By: Cynthia A. Pearson
Racism and sexism tormented Dr. Susan Moore during her battle with COVID-19. They very likely contributed to her death and shouldn’t have, and we are angry. Just two weeks before she died, Dr. Moore, who was Black, recorded a video in which she described in detail the dismissive and disrespectful treatment she was experiencing while being treated for COVID-19 at Indiana University Health System.
Despite being a physician herself, Dr. Moore wasn’t believed by a White physician when she reported that she was short of breath. She wasn’t believed by that physician when she said that her neck was extremely painful. Instead she was met with denial and distrust. “I was crushed. He made me feel like I was a drug addict,” she said in the video.
Too often being Black and female means having two strikes against you in the healthcare system. Reams of evidence exist to demonstrate how often physicians and other healthcare professionals disbelieve women’s own report of their symptoms. Patients with auto-immune conditions, 75% of whom are female, report describing their symptoms to an average of five different physicians before finding one who would take them seriously and order lab tests. Did Dr. Moore’s physician assume that she was exaggerating when she insisted that she was short of breath and only believe her when test results confirmed her description?
For Black, Latinx and gender non-conforming folks, barriers to respectful treatment are even worse. In some cases those barriers are the result of miseducation. A 2016 study demonstrated that more than half of a sample of young White physicians had false beliefs about Blacks, for example that Black skin is thicker than White skin. Those who held false beliefs were less likely to recommend adequate treatment. Did Dr. Moore’s physician falsely believe that Black patients need little or no treatment for pain?
In other cases, unconscious attitudes, such as implicit bias, affect the treatment of Black, Latinx and dark-skinned patients. In a recent report published in the American Journal of Public Health, implicit racial/ethnic bias was found among health care professionals in 14 out of 15 studies. Results also showed that implicit bias was significantly related to patient–provider interactions, treatment decisions, and patient health outcomes. Did Dr. Moore’s physician see a Black woman in a hospital gown and unconsciously believe her to be less credible than a white coat-wearing medical professional?
Dr. Moore fought for herself and insisted that her symptoms be taken seriously. By the time she recorded her video, CT scans had convinced the skeptical physician to approve pain medication and continued treatment with remdesivir. But Dr. Moore knew that her experience wasn’t unique. “This is how Black people get killed, when you send them home and they don’t know how to fight for themselves,” Dr. Moore said.
As Dr. Moore understood, this is a systemic problem that needs systemic solutions. Training alone won’t be enough to prevent other women dying from medical neglect and mistreatment, but reeducating doctors and nurses to “debias,” and unlearn dangerous and racist misinformation is absolutely necessary.
It’s time to start holding hospitals and health systems accountable for treating all patients with respect. The first step in that process should be to create mechanisms that hold providers accountable for their biases and accurately capture the experience of Black, Indigenous and other people of color. Promising models already exist. For example, in the SACRED Birth study, Black women scholars and mothers worked together to identify six aspects of care that should be assessed when evaluating how hospital staff treat people giving birth: safety, autonomy, communication, racism, empathy, and dignity. We know that if hospitals adjust their systems to treat Black birthing people with respect that treatment will improve for everyone.
Like many hospitals, Indiana University Health System tracks and reports its progress towards improving its treatment of patients with heart disease. They’re proud of the improvements they’ve made over the years. What would Dr. Moore’s experience have been like if Indiana University Health had been regularly tracking and reporting their hospital’s scores on dignity, communication and racism?
Racist treatment of Black, Indigenous and other people of color inside the healthcare system won’t come to an end until the system changes. Neither will sexist treatment of women and gender nonconforming people. Hospitals, medical schools, and healthcare systems must commit themselves to reeducating healthcare professionals, measuring patients’ experience, and striving for improvement. Outside organizations like the NWHN have a role to play in ensuring that these lifesaving measures become the new standard, expected by funders and regulators, as well as patients. It’s up to us to ensure that Dr. Moore’s death isn’t in vain.