Understanding History: A First Step in Advocating for Black Patients

Written by Alana Castro-Gilliard, OMS IV, Edward Via College of Osteopathic Medicine - Virginia Campus, AACOM Osteopathic Health Policy Intern.

As an introduction to this piece, it is important for me to note that I am not Black and not able to fully understand what Black patients or Black health professionals experience. I am a white Latina and OBGYN-to-be intending to highlight the importance of non-Black healthcare professionals working to learn from, and transcend, our American healthcare system’s generations of racial inequities. I am not the first to share these stories and I know that there are many more layers to add to this discussion. As healthcare professionals, it is our job to work through the lens of cultural humility, to break down our own implicit biases through historical and self-education and to create a healthy culture of accountability in healthcare teams.

I have seen the unfair treatment of Black patients as a medical student. I have most certainly also spoken or made decisions led by my own implicit biases. Recognizing and admitting that I have these biases has been a vital step in my training to become a physician, as has learning that discrimination can come in many  forms, from higher rates of negative patient descriptors and decreased pain treatment for Black patients, to lack of representation and pay inequality for Black physicians. Non-Black healthcare professionals must work harder to address these inequities because change should not be the sole responsibility of historically marginalized populations.

Non-Black health professionals should also understand the many examples that history provides for why they may not be seen as trustworthy in the eyes of patients of color. By learning historical context, we can begin the work to repair this relationship. There are many well-known examples, such as Marion Sims and his performance of unanesthetized surgery on enslaved women in the 1800s, and the 40-year, non-consensual Tuskegee syphilis study on Black men in the 1900s. I would also like to share a more personal, and potentially more common, example of how patients of color’s parents, grandparents and other family members’ negative experiences in hospitals continue to affect care delivery today.

While I was an undergraduate student in a research ethics course, a public health professional shared a conversation that they had with a research participant at the institution. The research participant, a Black woman, shared that my university was unlikely to recruit many members of the Black community to join their study due to past mistreatment. Patients who sought care at this hospital system a few decades back were placed in a basement with no windows, no dividers between beds, unwashed sheets, few light bulbs and often blood on the floors from previous patients. The patients were told that if they wanted a clean environment, they would have to do it themselves because no hospital worker should have to clean up after them. Experiences like these can’t help but forever affect and influence you and your family’s interactions with a hospital and its staff.

We must do better, and we can start by educating ourselves. We must learn from medical history so as not to repeat it, and so that we can better empathize with our patients. Medical school and residency program leadership can help by spearheading these efforts, by teaching about implicit bias and creating spaces where people can admit that they have biases of their own so that they work to reduce their harmful effects. If you are a non-Black physician and your gut reaction is to describe a Black patient as “non-compliant,” “refusing care,” “a frequent flyer” or “difficult,” ask yourself instead, was this patient trying to advocate for themself and/or was I doing a poor job of trying to understand their values?

The principles of biomedical ethics are beneficence, non-maleficence, autonomy and justice. This month, and every month, I implore you to better integrate these principles into every patient interaction, and to reflect on the injustices our predecessors have placed on Black and other marginalized populations and that we continue to place on Black patients now. Ask yourself where you could do better, and then do so.