Chapter 19: Medical Racism Is Real.

How The Color Of Your Skin Affects The Quality Of Your Diagnosis. And What You Can Do About It.

Kevin Wake called 911 from home as he realized that he was beginning to have a stroke. By the time the ambulance arrived, he was unable to speak or use his right side. He was conscious and could hear and see everything but couldn’t respond. The EMTs presented Wake to the emergency room as a suspected drug abuser overdosing based on just one observed fact: he was a Black man in Chicago. They didn’t know he had called it in or that he had said stroke to the operator. They didn’t know he was a successful pharmaceutical sales representative. He says he could hear the emergency room staff discuss his non-existent overdose. He became so angry that in a miraculous burst of strength he finally managed to signal for a pen with his left hand. Wake scratched down three words that saved his life: sickle cell stroke.

When patients need medical attention, we anticipate that we’ll be helped by caring experts regardless of who we are or where we come from. Patients of color in America have learned to check their anticipation at the door and replace it with unanchored hope.

If you are a patient of color, especially if you’re of African or Hispanic ancestry, your chances of misdiagnosis are greater than White patients and you have higher odds of suffering greater harm from diagnostic errors than Whites do. This holds true despite how wealthy, well educated, or influential you are. The unequal medical care and quality of the diagnosis you receive isn’t due to just location, education, or income. It’s impacted by doctor’s cognitive biases, along with decades of clinical studies that examined only White, male bodies, and a lack of understanding about the social determinants of biological illnesses.

Overall, there are five complex factors that impact diagnosis for patients of color:

1. Explicit Racial Bias

2. Implicit Racial Bias

3. Systemic Racial Bias

4. Lack of Trust

5. Lack of Access

1. Explicit Racial Bias

Perhaps this is what comes to mind first: pure discrimination. Simply put, some doctors and nurses are racist which can impact the quality of care for patients who meet their targeted criteria. If a dark-skinned patient seeks care from a racist, they’re unlikely to get the same level of care as a light-skinned patient.

It’s difficult for people to admit that bias might influence their diagnostic decisions. Most of them would likely protest, “I’m not a racist.” No research study can see into their hearts. Without an objective measure of who is and who isn’t racially biased, we can’t learn how much it might impact their medical decisions.

What we do know is how patients feel and what they report. According to the Pew Report Race in America, 59% of Blacks and 26% of Whites agree, “Blacks are treated less fairly than Whites when seeking medical treatment.”

The same is true of Hispanic patients. Almost two-thirds believe that they’re less likely to get the same level of medical care as White patients. And 60% think their health quality just isn’t a priority to hospitals and medical centers. When you look at Black Hispanics’ responses vs. White Hispanics’, the Black Hispanic patients report more negative experiences across every measure, 53% to 85% more.

Unfortunately, it is incredibly difficult to alter individual personal biases. There are steps you can take to help shield yourself from true racists with a stethoscope. [See Steps To Take To Protect Yourself below.]

2. Implicit Racial Bias

Everyone reading this has some sort of implicit bias. The main difference between implicit and explicit bias is whether you’re aware of your negative attitudes. Implicit racial bias occurs on an individual basis. It’s a type of cognitive bias, and like all cognitive biases, it can get in the way of an accurate diagnosis because the doctor or nurse are unconsciously weighting one type of data over another. Two of the ways implicit racial bias affects diagnosis include dismissing the patient’s information overall and downgrading the scope and quality of their pain.

Dismissed. Patients know when their voices aren’t heard. Patients of all races, ages, and genders feel judged and discarded based on some instantly observed fact of their existence, i.e., gender, weight, skin color, age, etc. Patients of color have the receipts that show their reports aren’t trusted.

In the book Invisible Visits: Black Middle Class Women in the American Healthcare System by Tina Sacks, Ph.D., she writes, “Black women are not considered credible witnesses to their own conditions.” For many of her study subjects, the main issue was not being trusted and not getting the quality of care they required and deserved.

Ignored Pain. One of the most common examples of implicit bias in medicine is that patients of color are either denied pain medications or get too little of them when White patients routinely get them. It’s significantly worse for Black patients. Even emergency medical technicians (EMTs) routinely give less pain medication to Black patients in pain for “fracture, burn, or penetrating injuries.”

