At a large Health Care Provider, employees and providers came together to discuss patient experience in the context of race, disability, LGBTQIA access, and gender equity. In there, they learn how to be allies to their patients with the aim of providing inclusive care. Some providers came to the conversations knowledgeable about issues while others nervously joined for the first time. The safe space the facilitators created in the inclusion dialogues stimulated provider’s thinking about systemic inequities and inspired many to take action to achieve health equity. Here are their stories.

Lesson Learned: challenge assumptions on gender identity to improve patient experience.

Linda, a physician’s assistant, learned the importance of asking about sexual practices even when she felt uncomfortable, and not assuming a person’s sexual preferences based on their outward appearance.

She had always been trained to ask patients upfront if they have sex with men, or women, or both. Over the years, Linda had found it difficult to practice this with every patient.

One day, a young man came in needing treatment for a sore throat. He had already been to four other providers and had no luck resolving the medical problem. As the patient was talking about his sore throat and how he had had it for years, she came to think of other things that can cause sore throat, including sexually transmitted infections.

She admitted that the looks of him on the outside – a burly construction worker, dressed in dusty work clothes – made her feel afraid that he would be offended if she asks him about his sexual practices. However, she had been reminded of the importance of this question while attending the dialogue on LGBTQ equity.

So, Linda took a deep breath and asked, “Do you prefer to have sex with men, with women, or both?” The patient responded: “Well, I have had one same-sex encounter. It was oral sex, and I have been worried since but have not told anyone about it.” Linda was surprised to learn that he had not shared this during his visits to other doctors over so many years.

The patient was relieved to meet a more inclusive health provider and thanked her for not asking in a judgmental way. Linda was able to get a complete history, conduct tests, and get the patient on the road to recovery.

As Linda reflected on this interaction, she said, “this was a good reminder of my own biases and assumptions, and the importance of coming to work with an open and inclusive mind that is accepting of everybody.”

Lessons Learned: Treatment for white skin is not a panacea for black skin.

Drew, a white nurse practitioner, saw an African American patient who came into his office looking for help with her acne. The patient had seen many providers over the years and had struggled with finding the right treatment. Unfortunately, due to the lack of proper treatment, the female patient had a lot of post-acne scarring and hyperpigmentation.

When Drew started to discuss treatments with the patient, he mentioned treatments that were better suited for people of color and provided her with options. The patient was very grateful and remarked that “no one had ever told her that there were different treatments for people of color.”

Drew felt great knowing the patient was properly treated. He credits the DEI inclusion dialogues with helping him be a better nurse practitioner. He also came away from the dialogues inspired to keep learning about these topics in hopes of becoming a more inclusive provider.

Lesson Learned: Become an advocate.

Mary, a nurse practitioner, learned during a dialogue on LGBTQIA care the importance of sharing her pronouns with patients and encouraging them to share theirs. She also learned to avoid assumptions about patients’ gender identity and better develop a trusting relationship with them.

During a visit with an elderly patient, she was determined to practice using pronouns. She said, “Hi, my name is Mary, and my pronouns are she, her, and hers. What’s your name and your pronouns?”

The patient seemed pleasantly surprised, and responded: “My pronouns are she and they”. After this, the patient openly discussed her/they same-sex marriage and said that over her sixty years of life, a doctor had never opened the space during visits for her to share who she was. She was feeling seen for the first time.

Listening to the patient’s feedback, made this encounter very special for Mary. It confirmed the importance of this work, especially in the rural community where she serves. Mary said, “It was very rewarding to be able to help the patient feel included.” From now, on, Mary always shares her pronouns and encourages others to do the same.

Conclusion

The dialogues program has been very successful at shifting provider behavior and improving patient experiences. As a bonus, volunteer facilitators are discovering that fostering these sacred spaces for learning helps counter burnout by enabling employees to better connect with each other.

Note: Names have been changed to protect confidentiality.

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