Eliminating Healthcare Disparities with Cultural Humility: Q&A with Kathleen Green, MD, OB-GYN

Healthcare and maternal outcomes shouldn’t hinge on race. And yet, Latinx and Black women are three times more likely to suffer complications during childbirth. Black women are twice as likely to die from those complications.

These disparities aren’t new, but COVID-19 laid them bare. Latinx, Pacific Islander, Indigenous, and Black Americans all have a mortality rate double or more than white and Asian Americans. Early reporting from US cities and states shows that vaccination numbers are similarly split, leaving these communities even more vulnerable.

Lack of access to quality care and distrust in the healthcare system share the blame. Providers need to take an inclusive, empathetic, and humble approach to repair that relationship.

We caught up with Kathleen Green, M.D., OB-GYN at the University of Florida, to talk about inclusive and culturally humble care. Dr. Green is board-certified in obstetrics and gynecology, with clinical interests including sexual dysfunction, adolescent gynecology, and breastfeeding support. She is also a OB-GYN provider on the Maven virtual network for women and families. 

Here are some of the highlights from the conversation.

What does “culturally humble” care mean, and how does it compare to cultural competency?

When we first started talking about care for everyone, we used the term “cultural competence.” But here’s the thing: Once you become competent in something, that means you’ve completed the learning process. So that’s why we’ve shifted to “cultural humility,” because it's really about being humble with every patient we see.

You have to meet every patient where they're at. And sometimes that means giving different care to different patients. One person’s needs are different from the other. You have to assess what each patient in front of you needs today.

What does that look like in practice?

We have a huge undocumented population here in Florida, especially in the farming community. Because it was harvest season, much of the community had never heard of COVID. We had to tell some patients that they had COVID while they were in labor, and that their partner couldn’t be with them. Again, they had never heard that term before.

And so cultural humility is about delving into what you can do to provide them with the best care while meeting them where they're at and understanding the forces that play. If a patient is “non-compliant,” you need to figure out why that is. Is it because they don't have the adequate resources to eat the foods they're supposed to eat? Do they not have the same level of education? Are we not providing them with appropriate translation services?

A big part of it is about empowerment, right?

Yes, and part of that empowerment starts by having providers that look and speak like our patient population. We’re expanding our midwifery practice right now — about four to five of our residents are fluent in Spanish and we have co-translation monitors for video calls. 

We also have community health fairs and ID drives, including a big text messaging effort to get the word out. We’ll text 500 community workers to let them know that we’re having the fair and that they can come get the COVID vaccine, free IDs, or a free mask. These are run by networks of community workers that have been trained to advocate for and teach patients about COVID.

“I tell patients this all the time: If your physician or provider is uncomfortable with you asking questions, you're seeing the wrong person.”

You mentioned texting. What are other ways technology can address care disparities?

Telehealth specifically helps. One of my patients, an African American female in Florida, lives about four hours away from me. After almost every single visit to her OB, she sets an appointment with me just to get my opinion. It's not that she doesn't trust her doctor. She just wants to know what I think. She even sent me pictures 10 minutes after her baby was born. That was one of the best moments.

As a doctor, I would love to know that my patient has the option to go to Maven or another telehealth provider and ask those kinds of questions as opposed to going on Google, Facebook, or to their friends. You want them to go to a trusted resource, especially if they can establish that trust and a long-term relationship with someone in healthcare.

Considering the Black maternal mortality crisis, how does your advice change when working with Black women?

Make sure that they understand that they have a right to ask questions. I tell patients this all the time: If your physician or provider is uncomfortable with you asking questions, you're seeing the wrong person. The provider should be able to say, “I don't know the answer to that, but let me look it up for you.”

If I can tell that they've had bad interactions with other providers, I will also say, “Listen, I am really worried about you. I understand that you're frustrated. I understand that you don't feel heard, but I am worried about you, and I'm going to lose sleep over you tonight.”

When they sense that you are truly worried about them and that you care, it changes the whole dynamic. Oftentimes we lead with our heads when we should be leading with our hearts.

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