The falsehood that Black people can withstand more pain than White people is sticky despite study after study disproving it. One study dug into medical students’ and residents’ (new doctors) false biological beliefs. Almost 90% of the White medical residents participating agreed, “blacks’ skin is thicker than whites.” The study also showed that these same residents “rated the black (vs. white) patient’s pain as lower and made less accurate treatment recommendations.” It’s a fundamental degrading of our shared humanity.

Actually, the opposite is true. Black patients report feeling more pain than White patients do for a wide range of medical conditions including arthritis, migraines, birthing labor, jaw pain, postoperative pain, myofascial pain, glaucoma, joint pain and AIDS.

Kevin Wake’s Sickle Cell Disease (SCD) is an extremely painful genetic blood disorder. The misshapen red blood cells get stuck in veins like a crowd trying to leave a championship game, too many bodies headed for the same exit. This prevents red blood cells from delivering enough oxygen to the body. It can lead to tissue death, immense levels of pain, and strokes, like Wake’s.

The majority of the 100 thousand patients living with SCD in America are Black. Stories and studies routinely show that SCD patients don’t get enough pain relief and what they get is often delayed.

Wake has turned his experiences into action for others as the President of a Kansas City-based Sickle Cell organization and a board member of the International Consortium for Health Outcomes Measurement (ICHOM). He wears a medical alert bracelet for SCD in the hopes that he will be able to skip the biases that impact the quality of care with solid evidence of his condition.

Children of Color. Black and Hispanic children’s pain is equally undertreated. They receive less pain medication across multiple painful medical situations, including:

• post-tonsillectomy

• broken arms or legs

• in the emergency department for abdominal pain and chronic pain

• and even after gallbladder surgery.

3. Systemic Racial Bias

The system reflects the people who design it, so medical racism is hard-baked into US healthcare. From research to emergency care, maternity to surgery, the outcomes are worse if you are Black, Hispanic, or Native American. A system this slanted may cause illness rather than heal it. When nearly every type of medical encounter is worse for specific groups of people, that’s systemic racial bias at work.

• Medical Research. Medical study participation was traditionally limited to young, mostly healthy, White men. Findings from those limited studies don’t fully apply to patients of color. Even today, non-White patients are poorly represented in clinical and drug studies. If the studies don’t include a diverse range of races and ethnicities, then medical education and training based on those studies miss key data. These knowledge gaps about patients of color hamper doctor’s ability to treat and heal them.

• Pregnancy, Labor and Delivery. Systemic racism is considered a major contributor to the much higher rates of death or harm to pregnant women of color. Despite improved techniques in the maternity ward, pregnancy, labor and delivery have become more dangerous, not less so, especially for Black women. Yes, rates of death and harm for all women and their newborn children are higher in the US than in other developed nations. However, if you are Black or Native American, the rates skyrocketwith a two-to-three-fold chance of death or harm vs. White mothers. Other studies indicate a three-to-four-fold risk of death for Black and Native American mothers. What is most infuriating is that medical systems know what needs to be done to reduce that gap but many have neither the funds or the will to do so. The statistics vary greatly by state.

• Skin Diseases. There’s a lack of training and education in diagnosing diseases on dark skin. Many skin symptoms look different on darker and lighter skin tones. For example, erythema (superficial redness) is a sign of inflammation, and purpura (purple spots caused by internal bleeding) is frequently a sign of systemic disease such as vasculitis. The reds and purples on light skin appear as dark brown or black on deeply pigmented skin.

• A Loop Effect. Does systemic medical racism also create disease? Black patients are statistically more prone to certain health conditions; including stroke, high blood pressure, heart disease, and diabetes. They might be more likely to die from cancer, especially lung cancer, than White patients. Attempts to identify if these conditions are genetic, racial or due to social determinants of health are hampered by lack of funding and complexity.
  
