For some people, visiting a medical professional when you’re not feeling well or are injured, is a routine process that ends in working toward a diagnosis and a solution. Yet for marginalized communities, in particular non-white Latinx and Black patients, getting validation of pain, and fair treatment in a medical office is not a guarantee. Historically, this rings true: Medical professionals over time have ingrained racial bias in treating Black patients, believing them to be more tolerant of pain based on widely circulated beliefs, according to the Journal of the American Medical Association.
Journalist, author, and advocate Elaine Welteroth is here to play a role in disrupting all of that. Just days after the 2022 birth of her son, she ended up with multiple blood clots, a dangerous condition called Deep Vein Thrombosis. She knew at that point that she had to advocate for herself to make sure she was safe, mostly due to her experience with the chronic pelvic condition symphysis pubis dysfunction, or SPD, during her pregnancy. Finding a doctor who could help treat that severe pain was no easy feat. “It was truly a struggle, especially in that first trimester. I had a hard time getting out of bed for 19 weeks,” she previously told Flow.
Welteroth’s story of SPD continued with a feeling of being unsafe trying to find the right doctor to treat her painful condition and guide her to the other side of the birth. “I felt the effects of white coat syndrome, when you are intimidated, belittled, and dismissed by an authority in a white lab coat, with a doctor who you are told is the authority over your body… Over time I felt the distrust setting in,” Welteroth tells Flow. “You give over your authority, silence yourself. I am very vocal, yet I found myself shrinking in the presence of physicians who made me feel incredibly small.”
As a result, she made the decision to go outside the hospital setting to have the birth (she clarifies that she’s not anti-doctor, but did what she felt was safest for her at the time). “I felt like I was at a crossroads, it was either give up my power, settle for less, even if everything in my body was telling me it was not safe, or take matters into my own hands,” says Welteroth. She notes that she was privileged enough to have the time for and access to alternative treatments for her chronic pain, including a chiropractor, acupuncturist, and herbalist, something that many Black Americans may not.
Her narrative is just one of many in the Black community. Pain inequity affects not only the Black maternal mortality crisis. Surveys unveiled by the Association of American Medical Colleges reveal that a high number of medical students still believed Black patients had physically thicker skin, and that 22 percent of Black patients are less likely than white patients to receive pain medication. Black patients are also more likely to get a more severe and delayed breast cancer or cervical cancer diagnosis, and have less access to treatment, according to 2020 research.
That’s why Welteroth is partnering with The Advil Pain Equity Project, which along with BLKHLTH and the Morehouse School of Medicine, are working to develop stronger processes to train medical students with less bias and increase patient self-advocacy. In addition, here are some potential solutions to raising awareness and eliminating pain inequity.
More healthcare providers of color
Diversity in medical schools has improved over time. But still, only 10 percent of medical students are Black and 12 percent identify as Latinx, according to data from the Association of American Medical Colleges. There is room for improvement, in that more BIPOC healthcare providers have the cultural competency to connect with patients who have a similar background and experiences in the medical system as them.
Anti-racism training in medical education
On that note, there needs to be improved training in medical schools to prevent innate racial bias from leaking into treatment. “Over the last few years, there have been more conversations within medical schools about medical bias and racism. And now it has reached the point where the AAMC, the American Association of Medical Colleges, has also developed competencies for medical schools,” says Uché Blackstock, a physician, thought leader, and speaker on bias and racism in medicine and healthcare. “They’re not required, but there are competencies around health equity for students, residents and practicing physicians about the competencies that they should have to be best prepared to deliver equitable care to patients.”
Better accessibility to midwives, doulas, and patient advocates
There is evidence that patient advocates including doulas can improve health outcomes: For example, people who had continuously had doula support during birth, making sure the patient was listened to and had their needs met, had a 10 percent decrease in the use of pain medications. Doulas and midwives are not always applicable to your health situation or not always accessible in every area. Dr. Blackstock recommends bringing a trusted friend or family member to health procedures and appointments instead to be another voice to advocate for you. “Oftentimes, you’re not feeling comfortable and you’re in pain. You’re not thinking clearly. It’s really wonderful to have someone there to support you just by their presence or to help you ask questions of the health professional to make sure you’re getting the care that you deserve,” she says.
Do a gut check when you go to the doctors
It’s not always easy to know when you can trust a medical professional to prioritize your pain and your care. You can do a quick gut check after an appointment or interaction to know if this medical situation is the right fit for you, according to Dr. Blackstock. “The answer is a quite simple one. Do you feel like you’re being listened to? I know it sounds simple, but it’s something that’s not happening in our healthcare setting,” she says. “You want to feel like your health professional is listening to you and then acting on your concerns. That is really what every patient deserves.”