Current perceptions in healthcare

In medical practice, there is an institutional and systemic belief that Black patients have thicker skin, higher pain tolerance, and feel less pain compared to White patients(1) —a myth held by half of White healthcare professionals (HCPs).(2) It has been reported that HCPs dismiss Black women’s pain due to the unfounded stereotype of ‘strong Black women’.(3) As a Black woman, I’ve received such prejudice and dismissal from non-Black HCPs. From being told, “you don’t look like you’re in pain”, while I was hunched over with severe and debilitating lower back pain, to another HCP excitedly saying, “I have to show this to my friends—they’ll love this” as he looked at an X-ray result that showed a painful ‘irregularity’ in my spine, while I looked at him, stunned. Why does this continue to happen to Black patients, and what can we do about it?

Deep-rooted false beliefs

HCPs are twice as likely to underestimate Black patients’ pain compared to other racial groups(4), leading to delayed diagnosis and treatment. HCPs with false beliefs about Black patients’ pain tolerance are less likely to prescribe proper pain treatments for Black patients than White patients(1); if pain treatments are prescribed, Black patients receive lower quantities.(1) A 2022 study found that almost half of first and second-year medical students hold false and fantastical beliefs that, compared to White people, Black people have thicker skin and quicker blood coagulation.(1) Another false belief held by HCPs is that White people are “nicer” than Black people, leading to increased consultation time with White patients compared to Black patients.(5) Furthermore, HCPs with racial bias speak faster and use more anxiety-related words when interacting with Black patients.(6)

Use paracetamol for chronic pain?

Feeling anxious while going through a physically painful ordeal is an unwelcome feeling. I should note that I have had a few amazing encounters with non-Black HCPs, where I have been listened to, and my pain intensity was believed. However, on the other hand, attending a general practitioner (GP) practice as a Black woman is usually accompanied by anxiety and fear of not being believed. I’ve been told to “just use paracetamol” for chronic pain, which led to me advocating for myself to receive stronger painkillers. I’ve watched HCPs roll their eyes as I described my pain. I’ve had excruciating pain that HCPs believed could be managed and treated with just cold compressions before dismissing me. This dismissal led to me returning home with no painkillers prescribed, and the following day, I was in the emergency room as the pain intensity increased. A non-White female HCP attended to me, and with one look and feel of the pain site, she was shocked that I’d gone for days in that condition. She prescribed strong painkillers and recommended holistic treatment approaches. I cried tears of relief. Not relief from the pain, but relief for finally being seen and heard. Years of dismissal by HCPs and almost having to ‘overprove’ my pain has resulted in me building a ‘live-with-the-pain-for-as-long-as-I-can’ approach rather than visiting the GP—a frustrating ‘Catch-22’ paradox.

 Unfortunately, my experience described above is common among many Black patients, especially Black women.

How do we address this?

To address these unfounded racial institutional and systemic beliefs effectively, it’s crucial to begin by targeting the core. What are HCPs being taught?

Diversify teaching and training materials

The teaching and training for medical/nursing students should include images of Black patients to show how certain diseases and pains appear on Black skin. This will ensure that diversity in the community is represented from the ‘get-go’—in the training materials before HCPs attend to real-world patients.

With diversity and inclusion at our core, Mednet Group recognises the importance of implementing these cornerstones in the workforce. We drive diverse thoughts, ideas, and perspectives. Furthermore, there are people within our organisation who mirror some of the therapeutic areas we create scientific content/materials for.

Implement cultural competency

Cultural competency training and diversity should be encouraged in the HCP workforce. Black patients should be empowered to advocate for themselves and refuse to be dismissed.

There is institutional and systemic racial bias in managing and treating pain reported by Black patients. As medical communicators, it is important to challenge these biases to ensure equal treatment, improve patient outcomes, and enhance trust in the healthcare system. This is a critical step in ensuring that all patients receive the quality of care and pain relief they deserve, regardless of their race.

References

 1. Hoffman, K.M. et al., Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between Blacks and Whites. Proc Natl Acad Sci USA., 2016. 113(16): p. 4296-4301.

 2. Sabin, A.J. How we fail black patients in pain. 2023  14th August 2023]; Available from: https://www.aamc.org/news/how-we-fail-black-patients-pain.

 3. Iacobucci, G., Most black people in UK face discrimination from healthcare staff, survey finds. BMJ, 2022. 378: p. o2337.

 4. Raphael, K. Racial bias in medicine. 2020  14th August 2023]; Available from: https://globalhealth.harvard.edu/racial-bias-in-medicine/#:~:text=The%20piece%20goes%20on%2C,to%20underestimate%20black%20patients'%20pain.

 5. Hall, W.J., et al., Implicit racial/ethnic bias among health care professionals and its influence on health care cutcomes: A systematic review. Am J Public Health, 2015. 105(12): p. e60-e76.

 6. Penner, L.A., et al., Reducing racial health care disparities: A social psychological analysis. Policy Insights Behav Brain Sci., 2014. 1(1): p. 204-212.