Approaches to diversity in family medicine: "I have always tried to be colour blind".
OBJECTIVE
To explore family physicians' perceptions of and experiences with patient diversity, including differences in sex, race, ethnicity, social class, sexual orientation, and abilities or disabilities.


METHODS
Semistructured, in-depth, qualitative interviews. SETTING Halifax metropolitan region, Nova Scotia.


METHODS
Twenty-two family physicians who ranged in age (25 to 65 years) and in years of practice (< 5 to > 20). Participants included both sexes, members of racialized minority groups, and those who self-identified as gay, lesbian, or bisexual.


METHODS
Physicians were recruited through information letters distributed by mail and through professional networks. Interviews and field notes were recorded, transcribed verbatim, and coded using data analysis software. Weekly team discussions enhanced interpretation and analysis.


RESULTS
Family physicians employed 5 main approaches to diversity: maintaining that differences do not matter, accommodating sociocultural differences, seeking to better understand differences, seeking to avoid discrimination, and challenging inequities. Quotes from interviews illustrate these themes.


CONCLUSIONS
Most approaches assume that both medicine (as a profession) and physicians are and should be socially and culturally neutral; some acknowledge that the sociocultural background of patients can raise tensions. Most participants in our study seek to treat patients as individuals in order to not stereotype, which hinders recognition of the ways in which sociocultural factors-both patients' and physicians'-influence health and health care. Critical reflexivity demands that physicians understand social relations of power and where they fit within those relations.
Beagan
Brenda L
BL
Dalhousie University, School of Occupational Therapy, 5869 University Ave, Forrest Bldg, Room 215, Halifax, NS B3J 3H5. bbeagan@dal.ca
Kumas-Tan
Zofia
Z
D001291:Attitude of Health Personnel; D018864:Cultural Diversity; D005194:Family Practice; D054625:Healthcare Disparities; D006801:Humans; D007407:Interviews as Topic; D009674:Nova Scotia; D017060:Patient Satisfaction; D010819:Physician's Role; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D011287:Prejudice; D036301:Qualitative Research
Acad Med. 2008 Jan;83(1):100-5
18162760
Can Fam Physician. 2005 Apr;51:478-80, 483-5
15856962
CMAJ. 2008 Nov 4;179(10):1007-12
18981441
Acad Med. 2003 Jun;78(6):549-54
12805032
J Gen Intern Med. 2007 Nov;22 Suppl 2:300-5
17957415
Soc Sci Med. 2000 Oct;51(8):1253-65
11037215
Can J Public Health. 2005 Mar-Apr;96 Suppl 2:S45-61
16078555
CMAJ. 2007 Dec 4;177(12):1513-9
18003954
CMAJ. 2007 Sep 11;177(6):583-90
17846440
Can Fam Physician. 1994 Mar;40:498-504
8199506
Can Fam Physician. 2007 Jan;53(1):105
17879421
Fam Pract. 2006 Dec;23(6):631-6
16799166
Acad Med. 2007 Jun;82(6):548-57
17525538
CMAJ. 2007 Dec 4;177(12):1522-3
18003952
Qual Health Res. 2007 Nov;17(9):1256-67
17968042
Am J Kidney Dis. 2006 Dec;48(6):964-71
17162151
Arch Fam Med. 2000 Sep-Oct;9(9):843-53
11031391
Acad Med. 2003 Jun;78(6):605-14
12805041
J Gen Intern Med. 2007 Nov;22 Suppl 2:368-70
17957428
Acad Med. 2006 Sep;81(9):788-92
16936481
CMAJ. 2006 Mar 14;174(6):787-91
16534085
CMAJ. 2008 Mar 11;178(6):681-7
18332383
Acad Med. 2008 Jan;83(1):106-11
18162762
BMJ. 2007 Feb 10;334(7588):280
17289707
Stroke. 2002 Jan;33(1):268-73
11779921