound, blood work, the whole nine yards, and they pinpoint the problem.
IHS, they give you a temporary solution or shot and it comes back up a month
later. (Native-American participant)
I think the way that race plays into it is because we all go to the Indian Health
Service because we're Indian. That's where we start out with our healthcare.
(Native-American participant)
I've had experiences where I had no choice but to go to the Indian Health Service.
You go in there, they rush through you. They misdiagnosed several things with
me, and you're just rushed through. I've dealt with accidents, and to get your
accidents paid for and stuff, IHS takes forever to get those reports through. It
took like 2 years, and that's a very long time. I don't know where they get that,
but I don't think that's right. (Native-American participant)
Attitude of Healthcare Providers
Some participants were surprised and disappointed by the uncaring
attitude exhibited by some of their healthcare providers or administrative
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D: RACIAL DISPARITIES IN HEALTHCARE
40
staff. In some cases, they felt staff were unwilling to help them, and infor-
mation about their health was delayed or not provided to them. In other
situations, doctors seemed more interested in insurance payment issues
and less concerned with providing appropriate care for their patients.
The doctor comes in and says, "Why is he on oxygen?" I was recovering from
surgery. He's looking at the chart and he says, "The insurance doesn't cover it.
Take it off. Just like that. I'm right there, and I'm thinking "Wow, that's
pretty harsh if it comesfrom a doctor." That was unfair I thought. (Hispanic
participant)
First of all, they didn't send me back the resultsfor 5-6 months. I can't get an
answer on the phone when I call. I have to call like 10 times and they put me on
hold and say they'll transfer me. They never transfer me. They hang up on me.
(Hispanic participant)
A few participants did not think their physicians took the time neces-
sary to listen to them or examine them properly. They felt that their over-
all health needs were being ignored.
[The doctor] just walks in and has other patients to see, [she asks] "What's
wrong with you now?" and that's it. Sometimes I will go into other things that
I havefelt and it's like, "Oh, just take vitamins. " What if there's something else
wrong? They're not trying to find out what's wrong. Maybe I have cancer or
something. (Hispanic participant)
They just come in, look at the chart, say, "OK, are you taking your medications?
See you in 3 months. " . . . if theyfind the chart. Sometimes they can't evenfind
mine. (Hispanic participant)
Other Stories About Misdiagnosis or Improper Treatment
Some participants spoke of going to the hospital or doctor and receiv-
ing misinformation or improper service from healthcare providers. In
some cases, participants said their healthcare providers misdiagnosed
their condition or were too passive in their treatment approach. A few
participants questioned whether some providers they went to were quali-
fied to make an accurate diagnosis of their health problem. Again, the
concerns expressed in these specific instances were linked to race and
ethnicity by implication only.
At the hospital, they sent me over to a doctor, who was not an [eye] specialist. He
diagnosed me with cataracts and said I needed surgery the next day. Thanks to
a miraclefrom God, I did not end up blind. [Afterwards] eight days went by that
I was blind in that eye.... Jose took me to another doctor. The [second] doctor
told us I needed surgery the next day. It's a miraclefrom God that I can see. The
other doctor left me with silicone. They put the entire amount that comes in the
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UNEQUAL TREATMENT
packet when they should have only put half. Why did the man who wasn't an eye
specialist tell me I had cataracts, when what I had was a detached retina? (His-
panic participant)
My daughter was young and I took her to the hospital. She had stomach pains. . .
I went to this private doctor and hospital and they sent us home with some
medicines.... The next day I sent her to school. The school called me up and
said, "You [have] got to come pick up this child because she can't even walk. " So
I said, "OK, I'm going to County General because they will make sure this
child's taken care of." I'm not going back playing with these people [at the
private office]. I took her to County General. They had her in there for 5 hours
checking everything. Ifound out that she had walking pneumonia. (African-
American participant)
In my country, if they find you have afibroma they remove it. They don't wait
for it to grow. Maybe if they had taken them out this wouldn't have happened to
me. (Hispanic participant)
INSTITUTIONAL DISCRIMINATION IN HEALTHCARE
In discussions with African-American and Hispanic physicians and
nurses, they spoke not only about the discrimination their patients experi-
ence at the provider-patient level, but also cited examples of how health-
care institutions perpetuate discrimination in their policies and methods
of practice. Providers felt institutions mandate policies that have a sig-
nificant negative impact on the provision or access to services for racial
and ethnic minority patients.
It's very difficult to recruit Hispanics [for clinical trials] who cannot under-
stand the consentform. Ifelt there was some resistance [to spending extra time
counseling Spanish-speakers]. [I was told] it was just not really necessary, that
I can just give them a synopsis of what is in that consentform. I said, "Wait a
minute. This is a very important piece of paper. Why should it be different?
You don't give a synopsis to English-speakers." So you can see sometimes the
double standard there. (Hispanic nurse)
They would not take certain doctors from certain ZIP codes, but we found out
what was going on and that subsequently has changed afew years ago. Because
they didn't want [minority] patients, they just excluded peoplefrom certain ZIP
codes,from certain sections of the city. (African-American physician)
Providers also cited examples of discrimination that they have had to
contend with personally during their medical training or professional
career.
