“May be less effective in African Americans.”
I had to look at that again. In the little box where I was expecting to read something like, “Do not use while operating heavy machinery,” or “Take with food,” was an unflinching declaration that my Black mother had been prescribed a pill that – because of her Blackness, somehow– might do more harm than good.
I called the pharmacy, hoping for some clarity. “Well, it’s just that this pill…” she stammered, and began again, “The truth is, there’s really only two medications that treat this particular issue and the other one doesn’t work as well. This one is better, but doesn’t work as well, unfortunately, on African-Americans,”
“But it was prescribed and is approved as effective, despite possibly lowering kidney function in Black patients without providing any benefit?”
“So whiteness is the default for measuring efficacy…”
The pharmacist didn’t answer. She didn’t have to. I don’t know why I was surprised – nothing about medicine is without racial bias.
Black people have a curious relationship with the medical community, characterized by abrupt vacillations between contempt and mistrust and occasional hero worship. A doctor has always been one of the most lauded occupations, a sure sign someone one “made it out,” that they “made good.” We’ve always regarded our own who held the title with esteem, pronouncing a young person’s ascent to that position with a certain breathless reverence, “Oh, you know he’s a doctor, now…”
Within our community, the role hearkens back to conjurers, and shaman. Doulas and doctors work in the same fields, and pharmacology and rootwork ain’t too far removed from one another. It stands to reason that we should have great respect for medicine, but that respect for the practice is complicated by our history in this country. We are a people who for 400 plus years in this country were seen only as breeders and workers; we were bodies – and were treated as such. Centuries of medical experimentation, vivisection, sterilization and organ harvesting without our consent has made us distrustful not of the white coat but of the white people who most commonly wear them.
We can argue that science and society have changed over time, but too often today’s Black patients are still guinea pigs and placebo recipients. Medicine, like all science, builds on the learnings and understandings of the past; and archaic notions of how Black patients can be treated remain firmly entrenched in the textbooks of medical students. Add to this travesty, the realities of current legislation and policy changes that are designed to leave Black people, certainly the most vulnerable populations of us anyway, without access to adequate healthcare, and the medical space becomes a truly abysmal one for us. If our people, especially our elders, are going to survive modern healthcare, we’re going to have to rescind some of the awe and deference we afford practitioners and treat our medical care like what it is: a fight for our lives.
My mother is on her third cardiologist in 2 years. She misses her old one, a suave, older gentleman with Obama good looks and a salt-and-pepper beard. Mama used to call him Dr. SwitchyTail because she liked the way he entered (and apparently left) a room. But when Mama was in the hospital suffering a second stroke, that was being misdiagnosed by 4 different doctors who’d never treated her, her beloved cardiologist recommended a course of treatment that would result in her spending an additional 3 days in intensive care.
When I finally met him on his rounds, I asked what led him to make this diagnosis that went so horribly wrong. He told me he listened to the information from the ER doctors and the attending (who were operating on only half information because I hadn’t gotten to town yet) and authorized the treatment that sent her blood sugar spiking to levels at one point nearly 8 times her normal without even examining her. When I pressed, I found that he did not give them any medical history and asked no further questions. He reported this all with an air that suggested a shrug; an “oops my bad” that could have cost my mother her life. I had him removed from her team and filed a formal complaint.
It pained me to do that to a Black professional in the medical field, but as I told him when he challenged me on my decision, there are other Black doctors, I have one mother. My mother is of that generation that reveres doctors. In their presence, her voice gets soft. She is agreeable and eager to please. She downplays the ailments that she complains about to me because she wants to curry favor with them. She wants “a good report.”
The deference she is inclined to show them is baffling to me because Mama is of the same generation that knew the horror of the Tuskegee Experiment and saw the stolen biological material of Henrietta Lacks turned into the miracle cell line called HeLa. Her generation has known medicine at it’s most evil, and yet she and her peers consistently defer to the power of the white lab coat. And the industry knows and exploits this.
After my mother was released from the hospital (prematurely) she was in what passes for a rehabilitation facility. These are sections of understaffed nursing homes with a few segregated rooms that are afforded 1 hour of physical therapy a day. They do not provide strict specialized diets, and they do not provide daily medical care. For this, they charge insurance companies exorbitant fees which in turn, causes the insurance companies to pressure the facilities to release the patients quickly in exchange for “considerations,” and they make the patients complicit in acting against their own self interests.
One day, while I was visiting a woman came in and started chatting up my mom. She was wearing white lab coat and carrying a clipboard. She called my mom by her name and seemed to know all her symptoms.