  Many experts believe that both health disparities and exposure to daily discrimination take a toll on the body leading to a greater likelihood you get high blood pressure, stroke, and/or heart disease. The more often you experience discrimination, the greater the impact on your health. It can become “death by a thousand cuts” instead of the natural onset of disease due to aging or family history. This is similar to the impact of Adverse Childhood Experiences (ACEs) to a lifetime of physical and mental health issues among people of all races.

4. A Lack of Trust

The ideal relationship between patient and doctor requires establishing mutual trust. But, there has been a unique history of medical research mistreatment of Black patients dating back to experiments on enslaved people. That’s resulted in a well-established and deep-rooted distrust among people of color for medical researchers, medicine and doctors in general. Two famous examples among many of medical research projects that harmed Black patients are the Tuskegee Syphilis Study and the story of Henrietta Lacks.

In 1932, the U.S. Public Health Service studied six hundred Black men in Tuskegee with and without syphilis in exchange for medical exams, food, and free burials. The “research” went on for 40 years, long after penicillin was available to treat the disease. The researchers never got patient consent, never explained what they were studying nor did they treat any of the patients.

Henrietta Lacks was a cancer patient who sought care at Johns Hopkins Medical Center in 1951. Her cervical cancer cells were the first cells cloned for use in medical research that survived the process; without her consent or compensation. The scientists who cultivated and sold her cells made millions, as did those who have used them successfully for testing drugs and treatments.

This long history has resulted in patients of color avoiding participation in clinical studies and regular visits to their doctors.

5. Reduced Access

Barriers to medical care are direct lines to poorer health overall. One of the first hurdles is getting an appointment with a doctor, a problem for every race and gender in America. Yet, Black and Hispanic patients still wait longer than White patients to be seen at their physician’s office and in the emergency department.

If the scheduler thinks your name or voice are Black or Hispanic, you’ll probably wait longer for an appointment, despite having the same insurance status as perceived white callers. Waiting means delayed diagnosis and higher rates of complication and death due to conditions like stroke, diabetes, high blood pressure, heart disease, and cancers. Delay can also lead to far more invasive treatments when simpler ones would work.

In addition, Black and Hispanic patients are less likely to have health insurance. They may live in neighborhoods with fewer primary care doctors and specialists. Hispanic patients can have additional language and cultural barriers. Given the current political battles over the federal budget and ACA, Black and Hispanic patients are likely to have even lower rates of health insurance and greater disparity in the coming months.

Steps To Take To Protect Yourself

Don’t let fear of medical racism keep you away from life-saving care. There are several things you can do to protect yourself and your family. Please save this list and share this chapter to spread the word.

1. Use your mobile phone’s medical apps so even if you’re unconscious, EMTs have access to your medical record and emergency contacts, avoiding what happened to Kevin Wake.

2. If possible, don’t go to the emergency department or any medical visit alone. Bring someone to advocate for you. Bigots don’t like witnesses.

3. Also bring a friend or hire a patient advocate to join you for key decision-making meetings, i.e., discussing surgery or a complex treatment plan.

4. Use the doctor’s or hospital’s patient portal to make your doctor appointments and avoid any unconscious scheduler bias.

5. If you are pregnant, see an OB/GYN (obstetrician/gynecologist) regularly and ask if you have any current health issues that might make your pregnancy risky. If you feel any symptoms that are concerning, don’t wait for an appointment. Call to be seen immediately or go to the emergency department of the best hospital in your area.

6. If your current doctor has used racist speech, report them to the appropriate state medical board.

7. If your current doctors are exhibiting implicit bias, seek a new practice, ideally one that reflects your culture and background. Ask friends and family, or look online for a physician of color in your area.

8. Expect evidence-based medicine. Disparity of care disappears when hospitals follow the evidence. Request relevant health screenings if your doctor doesn’t initiate them. The CDC’s guide to health for African Americans was removed in January 2025 but it’s available via the Wayback Machine. And here is a list of screenings by gender and age (but not race) that are helpful to bring with you to your next appointment.

9. Support the National Medical Association (NMA) the organization that represents African American physicians and their efforts to improve research and training.

What steps have worked for you? Please share in the comments below.

Next up, Chapter 20: Getting Old Is Not For Wimps. The Medical Challenges For Seniors And What You Can Do.

© Helene M. Epstein 2025