Fostering trust with Black patients

In this second part of two-part Spotlight on Health podcast series for Black History Month, Ontario doctors discuss how physicians can build relationships and cultivate trust with Black patients, while emphasizing the need for an increase in Black physician and medical school representation to provide equitable health care to Black Ontarians. 

Transcript

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Georgia Balogiannis: In this podcast the Ontario Medical Association looks at current issues of interest in health care. Spotlight on Health gives you all the straight talk. We're Ontario's doctors and your health matters to us. I'm Georgia Balogiannis for the Ontario Medical Association. 

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Balogiannis: February is Black History Month and it is as good a time as any to reflect on Black patients’ issues with health care. In this second part of a two-part series, physicians discuss steps needed to help build trust between Black patients and Ontario’s healthcare system.

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Balogiannis: Dr. Mojola Omoles is a general surgeon and breast surgical oncologist with the Scarborough Health Network, as well as a board member of Black Physicians of Ontario.

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Dr. Mojola Omole: It’s really important to have representation and having a diversity of physicians and not just around typical racial lines but also in terms of socio-economics. We talk often in medicine about the determinants of health. What really informs your health is the surroundings. 

If you do not have an understanding of what your patients go through in terms of trying to stay healthy and trying to access healthcare, there's no way you would know how to program that. Part of having a diversity of physicians within the healthcare force is to inform that. And so, instead of making decisions that have no bearings, that don't necessarily align with the lived experience of patients, this allows patients to actually have representation and a voice in the healthcare system.

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Dr. Omole: It is not the role, nor is it the job of medical students to be educating faculty and to be leading anti-racism training. That happened often after 2020, with the murder of George Floyd, where they called upon the students — who are also processing this — to be the ones who lead about that. Hire people who are experts in it who are also physicians — and there's quite a few of us — to talk to you and to talk to the faculty about ‘what does implicit bias look like’. 

There's not a single one of us, whether racialized or non-racialized, who don't have some sort of implicit bias. It really should be up to the faculty and the department to say “okay what can we do to learn more about how we can do better?” 

I think we need more Black physicians, but at the same time there's no point in having more Black physicians if they're entering into a hostile work environment. We need to overhaul the system. Until we clean house, we're just literally adding more people into a broken-down system.

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Balogiannis: Dr. Kwadwo Kyeremanteng is an ICU and palliative care physician, and the head of critical care at Ottawa Hospital, and hosts the podcast Solving Healthcare.

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Dr. Kwadwo Kyeremanteng: Having other Black physicians have a seat at the table to be able to relate and to advocate for Black patients is such an important tool, and we also need it amongst our leaders. When we have positions of administration or where high-level decisions are being made, it is so important to be able to have people that represent diverse perspectives. 

One of the ways that you’re really seeing medical schools make a difference in terms of ensuring representation is happening is having formalized programs. To have Black physician or medical student application avenues has been a massive driver for increasing enrollment. This is essential because it overcomes some of the systemic barriers that we've seen limit the ability to have representation. 

I truly believe education on diversity, inclusion, equity, at this stage is so important because it's one thing to have a mentorship program but it really is about action. It's really about believing it matters. Having that diversity perspective can only benefit. 

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Dr. Kyeremanteng: We are making strides forward to really support our Black youth and those that are striving to be in medicine, but I still think there's a gap in terms of those that are early in their career or established staff physicians. How do we support each other? You don't see too many formalized programs and I think there's a room for this. 

One of my key messages — what I love to give to our mentees — is “aim high”. Realize that you can get a seat at the table. You can achieve your dreams. And this is a time where we've never had so much advocacy, we've never had so many people in positions similar to mine that are advocating for this. And it’s an exciting time to see people that you wouldn’t normally see in medical school over the years now showing up in the hallways in the hospital. It’s been really encouraging and I really hope that we see more and more people apply.

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Dr. Kyeremanteng: I think about diversity as a superpower if you're an organization. This is allowing you to be more versatile, to have more solutions to needs of your community or your patient populations at a higher level. Representation matters. Having somebody at your table that can voice these concerns and highlight these areas that need improvement can only serve an organization well. 

The other thing is make it a priority and seek answers within the community. Hearing what they have to say — this is so important. For there to be significant change there has to be buy-in, not only from the Black communities or racialized communities, but we really need buy-in from everyone. If it’s not prioritized, it could just be put to a side and we won’t see that true change at a systemic level.

