The Institute of Medicine reported that
Racial and ethnic minorities tend to receive a lower quality of healthcare than non-minorities, even when access-related factors, such as patients’ insurance status and income, are controlled. (Smedley BD, Stith AY, Nelson AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academies Press; 2003:1)
Wolf et al. reported that the Black-White health disparity resulted in an additional 886 202 black deaths from 1991 to 2000 (Woolf SH, Johnson RE, Fryer GE Jr, Rust G, Satcher D. The health impact of resolving racial disparities: an analysis of US mortality data. Am J Public Health. 2008;98(suppl 1):S26-S28). Using 2002 data, Satcher et al. reported that if Black and Whites were equal, 83 000 deaths per year would be eliminated (Satcher D, Fryer GE Jr, McCann J, Troutman A, Woolf SH, Rust G. What if we were equal? A comparison of the black-white mortality gap in 1960 and 2000. Health Aff (Millwood). 2005;24(2):459–464). Yes, I have read them all, but none of this prepares you for when you become the statistic.
As a practicing clinician and scientist, I was upset and felt betrayed, but was not really surprised when I found myself on the receiving end of racially biased health care. I presented myself to the emergency room (ER) of one of the top US medical centers with acute severe lower back pain, foot drop, sensory deficit, and other symptoms consistent with spinal cord compression. A plain x-ray of the lumbar spine was ordered, and I was informed that if it showed something I would then and only then receive pain medication. In response to my request for a magnetic resonance image (MRI), which I knew was better than plain x-ray for imaging soft tissue, I was told that I could not receive an MRI through the ER. In addition, I overheard the resident discussing my case with the attending physician, stating that “he claims to be a physician,” implying that my stated occupation was not believed.
For weeks I suffered without any significant relief of my symptoms. Frustrated in my attempts to get adequate assistance, I asked a colleague who had recently received back surgery, and who coincidently was a White-American physician and scientist, to recommend a provider to contact regarding my symptoms and inability to obtain an appropriate diagnostic work-up. Not knowing of my ER experience, with great pride he shared his own experience in the ER. He explained his symptoms, which were pretty much the same as those I had complained of. Interestingly, in the same ER that I visited, he had immediately received pain medication, an MRI, and an evaluation by a neurosurgeon. He also quickly received surgery to release his spinal cord compression. Several weeks later I received an MRI ordered by my primary care provider that revealed spinal cord compression from a lumbar disc. When I later saw the same neurosurgeon that had seen and had been recommended to me by my colleague, I was informed that I was not a good candidate for surgery to relieve the spinal cord compression. The neurosurgeon pointed out on the MRI that my disc was protruding into my spinal canal and that eventually the disc would dry up and the motor and sensory function in my leg would return to normal. While my colleague returned to running months after his surgery, I continued to suffer and required five months of physical therapy before I could walk normally. Of note, years later I still suffer from sensory and motor deficits in my leg.
This experience serves as a stark reminder of the salience of the color of my skin to how I and others like me are perceived and treated. Similar experiences too often characterize the health care encounters of vulnerable racial/ethnic minorities and other US population subgroups and contribute to the persistent disparities in health outcomes that have been observed. As a physician, I let these personal experiences be a continual reminder of the danger of stereotypes, personal biases, and prejudices which have no place in the provision of appropriate patient care.