Podiatry Today had a chance to speak with Janet Simon, DPM, and learn more about her lecture at the Midwest Podiatry Conference on bias, cultural diversity and social determinants of health.

Why are bias, cultural diversity and social determinants of health so important to patient care?

Dr. Simon shares that to achieve the success that health care providers strive for, one must understand the profound impact of factors outside of the strictly physiological. Although, she adds, many of these factors are not in the control of health care professionals, some in fact may be, and warrant recognition.

“The identification of our own biases, while seemingly minute in measuring outcome success, on personal levels to our patients do have importance, as does being aware of cultural norms that may differ from our own,” she says. “Focusing on bias, cultural awareness and social determinants of health will not lead to right or wrong answers but instead hopes to generate thoughtful, wide-ranging and interactive discussion that will have greatest impact on those already vulnerable and disadvantaged.”

What do you feel DPMs should know about these concepts and how can they apply them in their clinical practices?

Pointing out that stereotypes are an identified negative factor in health care, she adds that unconscious (or implicit) bias occurs when such stereotypes influence the brain’s automatic processing. Therefore, those stereotypes can impact actions and judgements.

“Unconscious bias is a natural, universal method of cognitive processing,” she says. “Physicians are not exempt from unconscious bias and being personally aware can help to mitigate its negative impact.”

Dr. Simon explains that many non-medical factors can influence medical decisions. This might include patient’s style of dress, their race, ethnicity, gender, insurance status, or the clinical setting (ie “bad neighborhood” versus “good neighborhood”). She goes on to share that evidence shows that who a person is can have just as much influence on a medical conclusion as the symptoms with which that person presents. 

“Physicians who are culturally competent have improved health outcomes, increased respect and mutual understanding from patients, and increased participation from the local community,” explains Dr. Simon, the Executive Director of the New Mexico Podiatric Medical Association. “Additionally, organizations that are culturally competent may have lower costs and fewer care disparities.”

Can you share a few key resources DPMs can use to learn more? 

First, Dr. Simon says the American Podiatric Medical Association (APMA) has resources reviewed by the Public Health Preventative Podiatric Medicine Committee (PHPPMC) as well as continuing medical education at no- or low-cost focused on bias, cultural diversity and social determinants of health.

“The Implicit Association Test (IAT)  (https://implicit.harvard.edu/implicit) measures attitudes and beliefs that people may be unwilling or unable to report,” she adds. “The IAT may be especially interesting if it shows that you have an implicit attitude that you did not know about. The IAT is powerful instrument, which has been used to explore the impact of unconscious bias on behavior.”

Dr. Simon says that other resources are available though Think Cultural Health (www.thinkCulturalHealth.hhs.gov) and the Office of Minority Health (www.MinorityHealth.hhs.gov).