Another of the town hall co-moderators, Irene Blanco, MD, MS, is a professor in the Department of Medicine, Albert Einstein School of Medicine, New York City, and a co-chair of the ACR’s Diversity, Equity and Inclusion Subcommittee of the Collaborative Initiatives (COIN) Special Committee. Dr. Blanco noted that rheumatologists regularly engage in hard conversations with their patients, especially those who have complicated diseases. “How do we keep those conversations going?” she asked.
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Dr. Manning remarked that it is important to approach all patient questions directly and in a non-patronizing way. For example, for a patient concerned they might be microchipped when getting the vaccine, ask them what they think that could mean. Providers should not pass judgment, but continue to ask patients respectful, but probing, questions. “Particularly when there is not racial or cultural concordance or there are some areas where there isn’t trust, judgment could close the door, and you want to keep the dialogue going.”
Although many of Dr. Manning’s points can inform physician interactions with all patients, she also highlighted considerations that might arise when talking with members of minority groups. Specific concerns and life experiences more common among some groups may influence minority patients’ perceptions of COVID-19 vaccines and their personal willingness to be vaccinated.
“The old pandemic of social injustice is happening at the same time as the new pandemic of COVID-19. So that is impacting vaccine deliberations and what our patients are thinking about,” said Dr. Manning. It’s important to acknowledge the valid, historical reasons an individual from a minority group may think others may not have their best interests in mind. For example, Dr. Manning referenced the infamous Tuskegee study of syphilis patients in Macon, Ala., in which Black men were not adequately informed about their condition, nor offered effective treatment when penicillin became available in 1943.2
Historical inequities may lead some minority patients to have concerns that they may be unfairly and unsafely being used as test subjects, even today, Dr. Blanco noted. It does not help that rheumatology, like many medical specialties, is not very diverse. “I think, like many medical fields, we have a hard time having those difficult conversations around race, especially when providers are not racially concordant with [their] patients,” she said.
One of most important things a provider without racial concordance can do is to sincerely acknowledge the terrible experiences of minority communities in medical and other settings. From there, a real conversation can begin. “I think it goes wrong when people brush over [the topic] because it is so uncomfortable,” Dr. Manning said.