ST. JOSEPH, Mich. – Medical Writer Harriet Washington has some advice for what a health care system can do to earn the trust of the Black people who come through its doors.

After her online presentation Sept. 24 to the Spectrum Health Lakeland system in southwest Michigan (See “Torture and Abuse in the Name of Medicine, Washington gave her response to a question posed by Lynn Todman, who is leading Community Grand Rounds, a project to close racialized health disparities in Berrien County, Michigan.

Noting that Washington would be conferring with the Lakeland system “on a really detailed answer to this question,” Todman, who is also Lakeland’s vice president of health equity, asked Washington to sum up the approach in its essence. Todman asked: “What can health care institutions do to essentially earn the trust of African-American communities?”

Washington responded: “There’s a long-term answer and a short-term answer. The real long-term answer is to accept that the situation was created over centuries, and abandon the expectation that you’re going to fix it this month or next month or next year.

“For the long term, you have to do everything,” Washington continued. “You have to maximize the access to your system for people, and that might cost you something. African Americans are less likely to have health care and health insurance. That means you may need to start treating people who don’t have health insurance or easily reimbursable schemes.” 

Black people are also less likely to have a personal physician, Washington said. “Then you need to devise a way to assign personal physicians to people who don’t have one.

“All these things will certainly cost effort and time,” Washington said. “They may cost money as well, depending on how creative you can be in terms of funding.”

Washington also advocated that a health system increase representation of the community it serves by recruiting a significant number of lay people — “in numbers, not just a token one or two” — on to its institutional review board, or IRV. An IRV of half scientists (physicians) and half community people “will guarantee that you have research schemes more palatable to people in the area you’re trying to recruit from.”

Finally, in this boiled-down version of advice to a health care system about being trustworthy to Black patients, Washington spoke about two important things for medical researchers to remember. 

She said years ago she interviewed White researchers who were regarded with respect by African-American populations. These researchers made it very clear that they, or people they had trained, were there to serve the community for the long run and would be a presence in the community. Their commitment was for the long haul, not just “for two years to collect my data and disappear.”

The second thing these researchers did was act as advocates for the people they were researching. They asked the people in the area what they needed from the health care system. They let the residents know they weren’t guaranteeing they could get it, but would try to get it, Washington said.

Torture and Abuse in the Name of Medicine