The struggle is real in healthcare.

Gaining access to high quality, equitable health care services in the United States’ system should be easy, right? My “story” is pretty relatable to clinicians and I’ve been working in the healthcare industry for nearly 8 years, so communication between us should be clear, right? 

Not necessarily.

I’m privileged in the sense that, in theory,  I shouldn’t face many barriers when trying to navigate the United States’ complex healthcare system, but I have and I do. This not-so-recent revelation led to the thought, if I struggle, I can’t imagine what the healthcare experience must be like for a patient within a marginalized community! Spoiler alert: it’s an uphill battle for most. 

In this article, the final installment in a series studying the clinician-patient relationship, I will share perceptions from patients of a marginalized group in an effort to emphasize the fact that changing the way clinicians-patients interact is not only an ethical imperative but critical to patient safety. I believe the conversations not happening between clinicians and patients are putting patients at a higher risk for serious medical errors like misdiagnoses, and/or prescribing the wrong treatment plan or prescription drug.

The conversations I’m referencing contain the type of information that relate to a patient’s personal preferences and involve aspects of their health and well-being that do not necessarily involve physical pain and symptoms (e.g. socioeconomic status, education level, home environment, social context, values, beliefs, etc.) – you know, the social determinants of health (SDoH) that seem to be trending in healthcare discussions.

What do patients think?

In a recent study, I surveyed LGBTQ+ patients from both the U.S. and U.K. in an effort to understand:

  • Do patients of a marginalized group believe that, in general, clinicians know how to effectively connect and communicate with them?

Only 10% of patients surveyed agreed that clinicians know how to effectively connect and communicate with them.

  • Do patients of a marginalized group believe that, in general, clinicians have a sufficient amount of knowledge about the issues and realities they face as patient?

Only 6% of patients surveyed agreed that clinicians understand the issues and realities they face as patients.

How can we change the status quo?

Clinicians need greater support

How can we expect clinicians to successfully navigate patient relationships, especially with patients of a marginalized community, when most clinicians have not received the education and training they need to feel empowered to do so?

What’s interesting is, in many cases, patients can sense the clinician’s lack of comfortability! For instance, several patients in my study commented, “I don’t feel like my current practitioner is super comfortable talking about “it” (my sexual orientation and gender identity)” or “I feel like some clinicians are trained on how to communicate but it was probably a very short PowerPoint of “how to’s” and they probably aren’t comfortable”.

As I’ve said throughout the series, the clinician-patient relationship is not intuitive, so we need to stop treating it as such! We need to support clinicians with the resources and tools they need to advance their awareness and knowledge of the unique struggles that patients of marginalized populations face. This increased clinician awareness and knowledge can’t take take place without investment (humans, money and time).

Patients need greater support

“Only when I’m at an LGBTQ+ friendly office I believe that I can communicate openly about myself (e.g. my sexual orientation) without fear of being judged/perceived negatively” was a comment made by a patient in my study. 

There are many ways the healthcare system can improve the way marginalized groups of patients seek and experience care. 

For example, online search tools can help patients find, and in some instances, rate and review providers. Currently, there are a few web-based options that provide a seemingly unbiased, third party review system that allows patients to search on the basis of procedure, condition, speciality and hospital, to name a few, but there is room for improvement. For patients of marginalized communities there are specific dimensions of perceived quality that would be helpful to include in the tool as filtering criteria when searching for a provider. 

Another opportunity to convey support for patients of marginalized communities is to create a welcoming, inclusive environment. For instance, visual cues in a medical office matter in addition to both verbal and non-verbal communications by administrators and clinicians. The devil is in the details and no assumptions should be made.

Ultimately, I subscribe to the philosophy that if we can focus our energies on more effectively navigating interactions with patients of marginalized communities, we can, through that process, better support all patients. 


Agree? Disagree? Tell me what you think!


LinkedIn: and Twitter:@LaurenCHof

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