To Heal a Mocking Bird
By Randevyn Pierre
Black Healthcare Hesitancy and Its Impact, "The 100 Series"
Request from the Waiting Room:
We All Just Want to Be Okay.
The Urge to Dodge What’s Different
As humans, we have a natural tendency to gravitate to the familiar.
We generally cling to what we understand, resist the unknown, and shun the misunderstood.
Sometimes, it’s change we silently reject, and other times people are the change being rejected, therefore becoming the object of human resistance.
When it’s people, it’s called stigma.
Stigma covers a lot of ground and morphs into many forms, but always shares the same backdrop—ignorance.
Wheel of Misfortune
When I began this blog, I assumed I knew all about medical mistrust and the origins of healthcare hesitancy among African Americans. As I began to have conversations, I realized I’d only scraped the tip of the iceberg. The more I began to dig, the more bodies of these deep-rooted issues surfaced.
The United States has a history of inequity, and although many Americans have convinced themselves that our country has seen the worst of these self-induced storms, our clouds are still drizzling with the residue of the acidic effect of racism.
Those toxic rains continue to fall on every contextual area of our land—jobs, economy, housing, education and obviously–healthcare.
In the 100 series, there are 2 primary common threads in the 5 medical stories of African American individuals and their families.
(1) Black people don’t feel they are treated with the same decency and respect as White patients by non-Black doctors.
(2) Black people have a lack of trust for the medical institution in general.
From both a historical context and personal point of view, I was aware that many Black people didn’t trust White doctors when I began this column.
I also knew many Black people didn’t trust the United States government for the same reasons (historical and cultural)—but then came these other deeply revealing layers during my conversations with interviewees:
- There are White people who don’t trust Black clinicians—for suspicion of incompetency.
- There are Black people who don’t trust Black clinicians—for suspicion of incompetency.
- There are African Americans who don’t trust foreign doctors—because there are foreign doctors who tend to have assimilate to the ideas and views of White doctors regarding Black people in the United States (and therefore interact with them with the same disdain).
- If forced into an emergency health situation, some Black people would rather take a chance being treated by a White doctor (knowing this provider may or may not have as high of a regard for their humanity) over a Black doctor who may be more relatable. This is due to Black perceptions of competency and access to technological resources among White providers being more reliable.
- There are communities of Black people who prioritize their religious faith (with medication as their back-up plan), and those who prioritize medication (with religious faith as their back-up plan).
- Other African Americans from the same or similar religious communities choose to apply confidence in both religious faith and medication simultaneously to see which will be first to deliver the desired results.
Back to the Middle
The health disparities of African Americans across the board are multi-factorial, and there has been no monolithic solution to that challenge, but one idea seems to be synonymous.
The need for more Black doctors (who can offer African American patients quality care and authentic connections) is critical. Additionally, some health experts even believe Black people are actually more likely to live longer, healthier lives if treated by Black doctors.
This seems to suggest there is more work to be done by non-Black physicians to improve relationships with African American patients—but what’s really the reward in doing so, beyond more healthy people in our communities?
Physicians (across the board) are thought to be held to a set of ethical standards, sort of like a promise to abide by a number of principles including doing good, avoiding evil and most importantly–causing no harm to others.
Additionally, there are guidelines that already state that doctors must respect patients ‘without prejudice.’ Clearly, this has not provided doctors with enough inspiration to broaden their efforts around health equity in exam rooms up until this point.
There needs to be universal accountability on a systematic level. This should also be reinforced and supported on a federal level as a matter of public health and wellness.
In my conversations with patients over the years, I’ve found that many carry the idea that those who enter the medical field do so because they are interested in applying the science of human health and healing–for everyone. These were not usually Black patients expressing these higher expectations.
Many may also assume that our government would have, from its inception, made legislative provisions necessary to establish and ensure equitable access to educational resources for people of all races pursuing a career in the practice of medicine (see Healthcare Through Angela’s Eyes Part 1 of 2).
The stories shared by African American people, in this collection, expose neglect in many different forms, highlighting a timeline of horror and the long road yet ahead of us.
It is reasonable to deduce that no matter what race, gender, or ethnic group a physician personally identifies with, a part of their responsibility when serving patients is to apply cultural humility. This is a lifelong learning process, and it is part of the commitment of being a healing practitioner.
Mockingbird’s 4 Recommended Steps to H.E.A.L.
Mockingbird has gathered some thoughts for clinicians to consider when treating Black patients based on some of the information gathered during the 100 Series of this column. If you’re a patient wondering what kind of interaction you should expect during your doctor appointments, feel free to use this as your personal accountability guide for the provider.
- Hear the patient out.
Listen to the patient’s concerns/needs without interruption. Yes, you know the body, but this person knows their body. Don’t dismiss all the years they’ve spent living in it. It’s great data!
- Empathize with their human experience (expect it to be different from your own).
Provider should resist casting biased judgments. See the person as someone’s child, mother, father, sister, or brother; objectively seek to understand how their individual culture, choices, personality, lifestyle, and/or trauma may impact the patient’s current reality and wellness needs as a human being.
- Address all medical concerns, processes, clinical treatments, and options available (first taking into consideration learnings from the patient’s H and E).
Patient appointments should begin with an acknowledgment of what’s important to them personally; provider should be objectively invested in a patient’s total health and well-being as an ultimate mark of pride in service and their level of medical excellence and expertise.
- Leave the patient with more knowledge than they had before the medical encounter.
Answers are not always available, but comfort through guidance is. People often feel worse when they feel their questions were not addressed, and worse—when they’ve been dismissed or invalidated. Even when time isn’t a commodity—an intentional appointment where the provider has spent the patient’s time wisely can make a world of difference.
Former President Barack Obama is famously quoted as saying, “we have more in common than we have things that divide us.”
This philosophy may or may not have moved the needle on this country’s politics around human decency, but perhaps it offers us a start to reducing healthcare hesitancy in exam rooms all over the United States.
Everyone wants to be okay—without the anxiety of having to cross their fingers before stepping into an exam room.
We all deserve the comfort of knowing the best effort is on the other side of our medical appointment, whether the provider looks like us or not.