We would like to think that those we turn to for health care will approach all of us with the perfect blend of clinical detachment and compassion, carefully and thoroughly examining us without judgment, while at the same time doing all they can to improve our health.
Many healthcare professionals do indeed strive for and reach this ideal, but as in any field, healthcare professionals are human beings, and human beings are flawed. These flaws can, and often do, include holding implicit racial bias. And all too often, these racial biases negatively impact Black patients much more than those of other races.
One of the most common places for these biases to emerge is in the wording of medical records. Descriptors of the patients’ responses to medical advice and treatment are much more likely to be insulting toward the patient if the person is Black. For example, a Black patient is more likely to be described as “non-compliant” if their treatment does not appear to work.
An article titled “Physicians Use More Negative Words in Black Patient Records. Here’s Why That’s Harmful,” by Fran Kritz on the Very Well Health website details just some of this wording commonly found in the medical records of Black vs. White patients. In addition to words that suggest the Black patients do not comply with medical orders, descriptors such as “agitated” were much more common in the records of Black patients.
Anyone who has ever had a misdiagnosed medical condition knows that the information in your medical records is often accepted at face value by the next professional that treats you.
Once a person has a record of being noncompliant, agitated, and prone to refusing care, they will likely be approached by future healthcare providers as though they were true. This results in racial stereotypes impacting the patient’s medical treatment, even when the new healthcare provider does not hold those same racial biases.
Another way racism impacts medical care is when the word of a Black patient is not taken as often, or as seriously, as that of a White patient.
This disparity can be especially glaring when the patient is seeing a doctor for pain management. White people have higher rates of opioid addiction not because White people are naturally more prone to being opioid addicts, but because they are much more often prescribed these strong painkillers. Black patients are more likely to be assumed to be seeking drugs for recreational use.
Pregnant Black women who speak up with specific concerns about their upcoming birth are also much more likely to be brushed off than those of other races, according to a Winter 2019 article written by Amy Roeder and published in the magazine of the T.H. Chan School of Public Health at Harvard University. The article, titled “America is failing Its Black Mothers,” details situations in which everyone from tennis star Serena Williams to Black female doctors’ concerns about their own pregnancy or postpartum care were disregarded by medical professionals entrusted with their health. In some cases, this disregard even resulted in the patient’s death.
Just as Black people are often assumed to be resistant or non-compliant more often than those of other races, biased thinking can also lead to assumptions that the person will not seek proper follow-up care or tend to their overall health as well as a person of another race. Assumptions about the type of neighborhood a person lives in, their financial resources, their education, their diet, and other assumptions that might be made based on race can impact the way the healthcare provider treats the patient.
Those who like to think that blatant, ridiculous stereotypes and myths about people of other races are a thing of the past will be surprised to learn that even some of the silliest myths continue to circulate, and to impact the medical care of Black people.
When people who are not Black read statements such as “Black people’s skin is thicker than that of white people,” or “Black people’s nerve endings are less sensitive than white people,” it is tempting to smugly assume that these are antiquated beliefs from the early 1900s or the 1920s or the 1950s. They were actually reflected in a study published in 2016. The subjects of this study were not people who reported holding racist beliefs. They were not even selected from a random sample. This study surveyed first and second year medical students, people who are going to be in charge of the healthcare of others in the near future.
Fighting against these biases begins with awareness. Those who are in the healthcare field, or who are entering or planning to enter the healthcare professions, will serve many more people much better if they admit to and acknowledge biases and misinformation and work to overcome them than if they deny them.