Opening of anatomical theater at medical faculty at Bogomolets National Medical University circa 1853
Unknown author. Creative Commons Attribution-Share Alike 4.0
When I read the program for any
medical meeting, such as the annual American Psychiatric Convention, there has for years been a plethora of talks and forums about racism in medicine, equity
and diversity, and the like. Perhaps medical offices really are rife with bigotry and a lack of concern for minorities – particularly black
people.
Now don’t get me wrong. I’m sure there is still some racism in medical practice perpetrated by today’s doctors, just as in the rest of society. But people seem to lose sight of the fact that there has been tremendous progress in decreasing it in most of U.S. society. As author Steven Pinker writes in his book Enlightenment Now: "But it's in the nature of progress that it erases its tracks, and its champions fixate on the remaining injustices and forget how far we have come." (p. 215).
I once got into an argument with a young African American woman about this. She said there hadn’t been any progress here, even after the civil rights movement! The odd thing was that at the time we were enjoying a meal at a restaurant here in Memphis. I reminded her that when I was a kid, we wouldn’t have been allowed to eat together like that. In fact, she probably would not have been allowed in the restaurant at all. Her answer? Something to the effect of “Well, they still don’t like us here. It was probably better when it was out in the open.” Really?
The problem with poor outcomes in medical treatment for Black patients has several different causes besides racism, such as poverty, the crazy medical insurance situation in the U.S., and what I'm about to talk about. To hasten further progress, ALL of the various causes should be addressed. And before accusing me of "blaming the victim" in what I'm about to discuss, please keep two things in mind. 1. Just because behavior can be easily understood and justified does not automatically mean that it can't also be counterproductive. 2. When it comes to the results of repetitive human interactions in current U.S. society, "It's all my fault" and "I had nothing to do with it" are almost always false positions to take.
I’ve written before about the “game
without end” aspect of relationships between Blacks and Whites (7/23/13,
1/17/13, 4/3/12). The basic point is that a lot of difficulties in the current
relationships between Blacks and Whites stems from past racism, not current racism.
In a study
presented at the 2023 American
Association for the Advancement of Science annual meeting, Somnath Saha reported that he had came across
a cluster of studies showing that black people with cardiovascular disease were
treated less aggressively compared to White people. This professor of medicine
at Johns Hopkins University began poring through medical records. He found
that doctors are more likely to use negative
language when describing a Black patient than they are with a White patient. He found them described as “really difficult,”
“non-compliant,” and “uninterested in their health.” He attributed this to implicit bias by physicians— unconscious
judgments that can affect behavior.
Now, again, implicit bias is a real thing. We ALL profile other people, because we can't read minds. But is that the whole picture? Two studies bring up an important point. In an article talking about Saha’s
study, Antoinette M. Schoenthaler (a professor of population health and
medicine at New York University's Grossman School of Medicine),
said that disparities in pain management are pervasive and widespread across
the medical profession. But she also mentions a reason for it that is seldom
brought up: "Patients of color go
into an appointment with feelings of heightened anxiety because they're expecting mistreatment.; we've seen minoritized patients
have higher blood pressure in the context of a clinical visit because of these
expectations of anxiety and fear, and disappointment."
Medical
mistrust leads to greater health disparities in minority communities, according
to a poster presentation at DNPs of Color annual meeting held in Washington,
DC, October, 2023. It is not a phenomenon but a “true
medical issue,” said Clydie Coward-Murrell, MSN-Ed, BSN, RN, an African-American. “This clinical
issue is not as prevalent in other minority communities simply because of the
atrocities in health care that African Americans had to suffer for hundreds of
years.
Can anyone blame black patients for being suspicious of white
doctors? They seem to all know about the Tuskeegee syphillus experiment in which severe
damage was done to black patients. They may even know that black surgery
patients were in the past given less anesthesia than whites because doctors
thought they had a higher pain tolerance – a myth left over from slavery times
invented by slaveowners so they would not feel so bad about whipping them. They'd literally have to be crazy to completely trust doctors.
So maybe that’s part of why they seem to be angry and
non-compliant with medical treatments? And if that’s true, then couldn’t that
be a significant factor in explaining why other studies show that black
patients seem to have worse outcomes than white patients with similar
conditions? Because they don’t follow doctors’ orders as blindly? In that vein, let me tell you what one of my black psychotherapy patients told me: She had to hide the fact
that she was seeing a therapist because her fellow church members would
give her an extremely nasty round of criticism if they knew. Accusing her of just not praying hard
enough.
In my own experience as a medical student, resident, and psychiatrist, I have not personally witnessed a whole lot of obvious racism in my instructors and colleagues. Of course I am not black so I might not have seen racism that was present since it would not be directed at me. But I was a residency training director at a Southern medical school for 16 years. I had a lot of black psychiatry residents, and none of them complained about this.
We were told by the dean in
charge of residency programs that, although our school did not have affirmative
action, if there was a black applicant and a white one of roughly equal
qualifications, to take the black one.
The only time I ever personally witnessed really nasty racism
(and simultaneous sexism) among doctors was way back in the early 70’s when I
was a medical student in San Francisco. Clearly, my school was ahead of its
time so I had a biased sample – my class was 20% female at a time when there were a lot fewer elsewhere (there are now more female medical students than male ones). A Black
female classmate wanted to become an orthopedic surgeon. Surgeons were by far
the biggest Neanderthals for these issues back then. Boy, did they ever give
her a raft you know what when she applied.
So all this talk among doctors about how racist they all are is not something that only they hear. Black people hear it too. So what they are hearing is that they are right
to be suspicious of white doctors. While racism in medicine must still be addressed, talking about it way too much has the potential to backfire and make the problem worse rather than better.
