As physicians, we pride ourselves in our ability to be unbiased, objective observers. I think this edition of FP Essentials will test your ability to keep your personal experiences, political views, and cultural understandings from shaping how you view the evidence presented here. We live in a time when a person’s political affiliation often determines their response to inclusivity. I know that I have many friends and colleagues who saw the topic of this edition and had at least the passing thought that we need to stay out of social issues and just focus on health care. Whether you are an underrepresented-in-medicine physician or someone who groans every time someone mentions diversity, equity, and inclusion (DEI), I hope that you are willing to set aside your personal and political opinions on the issue and take the time to learn more about the evidence on this topic that profoundly affects the lives of our patients and colleagues.

Many of us now depend on value-based payment programs; pay-for-performance, accountable care organizations; and other alternative payment models for at least part of our income. These models incentivize physicians, practices, and health systems to improve the care and outcomes for their patients. Because the most vulnerable patients have disproportionately poor outcomes that bring down a practice’s averages, addressing barriers for these patients is the right thing to do both clinically and fiscally.

As a cisgender, heterosexual, White man, I thought discussions about serving diverse communities were something that impacted my patients, my community, and my colleagues but not me personally. Two years ago, that changed. With a move to Canada, I was suddenly an immigrant, a temporary foreign worker, and a foreign medical graduate. I have experienced what it means to have an uncertain immigration status. I encountered workplace abuse and wage theft that occur so often for marginalized people. I have seen the costs and inconvenience associated with not being able to establish a bank account, get a credit card, or obtain government services.

The first section of this monograph examines the risks of race-based medicine. The second reviews the social and structural determinants of health, how they impact patients, and how family physicians can impact these determinants. The third section looks at how to build a welcoming practice and diverse health care team. And, the last section discusses how to address health equity within your practice and community.

Even if you have frequently encountered these issues, I believe that the ideas presented here can improve your success in advocating for yourself, your patients, and your community. If many of these concepts are new to you, I encourage you to continue exploring and learning about how they are affecting the health of your patients. If you are unsure how to start exploring DEI, I suggest you learn more about implicit bias and how it impacts you and the institution you work within. The American Academy of Family Physicians has excellent resources on implicit bias at https://www.aafp.org/family-physician/patient-care/the-everyone-project/toolkit/implicit-bias.html

Ryan D. Kauffman, MD, FAAFP, CCFP, Associate Medical Editor
Family Medicine Physician
Erie Shores Family Health, Leamington, Ontario, Canada