Q&A

Racism in health care is 'a real thing,' says Indigenous physician

The president of the Indigenous Physicians Association talks about racism in health care after an Inuvialuit woman said her uncle died from the effects of a stroke after health care staff mistook the signs for drunkenness.

Overt or subtle discrimination 'can have very real consequences,' says Alika Lafontaine

The president of the Indigenous Physicians Association of Canada says racism in health care can have 'very real and sometimes negative' consequences.

Recently, an Inuvialuit woman from Aklavik, N.W.T., said her uncle died from the effects of a stroke after health care staff mistook the signs of the stroke for drunkenness.

Dr. Alika Lafontaine, an anesthesiologist in northern Alberta and the president of the Indigenous Physicians Association of Canada, spoke with Lawrence Nayally of CBC Radio's Trail's End about the racism and discrimination Indigenous people face in Canada's health care system.

Dr. Alika Lafontaine, the president of the Indigenous Physicians Association, says it's up to health care providers to constantly examine their biases. (University of Alberta)

The following interview has been edited and condensed.

Q.  What do we know about how First Nations people are treated in the health care system?

I think one of the things that has become very clear in the past few years through a body of research that is continuing to grow is that racism and discrimination when it comes to Indigenous patients is a real thing and it can have very real, and sometimes negative consequences when it comes to patient care.

Q. What kind of implications does this bias have on patients?

I think what we do know about bias is that it is implicit in the way we care for patients. I don't think a lot of patients appreciate that within 18 seconds of coming to see one of their health care professionals, we've already made a determination on what we think they have. That's been shown in studies that reach back several decades. What we get ourselves into trouble with as health care professionals is when we don't question whether or not that initial diagnosis, that gut feeling, is really what you have. We need to confirm that through physical exam investigations, lab results, and other things.

Q. Is that racism always overt, or can it be more subtle?

I think in speaking with patients, you hear the racism being expressed in a variety of ways. Any time a patient experiences hostility when they access a care environment, that's often how racism is expressed overtly —  the yelling or being told that what they think they have isn't really what they have or accusing the patients of being disruptive.

But there are a lot more subtle things like ignoring patients, slipping the chart to the bottom of the pile, not seeing them for hours on end.

When the niece was advocating on behalf of her uncle, one thing that struck me is that drunkenness can be mistaken for a stroke, it can be mistaken for a heart attack, it can be mistaken for high sugars — all of these things are within a list of differentials that we should investigate whenever a patient presents in a certain way, but we cannot know unless an investigation is carried out.

Q. Do you think that the problems with Aboriginal people and health care system getting better or worse?

I think we're definitely more aware of what's going on. I think that's a byproduct of the way we share information now, including social media. Patients are no longer unable to have a voice.

I think another thing that is happening is that Indigenous patients are realizing that they have rights, and these are rights that can be and are protected under law. I think we need to expand the rights of patients in general, and in particular with Indigenous patients we have to look at ways to enhance their right to receive equitable care.

Q. Do you think one of the solutions is having more Aboriginal doctors?

I think that's definitely a part of it. Indigenous physicians can act as resources for other colleagues who are trying to work through insight into issues of racism, discrimination and bias. Coming from our own communities, we understand what it's like to experience bias, discrimination and racism ourselves, and through the eyes of our family members, and I think that makes us much more effective at fixing this issue.