There are those that don't get promoted because of their race or whatever. The
reason [may be because] they're not well liked by administration or it may be
just that they don't want that person in that setting because of their race that
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is out there. Racism is alive and well, and those of us who think that it's not are
living in some kind of dream world. (African-American nurse)
The local medical society . . . it's got the good old boy attitude. It's the same old
doctors that have been running it, and they're still running it. The new guys
kind of have trouble getting in. (Hispanic physician)
I heard an Anglo doctor complaining that his daughter is having trouble getting
into medical school. Then another doctor jumps in, another Anglo, "Oh, don't
worry about it. I know the admissions coordinator. . . I'll get her in. I'll give him
a call and she'll be in. " When does a Hispanic or black student have those advan-
tages, the connections? I certainly didn't have any connections, and I still don't
have any connections. I couldn't get my son into medical school if I tried. (His-
panic physician)
INCLUSION OF AND RESPECT FOR CULTURE
IN HEALTHCARE EXPERIENCES
403
While some participants did not feel it was essential that providers
and patients be of the same race or ethnic background, many participants
felt that a cultural match between healthcare providers and patients is
helpful in communicating more easily. One African-American physician
summed up responses saying, "Basically, you're comfortable with what
you're familiar with. That's the bottom line." Participants felt that it is
easier to develop a rapport or discuss treatment options with healthcare
providers of their own race who already understand their language and
cultural idiosyncrasies.
I don't think necessarily you have to be an African American to provide good
care to African Americans, but if you're not you really need to be aware of the
culture and some of the issues in that culture, and really look at how you feel
about dealing with peoplefrom that culture. (African-American nurse)
For me, my doctor is a thin doctor, but she knows that I like Mexicanfood so she
knows it's hard for me to lose weight. She understands the way my parents
brought me up, the culture, the background, so she knows. In other words, we
understand each other because we're both Hispanic. (Hispanic participant)
If someone, the doctorfor example, is of the same ethnicity, Hispanic, he under-
stands the idiosyncrasies more. For example, for women, in our country there
are certain taboos. It is more difficult to talk about private things. So, a doctor of
our same race will understand those things more. (Hispanic participant)
If eel I could relate better to the African American [doctor]. He knows blackfolks
better. If you're talking about high blood pressure, diabetes, sometimes these are
things that traditionally do not happen to whitefolks. To the extent with the ills
that we suffer, I believe he would be better suited for me. (African-American
participant)
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404
UNEQUAL TREATMENT
I think there are just certain aspects of the culture that one may know a little bit
more about by just being part of the culture. For example, with Hispanic pa-
tients, it's more of a touchyfeely especially my relationship with older women.
There's always a lot of hugging or kissing, whereas with the men none of that-
there's only hand shaking. When it comes to my African-American women,
there is some touchyfeely stuff, but, again, there is more distance. I think just
being aware of the cultural attitudes makes it slightly different. (Hispanic
physician)
In instances where healthcare providers or administrative staff are of
a different race or ethnicity than the patients they are treating, partici-
pants expressed a desire for more patience and respect from their provid-
ers. They felt that doctors and nurses who are treating a high proportion
of patients from a particular racial or ethnic group should be familiar with
relevant customs that may impact patients' healthcare decisions.
One thing the elders they're stubborn. You got to have a lot of patience with
them because they think they're all right and they don't want to go to a doctor.
It takes a lot just to get them to go. Have patience and be courteous towards
them and respect them. (Native-American participant)
A lot of Native Americans are shy. I think that would be good for a doctor to
make sure the patient understands the treatment they're going to provide or the
cause of their illness and make sure they understand what's going on. (Native-
American participant)
Our culture is very different. The Americans have a different way of treating
people. We are more affectionate, sweet. We have a lot of time to give, they are
very quick. (Hispanic participant)
I think if[doctors] have a basic knowledge of the culture and are sensitive ofthat,
culture is just the traditional part of healing. There was one doctor at IHS. My
brother injured his leg, went in, had an x-ray.... I remember at the end of the
visit, and this was the only time I heard one of the doctors there say, "If you
want to go visit your medicine man, feel free to do that."(Native-American
participant)
Yeah, I had to have surgery and also my mom. In both cases this is the same
doctor, a specialist, and when he explained about my mom,for example, he even
took me in the room. He showed her and me, he even on a piece of paper showed
how the liver and all this, what they had to do and this and that, and explained
in language that we understood and took the time. It took him maybe a little
more than 20 minutes, and that counts for something in my book you know.
(Hispanic participant)
If they're going to practice in a Native-American setting, they should under-
stand how traditional medicine can lead to healing the patient. (Native-
American participant)
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D: RACIAL DISPARITIES IN HEALTHCARE
Understand what the past healthcare history has been to Native Americans.
Maybe just having an understanding of how Native-American healthcare has
been across the U.S., not just here in the Southwest, but everywhere. I think
that would make [healthcare providers] effective because then they would know
what's happened in the past and not repeat the same mistakes. (Native-American
participant)
CONCLUSION
405
The stories and recollections of participants across the eight focus
groups provide supporting evidence for the concern that racial and ethnic
minorities are less likely to receive appropriate medical services, and that
they experience a lower quality of healthcare than do nonminorities.
While racial and ethnic discrimination is not always easy to recognize or
recall, participants offered many concrete examples of discriminatory situ-
ations they encountered. This research adds to the growing body of lit-
erature examining racial and ethnic disparities in healthcare and provides
evidence of both interpersonal and institutional discrimination. Perhaps,
through continued research and awareness, healthcare delivery will be-
come more respectful and culturally appropriate for racial and ethnic mi-
nority patients in the future.
Representative terms from entire chapter:
healthcare providers
