Long-standing health disparities for the Black community are well known and documented. A number of factors contribute to these health disparities, but one problem has been a lack of diversity among physicians. While 13% of the American population is Black or African American,https://www.census.gov/quickfacts/fact/table/US/PST045221 only 5% of providers across the U.S. identify as such.https://www.aamc.org/data-reports/workforce/interactive-data/figure-18-percentage-all-active-physicians-race/ethnicity-2018 Research has found that physicians of color are more likely to treat minority patients and it has been argued that sharing a racial or cultural background with one’s doctor helps promote communication and trust.https://hbr.org/2018/08/research-having-a-black-doctor-led-black-men-to-receive-more-effective-care
At Included Health we believe that healthcare leaders, along with employers and health plans, must insist on a deeper bench of care professionals with the cultural competence necessary to build trust with Black patients and deliver high-quality, affirming care. Equity in care should be the standard of care.
In celebration of Black History Month we are amplifying the voices of Black clinicians at Included Health—making space for them to share their point of view on the state of disparities in healthcare. Continue reading to learn more about Dr. Walker, and her experiences as a Black physician in our Q&A series.
Dr. Barbara A. Walker
Question: Can you share with us a memorable experience you’ve had with the healthcare system — good or bad?
Answer: When I was in training, I worked with a popular local cardiologist on my cardiology rotation. I enjoyed working with him, he was a great individual and valued my opinion. Although I do not believe him to be a hateful or racist person, in the course of my training, I noticed a distinct pattern in his treatment of people of color compared to his white patients.
He would consistently order cardiac catheterization for symptomatic caucasians with risk factors, but would order stress tests/stress echo for his patients of color under the same circumstances. I gathered the courage to ask him about it.
I asked him why the difference in care management when African Americans, Native Americans and Latinx people generally have a higher risk of heart disease than white people.
Initially, he looked confused and suggested there must be subtle differences in the cases, but after I showed him several of the charts that were basically clinically identical other than race he paused. He became defensive and replied, “I’m not doing this on purpose.” It was almost phrased as a question to himself.
I went back to a patient we’d seen a few minutes before this conversation. An African American woman in her late 50s with intermittent chest pain. An electrocardiogram (EKG) test showed only subtle abnormalities, but she had a history of type 2 diabetes for about 15 years, hyperlipidemia and hypertension. He’d ordered a stress test. I asked him why he’d ordered the stress test instead of the heart cath.
He immediately answered, “Well she can’t afford the copay for the heart cath and her insurance is not that great.”
She was a school teacher and had great insurance.
He paused. “I think I’ve been assuming that my black patients are poor, uninsured or underinsured.”
He didn’t know how long he’d been doing that, it was subconscious. He did not mean it spitefully. In a way, he was actually trying to be considerate, but at the end of the day, he was routinely providing inferior care to his patients of color. His face turned red and he apologized.
I suggested presenting the best options and the estimated costs to all of his patients and letting them decide what they could afford. At least for the rest of my rotation, his behavior changed. I like to think it was a permanent change.
Q: How have you seen prejudice, discrimination, or social determinants of health (which disproportionately impact communities of color) affect the physical or mental health of Black patients?
A: On a daily basis I encounter people of color who have had their symptoms ignored or presumed to be secondary gain related.
I saw a patient recently with LUPUS (an autoimmune disease that occurs when your body’s immune system attacks your own tissues and organs), which is known to be a potentially debilitating disease and can require frequent doctor’s office visits. This patient’s rheumatologist had refused to fill out Family and Medical Leave Act (FMLA) papers and prescribed an anti-inflammatory drug, telling her that the drug would be enough to get her through her flare ups so she could continue to work.
My patient said he assumed she was trying to get disability when in fact she was trying to do what was necessary to not have her illness/disability be counted against her so she could keep her job. She was tremendously stressed out about it. She has missed a lot of days of work. She had been told by her supervisor that if she missed more than four unplanned days of work this year, she could be fired. The complete lack of compassion that both her white physician and her white supervisor showed is sadly very common for people of color.
Q: What is one thing that non-Black providers should strive for to serve Black patients better?
A: Believe your Black patients. Don’t assume the worst of them. Don’t make assumptions, period. Ask questions. Treat them with the same compassion and respect as they would any other patient.
Q: Why do you believe that having a diverse choice of healthcare providers makes patients feel more comfortable?
A: As a physician, when I see a diverse staff, it makes me think that the organization gets it. It makes me think it is a safe space to work in or to seek care.
For patients, there is almost always an immediate understanding of what it means to be from another country or a person of color if you are talking to a provider with the same background. There is usually an instant cultural understanding. Oftentimes patients can rest assured that a provider from your same background sees you as a human being. Not a statistic or stereotype. You can usually rest assured that they will not immediately presume the worst of you.
Q: What’s one piece of advice you would give to Black patients seeking mental or physical care?
A: Try to get recommendations from other people of color when you are looking for a healthcare provider. Advocate for yourself and ask a lot of questions. Do not be afraid to get a second opinion. If you do not feel your provider listens to you or if you feel like they are apathetic about your care, please get a new one.