How Long Are You Going to Keep Your Mouth Closed? (Part 1)

From day one, when I put on my short white coat as a medical student, I wanted my contribution to the medical world to be life changing. This wasn’t for egocentric reasons; I just wanted to see people happy. I wanted a happier world, and I equated health with joy. Simple.  The strategic marketing had me (and probably most of you) believing that the road to health, which supposedly leads to joy, is everyone’s way of life. However, in the 18 years since that moment, I’ve reviewed an abundance of literature and research that’s revealed that just as everyone doesn’t have the same education, protection, and housing opportunities, everyone doesn’t receive the same quality of healthcare, either. Now that I am a teeny tiny bit older, and have more mouth, I consider it my responsibility to describe the pervasive inconsistencies that continue to harm our community.

I want to be clear: People of color do not get the same care and treatment as their White counterparts. I will no longer keep my mouth closed because silence is compliance, and silence kills by allowing incremental medical neglect, or what we call “health disparities,” that lead to early death.

As a trainee, my colleagues and I typically saw patients of low socioeconomic status and uninsured patients in a variety of clinics, some freestanding, some religion-affiliated, and others hospital-based. The patients we cared for were disproportionally people of color, specifically Black and Brown. Their conditions often ranged from small, acute issues (like broken fingers) to complex chronic conditions, like diabetes mellitus, hypertension, and chronic lung disease. These urban clinics were blatantly distinct from the fully staffed, lush physician offices found frequently in the suburbs. The mission to offer health care to those who may not otherwise receive it was undoubtedly a righteous and worthy concept. However, allowing “trainees” to practice their budding medical skills on low socioeconomic status, uninsured Black and Brown patients reminded me of the historical insults of the past. 

I thought of abuses that permitted the use of Black, Brown, and poor bodies to be used as “clinical material” for White male-only medical institutions. Surgical procedures without anesthesia, painful caustic medicinal experimentation, and anatomical dissections were common offenses cloaked in medical education throughout the United States. But during my training, I often overlooked this. My colleagues and I toiled tirelessly with the modest knowledge and resources we were given, only vaguely realizing how our Southeast Asian population’s care was limited due to the complexities of the cultural, social, and language barrier and our own personal biases. At the time, I didn’t take these acts as mismanagement, but since my gullible training days, the disparities have come into full view. How, in a profession where we swear to do no harm, could these patients seem like nothing more than a procedural exercise, like a quiz that wouldn’t be graded? Maybe institutions are doing what they think is best, but is it the best course of action for the patient?

The inclination to withhold medications that would improve a patients’ hypertension or diabetes due to the assumption that they are unable to afford it is a common practice by providers. Thus, I am using my platform to educate instead of indignantly flipping over tables.

 Here’s the proof. A study published in JAMA in December 2021, which included 16,114 patients with high blood pressure in San Francisco, found Black patients were less likely to get their blood pressure under control than those in other racial or ethnic groups. This is due to a phenomenon called “clinical inertia,” or missed opportunities to start or increase therapy for an illness at the appropriate time[1], as I have seen with my own eyes.

 Furthermore, a study published in the Journal of the American College of Radiology (JACR) in February 2021, including 385,504 Asian, Black, and White women, examined breast cancer screening access, utilization, and outcomes by race. The results demonstrated that Black women were significantly less likely to have two or more screenings overall, and the utilization of 2D mammogram instead of 3D mammogram (the better mammogram) was higher amongst Black women.

 I could continue to chuck studies at you, but I think you get the point. There is a clear line in the sand concerning who consistently gets great care and who doesn’t. People of color and people with low socioeconomic status come up short each time.

 In case you were wondering how this affects us further, health disparities are expensive. They come with a price tag of approximately $93 billion in excess medical care and $42 billion in lost productivity per year, as well as the additional losses associated with premature deaths. Keep in mind, this was the case before the pandemic. Now, those numbers are much more dire. With such a grim reality standing in the way of health that leads to joy, what can we all do for better care?

PRACTICAL SOLUTIONS (You might want to print this and put it on the fridge.)

When you’re a patient, you’re the boss. You’re consulting a healthcare provider who is there to serve you. Long gone are the days of patients blindly following doctors’ orders. When you step foot in a care facility, you’re putting your health, and sometimes, your life, in their hands. Become your own advocate. Here’s how.

1. Always bring your medicine to each visit.

2. When your provider reviews your bloodwork, or “labs,” make sure you know what normal values/ranges are for each category they test and where you fall on the spectrum of what’s normal vs. abnormal.  

3. Ask what screening tests you need and why.

4. Get access to your patient portal account so you always have your electronic medical record. This is an excellent tool to keep up with your most current health status. Usually, these portals are as simple as downloading an app on your phone, knowing your account number (which you can get from the doctor’s office), and choosing a password.

5. Ask everything you want to know about medications: why you need the ones they suggest or prescribe, alternatives to their suggestions, side effects, and of course, the cost.

6. When your doctor refers you to a specialist, ask why you need said specialist, what they will be able to do for you, how long you should expect to be in their care, what results you should expect, and how the two (or sometimes more) doctors will communicate concerning your case. When you ask the right questions, it’s harder for doctors to ignore you. Teach them how to treat you.

7. When your doctor diagnoses you with an illness, ask how they came to that conclusion, how you can manage the disease, long-term complications it can cause, potential long-term outcomes, and the ways this new diagnosis will affect your day-to-day living.

These strategies are tried and true, but they only work if you’re able to find the care you need. All too often, people of color struggle to find a healthcare professional of color or any professionals who listen and advocate on their behalf. There are agencies and organizations who can try to help you find a doctor you can trust, like health departments, churches, local NAACP chapters and of course social media, but there’s no database to point you in the direction of doctors who care. I’m sure that many of my White family and friends also suffer from the same disregard. Thus, revising healthcare policies that improve the quality of care for economically under-resourced patients and people of color will enrich the care for all.

Have you ever been on the receiving end of health disparities? Share your experience in the comments.