Wow Your Audience with Culturally Appropriate Presentations

You volunteered to provide a presentation on morning rounds or at the monthly quality program. You believe in Health Equity. As you prepare, you ask yourself, “how I can ensure a culturally competent presentation in front of my colleagues?” I will walk you through 4 aspects of your performance that support your cultural agility and models the behavior of skilled physicians.

Number One: DO NOT Leave this aspect of your presentation until the last minute!!

  • Unless you have a working knowledge of the social determinants of health (i.e., you obtained an MPH degree) or you pay attention to the statistics about health disparities – you may need to do a google search to augment your content.
  • More importantly, if the nature of the disparity has not impacted you, you may not be versed in the nuances of this problem even with the subject matter you are delivering.
  • Stated differently, you often don’t know what you don’t know.

Number Two: Acknowledge Health Disparities with every presentation

  • Be a Rock Star and share the health disparity statistics associated with the disease or public health issue you are discussing whenever you give a presentation.
  • When we probe deeper and examine the structural reasons that explain particular disparities- from social determinants to implicit (unconscious bias). You not only highlight the work that must be done to alleviate the gap but also remind yourself and the audience that this work is of value in your department or specialty.

Number Three: Choose Pictures Wisely

  • I cannot emphasize this enough! As the adage says, “A Picture Says a Thousand Words,” stereotypes and discrimination hide
    neatly in visual displays. We must be mindful not to perpetuate them in our presentations.
  • Ask yourself – do the photos reflect the diversity in the community I serve? Do the images mirror my colleagues who are in my audience?
  • For example, if you are showing photos of pathology, be sure to confirm the pathology across all the groups that this pathology effects. I’ve been to so many lectures about STDs among adolescents and ALL the slides, and I repeat ALL the slides, depicted genital lesions on Black female patients-this is unacceptable! And Most importantly, ask yourself, what is the underlying message that gets transmitted with a slide deck like this?

Number Four: Choose Words Carefully and Avoid Stereotypes

  • Your hidden stereotypes may perpetuate harmful beliefs in a presentation in front of your peers. There are several ways to mitigate these stereotypes.
  • Pay attention to how you feel, think, and what your body reveals when you are talking about a group of people or people afflicted with a particular disease. If you feel uncomfortable, reflect on that because it has personal meaning for you and it may be lurking in your unconscious.
  • Take the Harvard Implicit Association Test. Get some “objective” ideas about some of the beliefs you hold. Save your results and consider interventions to expand your cultural agility. Then, retake the test.
  • Get feedback on your presentation from colleagues who may be closer to the patient population or community involved.<
  • Be courageous and ask people how they want to be identified. As cultures, societies move forward, identification changes. Terms no longer used include Oriental and Negro. Preferred identifiers include LatinX and African American or Black. If you can be specific about the country of origin that can be helpful as well.
  • Keep in mind that no group of people are homogeneous; there will be differences in opinion and belief. Expect “mistakes,” but graciously be open to learning new and different perspectives


Stacie L. Walton MD, MPH, recently retired from Kaiser Permanente as a clinical Pediatrician serving in the roles of both Diversity Champion and Communication Consultant. She served as a medical consultant in diversity issues for healthcare providers and institutions for over 25 years.

Currently, her cultural competency themes highlight the impact of implicit bias and privilege in patient interactions and health outcomes, as well as, how effective patient-provider communication requires both competences and humility.

Reducing Unconscious Bias in the Emergency Room

Bias is a neutral word.  A bias is a belief, a thought, a preference.  In and of itself, it has no leaning towards right and wrong, or best and worst.  Personal and social judgment assigns the bias a nuanced meaning.  In health care, these beliefs can turn into a missed diagnosis, an inappropriate treatment strategy, or a patient’s untimely death.  The most critical aspect of bias for health care providers is realizing that our unconscious beliefs guide our behavior towards other people, often unconsciously.  We often make decisions about how we interact with people through our biased lens.  We choose subconsciously whether we will lead with respect, or with dismissal, or even disdain.   It is crucial to recognize whether our biases are reality-based or a reflection of inaccurate assumptions about our patients, our colleagues, or ourselves. 

During the night shift in the Emergency Room internship year, I had an experience that illustrated my bias towards “inconsiderate” people.  It would become an AHA moment for me, with a conscious decision to do better.  As an intern, I managed the non-urgent side of the emergency room.  The night unfolded into the typical frantic evening with a stream of patients, procedures, multitasking and plenty of decisions to make.  A grandmother came in with her 10-year-old grandson for the evaluation of a rash. I’d been up all night; I was tired and impatient.  As I entered the exam room, I thought to myself as I read the chief complaint on the front page of the chart, why would anyone be coming into the emergency room at three in the morning for a rash?  Immediately, I smelled a distinct body odor.  The child was visibly dirty, wearing tattered clothes and avoided making eye contact.  His grandmother dressed in office attire that was upscale and clean shared the history.  I began to lecture the older woman about coming in at three in the morning for a simple rash, and I scolded the boy about his hygiene.  She watched me jot down my notes and let me finish with my tirade before she informed me that her grandson lived with his mother, and that they were homeless.   She shared that daily hygiene became challenging without access to water, and family relationships remained strained.  She was doing what she could.  She worked during the day and could not afford to take time off. She searched my face for empathy.  She said calmly, “Doctor, could you please stop scolding us . . . and just help us?”   A rush of warmth filled my cheeks, and I felt ashamed.  When had I become so insensitive? Why hadn’t I been curious about their situation instead of judgmental?

