Resources about different perspectives and experiences of healthcare to support continual professional development

The demography of the patient population may influence how they access health care. In 2020 the report Health Equity in England: The Marmot Review 10 Years On, pointed to the fact that health inequalities had grown in the 10 years previous, based on place, gender, ethnicity and deprivation.

Women’s health

Women live longer than men but tend to experience poorer health and poorer outcomes than men in many circumstances.

This report from the National Institute for Health and Care Research may be useful: Women’s Health: Why do women feel unheard? (2022)

The article explains that 4 in 5 women feel unheard or misunderstood. Reasons for this included: lack of staff time, feeling symptoms dismissed, lack of cultural awareness, feeling judged or lack of knowledge about a pre-existing condition.

Suggestions for good practice included:

• listen more and use non-technical language
• ask open questions
• undertake training in cultural sensitivities
• explore how patients perceive risk of illness.

The article has links to other useful articles about barriers, for example, to accessing mental health care, and how to communicate with patients with dementia.

Sexual orientation and gender identity

The National LGBT Survey: Research report (2017) shows that ‘evidence base points to LGBT people being more dissatisfied with health services in comparison to those who are not LGBT. This can include lack of knowledge among medical staff about the health needs of LGBT people, specific concerns with mental and sexual health services and, among transgender people, concerns with the gender identity services provided by the NHS.’

‘A high proportion (38%) of trans respondents accessing general healthcare services reported a negative experience because of their gender identity.’

Trans healthcare resources from the General Medical Council provide useful examples of how to make practice more inclusive, for example:

• ask don’t assume
• language matters – check preferred name, title and pro-nouns
• respect confidentiality
• not everything is about gender
• look out for mental health difficulties as a disproportionate number of trans patients will experience mental health difficulties

Religion and belief

Cultural, spiritual and religious beliefs can impact how people make decisions about their health.

Research shows that people of different religions and beliefs can suffer health inequalities. For example:

• research from NHS Bradford, Airedale and Leeds showing evidence of health inequalities affecting people of different religions
• a review from NHS Race and Health Observatory into how the NHS communicates with Jewish communities

This Department of Health culture, spirituality and religion: migrant health guide (2017) provides some suggestions for inclusive healthcare related to religion and spirituality, for example:

• ‘be aware of how cultural, spiritual and religious beliefs impact on an individual’s health and well being’
• ‘be aware of how their own beliefs and biases influence how they interpret others’ health needs’
• ‘demonstrate cultural responsiveness and literacy by sensitively exploring the cultural, spiritual and religious factors that are unique to each individual’s circumstances’

There are a range of useful resources to support better understanding of religion available on the Barts Trust website.

The article Cultural Competence in the Care of Muslim Patients and Their Families (2023) provides information about obstacles to healthcare in the diverse Islamic faith, and describes issues of clinical concern, identifies cultural differences in care, outlines important values in the religion and culture of Muslims and sets out some useful recommendations including:

• apologise for cultural mistakes
• ask the patient and family how you can help make their experience more comfortable
• avoid being judgmental
• avoid making assumptions and be patient
• avoid employees serving as interpreters for other employees
• be aware of the uniqueness of Muslims and their special needs
• be respectful
• consider diverse recruitment and include Muslims in the recruiting effort
• identify Muslim workers that can assist in the culturally sensitive care of the Muslim patients
• integrate all holidays, including those of Muslims
• observe body and facial language
• recognize how values, behaviours, and beliefs may affect others
• train staff about cultural competence
• use medically competent and fluent interpreters with training in cultural competency

Disability and experiences in healthcare

The charity Scope has useful resources about the social model of disability which demonstrates that people are disabled by barriers in society.

Kent and Medway PCT also provide some useful resources to make environments more inclusive for deaf people.

Race and ethnicity

The NHS Race and Health Observatory provides research about health inequalities on the basis of race (legally defined in UK law as colour, nationality, national origin, ethnic origin and ethnicity).

The Race Equality Foundation are a national charity that aim to tackle race inequality in public services. Their 2020 report on Musculoskeletal conditions and Black, Asian and minority ethnic people: addressing health inequalities found that there is a higher prevalence of musculoskeletal conditions in ethnic minority people.

They made a recommendation that prevention should be given greater priority, with musculoskeletal health being promoted, with an emphasis on inclusive messaging and communication that will be understood and acted on by black and minority ethnic people.

More guidance on legislation and rights in health care

• Guidance on the Equality Act 2010: more information about the obligations in the Equality Act 2010 which apply in England, Wales and Scotland.

• Guidance that includes the Northern Ireland equalities legislation: further information about obligations in the Equalities legislation in Northern Ireland.

• Your rights to equality from the Equality and Human Rights Commission
  

Case examples

Age

Iris is a patient in her 80s who visits her osteopath once a month for regular treatment to help her manage a range of health issues including severe osteoarthritis. She is quite slow these days, and takes a long time to get dressed after the session. To avoid rushing her, or cutting short her treatment, the osteopath leaves her to get dressed in her own time, and sees their next patient in another treatment room. On occasions when an alternative room is not available, they allocate an extra few minutes so that Iris has plenty of time.

Autism

Josh is an autistic 15 year old boy. His Mum makes an appointment with her osteopath to see Josh who has been experiencing some low back pain, but mentions that he is unsettled by new situations and people that he doesn’t know. The osteopath suggests that Josh and his Mum pop in to the practice after school a few days before the treatment so that he can see where he’s going, meet the osteopath and receptionist and see the room that he’ll be treated in. They do this, and Josh is much happier about returning for his first session with the osteopath.

Gender identity

An osteopath notices an increase in the number of transgender patients that they see. This is not something that they felt they were prepared for when they initially trained some years before, and so research how best to meet the needs of trans patients, and seeks feedback from existing trans patients as to how their care can be enhanced. As a result of this they review their website material, and make it clear that they have an inclusive practice and a clear Equality, Diversity and Inclusion policy. They make it clear that the practice is a safe space for trans patients, and ensure that patient forms do not assume binary genders. They are clear that they offer a safe space for patients to discuss health issues without assumptions being made as to the biological background to these, for example, recognising that male trans patients may experience menstrual issues.

Religion and belief

An orthodox Jewish woman has made an appointment and when she arrives, she realises that the osteopath is a man. She seems very uncomfortable. There are no other genders of osteopath available in this clinic. The receptionist asks the patient to sit down while she consults the osteopath. The osteopath gives the patient a list of alternative female osteopaths in the local area who she can access.

Ethnicity

A black pregnant woman has been recommended to try an osteopath for the pain she has had for the last month. The osteopath notices that she seems very nervous and is talking loudly in the waiting room. Before the appointment begins the osteopath spends time asking the patient about her experiences of healthcare so far in her pregnancy and if she has been to an osteopath before. The osteopath discovers that the patient’s mother died in childbirth due to complications that should have been noticed by health practitioners, and she has avoided all medical care most of her life. The osteopath takes time to explain how the treatments work and gives the patient time to ask questions. The patient appears calmer and more relaxed.