Reaffirming Our Commitment to Indigenous Health

Like many, I prechart for clinic. I scroll through referral letters, review results, and skim through subspecialty notes waiting in my inbox. Beneath an aesthetic letterhead I read a one-liner: “NO SHOW NOTICE. GIVEN THEIR FAILURE TO ATTEND THEIR APPOINTMENT, THEY ARE DISCHARGED.” Does this patient know they’ve been discharged—labeled a failure—for missing an appointment? Probably not. Does this care provider realize they’ve dismissed someone for an appointment they could not attend? Probably not. 

This patient can receive or make calls only when they have minutes on their pay-as-you-go phone. I suspect if I spoke to the clinic that discharged them, they would not know this. The patient doesn’t drive. They need medical transportation to bring them to and from their appointments. I suspect if I spoke to the clinic that discharged them, they would not know this. This patient lives on a reserve. Medical transportation hours cannot facilitate transport to the 8 o’clock appointment this physician’s clinic booked. I suspect if I spoke to the clinic that discharged them, they would not know this. I think about how I will share this with the patient tomorrow, how I will attempt to apologize on behalf of my profession for how we have failed them. 

This scenario is, of course, an oversimplification of the experiences of Indigenous people in health care—experiences that are affected by historical and present-day trauma (1), systemic and interpersonal anti-Indigenous bias (2), and other social drivers of health (3). The tragic deaths of Joyce Echaquan (4) and Brian Sinclair (5) serve as stark reminders of the devastating consequences of racism in health care. Their experiences are blatant examples of how anti-Indigenous bias manifests in medical settings. However, racism in health care is not always overt. A clinic discharge would never make the evening news. In fact, it’s more likely to be written off as a disinterested patient, rather than an unengaged clinician. The decision to discharge is a common example of the ways in which Indigenous patients are excluded from care. 

Serchen and colleagues (6) published a position paper from the American College of Physicians in 2022, outlining 12 recommendations to support the health and well-being of Indigenous communities. These recommendations are focused on policy-level drivers of change; however, the authors highlight unique opportunities for growth at the level of the individual clinician. We have a responsibility as clinicians to acknowledge the “racism, discrimination, … and other injustices” experienced by the Indigenous communities we work with, prioritize health and wellness while providing culturally appropriate care, and participate in addressing the “backlogs of care requests and the shortage of qualified physicians” (6). Of note, the recommendations recognize that clinicians serve in diverse roles beyond direct patient care. By addressing Indigenous health from bedside interactions to institutional policies, the statement provides structure for meaningful change. 

Indigenous peoples are diverse in their identities, experiences, and relationships with the health care system. The goal of this reflection is not to reinforce a narrative of helplessness, but rather to reaffirm a commitment to Indigenous health. As health care providers and agents of change, we must do better—not just in moments of crisis, but in everyday decisions that determine whether a patient is left behind. With the recent passing of Canada Day and the Fourth of July—holidays that celebrate national identity—it is time for us to reflect. Three years after the publication of Serchen and colleagues’ recommendations (6), it is worth asking: How are you and your institution doing in your commitment to fulfilling these calls to action? 

I live in the traditional territories of the peoples of Treaty 7, which include the Blackfoot Confederacy (comprising the Siksika, Piikani, and Kainai First Nations), the Tsuut’ina First Nation, and the Stoney Nakoda (including the Chiniki, Bearspaw, and Goodstoney First Nations). The city of Calgary, which I call home, is also home to the Métis Nation of Alberta (Districts 5 and 6). 

Please note that the scenario presented is a composite case, created by combining elements from multiple patients. It does not represent any single individual. 

References 

1. Toombs E, Lund JI, Mushquash AR, et al. Intergenerational residential school attendance and increased substance use among First Nation adults living off-reserve: an analysis of the Aboriginal Peoples Survey 2017. Front Public Health. 2022;10:1029139. [PMID: 36743177] doi:10.3389/fpubh.2022.1029139 
2. Roach P, Ruzycki SM, Hernandez S, et al. Prevalence and characteristics of anti-Indigenous bias among Albertan physicians: a cross-sectional survey and framework analysis. BMJ Open. 2023;13:e063178. [PMID: 36813494] doi:10.1136/bmjopen-2022-063178 
3. Cooke M, Shields T. Anti-Indigenous racism in Canadian healthcare: a scoping review of the literature. Int J Qual Health Care. 2024;36. [PMID: 39233448] doi:10.1093/intqhc/mzae089 
4. Nerestant A. Racism, prejudice contributed to Joyce Echaquan's death in hospital, Quebec coroner's inquiry concludes. CBC News. 1 October 2021. Accessed at www.cbc.ca/news/canada/montreal/joyce-echaquan-systemic-racism-quebec-government-1.6196038 on 27 April 2025. 
5. Geary A. Ignored to death: Brian Sinclair’s death caused by racism, inquest inadequate, group says. CBC News. 18 September 2017. Accessed at www.cbc.ca/news/canada/manitoba/winnipeg-brian-sinclair-report-1.4295996 on 27 April 2025. 
6. Serchen J, Mathew S, Hilden D, et al; Health and Public Policy Committee of the American College of Physicians. Supporting the health and well-being of indigenous communities: a position paper from the American College of Physicians. Ann Intern Med. 2022;175:1594-1597. [PMID: 36215716] doi:10.7326/M22-1891 

Angela Schneider, MD, MSc

Angela is a final-year general internal medicine fellow from the University of Calgary in Calgary, Alberta, Canada. She completed her bachelor’s and master’s degrees at McGill University in Montreal, Quebec, Canada. She is a current editorial fellow with Annals of Internal Medicine and is concurrently completing a postgraduate diploma in health research at Oxford University.