Recently, there have been multiple news articles addressing how Black people are not receiving adequate validation of their pain in healthcare settings. Jahi McMath’s case was a prime example of this. Jahi was a 13 year old girl who was declared brain as a result of complications from a tonsillectomy. Though she is more well known for the later-realized, misdiagnosis of her brain death, Jahi’s situation was also a case where her pain was not taken seriously. After her operation, Jahi immediately started coughing up blood – drawing concern from her family. The nurses delayed calling a physician because they did not think her condition was serious, even after Jahi’s grandmother (who was also a nurse) expressed the danger of the situation. By the next day, she was declared brain dead. And Jahi’s situation is not an outlier. Other recent incidents include how the world-class tennis player, Serena Williams, almost died after giving birth and how healthcare professionals have discriminated against Black infants in the NICU.
The real question is this – what will it take for healthcare professionals to validate Black pain? I think the solution to this issue is two-fold: self-examination and a willingness believe people. When we talk about self-examination, we have to ask ourselves, “What do I really think about Black patients?” A question that also goes hand in hand with this is “Where do I stand on the deservedness of white patients?”. Do you believe that there are inherent differences between Blacks and whites that warrant different levels of belief in the patient/healthcare provider relationship? I’m not asking for politically correct thoughts that you share in public so you don’t loose your job for being culturally insensitive. I asking for late-in-the-midnight-hour thoughts when it’s just you and the back of your eyelids. And seeing that it is probably tempting to lie to yourself as you read this, let’s bring this home. A series of studies done in 2014 show that Whites tend to superhumanize Blacks – which is a gateway to dehumanization. The studies showed that the more Whites associated Blacks with superhuman qualities, the more how they believed that Blacks had a lower pain tolerance. Another 2016 study was done on under treatment in pain tolerance for Blacks. The study showed that significant amounts both white laypersons and white medical students hold inaccurate views about African-Americans and pain tolerance such as Blacks having thicker skin than Whites. It also reconfirmed the previous research done showing that Blacks are less likely to receive the pain medications they need in healthcare settings.
We also have to have more conversations about believing patients. More and more dialogue is starting regarding physicians and their inclination to believe when people are in pain. Though most of it is being tackled by news outlets such as the Atlantic and Buzzfeed and mainly surrounds women, this is a valid part of the issue. Yes, there are hypochondriacs or people who take advantage of the healthcare system. But when patients say they are in pain or that something is not quite right, at a minimum, we should validate that experience. I would also posit that based on the other data available, that this phenomenon transfers into the Black community as well. In the spirit of honesty – if you aren’t believing women, you probably aren’t more inclined to believe Black women. Or Black people for that matter.
There is something to be said about the “magical negro”. The “magical negro” is a term I first heard used on the Black Men Can’t Jump in Hollywood Podcast. They use it to refer to Black characters in movies that are all essentially knowing, subservient, provide wisdom to their white counterparts, and are capable of enduring trial after trial because they are inherently stronger. I believe this thought process permeates most western cultures and shows itself in healthcare. There is an underlying thought process that says that Blacks are more resilient and don’t need as much support and help. Thats not true. We are fundamentally human. We may have had to become more resilient based on the nature of living while Black in this country, but we still need the same things. Fixing this will require a taking hard look at ourselves and how we feed into false, harmful stereotypes. Claude Steele gives this insight in his book, Whistling Vivaldi. He says, “the problem is that the pressure to disprove a stereotype changes what you are about in a situation. It gives you an additional task…You are multitasking, and because the stakes involved are high–survival and success versus failure in an area that is important to you–this multitasking is stressful and distracting.” Black patients shouldn’t have to juggle getting the care that they need and fighting against false pretenses. Because Steele is right – it’s stressful and distracting.
Until Next Time,
The Neighborhood Bioethicist
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