screening for impact of racism header
Marcie Hopkins, University of Utah Health
How to Meaningfully Address Race and Identity With Your Patients
Sometimes, just listening really helps. U of U Health patient Andrea Garavito Martinez and family physician Erika Sullivan discuss how physicians can meaningfully address health impacts of racism and identity with their patients.

didn’t choose Dr. Erika Sullivan as my primary care physician; I was randomly assigned to her almost 7 years ago. When I first met her, she sat down and rolled right over next to me where I sat on the exam table. She looked at me and asked, “How are you?” and I knew right then that she was going to be my doctor because she spoke to me without showing me her back. She was really talking to me.  

Over the years, she has shown me compassion, consideration, and most importantly–listening. It’s very important to me that my physician has some sort of understanding of the role of racism in how they interact with others and provide care.  

At every appointment, Dr. Sullivan treats me as a person, not a stereotype based on race or appearance. Other physicians can follow her lead by changing how they interact with patients, particularly patients of color.  

Providing person-first care 

There’s a stereotype that overweight Latina women get diabetes. Frankly, all my life, doctors always bring everything back to my BMI. Every time I see a doctor, especially in a very white state like Utah, all of my symptoms were attributed to my weight. Dr. Sullivan was the first doctor to ask about my mental health instead. 

When I tested as prediabetic, Dr. Sullivan gave me resources for my health. She connected me with a nutrition class and a diabetes group. She didn’t just say that it was my family history or my race or my weight that caused my blood sugar to be high. She focused on giving me what I needed to lower my blood sugar without placing blame. She put my needs first, before any of my “labels.” 

She has let me define myself. Whenever I saw her, she moved her computer screen so I could see what she was typing. She showed me the quick summary section of my chart where she wrote about who I was. Mine said, “Professor at Weber State.” In that section, I was defined in a way that I define myself, not by race or appearance. 

But that section could have said, “Obese Latina woman.” That would have felt totally different to me as a patient. Doctors should be using person-first language to describe people. There’s a big difference between “Obese Latina woman” and “Self-identified Latina with a BMI of 30.” There’s a lot of power in labeling how you see a person and how you treat that person.  

Body language is also important. Because of the history of racism in medicine, many patients of color mistrust physicians. When you are already feeling scared or mistrustful, having a doctor hover over you can be very, very intimidating. 

Instead, doctors can get on a patient’s level and look them in the eye, the way Dr. Sullivan did in my very first appointment with her. That can really make a difference in improving comfort and trust. 

Give patients space to share 

When quarantine first began, I had a telehealth appointment with Dr. Sullivan. George Floyd had just been killed and so many things were happening. Before we did anything else, Dr. Sullivan looked at me and asked, “How are you really? There’s a lot happening politically, so I just want to make sure you are okay.” 

I started crying because no one had asked me that. At the time, I worked with children who look like George Floyd. I’m a person of color and an anti-racist activist. It was a very difficult time. 

Whatever a patient says, it’s okay to not have solutions. Sometimes patients just need you to listen and sit with them, even it makes you uncomfortable. Just listening can really help.  

Be an ally 

Where I work, I am the only person of color. I am the only one who looks like me, and it began to take a toll on my mental health. I developed panic attacks and heart palpitations. I couldn’t sleep at night and felt like I was being followed.  

Dr. Sullivan suggested I see a therapist. When I told her I wanted a woman of color, preferably a Spanish-speaking Latina, she didn’t shut me down or direct me somewhere else. She recognized my need to be heard by someone who shared my experiences and helped me find a woman of color to talk to. She recognized that while she couldn’t understand personally what I was feeling, she could still help me in the way I needed.    

In providing care for me and for other patients, Dr. Sullivan was an ally. One of the first things I noticed about her was a little rainbow pin she wore. She said it was a reference to the care she provided for LGBTQ+ people. Even though I’m not part of that community, something about that small pin moved me. It showed me she was different, that she cared about being an ally to other communities.   

Her welcoming approach helped me feel safe and heard on all topics—from my physical and mental health to how racism is affecting my life. 

These little things, her mannerisms, her pin, the way she spoke to me, let me know that she really was interested in getting to know me, in connecting with me in a way deeper than stereotypes.

The Physician’s Perspective: Erika Sullivan, MD 

While I was raised to think about race and racial injustice from a very young age, I’ve become more aware of my own privilege and my ability to walk through life and not have to see things from another perspective as a white cisgender heteronormative-ish woman. Particularly within the last four years, I have deliberately tried to connect with people. I think if I’ve been struggling, others are struggling too, and the shared feeling is where we can build connection. My intention as a primary care provider is to get to know someone—who they are, their partner, their kids, their frustrations, the things they’re looking forward to. For so many people who do not identify as white, this last year has been particularly tough. 

As a provider, it's important that I don't make assumptions. My work with the LGBTQ+ population has helped me to get better at that. But I don't want to make assumptions about someone's life experience based on how they look. That's just not helpful or informative. There’s no data behind any of those assumptions, it's all stereotypes.  

The best thing that you can do is ask an open-ended question. You have to allow that question to be answered in a way that the patient needs to answer it. They may not want to talk about race right then, but you’ve giving them space to do so it if they want.

I start with a check-in that usually takes just a few minutes because you really don’t know what is going on in people’s lives unless you ask them. In these last 18 months, I ask “How is your pandemic going?” So much has happened over the last year, and we’re not usually talking about it at our doctor’s office. But in primary care, we get to build that feeling of closeness. Some have taken the opportunity to talk about COVID, others choose to talk about other things. I work to create space for people to talk about what’s affecting them. I also assume that just because I’m comfortable discussing racism doesn’t mean that is what the patient needs or wants. 

One of my most-used follow-up questions is “tell me more about that.” I try to give my patients the silence and space to answer. My biggest mistake as a clinician is talking too much, so I work to give people the space to share their story. 

As providers, we really like to offer discrete solutions. But many of the things that people are struggling with don’t have solutions. Sometimes you just have to sit with any discomfort that comes up and allow the person the space to feel seen and be heard. 

Originally published August 2021


Andrea Garavito Martinez

Patient, Assistant Professor, Weber State

Erika Sullivan

Family Physician, University of Utah Health

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