How racial microaggressions lead to poor care outcomes [PODCAST]

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“A few weeks ago, a white physical therapy colleague of mine unconsciously committed a racial microaggression. She was interviewing her patient, a middle-aged Black male, about his living environment. She asked him if his daughter was at home with him all day or if she went to work.

He asked her why she would even assume that his daughter did not work. The patient was so upset that a third party intervened to help the therapist finish the assessment. How did this incident impact his care? How did their dismantled communication impair information exchange and shared decision-making? How might this encounter affect his physical therapy outcomes?”

Jerenda Bond is a physical therapist and postgraduate student. She can be reached on Twitter @jerendabond.

She shares her story and discusses her KevinMD article, “The white guys vs. the janitors: How racial microaggressions lead to poor care outcomes.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Jerenda Bond. She is a physical therapist and postgraduate student, and she wrote the KevinMD article “The white guys vs. the janitors: How racial microaggressions lead to poor care outcomes.” Jerenda, welcome to the show.

Jerenda Bond: Thank you for having me. I really appreciate you allowing me to share this story here with so many others. I hope people can learn from it.

Kevin Pho: So we’ll get into that article in a little bit, but first off, can you share your story and journey to where you are today?

Jerenda Bond: Yes. I’m a physical therapist, and I have a doctoral degree in physical therapy. During my physical therapy program, I experienced this horrible racial microaggression, and as opposed to allowing it to define my weaknesses, I decided to use it. That prompted me to go on to enroll in a PhD program, and so the incident that happened is the basis of my research now. So I’m using it to do something positive.

Kevin Pho: All right, so let’s get into that story that you wrote in the article. Can you share a little bit more about that article, for those who didn’t get a chance to read it, and share that story, please?

Jerenda Bond: Yes. In the final year of my physical therapy program, my professors separated the class into two student groups for a competitive learning activity. It was actually a joint mobilization class, and so we were going to go over some terms just for comprehension and retention. The two groups were the white guys and the janitors, and the janitors were all the students of color. It was a really horrible, horrible experience.

The problem is that the students of color ended up not doing as great in the class as they could have, because they felt very intimidated. They felt pushed aside to the margins of the learning environment. So it was a good opportunity, unfortunately, to see how discrimination or microaggressions lead to poor care or poor outcomes.

Kevin Pho: So as this was happening, what happened immediately after? Was there any pushback? Did anyone raise any objections as this was going on?

Jerenda Bond: Absolutely. We took the incident all the way to the provost of the university, and we had several meetings about it. This is a really interesting intersection, because the students, of course, wanted the professor to be terminated immediately. From an academic perspective, the leadership had a different idea. It was such a highly specialized class that terminating the professor meant that the students would not get the education that they needed to finish the course and to graduate. And so they decided to let the faculty member continue on for the purpose of finishing, so that the students could finish.

It’s interesting, because as students, we didn’t think like that. We just wanted him gone. When I look at it now, looking back, I can appreciate the different lenses looking at the situation and why it probably was important for us to finish, because we did get to finish and graduate, and he’s gone now.

Kevin Pho: Was there any reflection on the part of the professor, and was there any follow-up or discussion after this experience?

Jerenda Bond: Well, there was discussion, because we had several meetings about it with the faculty member, with all the students, and with the leadership. In terms of reflection, he maintained his innocence, that it was just a game, and it wasn’t anything that was meant to be taken seriously. So it gave me an opportunity to see how one incident can be looked at from so many different perspectives, and that’s important when we think about all these different incidents that are happening even today.

Kevin Pho: So tell me how that particular incident motivated your research. I understand you have a doctorate in physical therapy. Tell me about some of the research that you’ve been doing that stemmed from this incident.

Jerenda Bond: Right now, I’m doing a research study that’s open. I have open enrollment right now, and I’m recruiting people of color who have experienced racial microaggressions in physical therapy. The incident made me start looking at these experiences. We know that students of color in physical therapy experience these microaggressions in the clinical setting, and it does have an impact on how they perform in the clinic and then, subsequently, how they perform on their boards.

We know that therapists of color have had these incidents in the professional environment. There was a story coming out of Canada about a director of a physical therapy program who was a person of color. She was meeting a leader of the hospital for an important meeting, and so she was waiting in the waiting room. He came out, and she was the only person in the waiting room. He looked at her, and he went back to the receptionist and said, “Where’s the director of the program?” The receptionist looked at him and said, “She’s over there.” And so he saw that therapist, who was the director, and said, “Oh, that’s not my meeting.”

So we know it’s happening in the profession, and what we don’t know is whether or not it’s happening with the patients. That’s where my research comes in, because we know that patients of color do have poor outcomes in physical therapy in general. So I said, “Well, let’s look at that.” And then I’m also looking now at how racial discrimination and race-based implicit biases affect orthopedic-related outcomes as well.

Kevin Pho: So anecdotally, can you share some case studies where patients may be victims of microaggression, whether in physical therapy or in a clinical setting, that you’ve noticed?

