Mayo Clinic study asks Black and brown youth about racism in health care

INTERVIEWER: The American Academy of Pediatrics says racism can negatively impact the health of children and adolescents. And the doctor's office is one of the places where kids may experience racial bias. A team of Minnesota doctors asked youth of color, ages 11 to 18, about their experience in a recent study.

And then, the researchers talked to their parents. Dr. Emily McTate is a pediatric psychologist with the Mayo Clinic and one of the authors of a study published earlier this year. She joins me now to talk about the project and its findings. Hi, Emily.

EMILY MCTATE: Good afternoon.

INTERVIEWER: You, I should say, Dr. McTate-- it's an Emily show today, so I got excited. You specialize in treating patients with cancer and blood conditions. How does their mental well-being, and racism specifically, affect their treatment?

EMILY MCTATE: I do appreciate the question, and thanks for having me on today. I think we see across the board, both in subspecialty care, as you mentioned, within oncology hematology, and if we zoom out to larger practice in primary care, negative impacts of racism that clearly lead to disparities for our patients and families.

INTERVIEWER: Well, let's talk about this study. What made you and your coauthors decide to conduct this research?

EMILY MCTATE: As you mentioned, the American Academy of Pediatrics is really clear that racism is a core determinant of children's health. It's clear that it negatively impacts their development biologically, psychologically, their behavioral functioning, really across the board. And when we think about places where kids are and opportunities to intervene, primary care offices and schools are usually what we think of.

And so we really wanted to understand, what are the experiences that kids and families are having in primary care offices and schools? And so we have some literature on schools as well. But, our data is consistent with the data across the country, that we'd like to think that we treat every patient and family the same, but we know we don't. And I think the value of the patient and family voice in this is really important.

INTERVIEWER: Yeah. How did you go about recruiting participants?

EMILY MCTATE: So we recruited through a few different ways, but mostly within primary care offices. And we're really thankful-- and I'm glad you brought that up, just because so thankful to the patients and families that offered their time, and not just their time, but, taking the time to sit and talk about challenges and experiences that you've had related to bias has a toll-- re-traumitization and all those things, so we're really thankful and appreciative of the families that participated to provide us this information.

INTERVIEWER: Well, what were some of the stories you heard from the youth participants in this study?

EMILY MCTATE: Sure. To be transparent, we heard things that were really hard to hear and really heartbreaking. We heard patients tell stories about, a few patients say, I never was asked about race or talked about race or racism. And actually, maybe it would have been helpful if an adult would have asked me about my experiences of racism before now.

We heard parents talk about their experiences in health care, where their symptoms are not believed. We heard patients talk about experiences of really clearly being targeted for bullying around their race in schools that weren't responded to or were kind of minimized. So lots of different themes came up. But again, I think are consistent with the broader literature-based-- but that patient and family voice part is really powerful.

INTERVIEWER: Absolutely. What about their parents and guardians? How did their stories add to the overall story?

EMILY MCTATE: Yeah. I think when we think about racism, we think about bias, we know the impact of intergenerational, and we also know that the way that families talk about racism with their kids can be a huge protective factor. And so having parents-- it was kind of interesting, because I think early on, and this is true for caregivers and youth, when we said, what would it be like to be talking about these things, I think initially there was hesitation.

What, we talk about racism with our medical team, you know? But throughout the focus groups, what came out was that really kind of an appreciation for, yeah, this does impact my child's health, impacts my child's development. And so if I have a health care provider who cares about my child's health and development, then this should be part of comprehensive care.

INTERVIEWER: Did any of these stories and findings surprise you?

EMILY MCTATE: I wish I could say they didn't. Having the opportunity and privilege to work with patients and families for some years, and hearing their stories, and having some of my own experiences as a woman of color in health care, they didn't surprise me. They were hard to read and hard to hear, but they were not surprising.

INTERVIEWER: Yeah. The pandemic and the murder of George Floyd led to such a surge of interest in addressing racial disparities in health care. From your perspective, are people in health care still as engaged in this issue as they were?

EMILY MCTATE: I think that, broadly, across the country, not just in health care, but across the board, there's been a decrease in momentum around efforts. Now, I like to think that that decrease in momentum is a decrease in the visual or maybe cosmetic victories. And what's actually happening now is there's work happening behind the scenes to really dismantle some of the structures that are in place that reinforce racism. I get really excited when I hear things about, at least in the world of healthcare, training that's happening differently for residents, and medical students, and fellows, and those early stages of career to really integrate this aspect of health.

INTERVIEWER: Well, one thing I like about this study is that you came up with recommendations for hospitals and clinics. What are some of those important ones?

EMILY MCTATE: We did. And not just for hospitals and clinics, but in general, I think the key pieces are that we heard from families were really validation of the lived experience from their health care providers. But I think that validation can be across the board-- not just from your health care provider, but from your friends, from your family to really appreciate and understand this is the social reality of folks who hold minoritized identities.

I think an acknowledgment of the value of the identities that folks hold. We heard from families intervening on racism, and then, really, a clear and transparent communication that racism is unacceptable and a commitment to supporting patients and families who are experiencing racism in all its forms.

INTERVIEWER: Your study points out a lack of research into this topic. Are there more questions you're hoping to study in the future?

EMILY MCTATE: So many more questions.

INTERVIEWER: Always.

EMILY MCTATE: Always. Especially as a psychologist, right? But yeah, I think the next steps are really getting some clearer information about, how do we really integrate experiences of racism, experiences of bias into our care of children? How do we assess not just the experiences, but the impact of those experiences?

And then how do we intervene at all levels? So how do we intervene when we know kids are experiencing more sort of traumatic-like symptoms. How do we intervene at some of the more mild symptoms level? So I think there's lots of opportunity to learn more about how we best care for kids.

INTERVIEWER: Well, thank you so much for your work and for taking the time to talk with me about it.

EMILY MCTATE: Thanks for having me.

INTERVIEWER: Emily McTate is a pediatric psychologist with the Mayo Clinic in Rochester. You can read more about this project in a recent story by Sahan Journal, and you can find that at sahanjournal.com. Also, we will have a link at mprnews.org.