In my recent TEDx Talk titled, Why Black Patients Don’t Trust the Healthcare System, I explored racially-based medical algorithms and their impact on health outcomes for Black patients. As a physician, I believe such algorithms have no place in the modern healthcare system, as they can affect how Black patients are diagnosed and the morbidity and mortality rates in the community.
A study published as recently as 2016 by the Proceedings of the National Academies of Science showed that 40 percent of first- and second-year medical students endorsed the false belief that “Black people’s skin is thicker than white people’s” and that trainees who believed Black people are not as sensitive to pain as white people were less likely to treat Black people’s pain appropriately. Another troubling report found that Black children diagnosed with appendicitis (which is extremely painful), were less likely to get pain medication in the emergency room than white children.
There is also the issue of the misguided notion that if someone is in pain, they must “present” (look and sound) a certain way. For Black patients, especially, if you don’t look tired or pained or display a discernibly dismayed facial expression, a practitioner may assume you are not in pain. Yet pain cannot be placed in a lane in this way. There are various components that make up the experience of, and reaction to, pain — and unfortunately for people of color, that’s not being addressed equally.
Inadequate tools, erroneous markers
Studies have even shown that some medical equipment may not accurately read Black patients’ results. Recent studies suggested that the oximeter, a critical tool for tracking the health of COVID-19 patients, inaccurately measures oxygen levels in people with darker skin tones, resulting in Black patients receiving less oxygen treatment than white patients. Anyone who has experienced a difficult respiratory situation knows it is not comfortable and can even be painful. When you use a tool that doesn’t work the same for every person and couple it with not addressing that patient’s pain, it can affect diagnosis, early care decisions and mortality/morbidity.
Additionally, there are still many wrong-headed, systemic racial practices in place in the medical field today. One is that the system tends to add a marker for Black patients indicating that their kidneys are likely healthier than non-Blacks — yet the kidneys of a Black person and a white person are the same. The practice of assuming otherwise can lead to poor health outcomes — for no other reason than it is what has always been done.
A Black person may be diagnosed with kidney disease later than might otherwise occur, and there could thus be (preventable) complications and pain because it wasn’t treated sooner. An e-medical journal found that this situation is keeping approximately 31,000 Black Americans off the kidney transplant list, while 300,000 are kept from qualifying for a nephrology referral, and 3.3 million are outside of the threshold for stage 3 chronic kidney disease.
Acknowledging pain, addressing biases
We have to understand that race is a social construct. It is not genetic. (There are diseases that affect certain ethnicities in greater numbers, but that’s not the same as making sweeping assumptions about members of a certain race.) Assuming we know someone’s pain scale based on their race and/or color of their skin is hurting people and affecting Black lives every day.
Pain should be treated according to how a patient is feeling and the circumstances surrounding it, not based on race. This takes time, effort, and, most importantly, a practitioner listening to and acknowledging what a patient is saying. Unfortunately, this is not happening for everybody because of unconscious or implicit biases.
Moving forward, to deliver equitable care, health care providers must take a step back and acknowledge biases where they exist. Providers who do not cannot fully take in what a patient is sharing with them. Additionally, more work needs to be done in schools that train health care professionals. It’s not just about curriculums, webinars, or having a diversity officer—it is about having sometimes difficult conversations and exposing students to the realities to help them work through uncomfortable feelings and check any biases that come to mind.
For Black patients—or any member of any marginalized group—to ensure you receive equitable and equal treatment, it is important to advocate for yourself. Speak up, ask questions, and seek different opinions if you don’t feel like you are being heard. Keep asking for what you deserve, and do not allow your pain to be dismissed.
For members of the broader community, it is important to note that biases don’t just affect people of color, it affects us all. Every person deserves the opportunity to receive quality medical care, and when that doesn’t happen, mistrust, rifts, and ill feelings develop between groups — and within the health care system. We all should advocate for change.
Bayo Curry-Winchell is a family physician and can be reached at Dr. BCW and on TikTok, Instagram, LinkedIn, and Twitter @DR_BCW. Dr. Curry-Winchell is Medical Director of Community Engagement and Health Equity, Co-Lead of Diversity, Equity, Inclusion, and Belonging, and Medical Director of Urgent Care Clinics, Carbon Health and Saint Mary’s Regional Medical Center, Reno, NV. This article originally appeared in the Nevada Independent.
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