Culturally Sensitive Dermatology Consults

Learning about different cultures and being aware of social determinants of health can help promote inclusivity.

In addition to myriad medical breakthroughs and treatment options being introduced, dermatologists are reexamining the specialty to maximize inclusivity. In this feature interview with The Dermatologist, Candrice Heath, MD, discusses how physicians can accommodate diverse patient situations to deliver quality care for all following her Skin of Color Update session.

The Dermatologist: How can practitioners accommodate diverse patient situations?

Dr Heath: One of the most important ways that practitioners can accommodate patients from a variety of cultural backgrounds is to really be invested in learning as much as possible about different people and different cultures. Being able to put these things into practice takes time, so I would suggest signing up for educational opportunities to learn more about not only diagnosing conditions in people with a variety of skin tones, but a variety of hair textures as well. It is also important to attend lectures that dive a little bit deeper into some of the cultural nuances that may change from patient to patient.

The Dermatologist: What are social determinants of health and how do they impact patients’ health outcomes?

Dr Heath: Social determinants of health are complex, and we are continuing to learn more about them. Some of the big topics are outside factors. For example, someone’s educational level will determine the type of job they are able to get, which can determine their income power and wealth, and that level of wealth or lack of wealth can determine what type of insurance they have, if they are able to get insurance at all, which can affect their access to health care. There are insurance plans that help most people get their foot through the door for care, but what about the quality of that health care?

Another determinant to look at is where people live. Depending on the location, they could be more exposed to pollution, smog, and poor air quality, all of which can impact their health. Additionally, where people live is often determined by their economic status or they are grouped based on their race; just being assigned to that specific location can impact their health and affect health care access. We may not really think about how complex our patients are outside of the exam room, but I try to challenge my colleagues to begin thinking about that through the lens of dermatology.

The Dermatologist: How can the dermatology specialty aim to be more inclusive?

Dr Heath: The topic of inclusivity has numerous layers to it, but one of the common components is that, as physicians, we want to focus on being welcoming. However, to make people feel like they are included in our practice, our medical and educational opportunities need to feel welcoming for the patient. We all must do some work to examine our own thoughts and biases that we may not have known even existed. Being willing to learn about how to be held accountable is the first step.

Another point is that medicine is rapidly changing. Every day something new is coming out. In addition to the changes that we have had to get used to over our medical careers, we also need to be as agile when it comes to our worldviews. The common thread joining all of us together as physicians and practitioners is that we want to do what is best for our patients.

The Dermatologist: What other pearls would you like to share with your colleagues regarding culturally sensitive dermatology consults?

Dr Heath: One of the top things that makes people a little bit uncomfortable during a dermatology consultation is around the topic of hair, such as discussing hair care, diagnosing a variety of hair loss conditions, and identifying different hair types. We published a paper in JAMA Dermatology a few years ago about how physicians should examine the scalp and hair of someone who has tightly coiled hair. Not only does it focus on the actual examination, but it also explores other nuanced techniques that can be used to make the patient feel more comfortable. That is just one example of something we can all learn, but there are a variety of topics that we can take a deeper dive into to increase cultural sensitivity.

Reference
Grayson C, Heath C. An approach to examining tightly coiled hair among patients with hair loss in race-discordant patient-physician interactions. JAMA Dermatol. 2021;157(5):505-506. doi:10.1001/jamadermatol.2021.0338