COVID-19 and Asian American Pacific Islanders
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Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; 2Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA; 3Department of Psychiatry, University of California Davis, Sacramento, CA, USA.
J Gen Intern Med DOI: 10.1007/s11606-020-05953-5 © Society of General Internal Medicine 2020
ongoing coronavirus disease 2019 (COVID-19) panT hedemic and tragic loss of life and employment have upended daily life in every community around the country. Unfortunately, Asian American Pacific Islanders (AAPIs), including those of non-Chinese heritage, have additionally been subjected to COVID-19-related discrimination. On March 14th, two Burmese-American children and their father were stabbed in public by a man who “thought the family was Chinese and infecting people with the coronavirus.”1 On March 19th, the Asian Pacific Policy and Planning Council (A3PCON), a coalition of AAPI community organizations, set up a public reporting center for COVID-related discrimination. Within the first month, A3PCON received 1497 reports of COVID-19-related discrimination, from verbal harassment and being spat/coughed on to physical assault and being barred from establishments, with reported incidents 2.3 times higher for women than for men.2 Racism can cause psychosocial trauma and maladaptive coping behaviors, and worsen physical health and health inequities.3 In this viewpoint, we discuss how providers can help address AAPI racism within the physician-patient relationship—especially as general internists comprise a key position in the frontline against the pandemic. At baseline, AAPIs have the lowest utilization of mental health services due to barriers in language, insurance, and cultural understanding.4 AAPI patients may not volunteer information to their doctors, and many avoid going out, even for essential needs, due to fear of violence and marginalization in public. In the primary care setting, clinicians can begin to address these issues by taking a moment to ask “Have you experienced any ‘acts of discrimination’ with everything going on?” Asking about discrimination in itself is an act of care, as it demonstrates acknowledgment of the Jiun-Ruey Hu and Margaret Wang contributted equally to this work and are co-first authors. Received May 1, 2020 Accepted May 29, 2020
current challenges in these communities and helps establish trust. The American Psychiatric Association’s DSM-5 Outline for Cultural Formulation notes that “Experiences of racism and discrimination in the larger society may impede establishing trust and safety in the clinical diagnostic encounter. Effects may include problems eliciting symptoms, misunderstanding of the cultural and clinical significance of symptoms and behaviors, and difficulty establishing or maintaining the rapport needed for an effective clinical alliance.” Therefore, the Outline calls for the clinician to assess the cultural identity of the individual, cultural conceptualizations of distress, psychosocial stressors, and cultural features o
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