Healthcare Inclusivity: The Great Oxymoron

The healthcare industry is one of the most debated concerns in this country and that was before a global panasonic. Varying issues ranging from accessibility to healthcare, implicit and explicit biases as well as lack of trust in the healthcare system inclusively plague many patients who, in their most vulnerable state, seek medical care. Those without these concerns must still circumvent preventable medical errors in order to receive the optimal care worthy of our collective and technological advancements. Usually, people who receive this level of care have two things in common. They are white and male. A utopian dream or a medical facility completely staffed by hundreds of Rosies from the Jetsons is the closest women, intersex, and the global majority will get to receiving unbiased healthcare if we don’t advocate for ourselves now.


Everyone deserves the same access and treatment to healthcare. Naturally, a person’s gender and heredity play crucial roles in the type of care someone needs over their lifetime. However, the healthcare system in this country has traditionally been based on the developments, research and experiments conducted by white men, because they were the only ones allowed to take part in the distinguished role of doctor or physician. Subsequently, many previous research studies included males and focused entirely on the ailments of that gender and continuously assumed their findings will translate across the board spectrum of all humans.


Treatment of Women


This way of thinking is the catalyst to the previous and increasing disparities in healthcare between genders that serves to negatively affect the medical treatment given to women. Even if we take away the fact that men, particularly white men, deem it acceptable to legislate the female body, healthcare providers still manage to exist within a paradox based on antiquated cultural ideologies that believe women, simply due to their gender, are more vulnerable to disease and death than their male counterparts, while simultaneously thinking the solution to this can be found in their own knowledge of the male human body rather than listening to their female patients. Ironically, women are on average are more likely to seek medical care, more resistant to disease and debilitating conditions than men due to lifestyle habits and lower alcohol consumption.


In other words, the implicit or explicit biases that contribute to gender disparity in healthcare are the same as every other form of inequality in this country. The standard of care given in medicine is perceived through knowledge and accessibility to that information. Although the primary leading cause of death for both men and women of all races is heart disease, a Harvard study concluded education and awareness for women on the subject is considerably lower due to research being primarily conducted on men. The same study also showed the typical symptoms of heart disease are based on those experienced by men and healthcare providers often misdiagnose women because their symptoms manifest differently. Consequently, women are less likely prescribed preventative medications and lifesaving procedures. Thus, the power of awareness, knowledge and accessibility, like most power that perpetuates inequality, resides within the boys club.


Treatment of Intersex Individuals


Specifically, implicit bias of intersex individuals demonstrates how powerful the component of awareness is within the healthcare system. The term intersex applies to those whose physical sex characteristics at birth or the onset of puberty present differently than the orthodox idea of male and female anatomy. Since the medical field of the mid twentieth century primarily comprised of one particular group of people, the standard of what it meant to be born a boy or a girl depended solely on their implicit bias.


Beginning in the 1960s as unproven psychologist recommendations increased, as many as 1 in 5,000 newborn babies braved non-life threating operations to internal and external genitalia that were simply based according to the implicit beliefs of how traditionally genders should appear. A number of times parents were involved with doctors in assigning the infant’s gender, but often this decision was made without the consent of postpartum parents and obviously without the awareness of the person affected.


The number of unnecessary surgical procedures on newborns has decreased in recent years with the assistance of advocacy groups who by their own efforts have brought awareness to this issue. Mainly because the doctors who were so aware of what it means to be male or female were unaware and completely oblivious to the fact that these surgeries would result in inaccurate gender assignment, loss of sexual sensation, sterilization, scarring, chronic pain, and chronic incontinence.


Don’t feel bad if this is your first time hearing or learning about intersex people or that the rate of intersex individuals is comparable to that of natural redheads. The implicit desire by previous and current healthcare providers to keep this topic under wraps further demonstrates the power and importance that awareness plays for those within the profession and how it prevents an inclusive approach to what encompasses over 60 conditions.


If everyone were aware of this occurrence, then this issue would be a collaborative effort between physician and patient based on objective reasoning and no longer a subjective methodology based on playing God. Luckily, institutions such as the Ann & Robert H. Lurie Children’s Hospital of Chicago and Boston’s Children’s Hospital declared in 2020 that they would no longer participate in intersex surgeries on those too young to give their consent. However, it is of worth to note that the male dominated field of medicine still favors biological men to the point where higher success rates of gender assignment surgeries occur more so in male to female procedures simply because of the antiquated view that believes it is easier to make a hole rather than a pole.


Treatment of Black Women


Although implicit biases are fundamental to the lack of inclusivity and awareness given to those outside the medical field, explicit biases fueled by incorrect and archaic knowledge continue to plague Black females seeking healthcare. Unfortunately, much of the treatment Black women receive currently is based off the inhumane beliefs and experimentations of enslaved African people.


