A young mother in Antelope Valley, California, bathes her children and dresses them in immaculate clothes, making sure they look their best for doctor’s appointments. “I brush their teeth before going to the dentist. Those are some of the things I do to protect myself from unfair treatment,” he explained to investigators.
A 72-year-old man from Los Angeles, aware that he is black, tries to make those who serve him feel comfortable with him. “My actions will probably be judged and applied to the whole race, especially if they are negative,” he said. “And more if they are perceived as aggressive.”
Many black Californians say they have adjusted their appearance or behavior — to the point of minimizing questions — to reduce the chance of discrimination and bias in hospitals, clinics and doctors’ offices.
Among the strategies they say they have adopted, 32% pay special attention to the way they dress; 35% change their speech or behavior to make doctors feel comfortable. And 41% tell their doctors that they are educated, informed and prepared.
These behaviors were covered by a survey of 3,325 participants in a study titled October “Listening to Black Californians: How the Health Care System is Undermining Their Pursuit of Good Health”, funded by the California Health Care Foundation. Part of his goal was to draw attention to the effort black patients must make to receive quality medical care.
“If you look at how often black Californians change their speech and clothing to get to a doctor’s appointment, that’s a sign that something needs to change,” said Shakari Byerly, whose research firm Evitarus led the study.
A third of black patients say they go to appointments with a companion who watches and advocates for them. And, according to the study, more than a quarter avoid medical care simply because they believe they won’t be treated well.
“The system looks at us differently, not just in doctors’ offices,” said Dr. Michael LeNoir, who was not involved in the study.
LeNoir, an Oakland allergist and pediatrician who founded the African American Wellness Project nearly two decades ago to fight health disparities, didn’t find the answers surprising, given that many blacks have learned to make such adjustments routinely. “Discrimination is rampant,” he said, “so we’re all learning our part.”
There is abundant evidence of racial disparities in health care.
Analysis Urban Institute published in 2021, found that black patients were much more likely to experience problems related to surgery than non-Hispanic white patients at the same hospital.
Study published in November by the National Bureau of Economic Research found that black mothers and babies have worse health outcomes than other groups at various levels of health care. AND second job published in January, led by researchers at the Dana-Farber Cancer Institute, found that older African-Americans and Hispanics with advanced cancer were less likely than non-Hispanic whites to receive opioids for pain.
Gigi Crowder, executive director of the National Alliance on Mental Illness in Contra Costa County, said she often sees delays in mental health diagnoses for black patients.
“I hear stories about how long it takes people to get diagnoses,” Crowder said. “Many don’t get their diagnosis until six or seven years after the onset of the disease.”
Nearly a third of respondents in the California Health Care Foundation study — which looked only at black Californians, not other racial or ethnic groups — said they had been treated poorly by health care providers because of their race or ethnicity. One participant said that her doctor simply advised her to exercise more and lose weight when she explained that she was short of breath. She eventually discovered she was anemic and needed two blood transfusions.
“I feel that black voices are not being heard. He doesn’t take them that seriously,” the woman told investigators. – In this case, I was not listened to, and in the end it turned out to be a very serious problem, actually life-threatening.
People interviewed by KHN who were not involved in the research described similar experiences.
Shaleta Smith, 44, of Southern California went to the emergency room bleeding a week after giving birth to her third daughter. The doctor wanted to release him, but the nurse called Smith’s obstetrician for a second opinion. It turned out to be a serious problem that required a hysterectomy.
“I almost died,” Smith said.
Years later, in an unrelated experience, her general practitioner insisted that her persistent loss of voice and fever were symptoms of laryngitis. After she begged to be referred to a specialist, he diagnosed her with an autoimmune disorder.
Smith said it’s unclear if bias was a factor in those interactions with doctors, but she always has to work hard to have her health issues taken seriously. When visiting his doctors, Smith tells them he works in the field of medicine and administration.
Black patients have to worry about finding doctors who will take better care of them.
Ovester Armstrong Jr. he lives in Tracy, in the Central Valley, but is willing to drive an hour to the Bay Area to find providers accustomed to treating black and other minority patients.
“I’ve dealt with doctors who don’t have experience treating different cultures, who aren’t aware of cultural differences or even our social lives, the fact that our menus are different,” Armstrong said.
But Armstrong may not find the doctor you’re looking for. AND 2021 UCLA study found that the proportion of black American physicians was 5.4%, an increase of only 4 percentage points over the past 120 years.
The LeNoir Wellness Project provides information to patients so they can ask informed questions of their doctors. And California’s Black Women’s Health Project employs health “ambassadors” to help black patients navigate the system, according to Raena Granberry, the organization’s director of maternal and reproductive health.
Joyce Clarke, 70, who lives in Southern California, takes written questions with her when she goes to the doctor. “Health care professionals are people first and foremost, so they come with their own biases, whether they’re intentional or not, and that puts a black person on guard,” Clarke said.
While the study sheds light on how black patients interact with medical professionals, Katherine Haynes, a program manager at the California Health Care Foundation, said further research could determine whether patient experiences have improved.
“The people who provide the care — the doctors — need timely information about what the patient experience is like,” Haynes said.
He produced this story KHNwho publishes California Healthlineeditorially independent service California Health Care Foundation.