Discussions about unconscious bias in healthcare decision making started in 1991 with the seminal article by Shulman et al.[1] Unconscious bias is more likely to guide behavior when we are tired, hungry, multitasking or experiencing acutely stressful situations.  It is at these moments when our sympathetic nervous system activates to ensure “our primitive need for survival.”  Any strategy that can bring our parasympathetic system on line will help us to make better decisions, maintain awareness, and remain creative in the chaotic moments. [2]   So, what would I have done differently had I known what I know now? Before moving from each exam room and encountering a new patient and their family, I would have taken one extra minute to engage privately in three mindful breaths. I would have taken another 30 seconds to prime my brain with positive intentions for providing the best care possible to the next patient waiting for me. Both of these actions would have decreased the chance of my operating through my unconscious bias and provided a better experience for my patient and his family.


[1] Schulman et al., “The Effect of Race and Sex on Physicians’ Recommendations for Cardiac Catheterization.”

[2] Ma et al., “The Effect of Diaphragmatic Breathing on Attention, Negative Affect and Stress in Healthy Adults.”


Stacie L. Walton MD, MPH, recently retired from Kaiser Permanente as a clinical Pediatrician serving in the roles of both Diversity Champion and Communication Consultant. She served as a medical consultant in diversity issues for healthcare providers and institutions for over 25 years.

Currently, her cultural competency themes highlight the impact of implicit bias and privilege in patient interactions and health outcomes, as well as, how effective patient-provider communication requires both competences and humility.

You Don’t Get Me

We live in a world that includes conflict and misunderstanding.  Often these misunderstandings occur with friends.   Frequently, understanding the “intent” behind the misconception and its  “impact” diffuses the conflict. Resolving the discord requires leaning into discomfort by embracing a courageous conversation regarding the impact.  Racism and internalized oppression complicate the relationship between “intent” and “impact.”

In the spring of 1988, as an intern at a Children’s Hospital in a major urban city, I  worked 100 hours a week, which included at least two sleepless nights.   As the only African American resident in the program, the isolation could be profound.  I found solace in the relationships formed with black ancillary and janitorial staff, and many of my Pediatric patients and families.

I met Jennifer,  my closest fellow intern, for lunch.  As we talked about the patients admitted to the hospital the night before, a comment from Jennifer filtered in from nowhere.  She said, ” You know Stacie, I don’t see you as black.”  Her tone was complimentary – light, airy, simple; the meaning, an insult – grave, surprising, hurtful.   As I looked at her perplexed, she continued to explain herself by saying, “You are so articulate and well-traveled. ” Seeing that I wasn’t rushing to validate what she was saying, she kept talking.   At no point did I correct her.

As I experienced this microaggression, I chose not to lean in, stop her rant, explain the misunderstanding.  I decided not to educate her on the impact of her assumptions about me.  I am African American, and my community is heterogeneous.  My culture defines me.  I am black, and I am proud.

We slowly drifted apart.  I answered calls less frequently.  The depth of my conversations became shallower.  We found friendships elsewhere.  I doubt Jennifer would point to her comment as the cause for us drifting apart, maybe she would.  I will never know. 

Fast forward 25 years, and I would have handled the interaction differently.  I would have confronted the microaggression, explained its significance, and educated Jennifer about her assumptions and stereotypes. I would have reminded her that for me being the “exception Negro” was not a badge I ever looked forward to wearing.  And, more importantly, that her comment assumed that being articulate made me less black and more white.   It was a lost opportunity to educate someone about the power of the impact, regardless of intent. 


Stacie L. Walton MD, MPH, recently retired from Kaiser Permanente as a clinical Pediatrician serving in the roles of both Diversity Champion and Communication Consultant. She served as a medical consultant in diversity issues for healthcare providers and institutions for over 25 years.

Currently, her cultural competency themes highlight the impact of implicit bias and privilege in patient interactions and health outcomes, as well as, how effective patient-provider communication requires both competences and humility.

Perspective

Perspective is everything!

Perspective helps to explain intent vs. impact when conversations or interactions turn sour.  We live in a world that includes conflict and misunderstanding.  Often these misunderstandings occur when we least expect.   Frequently, understanding the “intent” behind the misconception can diffuse conflict.

Be curious. 

When you find that you have unintentionally hurt or harmed someone, don’t be quick to defend yourself.  Remember perspective – you naturally will see the situation differently – we are all unique and come with unique life experiences.  Acknowledge the unintentional harm and apologize for it.   And, if you really want to promote connection, you will declare you will try not to do that again! 

Take a moment to conduct the exercise below that explores the concept of perspective.


Stacie L. Walton MD, MPH, recently retired from Kaiser Permanente as a clinical Pediatrician serving in the roles of both Diversity Champion and Communication Consultant. She served as a medical consultant in diversity issues for healthcare providers and institutions for over 25 years.

Currently, her cultural competency themes highlight the impact of implicit bias and privilege in patient interactions and health outcomes, as well as, how effective patient-provider communication requires both competences and humility.