Racism in Healthcare: How to Get the Covid-19 Care You Need
One reason Covid-19 is hitting black people and others of color especially hard is bias in healthcare. While it's an entrenched and systemic problem, there are some steps you can take to push back.
Nothing has stripped bare the disparities in U.S. healthcare more than Covid-19. The virus may be an equal-opportunity infector but it is selective in who it hurts the most and kills: African Americans and other people of color.
All of this unfolds against a backdrop of existing health inequalities, where black Americans have higher rates of heart disease, asthma, hypertension, diabetes, and other illnesses and are more likely to die from them as well. African-American men already have the lowest life expectancy in the nation. This doctor is making it his mission to stop his black diabetic patients from losing a limb.
While many of these inequalities are systemic and will need years to correct, says Veronica Gillispie-Bell, MD, an obstetrician and gynecologist at Ochsner Health in New Orleans, you can take steps now to get better care—whether you have symptoms of Covid-19 or another health issue. Here’s how to make sure you’re being heard and taken seriously.
Find a physician you’re comfortable with
If you’re African American, that might be a black or brown doctor. “Research shows that physicians of color provide better care to patients of color,” says Angelo McClain, PhD, CEO of the National Association of Social Workers. One study of 1,300 African-American men found that those who saw black doctors were more likely to get preventive care than those who saw non-black doctors. This, the authors concluded, could cut cardiovascular deaths among black men by 19 percent.
“Researchers attribute the improved outcomes to improved communication between black patients and black physicians,” says Dr. McClain. Unfortunately, there is a shortage of physicians of color in the United States. Blackdoctor.org can help you find a black physician near you.
But if you already have a relationship with a white practitioner, stick with them, says LaTasha Perkins, MD, an African-American family physician in Washington D.C. “Any medical professional you have a relationship with will speak up for you,” she adds. If you do have symptoms of Covid-19, it’s a good idea to call first (not visit) a doctor or other provider.
Take advantage of the CDC self-checker
Many of the symptoms of Covid-19 are “non-specific” meaning they could be caused by a number of things such as a common cold or the flu. That makes them easier to dismiss. Before contacting a provider, arm yourself with information from the Centers for Disease Control and Prevention’s (CDC’s) Covid-19 self-checker, advises Dr. Gillispie-Bell, who is also medical director of the Louisiana Perinatal Quality Collaborative.
“The CDC symptom-checker guide has an app and a place on the website,” she says. “You can put in your symptoms, age, and other information and it will guide you if you need to be tested.” That should bolster your case for rightful attention.
Know the facts about race and Covid-19
Another thing that should make people sit up? “Tell them you’re African American, and that’s a risk factor,” says Dr. Perkins. African Americans have a much higher rate of hypertension, diabetes, and coronary artery disease, which are the most common underlying conditions among people hospitalized were Covid-19.
“[The virus] is disproportionately impacting people of color and that stems from chronic diseases that are endemic in our communities,” says John Reid, development director at The Center for African American Health in Denver. According to Dr. Perkins, African Americans represent 75 percent of Covid-19 deaths in Washington, D.C. Yet they make up less than half of the district’s total population.
Make notes for yourself
Writing down your questions in order of priority before you talk to a provider is not only empowering, Dr. McClain says, it also “allows you the opportunity to practice how you will ask your questions, especially the most intimate questions.”
It also helps establish a relationship, which is so vital to getting good healthcare. “Giving the doctor a brief written summary of how you’re feeling, your symptoms, and reaction to your prescribed regimen and medications increases the odds of making a meaningful connection with your doctor,” says Dr. McClain.
And make notes for yourself during a visit or phone call as well, advises the Patient Advocate Foundation (PAF). You can even check information that’s unclear while you’re still in the conversation.
Hurry, but don’t rush
Many doctors have only 15 to 20 minutes to spend with a patient, according to Johns Hopkins Medicine. Probably even less on the phone during a pandemic. You’re more likely to get your needs met if you don’t beat around the bush.
“Rather than giving a long-drawn-out explanation of your health, symptoms, and factors that contribute to your health, be specific and succinct,” says Dr. McClain “You don’t have to rush through what you have to say, but hurry and limit the small talk.”
