THE LAST WORD
Tips to Help Teen Patients Deal With Discrimination
Even subtle bias can affect our patients, but talking about it can help.
Fam Pract Manag. 2016 Jul-Aug;23(4):44.
Author disclosure: no relevant financial affiliations disclosed.
It was 1997, and I had recently immigrated to the United States from Argentina to complete a fellowship in adolescent medicine and a master's degree in public health. I was seeing a doctor for the first time at my university for a recently developed rash. Exhausted, I just wanted a prescription. The doctor had taken some initial notes and then got called out of the exam room. As I sat there waiting, I noticed my chart lying open on the counter, and one sentence caught my eye: Patient states that she is a "physician."
It took the air out of me. Did this physician doubt my words? Why? I left the exam room that day feeling confused and hurt.
Years later, I came across the Institute of Medicine report Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. It showed that although physicians are supposed to protect, enable, and heal, we are among the perpetrators of bias, discrimination, and stereotyping. I began thinking about how to provide sensitive care by opening up this crucial conversation, starting with some of the most vulnerable patients: adolescent minorities.
Caring for teens often involves positive youth development,1 which includes coaching teens on being able to conquer all the basic developmental tasks by the end of their young adult years. Identity development is one of those crucial tasks, and it turns out that teens belonging to minority communities have an additional task that is quite complex: figuring out what ethnic group they belong to or identify with, and doing this in the context of a family that most likely is at a different point in the process.
When caring for teen patients, I usually initiate a conversation about their identity. I say, “I know that growing up can be rough as you try to figure out who you are on so many levels – culturally, vocationally, politically, sexually, religiously, and so on.” Then, I ask whether they have had any trouble in any of these areas.
At this point, they will often share a c
1. Lerner RM, Almerigi JB, Theokas C, Lerner JV. Positive youth development: a view of the issues. J Early Adolesc. 2005;25(1):10-16.
2. Cunningham G. We all do better when we all do better. Star Tribune. Sept. 22, 2010. http://strib.mn/1Ut0ZG9. Accessed June 1, 2016.
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