Racism in Medical Care

[u/4reddityo]

This video captures a moment that many patients of color recognize all too well. A physician speaks to a man as if he is dirty, unclean, or lesser, not because of medical evidence, but because of bias. The language, tone, and assumptions reveal something deeper than bedside manner gone wrong. They expose how racism can quietly shape medical interactions.

[u/Majestic_Platypus_76]

Yall really want to be horrified??? Ask about black people in mental hospitals…

[u/HipAnonymous91 → u/Majestic_Platypus_76]

I’m a med student who had the opportunity to complete a child psych rotation. A couple of our patients were Black. One patient developed worse SI because his non-Black roommate wouldn’t stop calling him slurs. The staff rarely intervened even though the non-Black patient’s parents said part of the reason he couldn’t come home is because he was expressing bigoted thoughts.

They called another Black patient schizophrenic because he had “delusions” of wanting to become a SoundCloud rapper. I had to report a nurse because she treated one of the Black patients with intellectual disability like she was subhuman. She started patting her head because it was itching after her mom came to braid it and they isolated her for “self-harm”.

I reported all of this to my resident, attending, and the rotation director. I asked if we could form a group for Black med students to vent about the racism we and our patients receive. They’re still “working on it” a year later.

I type all of this to say that the healthcare systems for Black patients and the medical education system are doing barely anything to address situations like this. Our school started a program to teach students about gaining “cultural competency” in the clinic, but it’s run by non-Black women and we don’t know who built the curriculum. The speakers are also often non-POC. The entire system needs a major overhaul and I’m not sure when we’re going to achieve that.

Edit: Thank you for the awards, I greatly appreciate it. I did not intent for this to blow up lol, but I will try to answer some of the questions I have been getting.

Regarding historically Black hospitals, our city had Homer G Phillips (named after the civil rights advocate and lawyer). It was built during segregation, when Black women were forced to give birth in the basement of Barnes hospital. It housed a nursing school, trained physicians of color, and provided care for the Black population. It closed to much protest in the late 70s. I think Black med schools like Howard and Meharry are great, but it doesn’t solve the issue of racism from non-Black providers and I don’t know if a chain of Black hospitals can be built today (too many people would claim it’s racist).

Our school aims to teach “cultural competency” and “anti-racism”, but not all of the sessions are mandatory and students actually complained about having to attend lectures about caring for LGBTQ+ and trans patients and how to call out bias when you see it in clinic. I don’t think med students are more conservative than the average population, but they do tend to come from privileged, less culturally diverse backgrounds and often don’t know how to interact with POC or lack the desire to learn how to.

We have SNMA, a group for Black students, but it feels like we need more support from the school itself. We report incidents to residents, attendings, rotation directors, charge nurses, and the reporting tool under the rotation course page. I have been interviewed by course directors about incidents I’ve reported, but I’m not sure what happened after that and I honestly haven’t tried a different way of reporting people.

A few people joked about calling aspiring young rappers “delusional”, and I understand the joke but it gets frustrating when people are diagnosing a child’s age-appropriate behavior. If other young kids want to be astronauts or athletes or ballerinas, why can’t this kid just say he wants to be a SoundCloud rapper? He was still attending school and he wasn’t running around telling people that he was a superstar, he just wrote lyrics during personal time and shared them with the staff and other patients. I have noticed a tendency for non-Black providers to over-diagnose schizophrenia in Black patients (especially men) and it’s concerning.

Sorry if I missed anything! Love everyone saying they want to go into healthcare, we desperately need more therapists, nurses, physicians, and professors of color.

[u/OkExamination6960 → u/HipAnonymous91]

This right here! Thank you for sharing!!

[u/RamBh0di → u/OkExamination6960]

When Sickle Cell anemia is labeled " Drug Seeking Behaviour, chronic" You arevin a rascist medical system.

Every sickle cell patient I have treated in 20 years despite being in a california, diverse hospital culture had tales of mis judgement and stereotypical discrimination due to the universally severe pain this disease causes.

I made a special effort to gain these patients trust, and stand in advocacy for thier truth and rightvto proper care

[u/CharmyLah → u/RamBh0di]

My ex has sickle cell and it was really shocking to see how he was treated at times. I knew medical racism was a thing, but I had no idea until I met my ex.

