People from many walks of life face bias in the U.S. health care system. Research has shown that the majority of health care providers have more positive attitudes toward white people compared to nonwhite people. Other studies have found that women, people who identify as LGBTQ, people from racial and ethnic minorities, and those with certain conditions — such as obesity — receive less accurate diagnoses, fewer treatment options, and worse clinical outcomes.

Clinicians who treat multiple sclerosis (MS) should develop and maintain cultural competency to ensure that all of the people they treat receive the same level of care, according to Alicia Sloan, senior social worker at the U.S. Veterans Administration (VA) Puget Sound Health Care System in Seattle. She has helped the VA design and implement cultural competency programs. The focus of such programs is to equip health care providers with the tools to understand, appreciate, and interact with people from other backgrounds.

Cultural Competency Leads to Better Outcomes

Research has found that improving cultural competency in health care settings can lead to increased patient safety, fewer inefficiencies, reduced care disparities, and lower costs. Sloan presented her approach to improving outcomes among marginalized populations with MS at the Consortium of Multiple Sclerosis Centers (CMSC) Annual Meeting in October.

MS providers typically treat people from diverse ethnic and socioeconomic backgrounds; people with varying sexual preferences and gender identities; individuals with varying physical and mental abilities; and people with a wide range of beliefs, values, and behaviors. All of them should receive effective, quality care, Sloan said.

However, research has found that people living with MS don’t always see eye to eye with their health care providers on addressing their personal quality of life due to poor communication and a lack of understanding, according to one study. A lack of cultural awareness and sensitivity are sometimes to blame for those gaps.

The Negative Impact of Microaggressions

For example, some health care providers can be — or seem — downright condescending or insulting to the people they treat, due to the language they use. When people encounter such microaggressions in any format, their trust, tolerance, and self-esteem can be affected, Sloan told attendees, according to an article on the CMSC website. “Microaggressions include micro-insults — verbal or nonverbal snubs, whether intentional or unintentional — that communicate hostile, derogatory or negative messages,” she noted.

Micro-insults can include insensitive behavior that may be unconscious, like telling jokes rooted in stereotypes. Micro-invalidations, on the other hand, often suggest that discrimination doesn’t exist, she noted.

Sloan has worked with the VA, which is the largest health care system in the U.S., toward reducing health disparities and inequities throughout the program. Through cultural competency programs, health care providers learn how to better understand and communicate with the people they care for.

“In clinical care, cultural humility can serve as a guiding concept for us,” she said, per the CMSC website. “It focuses on empowering patients on their journey of healing, rather than making assumptions about the patient's experience or using an authoritative or ‘fixer’ communication style rather than a guiding and empowering style. We all have the ability to provide culturally competent care.”