Medical Racism and Healthcare Inequality
In the final chapter of Arlinda's life, the American healthcare system failed her in ways that were neither accidental nor isolated. Her pain was undertreated. Her symptoms were minimized. The prognosis her doctors communicated to her face was measurably more optimistic than the prognosis they recorded in their clinical notes. Each individual incident could be explained as an unfortunate circumstance. Taken together, across appointments, emergency room visits, and pharmacy waiting rooms, they revealed a pattern of prejudice.
The author set out to write a biography of his friend. It was only after documenting Arlinda's medical experiences in full that the pattern emerged. The documented reality of Black women's healthcare experiences in America was present in Arlinda's story all along. Undertreated pain, delayed diagnosis, the persistent myth of higher pain tolerance, the institutional disregard of Black women's reported symptoms. For Once in My Life does not diagnose medical racism, or spoonfeed the reader the instances of prejudice. The author decided to render one Black woman's experience with enough specificity and honesty that the reader can see it for themselves.
If systemic racism seems like it will not budge, no matter how much we try, then we have not tried enough of the right combination of tactics. Here are some ways patients and caregivers can use to gain more control of their health outcome.
Document everything in real time. Bring a notebook or use your phone to record dates, names, what was said, what was prescribed, and what was refused. The gap between verbal communication and written records only becomes visible when you have your own parallel record. Your notes are your evidence.
Request your medical records regularly and read them. Patients have a legal right to their full medical records under HIPAA. Request them after significant appointments, not only at the end of treatment. Read what your doctors wrote about you. If the clinical notes do not match what you were told in the room, ask for the reason in writing.
Bring someone with you. A second person in the examination room changes the dynamic measurably. They can take notes, ask follow-up questions, and serve as a witness if the treatment you receive needs to be documented later. For Black women especially, having an advocate present has been shown to affect how their concerns are received.
Name what you are experiencing, explicitly. Research shows that Black patients who name their concerns about bias directly receive measurably different responses than patients who do not. It should not be necessary. Tell the healthcare provider, “I want to make sure my pain is being taken as seriously as it would be for any other patient.”
Seek out Black physicians and culturally competent care when possible. Studies consistently show that Black patients receive better pain management and more thorough diagnostic workups from Black physicians. The National Medical Association maintains a physician directory. So does the Association of Black Women Physicians.
Know your right to a second opinion. A second opinion is standard medical practice. If your instinct tells you your symptoms are not being taken seriously, act on that instinct. Arlinda’s story is a cautionary tale in trusting that instinct.
If you do not have a loved one who is or might be on the receiving end of medical racism, you can still take action.
Use your presence deliberately. If you are accompanying a Black woman through medical care, do not be passive. Introduce yourself, ask questions, and make it clear that what happens in that room is being observed.
Believe Black women when they describe their medical experiences. The first and most immediate act of ending medical racism is refusing to participate in the skepticism that sustains it. When a Black woman says her pain was dismissed, believe her. When she says the wait was longer than it should have been, believe her. The social permission for dismissal depends on people around the patient echoing the institution’s doubt.
Educate yourself on the documented patterns. The myth of higher pain tolerance in Black patients is documented in peer-reviewed research. This false belief is still held by a measurable percentage of medical students and residents, even by Black healthcare providers. Name it when you encounter it.
If you work in the medical system, you can do your part to address medical racism.
Examine the gap between verbal communication and clinical documentation. A verbal prognosis that diverges from the written record is all too common. Institutions that audit their communication patterns for racial disparity consistently find them. Commit to that audit.
Require implicit bias training that goes beyond awareness. Awareness training without behavioral accountability produces awareness without change. Effective programs build in observable practice changes and measure outcomes by patient demographics over time.
Diversify medical school enrollment and residency pipelines. The single most evidence-supported intervention for reducing racial health disparities is increasing the number of Black physicians practicing in underserved communities. Institutional commitment to pipeline programs is the foundation of structural change.
Create patient advocacy infrastructure. Hospitals that employ patient advocates show measurably better outcomes for minority patients. Advocates are individuals whose job is to represent the patient’s interests rather than the institution’s. It is a policy decision, not a cultural one, and it can be made at the administrative level.
Audit pain management prescribing by race. The data on racial disparities in pain management is consistent across decades and institutions. Hospitals that audit their own prescribing patterns by patient race and then act on what they find are demonstrating institutional accountability. Those institutions that do not audit are choosing not to know.
If you are involved in the community, you can be the cause for change.
Support the Black Women’s Health Imperative and similar organizations. The Black Women’s Health Imperative has been advocating for Black women’s health equity since 1983. So has the National Medical Association. These organizations perform policy, research, and community education work that individual action cannot replicate. Supporting them financially and politically will amplify all other efforts on this list.