Introduction by Vice Chancellor Steve Goldstein
In this installment of our Bridging the Gap series that focuses on health equity, Dr. Carol Major focuses on an important topic: how healthcare providers can counter inequity to provide Black mothers and their newborns excellent service. Dr. Major highlights that miscommunication and loss of trust between patients and providers contributes to the alarming rates of Black maternal morbidity and mortality.
In discussing how UCI is working to teach students and practicing professionals to recognize and overcome medical racism, Major provides a link to a powerful documentary produced by UCI medical students that shows the struggles Black women experience in the birthing process, Our Story: A conversation between Providers, Medical Trainees and Black Birthing Patients. Dr. Major and I could not be more proud that our students have created this teaching tool.
The UCI Health Affairs mission – Discover. Teach. Heal. – specifies our commitment as a learning health system to improve how we support wellbeing and care for illness each and every day. We investigate maternal and infant health to document, understand and explore how to reduce disparities. We teach our students, staff and faculty to reflect on cultural differences so they do not interfere with quality care or lead to harm. We support mission-based programs dedicated to building a healthcare workforce that reflects the diversity of the communities we serve. And, we foster interprofessional education and practice so students across health fields learn these lessons from one another.
When students stand up to advance our understanding of discrimination they are accepting the challenge to improve the world even as trainees, and they are showing us that the future of healthcare in their hands is bright.
Embracing Inclusion and Empathy to Improve the Black Birthing Experience
By Dr. Carol Major
Caring for patients requires constantly balancing empathy and understanding with clinical expertise; using knowledge of emotions as well as the human body. This is especially true during the birthing experience, one of the most emotionally complex medical procedures many patients will encounter. As medical professionals seek to provide the best possible care during childbirth, facing our own limitations as people can improve outcomes for our patients.
As we have increasingly come to understand, medical professionals’ individual life experiences—including our own cultures, behaviors and unconscious biases—have the potential to materially shape the ways we care for patients, and unfortunately can also contribute significantly to health inequity.
Two of the most important tools available to us in combating these tendencies are awareness of our own shortcomings and empathy for our patients. Empathy is rooted in understanding, but creating understanding is not an easy process. UCI / UCI Health is facing this challenge head-on, with creative approaches that are helping medical professionals recognize, and then hopefully avoid and overcome, gaps in care—with a special focus on meeting the specialized needs of Black obstetric patients and their infants.
Our Story: Student-Led Documentary Brings Awareness to All Providers
The alarming figures from the CDC on Black maternal mortality rates are not new ground, but they showcase the gravity of the stakes we are working to change. A documentary produced by UCI medical students—Our Story: A conversation between Providers, Medical Trainees and Black Birthing Patients—is helping drive important conversations about medical racism and diversity of birthing experiences. Part of a broader module about anti-racism in obstetrics and gynecology, the film highlights the experience of both providers and birth givers, helping to illustrate personal patient experiences — particularly in California, where only about three percent of physicians are Black. The film was created as a tool to help bring awareness and increase understanding for medical professionals and trainees.
The stories in the documentary help illuminate the potential for adverse patient experiences when there is a perceived—or sometimes, alarmingly real—disconnect with the medical professionals caring for them. Their stories are touching, eye-opening, and in the aggregate, paint a picture about the challenges Black birthers and health care providers face.
The documentary also touches on the notion of representation on medical provider teams—which matters in healthcare settings as much as it does in other aspects of life. As [division director for maternal fetal medicine / chief of maternal and fetal medicine] at UC Irvine, I have seen first-hand the value and positive outcomes of having physicians who represent the populations they treat—offering more listening, bringing inherent understanding, leading to more empathy.
Empathy is key to how we treat and serve patients. Cultural expectations about how patients advocate for themselves, ask questions, express pain and discomfort—all can cause misalignment and misunderstanding. And that can destroy the trust between patients and providers, impacting outcomes. In my many years of practice, I have seen that without trust, it’s not possible to have good health care. If your patient can’t trust you, or you can’t trust your patient, there is no foundational basis to the relationship; you have nothing to build on.
The students who conceived and initiated the documentary participate in an initiative I co-direct, LEAD ABC (Leadership in Education to Advance Diversity for African, Black and Caribbean communities), which focuses on training the next generation of medical professionals that want to address the healthcare needs of the African, Black and Caribbean community. We now have a dozen participants, who are mainly members of that community themselves, helping ensure that we are creating more health care workers of color for tomorrow. LEAD ABC incorporates courses on leadership and advocacy, and emphasizes community engagement and involvement—so students are actively engaging and giving to the communities they will eventually serve as medical professionals.
This is the kind of work that UCI scholars do—real work with an immediate, meaningful impact on their communities. Our Story has been shown to medical students, to our OB GYN residents, and others in the Orange County health care community. We are also exploring ideas for sharing it more broadly as a teaching tool for clinicians across the country via organizations that have a concern with healthcare disparities and the need for change, like the Association of Professors in Gynecology and Obstetrics.
If there is one takeaway, I hope it is this: that listening is core to our ability to serve our patients. Synthesizing some of these learnings and perspectives, our “Your Voice Matters” campaign helps train healthcare workers that all patient voices matter. We should be encouraging patients to express their concerns, and we have a responsibility to be responsive to their concerns—and to enter those conversations with empathy and understanding at the core of our patient relationships.
