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ESSAY: Let’s Take an Honest Look at Distrust, Disparities and Discrimination in Medical Care

Healthcare advocacy is multifaceted. From physician-led initiatives addressing policy and resource allocation, to research that intentionally and thoughtfully addresses disparities in access and outcomes, to development of integrated multidisciplinary treatment teams for personalized care plans, there is quite possibly no more important step than educating the lay person.  

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Dr. Imani McElroy. Photo courtesy of Dr. Imani McElroy.
Dr. Imani McElroy. Photo courtesy of Dr. Imani McElroy.

By Dr. Imani McElroy, Special to California Black Media 

As I became part of the small community of Black female surgeons, who represent less than 1% of all physicians, I embraced the responsibility with an understanding that part of my career would be dedicated to being a voice for marginalized and disenfranchised people.

Growing up in the San Francisco Bay Area, I observed the vast economic divide that that contributes to health care disparities. Unstable employment and housing, food deserts, underfunded schools, and escalating living expenses all play a significant role in poor health for Black patients.

They also are a direct reflection of centuries of systemic discrimination and racism that has crippled Black Americans dating back to the era of slavery.

The same issues have followed me personally. I live with asthma, which has quietly impacted my breathing since childhood. I have been fortunate to avoid long-term hospitalization, but I have had numerous visits to urgent care and emergency departments. I discussed my symptoms with my primary care physicians over the years, but it wasn’t until my third year living in Boston that I found a physician who attended to my symptoms and made the necessary adjustments that finally controlled my asthma. My asthma had progressed steadily for 15 years and despite being in the medical field and being able to describe the decline, my symptoms were ignored. This is a story that is too common amongst Black Americans. Even fame could not protect Serena Williams when she had to demand appropriate testing and treatment for blood clots in her lungs following the birth of her first child.

I understood that my role as health care provider extended well beyond the walls of the operating room and the hospital.

The plight of Black Americans within health care and the discrimination we face is well documented in both medical and lay literature.

In medicine, we celebrate J. Marion Sims as the father of obstetrics, but until recently, we rarely mentioned that most of his medical breakthroughs were achieved through the suffering of Black women who were not adequately anesthetized as he experimented on some of the most delicate parts of their bodies. Books such as Medical Apartheid and The Immortal Life of Henrietta Lacks document the long history of Black bodies being used for scientific experimentation without any compensation or acknowledgement.

If we are going to have an honest discussion about the root cause of medical mistrust within the Black community, the conversation cannot simply begin and end with The United States Public Health Service (USPHS) Untreated Syphilis Study at Tuskegee.

It’s essential to recognize that the generational trauma endured by the Black community contributes significantly to its skepticism towards medical institutions.

Healthcare advocacy is multifaceted. From physician-led initiatives addressing policy and resource allocation, to research that intentionally and thoughtfully addresses disparities in access and outcomes, to development of integrated multidisciplinary treatment teams for personalized care plans, there is quite possibly no more important step than educating the lay person.

Gone are the days of blind trust in a physician simply because of their title.

Furthermore, being able to empower patients to advocate for their health care needs will also allow physicians to understand how medical conditions impact their patients’ quality of life and everyday activities. Shared decision-making rests on a patient’s ability to trust the providers caring for them. The medical community owes it to Black Americans to afford them this trust.

As an advocate, I aim to bridge the gap between medical literature and lay literature. Making sure that our community has updated and accessible information that can impact their understanding of their medical conditions and improve the quality of care they receive.

As a Black woman in America, I face my own challenges, including navigating the health care system, and finding providers who look like me, understand my unique needs, and are willing to engage with me despite my medical background.

As my family members grow older and begin to interact more frequently with medical providers, I find myself in the frustrating position of having to help them advocate for themselves in a system that does not always listen.

My white coat does not shield me from the realities of being Black in America and thus I feel it is my duty to become part of the solution in addressing disparities in healthcare.

While much of the work to fix this problem falls in the hands of physicians and providers, active participation is required from both sides.

Increased representation in clinical trials will improve our understanding of risk factors and treatment responses. Attending health fairs and community outreach events will help increase medical literacy and understanding. Being persistent and truthful about symptom progression or treatment side effects is equally as important to help inform decision making.

Most of our medical knowledge is hidden behind paywalls buried in medical jargon. My goal is to help make what is happening in the medical community more accessible to our community.

About the Author  

A native of the Bay Area, Dr. Imani E. McElroy is a Clinical Fellow of Vascular Surgery at USC Keck School of Medicine. She completed general surgery training at the Massachusetts General Hospital in Boston, MA. She has a Master of Public Health from the Harvard T.H. Chan School of Public Health and received a Doctor of Medicine from the Charles R. Drew University/UCLA David Geffen School of Medicine. She earned a bachelor’s degree in Biological Sciences from the University of California Irvine.  

This article is supported by the California Black Health Journalism Project, a program created by California Black Media, that addresses the top health challenges African Americans in California face. It relies on the input of community and practitioners; an awareness of historical factors, social contexts and root causes; and a strong focus on solutions as determined by policymakers, advocates and patients.

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