Opinion: Re-establishing trust and improving outcomes in Nephrology

By Dr. O. N. Ray Bignall II

Bignall Headshot_0.jpgThis past week, I had the privilege of attending a panel discussion on health in the African American community hosted by my local church. Black community health professionals shared insightful advice, promoting health-seeking behavior in communities of color. Yet, when it was time for audience questions, the program took an unexpected turn: person after person lined up to share stories of mistreatment and disregard at the hands of medical professionals. It was painful to hear how little my community trusted health professionals like me to be a part of their healing.

As an African American pediatric nephrologist – one of a shrinking population of Black men in medicine – I sit at the intersection of our nation’s struggle to achieve health equity for ethnic minority populations who don’t trust us. This mistrust comes from more than a faint recollection of injustice chronicled in textbooks of American History. It comes from contemporary reports of immigrants afraid to seek medical care out of fear of deportation or dehumanization; and the stories of Black women – like Dr. Shalon Irving and Serena Williams – who experience morbidity and mortality in childbirth, in part due to doctors’ failure to recognize their complaints. These stories mirror the ones shared by attendees at my church’s seminar, and reveal that trust in our profession among people of color is at an all-time low.

Such harrowing tales become new threads in the narrative tapestry of injustice that includes the story of Henrietta Lacks and the less than 50-year-old Tuskegee Syphilis Study, still vivid memories within minority communities. Whether we like it or not, these experiences contribute to a cloud of mistrust of medicine that complicates our ability to provide care to our patients who disproportionately come from those very same communities.

As nephrologists, we are viewed as “guilty by association;” thankfully, we are not powerless to change this perception.

To re-establish trust and improve outcomes, we must carry health equity from “the bedside to the curbside.” From research and discovery, to policy and advocacy, nephrologists must engage directly with community members, stakeholders, and lawmakers. Minority communities need to see nephrologists in their schools, houses of worship, block parties, and community centers. We can increase our involvement in community-based participatory research (CBPR) that engages community members in the design, study, and implementation of evidence-based discovery. Nephrologists should also be taking our message to city halls, state houses, and our nation’s Capital to promote kidney disease research and advocacy for all our patients – especially those with disparate outcomes.

There is no greater partner in the work of health equity, advocacy, and outreach than the American Society of Nephrology (ASN), and ASN’s Policy and Advocacy Committee (PAAC) is one arm through which they diligently work to achieve this goal. It includes promoting workforce diversity, legislation to expand the rights of living organ donors, and advocating for increased funding for kidney disease and device research to offer better therapeutic options to all our patients. This is work the PAAC remains committed to expanding, and work of which every ASN member can be immensely proud!

ASN Member Services assures me that there are no chameleons practicing nephrology: therefore, I’m confident that none of us is able to change our skin tone to reflect all of our patients. I suppose then that it’s a good thing that building trust within communities of color has little to do with that! It simply requires nephrologists committed to developing durable relationships through patient care, community engagement, and outreach. And that’s something we all can do.

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Dr. O. N. Ray Bignall II
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Bignall Headshot_0.jpgThis past week, I had the privilege of attending a panel discussion on health in the African American community hosted by my local church. Black community health professionals shared insightful advice, promoting health-seeking behavior in communities of color. Yet, when it was time for audience questions, the program took an unexpected turn: person after person lined up to share stories of mistreatment and disregard at the hands of medical professionals. It was painful to hear how little my community trusted health professionals like me to be a part of their healing.

As an African American pediatric nephrologist – one of a shrinking population of Black men in medicine – I sit at the intersection of our nation’s struggle to achieve health equity for ethnic minority populations who don’t trust us. This mistrust comes from more than a faint recollection of injustice chronicled in textbooks of American History. It comes from contemporary reports of immigrants afraid to seek medical care out of fear of deportation or dehumanization; and the stories of Black women – like Dr. Shalon Irving and Serena Williams – who experience morbidity and mortality in childbirth, in part due to doctors’ failure to recognize their complaints. These stories mirror the ones shared by attendees at my church’s seminar, and reveal that trust in our profession among people of color is at an all-time low.

Such harrowing tales become new threads in the narrative tapestry of injustice that includes the story of Henrietta Lacks and the less than 50-year-old Tuskegee Syphilis Study, still vivid memories within minority communities. Whether we like it or not, these experiences contribute to a cloud of mistrust of medicine that complicates our ability to provide care to our patients who disproportionately come from those very same communities.

As nephrologists, we are viewed as “guilty by association;” thankfully, we are not powerless to change this perception.

To re-establish trust and improve outcomes, we must carry health equity from “the bedside to the curbside.” From research and discovery, to policy and advocacy, nephrologists must engage directly with community members, stakeholders, and lawmakers. Minority communities need to see nephrologists in their schools, houses of worship, block parties, and community centers. We can increase our involvement in community-based participatory research (CBPR) that engages community members in the design, study, and implementation of evidence-based discovery. Nephrologists should also be taking our message to city halls, state houses, and our nation’s Capital to promote kidney disease research and advocacy for all our patients – especially those with disparate outcomes.

There is no greater partner in the work of health equity, advocacy, and outreach than the American Society of Nephrology (ASN), and ASN’s Policy and Advocacy Committee (PAAC) is one arm through which they diligently work to achieve this goal. It includes promoting workforce diversity, legislation to expand the rights of living organ donors, and advocating for increased funding for kidney disease and device research to offer better therapeutic options to all our patients. This is work the PAAC remains committed to expanding, and work of which every ASN member can be immensely proud!

ASN Member Services assures me that there are no chameleons practicing nephrology: therefore, I’m confident that none of us is able to change our skin tone to reflect all of our patients. I suppose then that it’s a good thing that building trust within communities of color has little to do with that! It simply requires nephrologists committed to developing durable relationships through patient care, community engagement, and outreach. And that’s something we all can do.

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Tuesday, August 28, 2018