White doctors, especially males, are to Black women what white police officers are to Black men. It is commonplace that some white police officers have a tendency to view Black individual males and Black men in groups as gang members. Similarly, white doctors have a tendency to hyper sexualize Black women as well as view them as less intelligent due to ideas created during the enslavement of Africans and their descendants. Dr. Colene Arnold, a gynecologist who specializes in pelvic pain disorders, recounted a study that found Black women are less likely to be diagnosed for endometriosis than white women when experiencing pain, and instead, misdiagnosed as having pelvic inflammatory disease, which is typically sexually transmitted.


The slavery-era belief that Black people were hypersexual and simultaneously less intelligent than white people also continues to impact the care that Black women receive currently. Keisha Ray, an assistant professor at the McGovern Center for Humanities and Ethics demonstrated this idea by asserting, “When we look at patient testimonies, particularly from Black women, we’re seeing that these typical tropes are used…that they are hyper sexualized and that if they have some sort of illness or pain, that it’s likely self-inflicted in a sense that they did something wrong,” (Rao, 2020). In modern day terms this is equivalent to a 12 year old Black child being shot and killed by those sworn to “protect and serve” for playing with a fake, imitation gun because Black men are “known” to be gang members (rest in paradise Tamir Rice).


One can only deduce then that much of the medical treatments of Black women have absolutely nothing to do with their symptoms, medical history, or even their current physical condition but solely on unproven stereotypes. Dr. Arnold furthered her comments by asserting, “With Black women there is an assumption that they don’t know their bodies, that they don’t understand, that they’re not educated about their bodies.” The noticeable error of these misconceptions is that Black women are punished and treated in terms of what is stereotypically “known” and believed about what they lack while those with years of education do not have to account for their blatant outdated prejudices. This is especially disheartening when education data conclusively shows Black women are the most educated group in America.


I’m not a doctor but even I can see how humans who bleed for five to seven days a month every month for decades and not die would have different health concerns than those who don’t. Furthermore, I understood how this bloody phenomenon affects not only the reproductive system but also the endocrine, digestive, integumentary and nervous systems before it ever happened to me merely by living with my mother and two older sisters. So why does it take four year of undergrad, four years of medical school and three to seven years of residency to consider those who have the astonishing ability to carry and deliver an entire human being also have the capability of knowing when their bodies don’t feel right and this is also independent of their race?


So how did these unjust and explicit biases begin? Many consider the gynecological work of Dr. James Marion Sims during the 19th century as one of the main culprits. The Alabama physician conducted numerous experimental surgeries without anesthesia or consent on enslaved African women, which unfortunately resulted in the continued misconceptions of how Black women experience pain. Meanwhile, Sims preformed the same surgeries on white women with anesthesia under the unethical premise that enslaved women, due to their everyday arduous workload, were strong enough to endure those procedures naturally.


It seems unfathomable that a clear unethical idea birthed from colorism could root itself in an entire profession for over 150 years. Sad to say but it has and it’s not the only one. “A 2016 study found that nearly half of first year and second year medical students believed that Black people have thicker skin than white people, and perceived Black people as experiencing less pain than white people” (Rao, 2020). This reprehensible belief, created by another 19th century physician and wealthy plantation owner named Thomas Hamilton whose experiments involved torturing an enslaved Black man named John Brown, created blisters all over his body in an effort to prove Black skin went deeper than white skin.


The experiments conducted by these men during the days of slavery might have an ounce of validity considering the lack of commonsensical acumen and irrational credence of superiority that rivals only Dr. Moreau. However, there is no logical explanation for its existence today with all the technological, medical and psychological advancements of the 21st century. “A 2019 study published in the American Journal of Emergency Medicine analyzed data from 14 previously published studies on pain management and found that Black patients were 40% less likely to receive medication for acute pain compared to white patients and 34% less likely to be prescribed opioids,” (Rao, 2020). The only good thing that ever came out these unwarranted torturous experiments is that Black people can in no way ever be attributed to or blamed for the opioid crisis.


In the event you question my hypothesis that explicit biases are rooted in racist methodological and that this phenomenon still exists in medicine toady, then take the words from my best friend in my head, Wanda Sykes “Not Normal” stand up special. If that doesn’t make you stop for a second to say, “What’s up, Doc” then also consider Black people have the highest infant mortality rate of any racial or ethnic group in this country and Black women are three times likely to die of pregnancy related issues than white women. It’s even more discouraging to note, “60% of all pregnancy-related deaths can be prevented with better health care and communication,” as stated by Dr. Anne Schuchat, principal deputy director of the C.D.C. Ironically, these disparities are often the result of racism and sexism that cause stressors during crucial developmental periods, that trigger chains of biological processes that threaten their lives as well the their infants’ lives.


