The Presence for Racial Justice Project Trains Clinicians in Anti-Racism Communication Tools

Donna Zulman, MD, is the principal investigator for the Presence for Racial Justice project

In a time when medicine is dominated by Big Tech – electronic health records, telemedicine, remote monitoring, machine learning, and so on – is it any surprise that the sacred doctor-patient relationship is under duress? Doctor’s visits that were once central to clinical care are now at times perfunctory and mutually unsatisfying. Now add in racial bias, often unconscious but sometimes not, and you’re facing a problem that adversely affects a huge swath of our population.

Two recent news articles point to the fact that Black patients in the U.S. receive inferior medical care compared with White patients. There are undoubtedly multiple reasons for this, but an ongoing project known as Presence for Racial Justice aims to address this challenge by training clinicians in anti-racism communication tools that will help them build trusting relationships with Black and other marginalized patient populations.

Presence, a Stanford center founded by Abraham Verghese, MD, professor of infectious diseases, aims to explore and encourage the art and science of human connection in medicine. One of its early and best-known successes is Stanford Medicine 25, which teaches thorough physical examination skills to trainees and has become a global movement.  In January 2020, Verghese and collaborator Donna Zulman, MD, assistant professor of primary care and population health, published an article in the Journal of the American Medical Association describing five practices to foster connection with patients, the Presence 5. Shortly after, racial health disparities observed during the COVID-19 pandemic spurred the team to adapt the Presence 5 practices to address racism and promote health equity, an effort that developed into Presence for Racial Justice.

Meet the Researchers

Central to this project are four young researchers, three Graham Ladensohn-Presence 5 Summer Fellows and one post-doctoral fellow, who spent much of the summer of 2020 working with the Presence for Racial Justice team to establish the foundation for the project. Despite significant limitations imposed by COVID-19 (they have never met in person, for example), the group made significant progress, developing research partnerships with four clinics serving predominantly Black patients, conducting interviews with patients and discussion groups with clinicians (all of which have been virtual, adding challenges and opportunities to developing these partnerships), and synthesizing findings for medical education purposes.

Joy Cox, PhD, is a recent doctoral graduate of Rutgers University who studied Organizational Communication. With extra time on her hands last summer, she responded to an opportunity to become a fellow in a program geared toward anti-Black racism in medicine, a topic of interest as her research focuses on identity within the context of race, body size, health, and the complexity of intersectionality.

Cox’s main role in the project, she says, “was to lend my expertise as someone familiar with racial disparities in healthcare and society writ large, along with the knowledge of design and methodological approaches to qualitative research." In interviews with non-medical professionals about racial bias in the workplace, she says, "this project was so full of rich data that really helped to draw out the nuances on the topic of racial bias in the workplace among Black and non-Black participants. The data of people's experiences was so enlightening and at times also hard to read. I really see this project adding to the discussion about race and helping to spur changes Black people rightfully deserve."

Joy Cox, PhD

Kelsey Henderson

Megha Shankar, MD

Mauranda Upchurch, MS

In addition to working on the data already gathered, Cox and her colleagues hope to make presentations and set up workshops on racial justice. Ultimately for her, “the hope was to come away with a product of change to implement in medical and nursing schools across the country, thus improving quality of care.”

Mauranda Upchurch, MS, received her master’s degree from the School of Medicine’s Community Health and Prevention Research Program in 2020, one year after graduating from Stanford with a bachelor’s degree in Human Biology and Health Policy. With several months to go before beginning a job with a management consulting company doing health care strategy, she also joined Presence for Racial Justice.

Her role, she said, was “building out our capacity for a Community Advisory Board of both patients and clinicians. This involved having hard conversations about what we’re doing wrong and right.”

Upchurch feels that the way clinicians think and express themselves is not like the way patients do, and clinicians may not even be aware of it. “We are trying to get to where clinicians can have deeper conversations with their patients by using language that the patients understand.”

After interviewing numerous patients, Upchurch is now going through those interviews to ensure that the answers are able to be extracted and analyzed.

The third summer fellow, Kelsey Henderson, is a second-year student at Meharry Medical College whose focus on this medical education project seems fitting. The aim as she sees it is “to teach the things that one can do to become an anti-racist physician by implementing an anti-Black racism strategy in medical school curricula.”

Henderson feels it is critical for medical students and clinicians to be aware of more than just diagnoses and therapies when they work with Black patients: “They need to think about how their privilege impacts how they look at a patient,” as well as how a patient might deal with the physician’s recommendations once a clinic visit ends.

The Presence for Racial Justice project allowed Henderson an opportunity to contribute to the Black Lives Matter Movement in a way that fit seamlessly into her medical school studies. Through this project, she feels that “I did something that people before me have been screaming about, trying to bring attention to the fact that Black patients have not been treated equitably in the past.”

Our goal is to identify specific communication strategies and practices that clinicians can use to address racism that affects their patients’ health and well-being.

Another part of the project involved interviewing professionals from outside the field of medicine who work closely with Black communities. The team interviewed individuals representing diverse fields such as ministry, business, social activism, and the arts. Megha Shankar, MD, a postdoctoral research fellow, led these interviews. In order to gain truly useful information, she says, “We had an interview guide that focused on experiences, such as what do people do to build trust with others they work with; what experiences do people have with anti-Black racism specifically; what kind of practices do people do to promote racial justice; what are some anti-racism practices that people currently use.”

Shankar feels that the pandemic was partially responsible for their being able to recruit the three fellows: “It’s really because of COVID-19 that we were able to recruit such a geographically diverse group of fellows to collaborate on this project, and partly through them that we were able to recruit such a strong group of community partners.”

Zulman is the principal investigator for the Stanford Presence for Racial Justice project. While she is pleased by the progress made last summer, she recognizes that they are tackling “a very complicated problem with deep historical roots.” She does not think that this research will offer the sole answer to the problem, but she is hopeful that the interventions generated by this project will make a difference.

“Our goal is to identify specific communication strategies and practices that clinicians can use to address racism that affects their patients’ health and well-being. Whatever we learn will need to be implemented together with structural and systemic interventions.”

For now, she says, “this is a work in progress.”