Jerenda Bond: Yes. Just about maybe six weeks ago now, I have a colleague, a white physical therapy colleague of mine, and she was conducting an assessment of a patient who was a middle-aged Black man. In interviewing him to find out about his home environment, she asked him if his daughter was home all day or if she went to work. The patient became furious, and he said, “Why would you even think that my daughter doesn’t work?” Her intention was really just to find out about his home environment in order to make safe recommendations for him for discharge, but the impact was just this really painful reminder about poor assumptions.

And so some people may ask, “Well, how should she have asked that question?” The best way to ask the question would have been, “Is anyone home with you, and can you tell me, you know, what that looks like?” So that’s one situation.

We’ve had situations where patients of color are assumed to maybe be drug-seeking when they’re not. We know that there are pharmacies throughout the neighborhoods, especially neighborhoods that are embedded in minority populations, where the pharmacist will only dispense half of the prescription for the patient and say, “I’m just going to give you half. You come back for half.” Well, there are so many problems with that, because what if the patient doesn’t have transportation to get back there in two weeks? And so now, all of a sudden, we have pain management issues superimposed on transportation issues, and now we have compliance issues, because we wonder if they’re even taking their medicine appropriately. So those are two of very many stories that are coming out of this.

Kevin Pho: Now, some people who commit microaggressions may not be aware at the time that they’re doing so. What are some things that we should look out for, we who don’t have the lived experience of the patients? What are some things that we should look out for? What kind of questions should we be asking?

Jerenda Bond: That’s a fabulous question. To start off, I would say I think the best way to get this started is for us to become more comfortable with talking about these uncomfortable things, and just talk to anybody about it. It doesn’t mean that person’s going to give you advice, but the more we talk about it, the more we become comfortable talking about it, and then we’re willing to talk about it with more people, and we’re willing to hear people’s stories. That’s important, because we want to get to a point where we humanize these experiences. Because when we humanize them, then we can empathize with people, and we know that empathy is the path to self-awareness. And self-awareness allows us to say, “Hmm, am I doing this? How do I contribute to this?”

I think the best thing to do, starting off, outside of talking to people, is to realize that the stories you hear are people’s stories. Sometimes it may be difficult to believe them, because they’re not your lived experiences, but we really need to suspend disbelief and take those stories at face value, as they come, and just say, “Wow, how would I have felt if I were in that person’s shoes, and how would I want to be treated?” That’s a really good starting place for us.

Kevin Pho: We’re talking to Jerenda Bond. She is a physical therapist and postgraduate student, and she wrote the KevinMD article “The white guys vs. the janitors: How racial microaggressions lead to poor care outcomes.” Now, in the time between that story that you shared in this article and now, have you noticed any progress when it comes to microaggressions?

Jerenda Bond: I have. I think the best progress is that the landscape is a little more open for the conversation. We’ve had a lot of unrest throughout the entire world over the last two years, especially the last year and a half. A good example was just a couple of weeks ago. I received a phone call, actually, in response to my research flyer, and it came from a gentleman who identifies as a non-Hispanic white gentleman. He told me that he felt very offended by my research flyer, because he was excluded from the study. He said, “This shouldn’t be just for people of color.” And so when he called me, he was quite inflamed, and some of the terminology that he used was “colored people” instead of “people of color,” and he said, “I saw your little flyer.”

He and I dialogued for easily 30 minutes, and the good part of the story is that we were able to go from an inflammatory dialogue to a really nice, safe space of more mutual understanding. I explained to him the purpose of the research, and the fact that he wasn’t so much excluded, but why I was particularly looking at these experiences with people of color. He went from saying “colored people” to “people of color,” and from saying “you’re a research flyer” to “your research brochure.” He ended by asking the question, “Well, why is it that people of color have poorer outcomes?” And he said, “Well, I guess that’s what your research is getting to the bottom of.” He said, “You know what? I wish you all the best with your research. I’m really glad that you’re doing this, and I encourage you to use this phone call and this conversation in your research any way that you can.”

And so it was an example of how the landscape is right for us to really have these discussions and not run away from them, because he could have decided to not pick up the phone and call me, and I could have decided to not continue on with the conversation. But he and I hung in there, and look at this wonderful place that we arrived at.

Kevin Pho: So I could easily imagine that conversation taking another turn. So at that moment, what are some of the things that you did to not have that conversation take a turn for the worse?

Jerenda Bond: That’s a really good question. I worked to help him understand why the research was important, so I talked about some of the data. I said, “Hey, this is what we’re seeing. These are some of the differences that we’re seeing in some of our white colleagues or our white patients and some of our Black colleagues or our Black patients. These are the differences, and this study showed this, and this study showed that.” He was listening in, and he would share his story as we were talking, and so we were just navigating his story and my story and the world’s story, and it worked. We didn’t get loud with one another. We just hung in there.

Kevin Pho: And my final question: What’s your take-home message that you want to leave with the KevinMD audience?

Jerenda Bond: My take-home message is that we should realize that we all can make microaggressions. It doesn’t necessarily have to be racial, because microaggressions come in many different forms: gender, sexual orientation, religious status, disability, or any marginalized status. We all commit them, and many of us have been recipients of them. So we should be patient with ourselves and patient with one another while we figure this out and learn how to navigate it, and have a commitment to just treat each other equally well.

Kevin Pho: Thank you so much for sharing your time and insight, and thanks again for being on the show.

Jerenda Bond: Thank you. Have a good day.

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