The study recruited "white laypersons," white medical students, and white residents. The regular white folks were asked to judge, on a four-point scale, the level of pain they'd experience in eighteen different scenarios, like getting a paper cut or slamming your hand in the car door. They were then asked what level of pain a black or white person of the same sex in the same scenario would likely experience. Next, they responded to fifteen statements about biological differences between the races—like "Black people have thicker skin than white people" (false), "White people are less prone to strokes" (true), "Blacks have stronger immune systems" (false)—rating each on a six-point scale from one (definitely untrue) to six (definitely true). Meanwhile, the 222 first-, second-, and third-year students and residents read mock cases about a black and white patient, rated their pain from zero to ten, and made recommendations for pain treatment.As the researchers anticipated, the "laypersons" who held false beliefs about biological differences rated the pain of the blacks lower than the whites. Half of the medical students and residents subscribed to at least one false belief. Twenty-five percent of the residents believed black people have thicker skin. Those with the inaccurate misconceptions then rated the pain of blacks lower than whites, and in turn made less appropriate treatment recommendations.
White doctors rate their black patients' pain lower than that of their white patients.
Even without knowledge of these studies, a long, messed-up history inevitably leads to a distrust of white doctors among people of color. Consider, for instance, that many of the earliest advances in modern gynecology were because of the heinous anesthesia-free experiments and surgeries that physician James Marion Sims performed on enslaved black women whose bodies served as sandboxes for the sadistic, privileged and curious.And then of course, there is the Tennessee Tuskegee Experiment, a 40-year study during which the US Public Health Service studied untreated syphilis in 399 black men in Alabama (and actively denied them treatment) under the guise of free healthcare from the government, all for some precious data from their autopsied corpses.These atrocities may have happened ages ago, but yesteryear's depravities leave a residue of distrust between patients of color and their white doctors.Washington, DC-based school administrator Akela Stanfield is quite familiar with that distrust. She spent a year being stereotyped by and receiving few answers from a string of doctors while trying to get to the bottom of the discomfort she'd been experiencing."Being a black female who is overweight automatically puts you in a diabetic category," she says. "They kept telling me I was 'pre-diabetic,' and I took way too many glucose tests. They were hunting for diabetes. I used to hate it—they would focus on it so much when I simply did not have diabetes."
Yesteryear's depravities leave a residue of distrust between patients of color and their white doctors.
Imani J. Walker, psychiatrist and full-time black woman, recalls shadowing an Egyptian-American doctor at Temple Hospital in North Philadelphia. The doctor asked a group of residents visiting a black patient, "What do you do at Temple if you forget a patient's name?""Look at her chart?" they wondered."Look at her arm. It's usually tattooed on her somewhere," he replied."That kind of thing was commonplace," Walker says, adding that the discrimination is not limited to white healthcare providers. "They treat people like statistics."Jennifer Braun, a white staff psychologist who provides treatment for patients deemed incompetent to stand trial at Napa State Hospital in California, ensures that she, for one, treats patients like people, not demographics, when trying to differentiate between severe mental illnesses. At the same time, she sees how patients of color can thrive when treated by a physician they are comfortable with."This is my professional and personal belief, but the cornerstone of meaningful therapy is allowing someone to bear witness to your life from a place of understanding, free from judgement," she says. "To be able to see yourself reflected in the other can lead to profound healing."
The white male doctor told Long he'd have to "bring her in so he could get her up on that table and manhandle her a bit to see what's wrong."
Walker echoes those sentiments. She recalls a suicidal patient of Chinese descent in her facility recently. The young woman was highly paranoid and talked of death constantly. After two weeks of treatment with little insight to the source of her trauma, she revealed that she was afraid she had brought shame to her family and would be viewed as a disappointment. If she had a doctor of her own ethnicity, it may have been easier for her to convey those nuances and the significance of familial shame in Chinese culture.Though cultural competency is taught in medical school, Walker says that you can't teach empathy. "I grew up in Harlem. I'm used to people in wheelchairs, doing crack outside, whatever. So if you're [a doctor] in an inner city hospital and can't see the human in these patients and aren't comfortable interacting intimately with people who don't look like you, they won't get the care they need," she says. Furthermore, because of interactions with police, she adds, patients view everybody in positions of authority as "the cops." "I let them know that I'm not that person and they can trust me," Walker says. "It helps to be able to speak the same language."
Patients of color can thrive when treated by a physician they are comfortable with.