Systemic bias: Breaking down barriers and improving our health care processes

Dr Kathleen Ross

“Remember, upon the conduct of each depends the fate of all.”
– Alexander the Great

Over the past several months, the unrest across the globe has pushed us to look deep within ourselves and acknowledge that we all carry certain opinions and prejudices about others that influence our behavior. Unconscious biases are what we think or believe based on color, race, gender, culture, age, physical appearance, and much more. Discrimination is when we act on those biases. No one is immune, because in many ways we define ourselves by our differences, our individual history, and our lived experiences.

Nowhere is bias more apparent than in the historical experiences of our First Nations, Inuit, and Indigenous peoples, alongside other racial minorities. I can trace my ancestry in Canada to White settlers who came north with the Loyalists in the War of 1812. My relatives were involved in homesteading, farming, fishing, logging, providing medical care, and engineering our cities across Canada. This is a very brief parallel history compared to those who inhabited the land for centuries before us. While there are many examples of my family’s shared work on food security, watershed protection, fisheries protection, and respectful cultural engagements, we were far from truly integrated. I acknowledge this disparity—and my own privilege—up front, as it colors my own perspectives and biases.

When reports of systemic racism were first brought to light this year regarding the allegations of discriminatory games played in some emergency rooms in BC, the majority of us recoiled in shock, disbelief, and dismay. Many could not believe this practice existed in today’s world. My response was clear: there is no place for racism in our communities, profession, or health care system. We can do better, and we need to be better for our patients. Basic respect and dignity should be a given, and should not have to be earned by anyone when seeking health care.

We are fortunate in Canada that our modern medical profession is composed of a diverse group of physicians from a multitude of cultures, each with characteristics and human fallibilities reflective of our population. We are ready to make that tremendous leap forward, openly acknowledging that prejudice and biases exist in our professional culture and training. We are prepared to begin the hard road toward improvement.

Recently, it was my very great pleasure to participate in the BC Physician Integration Program orientation for practice-ready international medical graduates organized by UBC CPD for both specialists and family physicians. The agenda introduced many aspects of health care delivery here in BC, including an introduction to Indigenous health, cultural considerations in communication, and physician health and wellness. While cultural considerations in communicating effectively with patients are not unique to BC, or global health care delivery, emphasizing this important aspect of care at the outset of our medical careers is critical to our success.

Early introduction to resources such as the San’yas Indigenous Cultural Safety Training (www.sanyas.ca) and Trauma-Informed Practice Guide (https://bccewh.bc.ca/wp-content/uploads/2012/05/2013_TIP-Guide.pdf) has the potential to significantly increase awareness of our own internal biases and help us to make conscious decisions to address these biases.

As well, in 2018 Doctors of BC signed the Declaration of Commitment on Cultural Safety and Humility in Health Services (www.doctorsofbc.ca/news/supporting-cultural-safety-first-nations). This declaration is our commitment to partner with the First Nations Health Authority to advance cultural safety and humility, which in turn is based on mutual respect, understanding, and reciprocal accountability during every encounter with our First Nations patients.

It is incumbent on us to understand the traumatic past that Indigenous peoples survived, including residential schools, the sixties scoop, malnutrition studies, and so much more. In many cases, this trauma manifests itself as mistrust of the health care system. These resources should assist in ensuring practitioners can approach patients from a place of appreciative enquiry. It is important to remember the multitudes of experiences that exist in BC, and how these experiences and cultures may affect how health care is accessed and delivered. While I completely respect that breaking down long-held, often unconscious, prejudice is difficult, naming and owning the disconnection is an important step toward respect, inclusion, and optimal patient care. We begin at the beginning.

For our part, Doctors of BC’s Board of Directors accepted all 57 recommendations of the Diversity and Inclusion Barrier Assessment Report (www.doctorsofbc.ca/advocacy-and-policy/advocacy/hot-topics/diversity-and-inclusion) and is currently establishing the best approaches to implement them. But some of this important work has already begun. The Diversity and Inclusion Working Group has been formed; its role is to provide input into implementing recommendations from the Barrier Assessment report and to develop a high-level diversity vision statement for Doctors of BC. As well, unconscious bias training for members of our governance structures, including the Board, statutory and standing committees, the Joint Collaborative Committees, and the Representative Assembly, will take place over the next year. It is part of our commitment to support greater cultural diversity and inclusion, and our efforts to combat racism and support cultural safety within our membership.

Doctors of BC is collaborating with all of our partners, government, and health authorities, including the First Nations Health Authority, to break down barriers and improve our health care processes. This cannot be done in a vacuum. Only together can we reach our full potential. We will collectively strive to find our similarities, that common ground of humanity and respect that links us together. Only then will we be at our best as a society, and as a profession, best equipped to meet the needs of all our patients.
—Kathleen Ross, MD
Doctors of BC President