Jose Luis Pelaez Inc/Getty Images
If you are concerned that your personal history, race, ethnicity, or something else isn’t being addressed, says Shonta Chambers, PAF’s executive vice president of health equity and community engagement, then ask “What is the best option for me?” Or “When you take into consideration other individuals that are very similar to me in terms of race, in terms of age, how have they fared when similar courses of care have been recommended?” You know yourself and your situation better than anyone and as the PAF points out, your instincts are important. (Know the questions doctors actually want you to ask them.)
That means being up-front about underlying conditions which may put you at higher risk for Covid-19 complications but also about the context of your health, says Chambers. “The health of an individual exists outside the four walls of the healthcare system,” she says. “It exists in a social context, where you live and work.” Let’s say your doctor recommends testing for Covid-19. Ask about specific locations that would work for you. “Testing sites for the most part are not in African-American neighborhoods,” says Dr. Gillispie-Bell.
If your physician isn’t listening, tell them more about yourself: where you live, if you are living with your sister and three kids, that you can’t self-isolate, says Dr. Perkins. “Now is not the time to be embarrassed,” she stresses. “This is not the time to back down.”
Get a second opinion
Don’t be afraid to seek advice elsewhere, says the PAF. You can tell the doctor you are planning to do this—it’s a common practice pandemic or no pandemic. “Don’t take no for an answer,” says Dr. Perkins. “Go to someone else.”
Trust is a major part of the doctor-patient relationship and part of getting good care. Unfortunately, says Dr. McClain, research has shown that “many black people don’t trust their healthcare providers to act in their best interests.” And often with good reason.
A study in the Proceedings of the National Academy of Sciences reported that about half of white medical students and residents believed false statements about differences between blacks and whites, such as “black people’s skin is thicker than white people’s.” (Here are some clear signs you need to fire your doctor.)
Numbers speak: “If you find you’re hitting a brick wall, then call in your church leader, your local representative, someone who is local, not state,” says Dr. Perkins, who is also an assistant professor at Georgetown University’s School of Medicine. Reid, the development director at the Center for African American Health in Denver, is a 64-year-old African-American man with type 2 diabetes.
He says he has been “pounding relentlessly” for his healthcare system to give him a test. They didn’t budge but when center hosted a testing event earlier this week, he and other staff members were able to get a free test. He’s waiting for the results. “You’ve really got to be proactive and step up like your life depends on it,” he says.
Know the facts
Before you develop symptoms and need to contact a healthcare provider, know the facts about Covid-19, advises Dr. Gillispie-Bell. Although there don’t seem to be any differences in how Covid-19 symptoms manifest in different groups, African Americans do tend to have much more severe symptoms when they are admitted to a hospital, adds Dr. Gillispie-Bell.
“Patients should educate themselves on the signs and symptoms of Covid-19 and also be aware that if the symptoms are worsening, you have to seek care,” she adds. Know about ways to protect yourself as well. “For anyone, it’s important to realize that access to quality affordable healthcare is a fundamental right and not to be passive,” says Chambers.
- Health Affairs: "Disparities In Outcomes Among COVID-19 Patients In A Large Health Care System In California."
- APM Research Lab: "The color of coronavirus: COVID-19 deaths by race and ethnicity in the U.S."
- The Century Foundation: "Racism, Inequality, and Health Care for African Americans."
- Veronica Gillispie-Bell, MD, obstetrician and gynecologist, Ochsner Health, New Orleans
- Angelo McClain, PhD, CEO, National Association of Social Workers.
- Stanford Health Policy: "More Racial Diversity Among Physicians Would Lead to Better Health Among Black Men, Research Shows."
- Centers for Disease Control and Prevention: "Symptoms of Coronavirus."
- LaTasha Perkins, MD, family physician and assistant professor, Georgetown University School of Medicine, Washington, D.C.
- American College of Cardiology: "Clinical Course and Risk Factors for Mortality of Inpatients With COVID-19."
- American Heart Association: "African Americans and Heart Disease, Stroke
- John Reid, development director, The Center for African American Health, Denver, Colorado.
- U.S. Census Bureau: "QuickFacts: District of Columbia."
- Patient Advocate Foundation: "Tips for Talking With Your Doctor."
- Johns Hopkins Medicine: "Don't Be Shy: 4 Tips for Talking to Your Doctor."
- Shonta Chambers, MSW, executive vice president of health equity and community engagement, Patient Advocate Foundation.
- Proceedings of the National Academy of Sciences: "Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites."