Never before have the levels of inequity in our society been more clearly visible than now, as we deal with the COVID-19 pandemic. These communication skills, developed by VitalTalk and its collaborators with expertise and experience in this space, are meant to provide tools for frontline clinicians. These communication skills alone are not going to fix structural racism, but they could enable clinicians to understand our patients’ experiences better and to meet them where they are. You can also download an editable version of this script.

Watch for Behaviors That Signal Mistrust

Principle: mistrust is often expressed nonverbally—we call these mistrust cues

What the patient does or says: Gestures that say ‘I don't really want to be here’ such as closed posture, folded arms, stern glances, or eye rolls.

What the clinician says: “It looks as if you might have something on your mind. Is it something that might help me understand your situation better?”

What the patient does or says: “I am concerned that I am not being told everything about COVID-19."

What the clinician says: “There is a lot of information out there, and some of it is not factual. Let’s start with your most important concerns. Your trust is important to me.”

Probe For Experiences of Racism

Principle: naming racism explicitly shows that you recognize that it exists

What the patient does or says: Patient recounts something they have seen in the news about how COVID-19 affects black people (e.g., “I have read that black people are more impacted by COVID-19.”)

What the clinician says: “I have read that also. Are you concerned that racism may be involved?” A follow-up: “What does racism look like from your perspective?”

What the patient does or says: Patient describes an instance where a family member had a negative outcome with care (e.g., “My aunt did what they told her to do, but still ended up in the hospital.”)

What the clinician says: “Anybody would be concerned about that. I would be concerned too. What happened?... Do you think she was being treated differently because of her background?”

Acknowledge Harms that Occurred From Prior Care

Principle: acknowledging racism explicitly can build trust

What the patient does or says: Patient describes frustration or lack of engagement with health care (e.g., “I went to the emergency room, but they didn’t really do anything.”)

What the clinician says: “I have heard from other black patients that they have had negative experiences with health care that make it hard to trust the medical system. I realize that racism exists in medical care. How much has it affected you?”

What the patient does or says: Patient describes frustration with a clinician (e.g., “That doctor did not seem to listen to me.”)

What the clinician says: “That sounds frustrating. I acknowledge that we clinicians don’t always listen well, and sometimes racism is involved. I want to do what I can to help you get the care you need.”

Offer to Partner in the Way the Patient Wants

Principle: allow the patient to describe what they would like before you jump in

What the patient does or says: Patient voices interest in their own health (e.g. “I have been trying to take care of myself.”)

What the clinician says: “I am glad to hear that you take care of yourself. How could we work together on your health?”

What the patient does or says: Patient voices understanding of recent diagnostic tests (after clinician has explained them). “Ok, what do I need to do?”

What the clinician says: “I’m going to explain a plan that would be the best treatment for your medical condition. Then I want to hear your thoughts and concerns about the plan because we can customize it for you.” And: “Please don’t hesitate to ask for clarity on the words I use. We medical people sometimes speak in another language. My goal is to help you in the best possible way.”

Invite the Patient to Bring in Important People From Their Community

Principle: cultural norms may involve decisions by an extended social group, rather than an individual

What the patient does or says: After hearing the treatment recommendation, the patient says, “I’ll think about that.”

What the clinician says: “Many of my patients want to include someone from their family or faith or community in medical decisions, and I welcome that. If there is someone that you want to bring into this discussion, we can do that.”

Special Thanks:

  • Cynthia Carter Perrillat, MPA
  • Tessie October, MD, MPH
  • Kimberly Johnson, MD

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