Jessica Nutik Zitter, New York Times, June 29, 2019
People of color have suffered from health care disparities over the whole history of our nation, usually in the form of lack of access or undertreatment. A 2017 study found that in New York City, African-Americans were significantly underrepresented in the best hospitals, even after controlling for insurance coverage.
African-Americans, including children, are more often undertreated for pain compared with their white counterparts. While 74 percent of white patients with bone fractures in an Atlanta emergency room received pain medications, 57 percent of African-Americans did. African-American children with an appendicitis were one-fifth as likely to receive opioid medications for pain, a cornerstone of care, as white children. Such inequities, the manifestations of implicit bias and institutional racism, are only the tip of the iceberg.
But there is a sadly ironic twist when it comes to disparities in dying. Although African-Americans are deprived of proper treatment for much of their lives, at the end they suffer from too much of it. They are more likely than white people to die attached to machines, their deaths stretched out, their suffering prolonged.
Why is this? Like so many difficult problems in medicine, it’s complicated, and of course it varies from case to case. As a white physician who cares primarily for African-American patients in Oakland, I have noticed two recurring themes in my work. On the patient side, there is often powerful distrust of the health care system, a fear that we doctors — who are mostly white — will deprive them in their time of need. On my side, there is my own guilt, my fear of being perceived as racist or somehow embodying an oppression I am often blind to. When these factors collide, doing more can be a temporary salve.
There are steps that white doctors like me can take to change this dynamic. One strategy is to work in partnership with other members of the hospital staff. It is an entirely different experience for me to enter a patient’s room accompanied by the African-American chaplain on our palliative care team, the Rev. Betty Clark.
Prayer can also be a bridge. Most of my African-American patients are people of faith. I used to step out of the room after discussing their medical situation, in order to “give privacy” to the patient and the family as they prayed. But Betty began inviting me to stay. I quickly came to see how much this mattered to my patients and also to me. The sense of human connection around the bed reminded me of the reasons I went into medicine in the first place: to connect with other human beings, to support their needs and to offer the best care I can.
Doctors must do a far better job of caring for African-American patients from birth all the way to death. There is so much we have to do, but a good first step would be to stay in the room and face our discomfort, instead of running away from it.