Is It More Than White Coat Syndrome?
Implicit Bias in the Medical Field
By Shereá Denise
A few months ago I wrote a blog post about inequality in healthcare, particularly for Black women (Ain’t I A Woman?). Due to a recent medical issue, I felt compelled to revisit the conversation about how racism and implicit bias impact healthcare, particularly for Black women.
Implicit racial/ethnic bias among health care professionals has been examined multiple times and in multiple ways. We have seen it discussed with regards to Black women’s mortality during childbirth, as well as with the use of Black bodies for things like the Tuskegee Study (beginning in 1932). We have also heard it referenced in regards to legal issues of consent, particularly in conversations about Henrietta Lacks (1951).
A 2015 systematic review of racial/ethnic bias among medical professionals stated that: “In the United States, people of color face disparities in access to health care, the quality of care received, and health outcomes. The attitudes and behaviors of health care providers have been identified as one of many factors that contribute to health disparities.” To be more specific about what implicit bias is, the same review stated that: “Implicit attitudes are thoughts and feelings that often exist outside of conscious awareness, and thus are difficult to consciously acknowledge and control. These attitudes are often automatically activated and can influence human behavior without conscious volition.”
It would seem that, in 2020, we would have experienced such growth as a nation that there would be no reason to still be discussing implicit bias, that people would be so self-aware that we would not have to talk about how medical professionals mishandle Black bodies and mistreat Black people. As if 1932 and 1951 were not enough, in the last several weeks I have heard and read about at least one Black mother and her unborn child losing their lives due to undiagnosed preeclampsia and about Black people being used (primarily in African countries) to test vaccines for COVID-19.
When will the medical field stop seeing Black people as glorified guinea pigs whose lives can be lost in the name of excuses and experimentation?
We have been continuously reminded that Black lives matter since the murder of Trayvon Martin in 2013. Despite the fact that we primarily use the BLM chant as a response to legal injustices and police brutality, we must keep in mind that Black lives also matter in the doctor’s office.
Look at the men of the Tuskegee Study. Their experiences predict things like COVID-19 vaccines being tested on African people. The beliefs of medical professionals - whether correct or incorrect, whether justified or unjustified - should not determine how they view Black patients. Their beliefs should have no bearings on their ability to provide quality care to Black patients or on their ability to decide not to treat human beings as test animals.
To be clear, police officers and white vigilantes are not the only ones taking Black lives. Medical professionals are too.
On June 10, 2020, I began to feel pain in my back. Assuming that I had slept wrong, I continued on about my normal day until June 12, 2020, when I noticed what felt like a large swollen area in the middle of my back. The pain continued to intensify and, by June 14, 2020, I was sitting in Urgent Care hearing a white female Nurse Practitioner explain to me that she believed an antibiotic cream and a few doses of an antibiotic medication would cure what appeared to be an infected area in my back. I did not push back on her decision because the only other medical provider who was present at the facility was the same white male Physician who misdiagnosed me in the Fall of 2019. In fact, I was relieved that she had diagnosed me so quickly and that I would not be forced to encounter him again.
After a week, the swollen area on my back was continuing to grow and hurt worse. I could barely move my arms without being on the verge of tears. I was not able to do much more than lay face first in my bed and pray that, by some divine intervention, this pain would leave my body. With only a few antibiotics left, I decided to see my Primary Care Physician, a Black woman. While she did not openly criticize the course of treatment that the Urgent Care Nurse Practitioner had recommended, it was clear that she did not agree with it. I was sent for an ultrasound, put on a stronger antibiotic, and told to abandon the topical cream that I had been given. The next afternoon a portion of my back was cut so that a large sebaceous cyst and the surrounding infected pus could be removed. I had a skin infection - possibly from the cream given to me - as well as an internal infection that tested positive for bacteria.
In the weeks following the procedure, I still had to go to the doctor’s office routinely for wound care. At one of my last visits I was informed that, though they did not want to scare me after the original procedure, my Physician believed that - if I had waited a few more days to come see her - I would have had sepsis, causing me to be hospitalized.
Since the procedure, I have had another encounter with White nursing staff who seemed fairly incompetent at ensuring proper wound care, causing me to begin experiencing increased pain in and around the incision on my back. Thankfully, a Black Nurse took charge of my care and I have had little to no issues since.
Thank God for Black women.
Throughout this process, I kept being reminded of the video circulating on the internet where an unidentified woman pretending to be a Nurse jokingly danced to the sound of a patient (played by the same woman) coughing and gasping for air. While I am sure that the woman anticipated laughs and applause for her dance skills, many Black women took offense to her antics. Why? Because we struggle enough to have quality access to healthcare, let alone to get (perhaps unknowingly) biased medical professionals to listen to our concerns and take our symptoms seriously. (Also - as an aside - is it really that shocking that the Black Community does not find this amusing? I mean, we are the same community that continues to hear the words “I can’t breathe” echoed by our brothers and sisters as they are being killed in the streets by white police officers.)
I cannot begin to pretend to know the backgrounds or experiences of the white medical professionals that I have encountered since September 2019, but I can say that I have reached a point where I believe it is necessary to find medical providers who understand me better than many of the ones that I currently have. In light of my increased efforts to support Black businesses, I am also taking it upon myself to ensure that as many of my providers are Black women and/or Women of Color as possible. Though this has proven somewhat difficult in The Bible Belt South, I am nonetheless becoming more educated about what provider options exist in my state.
While my own solution has been to look for more providers of color who I am more comfortable with, I recognize that others may forego medical attention altogether because they do not trust medical professionals or because they anticipate that their illnesses will be trivialized, as demonstrated in the video referenced above. I do not agree with that approach, but I certainly understand the inclination. After all, there have been attacks on Black people over and over and over again since this country’s deceptive founding.
The attacks have not only come from those with whips and chains and ready access to the auction block. The attacks have not only been at the hands of those professing to protect and serve. The attacks have also been perpetuated by those swearing to be zealous advocates yet failing to do their due diligence. And so often - too often - the attacks have been perpetrated by those taking medical oaths, affirming their intention to act with equality and justice in mind, yet failing their patients and causing unnecessary illnesses and deaths.
People say they are tired of hearing that Black lives matter. Meanwhile I am tired of how frequently the point is driven home that our lives do not seem to matter at all.
In the event that you would like to find more physicians of color near you, make sure to check out apps such as the Health in her HUE or utilize everyone’s favorite search engine, Google.