My very good friend, Jessica, was out on one of her daily social-distanced strolls, when out of nowhere, a dog ran towards her and bit her on the leg.
The owner of the dog, who was very apologetic, called 911 immediately. The bite was so bad that Jessica had to get 16 stitches. While at the ER, no doctor asked her of her pain level. Moreover, after stitching her, they sent her home and told her to take Advil.
Jessica is a woman who identifies as black. When she shared her experience with me, I was as upset as she was. I had certainly had my share of bad experiences in the doctors office. Even more upsetting, I have had bad experiences, demanded better, then got better treatment once the hospital staff realized I knew the appropriate standards for care, including the types of medications I was entitled to for my pain or other ailments.
Discrimination towards women of African descent in doctors offices is pervasive. Many white medical professionals (half according to some reports, but I’d argue more) believe the myths that black people have “thicker skin than white people,” their “nerve endings are less sensitive than white people’s,” and “black people’s blood coagulates more quickly than white people’s” (only about 5% of physicians in America are African American (AAMC, 2019)). According to the Association of American Medical Colleges, 40% of first and second-year medical students endorse the belief that black people’s skin is thicker than white people’s.
These implicit biases influence how doctors treat black patients, meet their requests, and manage their pain. Black women are particularly at risk due to medical care associated with reproductive health and childbirth. Furthermore, social class, income, and medical insurance have little to do with racial discrimination. Black middle class women experience higher stillbirths (the baby dies before or during delivery) and maternal mortality (the mother dies before or during delivery) than white women of lower class, largely due to racial bias among doctors (CDC, 2019).
When black women share their symptoms with doctors, they are often not believed. In more extreme cases, black women are misdiagnosed as having borderline or histrionic personality disorder when simple tests would reveal biological causes for the pain they report experiencing (NCBI, 2015).
Even tennis great Serena Williams discussed in Vogue how implicit racism among medical professionals almost cost her and her baby their lives:
Because of her history of blood clots, and because she was off her daily anticoagulant regimen due to the recent surgery, she immediately assumed she was having another pulmonary embolism. (Serena lives in fear of blood clots.) She walked out of the hospital room so her mother wouldn’t worry and told the nearest nurse, between gasps, that she needed a CT scan with contrast and IV heparin (a blood thinner) right away. The nurse thought her pain medicine might be making her confused. But Serena insisted, and soon enough a doctor was performing an ultrasound of her legs. “I was like, a Doppler? I told you, I need a CT scan and a heparin drip,” she remembers telling the team. The ultrasound revealed nothing, so they sent her for the CT, and sure enough, several small blood clots had settled in her lungs. Minutes later she was on the drip. “I was like, listen to Dr. Williams!”
Doctors are not usually explicitly racist. They don’t often run around calling people slurs or advertising racist political views. Moreover, unless you’ve been a white person, you wouldn’t know if you’re being treated differently because of implicit racial bias. This is why if you are a woman of African descent, it is imperative that you learn as much about your body, your health, appropriate standards for treatment, and advocate for yourself aggressively. It might feel like more work up front, but it can mean the difference between your life and your death.
What You Can Do
You are always in power. Here are 5 things that you can do to increase your confidence so that when stressful situations arise, you'r ready to respond in a manner that optimizes your and your family's health outcomes.
1. Get regular checkups with your primary care physician.
Regular check ups enable medical professionals to have a documented baseline for your wellness. It’s important that your doctors know what your body is like when you are in a normal, healthy state. This way, if something has changed, changes can be more readily identified and problems can be fixed.
Also, regular check ups build rapport with your doctors, nurses, and hospital staff. People are more likely to see you as a human being when they are familiar with you. Implicit biases are heuristics (mental shortcuts) that people use when under stress. Familiarity decreases stress levels and enable more critical thinking.
2. Recognize that doctors are people too.
All of the issues that exist in the world exist in the medical profession. Doctors specialize in treating certain illnesses and conditions, but they are not experts at self awareness or mindfulness. A racist who becomes a doctor is a racist. A sexist who becomes a doctor is sexist. A homophobe who becomes a doctor is homophobic. A transphobic who becomes a doctor is transphobic. Doctors who have developed excellent bedside manner can still be biased. Knowing that doctors are people who are just as flawed as anyone else can help you to have reasonable expectations. They don’t know everything and they are not better or smarter than you. If you receive a diagnosis that doesn’t feel quite right, seek a second opinion, more tests, and, if necessary, legal action. I once called a doctor a liar to his face and walked out, not paying anything and dared anyone to charge me for the visit. Then, I got a new doctor who actually listened to me.
3. Have a knowledgable emergency contact.
I believe that everyone in the world should get basic first aid and CPR training. This way, everyone has a first responder in the home or nearby. You may know yourself. You may know your body. You may know your health history backwards and forwards. But what if you arrive to the hospital unconscious? You can’t tell anyone anything or advocate for anything if you are not responsive. Have ongoing conversations with the people in your household, your friends, and specific people in your community about your health needs. Since you’ve built a relationship with your primary care physician, they’ll have your emergency contact(s) on file. Your emergency contacts will advocate for you on your behalf.
4. Become the knowledgeable emergency contact.
Be an advocate for the health and wellness of the people in your family. You don't have to go to an expensive medical school to get basic first responder education and detailed information about the health conditions of the people in your life. The more you learn, the more you teach. Then, everyone around you knows as much as you do. That's a set up for success.
5. Make a whole lot of noise
It is better to be perceived as trouble than to be perceived as painless in a painful situation. If you feel pain, scream, yell, and do whatever you have to do to get the help you need. Demand the pain medications that you know work for you or you have used in the past. Demand the best pain management, and let people in hospitals know that you have advocacy. You deserve the best possible medical care in the world. Know this and demand it.
My friend, Jessica, did some research, shared her experience, and discussed on her social media the real implicit biases that exist in the medical profession towards black people, especially black women. As a result, I was compelled to write this piece and continue sharing this information. Until all people are treated equally in every circumstance by the trained professionals who are supposed to look out for us, we will continue to tell these stories and share this information. Now you can too. The more we talk about it, the more things change.
Dr. Cathryn D. Blue, PhD is a social psychologist, race and identity researcher, and contributor to Kahnma.com