A study published in BMJ Quality & Safety in 2023 estimated that over 790,000 patients are either permanently harmed or die yearly from misdiagnosis. Interestingly, racial minorities and women are 30% and 20%, respectively, at a higher risk of being misdiagnosed compared to white men.
The story of Charity Watkins who nearly died due to heart failure, but was misdiagnosed with postpartum depression; and the story of Kevin Wake who suffered sickle cell stroke but was misdiagnosed as suffering from a drug overdose because he was a Black male are just a few of the numerous cases fueling distrust of Black patients for white healthcare practitioners. Healthcare practitioners need to build trust with Black patients and we’ll discuss how that can be done.
Why distrust in healthcare is a big deal
A 2013 study by the National Human Genome Research Institute found that Black patients easily shared their symptoms exhaustively with Black physicians which led the researchers to conclude that racial concordance can enhance communication and trust—which is crucial in medicine.
Racism and systemic marginalization dating back to the slavery era when Black adults were used as medical specimens have ingrained distrust for anything white in the minds of many Black adults. This distrust can have a huge negative impact on the health system where accurate diagnosis depends hugely on the trust and openness of the patient to the physician.
The distrust of Black adults for the healthcare system is also evident in the lower uptake of vaccines. In some Northern parts of Nigeria, vaccines are seen as tools by Western countries to drastically reduce their population. Consequently, there is often a lower uptake of vaccines there than in other parts of the country.
Since 2010, the Centers for Disease Control and Prevention has consistently recorded lower flu vaccine coverage in Black communities. During the 2021 to 2022 flu season, the agency recorded 42% coverage among Black adults which was lower than 54% recorded among white and Asian adults.
Until recently, the test that ranks patients that will receive a kidney considered race which placed Black patients lower on the waitlist. The decision was based on outdated studies that assumed Black patients had differences in kidney function compared to other racial groups.
The distrust of Black adults for the healthcare system can have a dangerous effect like hampering important vaccination programs to achieve herd immunity which is important for preventing disease outbreaks.
How cultural differences can lead to distrust in healthcare
Cultural differences (socially acquired values, beliefs, and rules of conduct which impact the range of accepted behaviors distinguishable from one societal group to another, according to Adler) is the other issues a non-Black physician may not fully comprehend. An example of how cultural differences can be a barrier to trust in healthcare was told by Dr. Junko Takeshita, a dermatologist of Asian descent who had limited experience caring for Black patients.
Takeshita gave a Black patient a medicated shampoo prescription for the treatment of scalp psoriasis (a skin condition that leads to thick, discolored patches on the scalp). The dermatologist assumed the woman would use it every day without realizing that many Black women only wash their hair a few times a week or month because frequent shampooing damages their natural hair.
As you might have guessed, the prescription did not work because the patient did not use the shampoo as she should. In such a situation, it is easy for the patient to assume that the dermatologist is not qualified. Also, it may not have been easy for the Black patient to tell the dermatologist that she doesn’t wash her hair every day for fear of the stigma that it may elicit.
Sadly, only 5.7% of US doctors are Black. That means not every Black patient who wants to see a Black physician will have access to one.
Tips to improve trust in healthcare in Black communities
There are hundreds of tales of Black people being exploited in medicine without getting credit or compensation. For example, Henrietta Lacks’ cervical cancer cells were harvested and cloned for use in medical research. Nobody sought her consent for it, neither was she compensated by the scientist who made millions from selling her cells.
The first brick in building trust is openness and truthfulness. Once the brick is laid, it must be nourished with effective and extensive communication. Here are the tips to enhance healthcare trust in Black communities.
1. Increasing the number of Black physicians and healthcare providers
Several studies have shown that most patients prefer to be attended to by someone from their racial group. Currently, there are not enough Black physicians and healthcare providers to go round. Consciously encouraging the enrollment of Black students into medical schools will be a game-changer.
2. Expand access to healthcare in underserved Black communities
The disparity between how easily a white patient can access healthcare compared to a Black patient will continue to fuel distrust. Dismantling that barrier and making healthcare accessible to all will help improve trust.
3. Consciously learning the cultural nuances of Black communities
While waiting for the time when there will be enough Black physicians for everyone who wants to see one, white physicians can consciously make more effort to learn the cultural nuances of Black communities and how it affects their way of life and perception of health. Conscious changes like having more Black professors in medical schools and illustrations of Black patients in textbooks to show how conditions present in Black individuals will help to dismantle age-long stereotypes.
There should be more training programs dedicated to helping healthcare practitioners understand verbal and nonverbal culturally nuanced messages. The recent partnership between Amgen and Black Health Matters is crucial in building trust. Having this cultural competence can forge stronger bonds between Black patients and white physicians.
4. Increasing public education and targeted outreach
Medicine has advanced in leaps and bounds, thanks to technology. However, people in Black communities are less likely to benefit from them or will reject these new procedures if they don’t understand them or they are too expensive for them to afford.
In 2021, Johnson & Johnson partnered with a nonprofit, CareMessage, to deliver health information to underserved communities. The nonprofit sent over 175,000 COVID-19-related messages to minorities in rural and urban areas. In addition to informing, this type of partnership can make people in Black communities feel seen, which can boost trust. This also highlights the need for more inclusive, low-cost public health seminars for all ages.
5. Enhance the social determinants of health in Black communities
Healthcare doesn’t start at the hospital. It starts with social determinants of health which is a concept that says where you live, play, and work can affect your health outcomes. Black and minority communities often see fewer green spaces and face challenges with accessing fresh food and other basic amenities. Improving the social determinants of health is a crucial step towards building trust.
6. Health practitioners should be aware of their biases and prejudice
The failure of some healthcare practitioners to accept their biases and racism-inspired attitudes is the barrier preventing them from connecting with Black communities. Self-awareness on the part of the physician will help the physician to view health and healing through the eyes of their Black patients.
7. Recruiting more Black participants in clinical trials
People in Black communities will be less skeptical about new drug discoveries if more Black scientists and volunteers are part of the study and clinical trials. Also, it will help the researchers to know if the drug reacts differently to different races. This sort of representation should be intentional and part of the clinical study design.
The mistrust of people in Black communities for the healthcare system has been left unchecked for centuries and it will be an oversimplification to think that the problem can be solved overnight. However, enforcing the tips highlighted above will go a long way in turning the tide soon.
For more reading
https://www.aamc.org/news/do-black-patients-fare-better-black-doctors
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3644014
https://www.cdc.gov/media/releases/2022/s1018-vs-flu-vaccine.html
https://qualitysafety.bmj.com/content/33/2/109
https://edition.cnn.com/2023/02/21/health/black-doctors-shortage-us/index.html
https://www.linkedin.com/pulse/repairing-trust-between-black-americans-us-healthcare-michael-sneed
https://www.fastcompany.com/90610631/black-health-disparities-equity
https://ssir.org/articles/entry/building_trust_with_communities_of_color
https://www.amgen.com/stories/2024/03/building-trust-with-the-black-community
