When therapists face discrimination

Zara Abrams
The Monitor on Psychology - April 2018

Here is an excerpt:

Be aware of your own internalized biases. 

Reflecting on their own social, cultural and political perspectives means practitioners are less likely to be caught off guard by something a client says. “It’s important for psychologists to be aware of what a client’s biases and prejudices are bringing up for them internally, so as not to project that onto the client—it’s important to really understand what’s happening,” says Kathleen Brown, PhD, a licensed clinical psychologist and APA fellow.

For Kelly, the Atlanta-based clinical psychologist, this means she’s careful not to assume that resistant clients are treating her disrespectfully because she’s African American. Sometimes her clients, who are referred for pre-surgical evaluation and treatment, are difficult or even hostile
because their psychological intervention was mandated.

Foster an open dialogue about diversity and identity issues.

“The benefit of having that conversation, even though it can be scary or uncomfortable to bring it up in the room, is that it prevents it from festering or interfering with your ability to provide high-quality care to the client,” says Illinois-based clinical psychologist Robyn Gobin, PhD, who has experienced ageism from patients. She responds to ageist remarks by exploring what specific concerns the client has regarding her age (like Turner, she looks young). If she’s met with criticism, she tries to remain receptive, understanding that the client is vulnerable and any hostility the client expresses reflects concern for his or her own well-being. By being open and frank from the start, she shows her clients the appropriate way to confront their biases in therapy.

Of course, practitioners approach these conversations differently. If a client makes a prejudiced remark about another group, Buckman says labeling the comment as “offensive” shifts the attention from the client onto her. “It doesn’t get to the core of what’s going on with them. In the long run, exploring a way to shift how the client interacts with the ‘other’ is probably more valuable than standing up for a group in the moment.”

The information is here.

It turns out empathy can be taught

By Craig Dowden
Special to Financial Post
Originally published July 7, 2013

There has been increased emphasis on empathy in the field of medicine in recent years. Empathy, it turns out, is directly related to key outcomes of interest to medical observers, including improved patient satisfaction, better patient adherence to proposed treatments, and increased well-being in doctors (including lower burnout). It has also been linked to a reduction in errors by doctors and fewer malpractice claims. As a consequence, the desire to enhance empathy in doctors is not only a noble and laudable goal, but also a valuable one from a bottom-line perspective.

Seeing the profound significance of empathy in medical settings, Dr. Helen Riess, an Associate Clinical Professor of Psychiatry at Harvard Medical School and Director of the Empathy and Relational Science Program at Massachusetts General Hospital, set out to explore whether it was possible to bring about observable improvements in physician empathy. Drawing on Daniel Goleman’s work in the area of emotional intelligence, as well as elements of the neuroscience of empathy, Dr. Riess designed and implemented an empathy training program for physicians.

The entire story is here.

Physicians build less rapport with obese patients

By K.A. Gudzune, M.C. Beach, D.L. Roter, & L.A. Cooper
Obesity (Silver Spring). 2013 Mar 20. doi: 10.1002/oby.20384.

Abstract

Objective: 
Physicians' negative attitudes towards patients with obesity are well documented. Whether or how these beliefs may affect patient-physician communication is unknown. We aimed to describe the relationship between patient BMI and physician communication behaviors (biomedical, psychosocial/lifestyle, and rapport building) during typical outpatient primary care visits.

Design and Methods: 
Using audio-recorded outpatient encounters from 39 urban PCPs and 208 of their patients, we examined the frequency of communication behaviors using the Roter Interaction Analysis System. The independent variable was measured patient BMI and dependent variables were communication behaviors by the PCP within the biomedical, psychosocial/lifestyle, and rapport building domains. We performed a cross-sectional analysis using multilevel Poisson regression models to evaluate the association between BMI and physician communication.

Results: 
PCPs demonstrated less emotional rapport with overweight and obese patients (IRR 0.65, 95%CI 0.48-0.88, p=0.01; IRR 0.69, 95%CI 0.58-0.82, p<0.01, respectively) than for normal weight patients. We found no differences in PCPs' biomedical or psychosocial/lifestyle communication by patient BMI.

Conclusions:
Our findings raise the concern that low levels of emotional rapport in primary care visits with overweight and obese patients may weaken the patient-physician relationship, diminish patients' adherence to recommendations, and decrease the effectiveness of behavior change counseling.

And, click here for a blog post on this article, with the excerpt below:

Are Doctors Nicer to Thinner Patients?

By TARA PARKER-POPE
The New York Times - Well Column
Originally published April 29, 2013

Here is an excerpt:

“When there is increased empathy by the doctor, patients are more likely to report they are satisfied with their care, and they are more likely to adhere to recommendations of physicians,” Dr. Gudzune said. “There is evidence to show that after visits with more empathy, patients have improved clinical outcomes, so patients with diabetes have better blood sugar control or cholesterol is better controlled.”

Dr. David L. Katz, director of the Yale-Griffin University Prevention Research Center, says that overweight patients often complain to him that doctors appear judgmental about their weight, at the expense of other health concerns.

“You come in with a headache, and the doctors say, ‘You really need to lose weight.’ You have a sore throat, and the doctor says, ‘You really need to lose weight,’ ” he said. “These patients feel like the doctor doesn’t help them and they insult them, and so they stop going.”

In dealing with patients who are overweight, Dr. Katz added, doctors often show the same biases and prejudices as the culture at large. The problem may be compounded by the fact that doctors are trained to deal with immediate medical problems that have specific solutions, like a pill to lower blood pressure or emergency treatment for a heart attack. But obesity is a far more complex problem that isn’t easy to solve, and that can be frustrating to doctors.

“When we can’t fix what is broken we tend to behave badly,” he said.