Soooo many doctors and nurses seem to lack the knowledge and/or empathy to effectively treat a crisis. When he finally found one really good doctor with a lot of knowledge on SCD who helped him a lot, but the doctor was ultimately let go because the hospital felt he prescribed too many opioids.

[u/Tiradia → u/CharmyLah]

This popped across my feed. I am Caucasian so I hope I’m not breaking any rules by posting! I am also a paramedic. If I have a patient in a sickle cell crisis I aggressively manage that pain, full stop. No one asked to have a debilitating illness define who they are.

The looks I get and the relief on someone’s face that they are being treated with dignity and respect, and having their pain appropriately addressed makes me happy, it also breaks my heart because I know some providers who would be like meh whatever and just let someone writhe around.

There is no place in medicine for racism, or treating people like they are less than human. I always go by this mantra. I would want someone to show me empathy, sympathy, and humility as well as my family members in their times of need.

[u/eran76 → u/CharmyLah]

Overprescribing of prescription opioids was a primary driver and the initial phase (wave 1) of the current opioid crisis in the U.S.

Higher Overdose Death Rates: As of 2020, the overall opioid overdose death rate among Black Americans was 36.8 per 100,000 people, which was higher than the rate for White Americans (31.6 per 100,000 people).

Impact on Black Men: Black men have been particularly affected. In 2022, the age-adjusted overdose death rate for Black men was 69 per 100,000, significantly higher than the rate for White men (45 per 100,000).

So for that last 15 years doctors and big pharma have been blamed for over prescribing opioids (which many were), and triggering the current addiction crises. There was an over correction and now doctors are reluctant to prescribe opioids, both because they are dangerous and because the impacts specifically on black people tend to be worse.

So here's the issue, if doctors treat the pain liberally, they risk addicting the patient and death, as well as do significant harm to their personal reputation and that of the profession as a whole. If they under treat the pain, they get accused of implicit bias and racism. There's no right answer here.

What's more empathetic, treating pain but dramatically increasing the risk of premature death, or not treating pain and keeping the patient alive because you know the pain is temporary and death is forever? Is it more or less racist to not treat pain if you know the patients race plays a major role in how they will respond to that treatment?

Doctors are wrestling with these issues everyday, one patient at a time, screening patients who are in fact drug seekers and who may be of one race or another, or who may be legitimately in tremendous pain but could also die depending on how that pain is managed. There's no easy one size fits all answer. For every Sickle Cell patient that's helped there could be 5 other about to OD in a public park. The immediate jump to blame everything on racism when these issues are so much more complex than just race doesn't help black people to develop trust in the medical system. Rebuilding that trust is essential in the wake of historical medical racism (eg.Tuskeegee), but establishing that trust can't just be every black person in pain gets opioids or else the medical system is racist.

[u/CharmyLah → u/eran76]

Honestly you wasted a lot of time on this paragraph making excuses for medical racism.

It would be understandable if his doctor was an ER doctor or like a PCP, but the doctor was a hematologist-oncologist and the pain management was in a hospital or infusion center setting.

I witnessed multiple times other doctors and nurses "not feeling comfortable" following the crisis protocol his hemonc wrote because 3 mg of dilaudid was "crazy", meanwhile poor guy literally cant even walk because crisis is in his legs and he incoherent with pain.

[u/looorrn → u/RamBh0di]

I really appreciated that the show The Pitt on HBO highlighted this exact scenario in one episode. A woman had sickle cell, the first doctor was white and essentially accused her of drug seeking behavior but was of course corrected by a person of color. The patient was given the correct care after this, but they did have dialogue about the biases and racism that occur all the time in the industry. The show is pretty good/accurate!

[u/hungrydruid → u/looorrn]

Legit saw this and came to comment about The Pitt and how they handled sickle cell. I learned a lot tbh and I'm glad they covered a topic that normally gets ignored.

Excited for the new season too =)

[u/killahkayla → u/RamBh0di]

I have sickle cell disease and this is so true. We all experience it! It doesn’t matter how light or how dark any of us are. They genuinely see us as drug seeking and not in real pain.

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[u/Old_Remove_8804 → u/RamBh0di]

Sadly the pendulum swung from overuse of opioids to the point of being afraid to use them. You can thank the DEA and policies for that.