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03/21/2017

Intersectionality and the Dangers of White Empathy when Treating Black Patients

by Keisha Ray, Ph.D.

(Originally presented at the 7th International Health Humanities Consortium meeting in Houston, Texas)

I’ve had many odd, seemingly racially motivated experiences with racially uneducated and racially insensitive doctors and nurses. From being told by one of my white physicians that I sound white when I speak, to another physician calling me “sista girl” for what seemed like 100 times during our brief 15-minute interaction, or another physician who in disbelief kept asking me “Are you sure you’ve never been pregnant? It’s very rare for a black woman your age to not have had any pregnancies. Maybe you think I mean births, when I mean pregnancies?” At the time, I was only 25 years old. Although these stories made for good laughs between my friends and I, there is one experience that I have had with the medical profession that was less comical because my doctor’s attitudes about race could have had serious effects on my health.

When I was a senior in college I discovered I had hypertension. I went to see a doctor at a family medicine facility and was prescribed a common hypertension drug. While meeting with the doctor in her office, she was very reassuring and told me not to worry that this drug has been known to work very well for black people.

But this drug did not work for me at all. Consistently my blood pressure readings were 140/120 (what is considered “normal” varies but typically 120/80 is the standard). So after taking the drug for a month as instructed, I went back to see my doctor. In that office I encountered an utterly dumbfounded doctor. She just could not believe that the drug did not work for me. She kept saying “I just don’t understand. This drug is supposed to work for black people.” She even said “Plus it’s cheap, so it’s good for poor black people” without ever asking me about my financial status. My doctor then said that she was going to come up with a new game plan and I was optimistic that something was going to be done about my hypertension. Little did I know that the doctor’s “new” game plan was actually the same game plan. Her recommendation: “Let’s keep trying because this drug is supposed to work for black people.” So I left the doctor’s office with a BP of 140/120 (and sometimes higher) and with another month’s supply of the same drug and the same dosage because after all, this drug is supposed to work for black people.

Eventually, I went to a new doctor who was willing to try different drugs to help me and eventually I got my blood pressure controlled. But this experience left a lasting impression on me. Namely, because this was only the beginning of a series of encounters with doctors who dispensed overly generalized care and only saw me as a black patient and nothing else.

Experiences like this have made me hyperaware of my blackness when I enter a doctor’s office. Often, patients complain of feeling like just another number to their doctors, but when I go to the doctor I feel like just another black person. My doctors don’t see me. They don’t see that I am a black person who is also a woman, a professional philosopher, a friend, a runner, a candy aficionado and so forth. They just see a black person.

The stories that my family and black friends tell me show me that I am not alone in my experiences, nor am I alone in feeling like I am just a skin color to my physicians. I agree with scholars who argue that medical students and physicians need more education to be better doctors to their patients of color, specifically their black patients. But my concern is that in an effort to make them aware of their own racist behaviors and the idea that physicians participate in and contribute to a historically racist institution, our message will get lost in translation. What we will intend to say is that black people have a special relationship with medicine and we have to recognize that and give them treatment in such a way that recognizes this relationship. But what they will hear is a message of homogenization—that every member of the black race requires the same kind of special treatment simply because they share the same common feature, dark skin. And as a result, when a black person like myself walks into a doctor’s office her race will be treated first and her body and mind, second.

One way to address this concern is to teach the importance of intersectionality. The term, made popular by Kimberle Crenshaw, originated as a way to recognize how all of the parts of ourselves intersect in our identities and in discriminatory practices. For instance, according to intersectionality, the ways in which black women may experience sexism in the workplace are not the same ways in which white women may experience sexism in the workplace because her blackness and womanhood work together in discrimination. At the core of intersectionality, however, is the idea that we are not singular people; no one is situated in just one social category. And all of the categories that we are situated in make us uniquely ourselves. If we teach intersectionality as a part of medical education, perhaps this could send the message that when patients enter a doctor’s office they should be thought of as a whole person made up of multiple social and biological parts. Within the context of intersectionality, no patient is just a black patient, but a black woman and academic or a black man, father, and businessman. This is also a way to acknowledge that all parts of a person ought to be taken into consideration when diagnosing and treating disease.

Another concern that I have about incorporating race education with medical education is the relationship between race education and a favorite topic of medical humanities instructors—empathy. Empathy, or the ability to imagine what it would be like to live in someone else’s shoes is often encouraged as a skill that practitioners can use to be better caregivers. Although, we want our physicians to be empathetic, often, as a part of our empathetic imagination, we will try to find some likeness between the subject and ourselves. We will say things like “If this were me, how would I react?” or “If this were me, what might I consider to be a desirable outcome?” But because the overwhelming majority of physicians treating black patients are white, empathetic imagination runs the risk of making whiteness and the white experience the standard by which all non-white patients and experiences are judged.

Empathy first requires us to identify what makes someone different. And while this is important, medicine also requires us to not exaggerate our differences, particularly those between black and white patients. Yes, we have to acknowledge how black patients’ needs may sometimes differ from white patients, but black patients are still people just like their white counterparts. Both black and white patients have desires to be healthy and live the kind of lives that they deem worthy of living. So when adding race education to a curriculum that already stresses the importance of empathy, we have to teach both in such a way that doesn’t exaggerate the differences between black and white patients, but also recognizes the differences between black and white patients and the differences among black patients.

This exaggeration of differences between racial groups and overgeneralization of members within a racial group often happens when people are unwilling to accept their role in racist institutions and unwilling to confront their own racist behaviors, which many people are unwilling to do and we shouldn’t expect that medical students and physicians will be any different. For this task, acknowledging intersectionality might again be helpful, particularly if we can show physicians how they themselves benefit from intersectionality and how intersectionality can make them better physicians.

Overall, my concerns about making sure that medical students and physicians have more education about race in general and medicine’s racist past and present is that it must be done the right way as not to promote an exaggeration of differences when there aren’t any and a denial of black people’s individuality. Although topics like intersectionality can be daunting to medical students and physicians it is their job as either future caregivers or currents caregivers to be more individually attentive to their patients rather than pawn treatment off on perceived race categories and the supposed characteristics of the people who fill those categories.  When physicians do rely mostly on race to treat their patients, the patients suffer by not receiving holistic treatment, one that sees them for the individuals that they are, but also the reputation of the entire profession suffers because it becomes known as a profession that would rather rely on information not supported by science and geneticists than to treat their person as an whole entity. So when physicians allow the concept of race to take on the role of diagnostician, they are failing at their jobs. And when we don’t teach them how to avoid this and one of our students says “this is supposed to work for black patients” to one of their patients we also have failed as bioethicists and health humanists.

 

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