It’s hard to believe that listening and treating a woman with respect and dignity would aid in the successful delivery of their child but it’s true and something I can wholeheartedly attest to. Picture this. Kentucky 1980 something. It was a beautiful spring morning, and my very pregnant mother was tending to her precious rose garden, when she inadvertently watered her flowers organically. My precautious father drove to the hospital and immediately checked into a room in the labor and delivery ward. This being her third child, the contractions were quite close together and she dilated significantly to the point that my father explained the unborn child was coming exceedingly fast when the doctor came to examine her. The doctor, still in his street clothes, rest assured my parents that the baby wouldn’t arrive for a couple hours at least and left to attend to other patients.


Roughly, forty-five minutes later, my father grabbed the first nurse he could find, pulled them into the room and showed them the baby’s head protruding from my mother. The doctor nonchalantly returned minutes later surprised to see the baby’s head and neck. With no time for anesthesia or for the doctor to change into scrubs and gloves, they rolled my mother down the hall towards the delivery room. They never made it. The bare handed doctor delivered me right there in the middle of the fourth floor hallway of the hospital where my mother worked as psych nurse two floors above. She slept for three days straight and experienced a mild case of postpartum depression while I spent my first hours in the NICU with a gnarly case of jaundice and the words “Unsterile Birth” forever on my birth certificate simply because a doctor, who never gave birth, thought he knew more than the words and experience of his patient.


What Do We Do


Now I haven’t brought all this evidence to the forefront for nothing. I wanted to make sure women, intersex individuals and people of color, also known as the global majority, are aware that inclusivity in healthcare doesn’t exist for us but there are ways for us to change this. Primarily, preventative measures are the number one way to avoid being at the hands of a system still rooted in sexism and racism. Know your body and regulate your health by getting regular check-ups. I’ve noticed I receive better care during annual visits than when something is actually wrong. It’s the same jovial treatment I receive when getting an oil change or tire rotation versus the cold shoulder treatment when getting my brakes fixed or new tires.


Secondly, record any symptoms in a notebook when they appear. Even with preventative maintenance, things still occur and that the best way to communicate what’s going on is to have detailed evidence of the changes in your body. Also, pain has a way of eliminating important details from the mind and writing things down in the moment can aid in a correct diagnosis. That said; don’t wait until something big happens to seek help. If nothing else, reach out to that family member who is a nurse or healthcare professional and tell them about what you’re experiencing as well as the documented happenings.


In the event you have to seek medical care, please know that you have rights as a patient. As a matter of fact, you can find the Patient’s Bill of Rights on Google. These rights apply to everyone assert your right to choose healthcare providers who give you high-quality healthcare when you need it. In other words, you have every right to speak up and ask for another provider if you suspect they are not listening to you, are discriminating against you or not treating you with emergency services due to authorization or financial reasons. However, the same Patient’s Bill of Rights includes consumer responsibilities that have to be mentioned. Naturally, we as patients must also treat healthcare providers with respect and honesty. It is also our job as a patient to take responsibility for our health and exercise, eat well and limit toxins in our body.


The best way to currently take responsibility for your health is to get a Covid-19 vaccine. I know plenty of people who are unvaccinated for many reasons, but if you are a woman or apart of the global majority, you really don’t have the freedom of taking your chances if you do acquire the virus. It also doesn’t make sense for me as a Black woman to avail myself to a virus that would put me in the midst of racism and sexism with an apparatus down my throat preventing me from speaking up for myself. For those that use the Tuskegee Experiment as a justification to not get it, this is the exact opposite of what happened then. Blacks were given syphilis and were denied treatment of it so doctors could evaluate the effects. In this case, the same vaccine is being given to everyone with the only difference being if you get it from Pfizer or Moderna.


I could go on for days about this topic with historical evidence that demonstrates the lack of inclusivity in healthcare, thus, to say the opposite is the biggest oxymoron of our current time. Although unfortunate, implicit and explicit biases rooted in sexism and racism are still prevalent throughout our country. I’m aware of the many global majority members that are doing their part to change this fact but awareness of the problem by the masses is key and advocating for our rights as patients in healthcare settings is essential.



Additional Resources:

Roni Caryn Rabin https://www.nytimes.com/2019/05/07/health/pregnancy-deaths-.html?.?mc=aud_dev&ad-keywords=auddevgate&gclid=CjwKCAjw49qKBhAoEiwAHQVTo5kSHtlDCUMEKy7VW3sgeQmpE04mxjokeQoyeyey1zOjcg_oxJ6xvBoCwDEQAvD_BwE&gclsrc=aw.ds


Vidya Rao https://www.today.com/health/implicit-bias-medicine-how-it-hurts-black-women-t187866



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