Survey of Alberta doctors suggests concerns about anti-Indigenous biases in health care

The Metis Nation of Alberta says many of its members have experienced racism when accessing Alberta's health-care system.

"Rather than risk being discriminated against or feeling less than … They’re choosing not to go," said Reagan Bartel, director of health for the Metis Nation of Alberta.

"Our community feels that very deeply, that physicians are above and Metis people are below, and that’s not a good place to be when you’re seeking help." 

A survey of Alberta doctors backs up some of those concerns.

Researchers at the University of Calgary sent the survey to every licensed doctor in the province in September 2020 to determine their biases, following high-profile deaths of Indigenous patients in Canada’s health-care system. 

"We need to look at ourselves and really face this, that we have explicit and implicit anti-Indigenous biases and it's harming our patients," said Dr. Shannon Ruzycki, one of the lead researchers. 

"We need to stop denying it and we need to really reflect on what our part in changing the system is." 

Just over 1,000 of Alberta’s roughly 12,000 physicians took part in the survey, but only 375 of them answered questions about anti-Indigenous bias. 

COVID-19 is believed to be a factor in the low response rate. 

In the question that asked doctors if they preferred white or Indigenous people, 25 per cent said they preferred white people, and more than eight per cent said that they felt unfavourably toward Indigenous people. 

"That’s significantly more than zero, which is what we would hope to see when we're asking people if they feel racist against a particular group," said Pamela Roach, another lead researcher. 

In the open comments section, several white doctors even expressed feeling racism from Indigenous people and not the other way around. 

"The most common sort of racism I have seen is an Indigenous person being racist in words and actions against white people. This is 100 times more common than the converse," one doctor wrote, according to a study about the survey published in the online peer-reviewed journal BMJ Open in March. 

Roach, who is a member of the Metis Nation of Alberta, says these types of comments aren’t surprising. 

"I think anytime people are challenged on really problematic views, it's a mechanism of defence to say, ‘Well, this person did this, and that justifies my behaviour,'" she said, adding that this comes from a lack of understanding of the wider system of power. 

"The actions that happen on the back of this bias that we see, have really far-reaching implications for patient outcomes. And I think we need to think about accountability and the fact that we can no longer deny that it's happening."

Bartel agrees, and is calling for more action to address this. 

"We're missing that accountability. There is not room for a racist doctor. There is not room for a racist nurse, and yet they exist, because we do nothing about it." 

HEALTH ORGANIZATIONS RESPOND TO SURVEY

The College of Physicians and Surgeons of Alberta (CPSA) has a complaints process for patients and says the outcomes will vary depending on the situation. 

It has also created an Indigenous Advisory Circle to help connect Indigenous doctors and patients. 

"The work in this area is just beginning, but the goal is to listen to and learn from members of the Circle, to help us better understand and support Indigenous patients, and better guide the physicians who care for them," CPSA said in a statement. 

Alberta Health Services (AHS) has a process for dealing with patient complaints as well. 

It has also established the Indigenous Wellness Core with staff to help Indigenous patients through the health-care system. 

"Racism, discrimination, and unconscious bias have no place within Alberta Health Services," AHS said in a statement. 

"We are striving to improve our system, and provide an environment where everyone, including patients, families, health-care providers, physicians and volunteers feel safe, healthy and valued." 

AHS also requires all staff to complete mandatory Indigenous awareness and sensitivity training.