What is Race?
Race may be a central part of our self-concepts within racially diverse, North American societies. Although its ubiquity may make it seem as though it is an indisputable, physical, or biological fact about people, the reality is that race is a social construct. That is, race exists within our collective social understanding of it. For example, the definition of “Blackness” has not been constant over time or across regions. In America in the early twentieth century, there were different criteria for deciding whether somebody was Black based on varying levels of African ancestry (Dreyup & Graves, 2022). It is important to remember, though, that just because race is not biologically based does not mean that we should disregard it entirely. Just as money is a social construct that shapes our lives, race affects many, if not all, facets of our lives, too. One domain in which race can influence people’s experiences is healthcare. Misconceptions about race that are held by the public and by healthcare providers can have serious implications for the healthcare and health outcomes of racialized people.
Race and Healthcare
Race is regularly included in various diagnostic tools as a factor that can influence health concerns. Below, we explore three areas of healthcare in which a patient’s race can affect the diagnoses and treatment plans they receive.
Nephrology
Physicians use specific assessments to determine if their patients should receive kidney disease diagnoses, get referred to specialists, or be eligible for kidney transplants (Tsai et al., 2021). Race is included in equations used by physicians to assess their patients’ kidney function. Specifically, Black patients' scores are systematically made higher, and this can affect the care they receive for kidney disease management. This inflation can disadvantage Black patients by inaccurately placing them above thresholds that would qualify them for care for their kidney health.
Pain Management
Pain management is an important part of many patients’ healthcare plans. However, there are unfortunately disparities in how people of different races receive pain assessments or pain medication. For example, one study found that Black, Asian, and Hispanic patients received fewer postpartum pain assessments than White patients (Garvick et al., 2023). Additionally, minority patients were less likely to receive painkillers despite having similar illnesses or injuries (Garvick et al., 2023). Having poor pain management plans can reduce patients’ quality of life. They will have reduced physical and mental health from dealing with chronic pain, they may have a reduced capacity to do their work, which may cause financial strain, and they may be less able to engage in social activities.
Obstetrics
When people become pregnant after having a cesarean section, they are assessed for risk if they were to have a vaginal birth for their current pregnancy (Vyas et al., 2022). Black and Hispanic women are predicted to have a higher risk of having an unsuccessful delivery. Although other variables also are related to vaginal birth outcomes, they are not considered in the assessments. In the United States, minority women have cesarean section births at higher rates than White women. This is concerning because cesarean births are often associated with worse maternal health outcomes, which, as Vyas et al. (2022) note, may exacerbate existing elevated rates of maternal mortality for Black people.
Additionally, Black people have higher rates of miscarriages, and Black and Puerto Rican women have higher rates of preterm births when compared to white women (Bryant et al., 2010). While the exact reason for this disparity is unknown, social and structural barriers that are associated with race may be partly responsible. For example, Black and non-Black Latin American people are more likely to be of lower socioeconomic status, so they will have to deal with stressors that come with those experiences (Bryant et al., 2010). They will also be less likely to be able to access resources like appropriate prenatal care.
How can Healthcare Providers Advocate for their Patients?
Believe your Patients When They Tell you They’re Not Okay
Many people feel wary in healthcare settings because they feel that they will not be heard. To provide any kind of care, especially in a context where people are so vulnerable, it is important that you are open to listening and learning and that you validate people’s feelings.
Make an effort to Care for Diverse Populations
The best way to better serve your patients and increase your cultural awareness is to expose yourself to patients whose identities and experiences differ from yours. The more you get to know different people, the more you’ll grow in understanding and compassion.
Embrace Discomfort and Treat it as a Learning Opportunity
It can be hard to admit that you’ve made a mistake or hurt somebody. However, nobody is perfect, and a key part of providing care is being able to apologize and take responsibility. Reflect on what you could have done better, and make sure you take it upon yourself to learn how you can do better for the future.
Balance Patients’ Experiences of Illness with Objective Scores in Guiding Care
Objective scores are useful tools in communicating symptoms and guiding diagnoses. However, it is important to understand that scores are not always representative of diverse populations and that not all people will present their illnesses in the exact same way. For example, eczema may present differently on different skin tones, and the description in the Eczema Area and Severity Index may not capture the different presentations, which could lead to underdiagnosis or misdiagnosis in racialized patients.
How can Patients Advocate for Themselves?
Bring someone you trust with you to medical appointments
Going to medical appointments can be really scary, and they can be especially daunting if you have to do it alone. However, you do not have to do it alone! You can bring somebody that you trust along with you to your appointments. Knowing that you have support can help you feel more empowered to speak up on behalf of your needs.
Request translators
Communication is key in all domains of our lives, and this holds true in medical settings, too. If you don’t feel like you can clearly share your health concerns with your healthcare provider in a non-native language, then you can request to have a translator assist you. This can reduce the risk of miscommunication.
Communicate your needs with your healthcare provider if you feel safe
Sometimes, issues might arise because you and your healthcare provider are not on the same page. If you feel comfortable doing so, let your healthcare provider know how you’re feeling and how they can help you. If they know what your needs are, they can provide better care.
Try to have self-compassion—not only will it help you stay calm but also provide you with the clarity needed to call discrimination out (Neff, 2021).
It is completely normal to feel frustrated when people seem unable or unwilling to understand your lived experiences, especially those who are meant to be providing care. Give yourself and your healthcare provider patience and empathy in navigating that difficult situation. Recognizing the disconnect can help you better advocate for yourself.
References
Bryant, A. S., Worjoloh, A., Caughey, A. B., & Washington, A. E. (2010). Racial/ethnic disparities in obstetric outcomes and care: prevalence and determinants. American Journal of Obstetrics and Gynecology, 202(4), 335-343.
Deyrup, A., & Graves, J. L. (2022). Racial biology and medical misconceptions. New England Journal of Medicine, 386(6), 501–503. https://doi.org/10.1056/nejmp2116224
Garvick, S. J., Banz, J., Chin, M., Fesler, K., Olson, A. M., Wolff, E., & Gregory, T. (2023). Racial disparities in pain management. JAAPA, 36(11), 37–41. https://doi.org/10.1097/01.jaa.0000979472.53675.b6
Neff, K. K. (2021, June 14). Four ways self-compassion can help you fight for Social Justice. Greater Good. https://greatergood.berkeley.edu/article/item/four_ways_self_compassion_can_help_you_fight_for_social_justice
Tsai, J. W., Cerdeña, J. P., Goedel, W. C., Asch, W. S., Grubbs, V., Mendu, M. L., & Kaufman, J. S. (2021). Evaluating the Impact and Rationale of Race-Specific Estimations of Kidney Function: Estimations from U.S. NHANES, 2015-2018. EClinicalMedicine, 42(101197). https://doi.org/10.1016/j.eclinm.2021.101197
Vyas, D. A., Eisenstein, L. G., & Jones, D. S. (2021). Hidden in plain sight—reconsidering the use of race correction in clinical algorithms. Obstetrical & Gynecological Survey, 76(1), 5–7. https://doi.org/10.1097/01.ogx.0000725672.30764.f7