Monday, May 21, 2018
Opinion

Medical racism's high cost

In his new book, Black & Blue: The Origins and Consequences of Medical Racism, John Hoberman shows how racial bias among doctors negatively affects diagnosis and treatment for black patients.

The book comes at a perfect time, during the implementation of the Affordable Care Act, President Barack Obama's biggest domestic accomplishment.

In an email message, Hoberman, professor of Germanic studies at the University of Texas at Austin, wrote that the legislation "serves the medical needs of countless African-Americans by making medical care available to millions of people who have not been able to afford it. It is well known that poverty and lack of access to care do more to cause illness and premature death than any other factors."

While access to care for African-Americans is important, quality of care is crucial. But all too often and in too many medical offices and facilities nationwide, the quality of care patients receive depends on the color of their skin.

This moral shortcoming should be earnestly discussed at the highest levels of medicine, but it rarely is, Hoberman writes. It definitely is not part of medical schools' curricula.

Many studies have documented racial discrimination in U.S. medicine. As far back as 1979, for example, a team of medical authors wrote in the Journal of the American Medical Association that "it is an open secret that physicians dislike certain patients." The open secret was that African-Americans sat at the top of the list of disliked patients.

Black & Blue goes where previous studies have not. It is an unapologetic and systematic analysis of how American doctors perceive racial differences and how their opinions determine diagnoses and treatment of their black patients.

Like others who have written about medical racism, Hoberman traces the history of medical abuses of black people. But unlike others, he explores the racially driven thinking and behaviors of today's physicians, revealing the physician's private world, where racial biases and misinformation distort diagnoses and treatments.

Although many people believe that doctors are paragons of reason and are members of a unique moral community, Hoberman writes that doctors have the same racial stereotypes, believe the same tales and hold the same beliefs about racial differences in the general population.

Racial folklore is part of all "medical subdisciplines," from cardiology to gynecology to psychiatry, Hoberman argues. And doctors have placed racial identities on "every organ system of the human body, along with racial interpretations of black children, the black elderly, the black athlete, black musicality, black pain thresholds, and other aspects of black minds and bodies."

He writes that blacks are fully aware of their diminished value and mistreatment, learning long ago to distrust the white medical establishment. And they know something else: The medical profession refuses to examine itself seriously.

The relationship between blacks and the mostly white medical profession is dysfunctional, and that dysfunction has caused great medical harm to blacks, Hoberman writes. Studies regularly show that blacks in general are not as healthy as whites, but these same studies fail to reveal underlying causes of the disparities. We read about the large numbers of blacks who lack insurance, and we know that few primary care doctors practice in black communities. We rarely read, however, about the negative impact of the bias, prejudice and stereotyping by health care providers that may directly contribute to the poor health of blacks.

Many blacks hesitate to enter offices where they know their skin color alone will mark them as being unworthy of the best care.

African-American patients are not the only victims of racism, Hoberman writes. Many black doctors face the same discrimination and slights blacks seeking treatment face.

The cure for medical racism, Hoberman argues, will come only when medical schools abandon their "race-aversive curricula" and start including "real race relations training."

He also argues that black leaders outside what he refers to as the "vulnerable black medical community" should take up the cause of demanding changes in the nation's medical schools. The ugly truth, he wrote in an email message, is that "most white people are not interested in black people's problems."

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