Many Americans looked upon the white supremacist rally at Charlottesville, Va. with disgust and disbelief. However, many black American looked upon the events as a reaffirmation of what they long since known: vicious racial hatred has always boiled beneath the surface. This attitude has shaped many black American’s approach to healthcare.
Many black Americans do not trust their healthcare providers to act in their best interests. Research has shown that blacks are much less likely to report trust in their physicians and hospitals; thus, are less likely to seek treatment or be compliant with recommended treatment plans.
{mosads}The medical community should care about this collective sense of black distrust in medicine, as it is a major factor in the well-documented health disparities between blacks and whites.
In many cases, when blacks have the same diseases as their white counterparts, blacks are much more likely died sooner. For instance, blacks are three times more likely to die of asthma than white Americans. Blacks have a 25 percent higher cancer death rate than their white counterparts. Black women have a 20 percent higher cancer death rate than white women. Blacks tend to develop chronic disease earlier in life and overall have shorter life expectancies when compared to whites.
Trust is not only a foundational element to a therapeutic doctor-patient relationship but also is a vital factor in patient’s decision making to seek-help early before diseases advance beyond treatment possibilities. In order to address this distrust of the U.S. healthcare system, there must be exploration of the historical roots and how prejudice operates in the modern medical context.
A historical perspective
The U.S. medical establishment has a long legacy of discriminating and exploiting black Americans, the indelible memory of which remains deeply embedded in the collective consciousness of the community. Historically, medicine has used black bodies, without consent, for its own advancement; while, medical theories, technologies, and institutions were used to reinforce systems of oppression.
In the Antebellum period, blacks were forced to participate in dissections and medical examinations. Dead black bodies, robbed from their graves, were a continuous source of surgical and anatomical experimentation. The psychiatric diagnosis of drapetomania, or “runaway slave syndrome,” was created to diagnose and pathologize African slaves who fled their vicious slave owners. To runaway from slavery was considered a disease. The treatment was often amputation of extremities.
Later during Reconstruction Era, white American doctors argued that former slaves would not thrive in a free society because their minds could not cope psychologically with freedom. In the Civil Rights era, psychiatrists used the concept of schizophrenia to portray black activists as violent, hostile, and paranoid because they threatened the racist status quo.
The Tuskegee Syphilis Study, where hundreds of black men, without their consent, were intentionally administered syphilis and denied treatment, became the very embodiment of the way medicine and medical research was weaponized against African Americans. Scholars have written for decades about the Tuskegee experiments symbolizing the racisms embedded in medicine and laying the foundation for the black communities distrust of physicians and research. Many scholars agree that although the black distrust of the health system started way before Tuskegee, this study has been become the central metaphor and focal point to explain black distrust in medicine and public health.
In modern times
As healthcare professionals, this is the cultural and social genealogy that we have inherited. Is it no surprise that blacks do not trust doctors or hospitals? Despite trends in the reduction of racial prejudice over recent decades, the marginalization of black Americans takes place at every level of the contemporary medical system.
In my work as a psychiatrist, I often observe the differential treatment of patients based on race or ethnicity. This discrimination may take the form of differential prescription patterns at times or increased restraints use in the hospital. I have observed hospital staff insistent that certain black patients were “dangerous” requiring four-point restraints, which meant that each of the limbs would be strapped to the bed.
In my own research, I have found that black Americans with mental health diagnoses are less likely to receive certain medicine for their conditions compared to whites with the same condition. Blacks are less likely to be prescribed newer, better-tolerated medicine called atypical antipsychotics. Rather, they tend to be offered older medicine with worse side effects. Specifically, a drug called Clozapine, which is considered the “Cadillac” of psychiatric medicine because of its superior effectiveness, is prescribed less in minority patients with serious mental illness when compared to white patients.
From the a time a person enters the waiting area of an emergency room or clinic to the time spent with the doctor as well as the doctor’s treatment decision-making is all influenced by race and ethnicity.
One study of emergency room records indicates that black patients are more likely than whites to receive lower triage scores for the same complaints, meaning that triage personnel rate the complaints as less serious. As a result, less serious complaints in emergency rooms translates into longer wait times. Even in case of serious medical emergency, such as in the case of stroke, where time to intervention is critical, blacks experience long wait time for stroke medications.
After long wait times, when minority patients are finally able to even see a physician, several studies have shown that physicians spend less time with blacks patients when compared to whites, and are less likely to perceive the patient as being honest regarding their symptoms.
What can we do?
The medical community must address the real sense of suspicion, distrust, and cynicism that is deeply embedded in black collective memory. Earning a patient’s trust is a very difficult feat given these historical forces, but medical education systems, hospitals, and physicians themselves can take steps to address this issue.
First, physicians, hospitals, and schools can address the role of implicit racial bias, which is often described as automatically activated and often unintentional. Implicit racial bias has proved to be a powerful, validated tool to help explain health care disparities. For instance, in one study, doctors who were found to have higher levels of implicit bias (as measure by the Implicit Association Test) were more likely to withhold treatment from a black patient.
The schools of medicine can do its part in ensuring doctors are properly trained by integrating the concept of implicit bias into the medical education curriculums. Health care organizations should also offer training to health care professionals to address implicit bias. Researchers like, Patricia Devine, Professor of Psychology at University of Wisconsin-Madison, have understood implicit bias to be a habit of the mind, and can be changed over time, if the person is aware, concerned, and interventions are employed to replace the bias.
It must be acknowledged that gaps in healthcare disparities results from of a myriad of other social determinants of health such as: education level, employment, housing, community recourses and health eating. For this reason, holding policy makers accountable for ensuring universal equity to a variety of social resources will prove to be effective at improving the health of black communities as well.
Efforts to improve the health outcomes for black Americans must acknowledge the brutal history and shadow cast from decades of discrimination and the resultant collective distrust within the community. As president Bill Clinton once apologized, “We cannot be one America when a whole segment of our nation has no trust in America.”
J. Corey Williams M.D. is a resident physician at Yale University Department of Psychiatry. He mentors inner city youth and is interested in ethnographic research in disruptive behavior disorders in children.
The views expressed by contributors are their own and are not the views of The Hill.