After a serious car accident in 2014, Elizabeth Gavin suffered from severe back pain. “On and off for four years, I'd mention the pain to doctors when it bothered me, and they'd bring up getting started on the track for weight loss surgery,” Gavin, 31, told TODAY. Doctors told her she shouldn’t be experiencing pain from the accident and the back pain was due to her weight.
“I asked for physical therapy and was directed toward nutrition,” she said. Two years later, another doctor discovered Gavin had a severe misalignment of her spine as a result of the accident. She finally had physical therapy to condition the muscles in her back to support her spine and shoulder. During the 4-year ordeal of suffering through the pain, Gavin was cautious about insisting on pain medicine. “I asked for pain meds but was careful because I didn’t want seeking behavior noted in my chart,” she said.
Being Black and female in the health care system is complex. A 2017 study in the journal Critical Public Health noted that health care inequities exist for Black women across socioeconomic statuses. The researcher argues that Black women, fully aware of the stereotypes and racism working against them in the health care system, often rely on communication strategies and other skills to navigate doctor-patient interactions and mitigate the effects. Racist beliefs about biological differences between Black and white people can also play a key role in the way medical workers treat or fail to treat Black people’s pain. It’s not, however, just when it comes to pain management that Black women have to advocate for their health care needs.
Dr. Joi Bradshaw-Terrell, an OB-GYN in Chicago, Illinois, said the problem isn’t limited to racist beliefs — it’s a part of the health care culture that has served to disempower Black women. “Traditionally, we don't advocate for ourselves,” she said. “Historically, Black women have been taught to see a physician, they tell you something, and you just do it. You don’t ask questions.” Asking questions, however, is the first place she suggests Black women start in their communication strategy with doctors. Dr. Laurie Zephyrin, an OB-GYN and vice president of Delivery System Reform at the Commonwealth Fund, agrees.
“As an OB-GYN, I always tell my patients there are no bad questions,” said Zephyrin. “It’s your body and your right to ask questions.” However, she said, the doctor-patient experience can be intimidating in the moment. Zephyrin suggests preparing a list of questions in advance, putting them down on paper, and referring to them during the conversation or even handing the list to your provider. Remember — it’s OK and actually your right to ask questions about your treatment as well as what’s being explained to you.
The number one question Bradshaw-Terrell recommends Black women put on this list is, “What are the top three complaints you hear about this treatment?”
“Always make sure you go over the most common side effects or complaints of a treatment plan or medication prescribed to you so you can make an informed decision,” she said. After all, your medical care is your decision.
During the short amount of time Bradshaw-Terrell has with her patients during appointments, she makes it a point to ask women if they have any questions. “I read body language to see if my patients understood me. Maybe they have a question or something needs explaining. I try to pause, allow a little timing and make sure each step of my explanation is really understood,” she said.
Doctors and nurses often barrel through conversations without considering the unique cultural needs of Black women. Bradshaw-Terrell said don’t be afraid to politely interrupt. “People often feel like they can’t interrupt us. We’re human. We’re just people,” she said. “Don’t think that just because somebody is a physician that makes you inferior.” It’s also never too late to pick up the phone or log into your patient portal and send your doctor a question that you think of later.
Black women often work hard to avoid reinforcing stereotypes and racist beliefs about being less intelligent, non-compliant, argumentative and drug-seeking by not asking too many questions or raising too many concerns. “For Black women, there's often a hesitation to speak up because of how historically health care has treated Black female patients,” said Bradshaw-Terrell.
It’s unfortunate that Black women, who already experience high levels of chronic stress from racism, have to put so much effort into navigating the health care system. Black women are less likely to be diagnosed with breast, endometrial and cervical cancer than white women; more likely to die of those typically symptomatic cancers; and more likely to be misdiagnosed, given the wrong treatment, or no treatment at all. The real problem, Bradshaw-Terrell said, is that Black women are often opening up about their symptoms but are quickly shut down. Whether it’s concern about a medication that’s been prescribed, asking for testing or talking about a treatment plan, Zephyrin said if you’re feeling dismissed or not listened to, say so. “Don’t be shy about saying directly, ‘I don’t think you are hearing my concerns,’” she said.
In any health care environment, don’t doubt your experience, but do take action. “If you are unsatisfied, hospitals and health systems have patient advocates,” said Zephyrin. “Ask your provider to be connected to the patient advocate or the hospital.” If an interaction with anyone on your medical care team leaves you feeling uneasy, instead of questioning if what you’re experiencing is medical racism or implicit bias, trust your instincts. Get the care you deserve elsewhere.
“You don't have to accept that. You don't have to be treated that way,” said Bradshaw-Terrell. There are certainly barriers for many Black women to changing doctors — insurance network limitations, distance and transportation, access to culturally competent providers — and the onus should not be on Black women to receive the care they deserve. However, Bradshaw-Terrell wants Black women to know that the doctor-patient relationship should be just that — a relationship.
“When it comes down to it, doctors need to listen to Black women,” she said. “If yours doesn’t, that’s a relationship you need to get out of.”
This article was originally published in July 2020.