“…So I bet you’re feeling pretty ready to get out of here, huh?”
Mama, eager to please, nodded.
“Getting pretty sick of laying around?”
“ Yes,” Mama said with a smile, “ I want to get back home.”
“Well we’re gonna try and getcha outta here, m’kay? S’at sound good?”
“Sounds great!” Mama said, still smiling.
That’s when I interrupted. “Ma’am I don’t see a name tag and I’ve not seen you before. Who are you?”
“My name’s Melinda.”
“No, who are you? You’re not the head nurse, you’re not the visiting physician I met…Who are you to my mother? What is your role in her care?”
“Oh, I’m not with the facility. I’m actually a representative from her insurance company doing an evaluation to see how your mother’s feeling and how much longer she needs to be here.”
“Are you a medical professional?”
“I’m a medical liaison.”
“Are you a doctor?”
“Sir, like I told you…”
“No. Let me tell you. You’re a vulture in a lab coat masquerading as a doctor, asking leading questions of a septuagenarian who has recently suffered brain trauma. You’re here to get her to say she no longer needs care so you can cut off her care. But have you spoken to the doctor on call? Have you spoken with her therapists? Did you ask her if she is able to go home or just if she wants to? I’m going to tell you right now, whatever decision you come to I’m going to dispute it and I’m going to report every question you asked her and exactly how you asked it.”
She looked me up and down, studied my saggy jeans, untucked shirt. She looked at my face trying to see through the dark lenses of my glasses for some hint of wavering in my stoic expression. Finding none, she left without further comment.
I am not what most medical professionals expect. I rattle off my mother’s prescriptions without stumbling over a single pronunciation or stammering over a dosage. I can recall my mother’s entire medical history — every procedure, every doctor, and often specific dates. I cross-reference their notes with the notes from other doctors and before following any recommendation, I ask if they consulted the specialists in that field who also treat my mother. If they haven’t, I provide the name and office number of the specialist and tell the doctor I’ll be alerting them to expect a call. I do all of this now from behind a pair of shades, in a hoodie and jeans, though a year or so ago, I would dress up to go to the doctor’s office.
I learned quickly, that doctors treated me differently when I was dressed for the boardroom. I didn’t like it, but I would dress the part for the sake of my mother. I needed these doctors to know from the moment I entered the room they were dealing with someone professional. When I was in street clothes the attendings in the ICU would start off with cursory dumbed down answers, and only offer detailed explanations when I pressed with specific and pointedly loaded questions. But when I had on a jacket and hard-bottoms, I became “Mr. Long” and the assurances that they were going to give my mother the best care came wrapped in a detailed exposition of the process and her continuity of care. My case is not unusual. These doctors are judging you too.
The honor of the Hippocratic oath aside, most medical professionals do a pre-diagnosis of us before they even ask about our symptoms. Black people are disproportionately affected by heart disease, diabetes and stroke. We have a higher rate of obesity than the national average, and most of this is attributable to the fact that we are disproportionately economically disadvantaged. This all factors into how we are treated.
I have had some real-talk conversations with doctors who’ve told me plainly that they don’t spend a lot of time trying to save people who aren’t interested in getting better. But how do they make the determination of someone’s commitment to health? They see poor, fat, Black people and they assume they are lazy, bad eaters who are committed to a downward slide to bad health. They see extra pounds and they assume poor health without accounting for the physiological differences in the way Black bodies carry weight. They find that Black patients avoid going to the doctor and they assume a lack of commitment to their own health, not accounting for the financial hardship a doctor’s visit represents for many underprivileged patients or the centuries of abuse Black patients have suffered at the hands of doctors, white doctors in particular.
Accordingly, severe issues go undiagnosed or put back in the patients’ court with a simple, “Well, you’re gonna need to get some of that weight off and avoid salty foods. Get more active.” They ignore us when we complain of pain and believe we are more resilient to it. These aren’t diagnoses or medical opinions, they are reframing of old social stereotypes that have been canonized in medical textbooks. In 2017, Pearson publishing was pressured into recalling textbook that among other absurd claims stated “Blacks” believe “suffering and pain are inevitable” and “report pain more intensely than other cultures.”
The mistrust we’ve historically had in medical practitioners is well-earned, and the field is moving too slowly to correct the error of centuries of bad teaching. White supremacy is alive and well in medicine, and the nasty effects of it will continue to threaten our health and well being until we get sick and tired of staying sick and tired and put Black lives over white coats. We must demand the quality care we deserve.