Black History Month Perspective: "Providing Culturally Humble Care"

Wherever we work in health care, it’s our responsibility to meet each person who comes to us with a perspective that is unclouded by internal bias or prejudice. In recognition of Black History Month, we checked in with Marissa Coleman, PsyD, who is a Staff Psychologist within the Department of Psychological Services. Her role includes providing clinical care, as well as, training focused on Equity, Diversity, and Inclusion.  

Q: You mention history playing a role in how African Americans are treated in the health care environment. Can you elaborate on that?

A: Absolutely! Historical oppression and medical trauma are woven into our country’s history. The effects of these experiences continue to impact how Black communities interact with the medical field.

Q: Such as?

A: The Tuskegee Study of Untreated Syphilis is an infamous example. It was an unethical clinical study conducted between 1932 and 1972 by the US Public Health Service to observe the natural history of untreated syphilis in African American men. After being recruited by the promise of free medical care, 600 men originally were enrolled in the project.  The participants were primarily sharecroppers, and many had never before visited a doctor.  Of the men enrolled in the study, 399 had latent syphilis and 201 didn’t have the disease. The men were told that the study was going to last six months, but it lasted 40 years, and even after the funding ran out, it was continued without informing the men that they wouldn’t be treated. None of them were told they had syphilis and none were treated with penicillin, even after it was proven that the antibiotic could cure them. As a result of the Tuskegee experiment, many African Americans developed a lingering, deep mistrust of public health officials and medical providers.

Another example is Henrietta Lacks, an African American woman whose cancer cells were cultured to become the first immortalized human cell line for medical research in 1951- without her and her family’s consent. 

Notably, these experiences were not that long ago and the mistrust from the Black community is often passed down through generations.

Q: Can you be a little more specific about how that is?

A: Well, quite understandably, when there is systemic harm done to a community there will be a deep sense of mistrust and post-traumatic effects.  I see this surface in my work related to how therapy is underutilized by the Black community.  Research also demonstrates that medical care is also underutilized by Black individuals.  This is not because of non-compliance or disinterest in our own well-being and health.  I believe it is a direct result of historical trauma and a lack of acknowledgement and healing between the Black community and the medical field. 

Q: How can we as health care professionals address this?

A: We have an amazing opportunity to right this ship and facilitate healing—both physically and psychologically.  I believe that the work starts with ourselves.  Once we educate ourselves about the effects of historical trauma and raise our consciousness about our own implicit biases, then we can provide culturally humble care to our patients. This would impact how we perform intake assessments, view differential diagnosis, recommend treatment options, and ultimately build rapport. 

Q: Can you give an example?

A: Yes, the language we use and the questions we ask hold a lot of power.  As providers, we set the tone for how clinical interactions unfold. For example, asking a patient “what barriers are you experiencing with keeping our appointments or taking your medication as prescribed” opens up the door for honest and non-judgmental communication. I try and make a point to ask each of my patients what information they believe is important for me to know about them verses taking the position of an “all knowing” provider. The later just perpetuates the power hierarchy that has caused harm to many communities. Lastly, taking a thorough trauma history and discussing a patient’s past experiences with medical and psychological providers profoundly contextualizes a patient’s presenting problem. 

Q: Have you noticed other providers being open to this dialogue?

A: Yes! That is one of the most encouraging things I have experienced working at this hospital as a Black woman. I do believe we have a lot of work and challenging conversations ahead of us but the desire and energy behind Equity work at UVM Medical Center is growing. I see it with my interactions with other providers.  

I am a member of the Equity, Diversity, and Inclusion Steering Committee and when Dr. Steve Leffler joined us for a meeting it was hopeful to hear him discuss the impact of implicit bias and his investment to diversify our workforce. I feel so fortunate to be in a department, under Dr. Marlene Maron’s leadership, that values culturally humble care and is invested in our multicultural learning and growth. Thank you for providing a platform to continue these crucial conversations!