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Balogiannis: Dr. Queenette Asuquo is an emergency medicine physician with the Chatham-Kent health authority and an adjunct professor at the Schulich School of Medicine and Dentistry at Western University.

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Dr. Queenette Asuquo: Having Black doctors in a healthcare system, and also for Black patient, it’s really important considering the populations of Ontarians and the fact that we are a diverse, multicultural society. It goes a long way to make the Black patient more comfortable. It also makes them to see themselves in their healthcare. 

They generally tend to be more trusting if their physicians or their healthcare providers are Black like them. And they tend to feel that they have a good or a better understanding of what is going on with them and generally they would want to open up more. The chances of them complying to their treatment is also higher. And this goes a long way to better their health and minimize complications that could happen if they are being treated by physicians that they don’t trust.

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Dr. Asuquo: In terms of the highschools today, it's important that at the very early stage, while they are trying to figure out what pathway they want to take in life, if they have any interest in medicine or Health Sciences, that they have mentorship. If their mentors are Black like them, or Indigenous like them, they see that this is possible. “I can survive in this system.” 

I feel that it shouldn't just be the Black medical student. Even the non-Black should also have some time spent with Black physicians to help understand better the Black people’s history, how they see things, and how they can help them going forward.

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Balogiannis: Dr. Chiebere Onyebuchi Ogbuneke is a family physician in Sudbury, and the international medical graduate coordinator at Northern Ontario School of Medicine.

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Dr. Chiebere Onyebuchi Ogbuneke: I believe it was two years ago that we saw the largest number of Blacks being admitted in a particular year into a medical school. At the moment I'm noticing there are more residents who are People of Colour. That encourages because it basically means that people are listening, and it is translating into some of the successes. 

We haven't reached the promised land, but I believe that we are making steps in the right direction. And it can only, and should only, be encouraged. Because I believe that there is still room for more improvement. Education, to me, is a key. The enabling environments, which also includes having the professionals that are willing to be mentors. And who best to teach? The person who has had lived experience. 

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Dr. Ogbuneke: The Black physician is, in my opinion, more culturally competent in handling the Black population because not only do they have a shared culture, there is that shared belief. Not only is there a shared belief, in some cases there could be a shared language. And there is something very, very important in the medical field and that is trust. Because when you get the trust, you get the rapport. When you get the rapport, it’s a lot easier for you to communicate and do things or help the patients. 

And how best to get somebody's trust? If you understand the culture of the person; if you understand the language of the person; and if you understand their social belief system. And with your professional knowledge, you are able to tailor it to the needs of that individual. When you are hurt people understand how you feel, what is going on, and how best to be able to help you.

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Balogiannis: Dr. Clover Hemans is a family physician in Halton Region and the chair of governance for the Canadian Medical Protective Association.

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Dr. Clover Hemans: I believe that it’s quite important to have representation at the table where decisions are made but also at the place where you receive your care. And while I'm speaking of the Black individual, and I obviously believe that it's important for Black physicians to be there for Black patients, there is a depth of lived experience that is very difficult to really express and understand literally unless you’ve lived in the shoes. A lot of it literally has to do with being open, to listening to the individual and being respectful of what they're telling me. 

There are so many ways and so much history that goes behind some of the stories that people tell us. Skin colour is not the only thing that's going to affect our hopefully therapeutic relationship, but it might be something that decreases their angst when they come in after having some experience.

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Dr. Hemans: You can't do this alone. You’ve got to have collaboration and the ability to outreach. And what happens at the educational level — they need mandatory exposure to medical history, medicine’s history. And they need to have people outside of medicine tell their stories so you get a real understanding about what it feels like. It has to be mandatory. This needs to be part of medical education. 

What we sometimes will hear in response is, “look it's already such a busy curriculum. What are we going to have to give up in order to include this?” How about you get rid of some of the stuff that maybe doesn't need to be there? That may not be based in fact and, it, replace it. And that could be said for a few things. But I can tell you that getting buy-in actually at the stage where people are learning, I believe that it's quite important. 

So I feel like I'm living in a time where we're galvanized and pushed by some very bright people. That makes for exciting times. And the fact is we're actually gathering younger people to continue the conversation. And hopefully more than the conversation — to push for action.

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Balogiannis: This podcast is brought to you by the Ontario Medical Association and is edited and produced by Jodi Crawford Productions. To learn more about the Ontario Medical Association, please visit oma.org.

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