OPINION: Skirting Death by Implicit Bias at the Doctor's Office

by Ralina L. Joseph

A couple of years ago racism almost killed the love of my life, my husband, the father of our two children. The attempted murder didn't come about through police violence or Karens trying to regulate his use of public space. Instead it came through the hands of the very people who should be improving the quality of his life: his doctors.

My husband doesn't like to go to the doctor. His mantra when it comes to medicine is "They don't do anything." He says this because he has experienced a medical industry in which doctors and nurses don't spend the time necessary to see him, to listen to his pain, to diagnose his illnesses, and to constructively devise solutions. As decades of research now shows, medical interactions are "racially discordant" for patients like him — a 6-foot-6 Black man whose doctors' visits are characterized by medical personnel moving him out the door of the examination room as quickly as possible. Such racial discordance means that patients like my husband will deal with shorter, less-informative, less-patient-centered, and fewer relationship-building experiences in a doctor's office. He is a mid-40s former athlete who has many persistent pains, but because of his alienating experiences with doctors, he chooses to deal with his sometimes-excruciating pain alone rather than seek medical help.

Almost three years ago, however, my husband's pain led him to the place he avoided most: the doctor's office. My golden-skinned man was starting to lose his color. His strong gait was becoming labored. His breath was slow. He wasn't himself. When he went to the doctor's office, they quickly examined him — less than five minutes, he estimates — and then sent him off with a diagnosis of seasonal allergies. Doubling up on over-the-counter allergy meds, he shook his head and soldiered on.

But he got sicker. Over the next weeks he struggled to walk across a room without having to hold onto furniture for support. His breath came out ragged. His skin had become almost grey in tone. I was terrified, staying up at night listening to his breath, and despite his "They don't do anything" mantra, I successfully harassed him into returning to the doctor. This time he received a few more minutes of examination and a chest x-ray but left feeling brushed off again. He came back with a diagnosis of walking pneumonia and prescription for steroids. He took his pills. And still he got sicker. And sicker. Looking into my 42-year-old husband's face, the love of my life, the man who had been my center for over half our lives, I thought he was going to die.

At that point he was going to a branch of the large HMO his work subscribed to in the overwhelmingly white end of our city, near his work but not our house. HMO-style, he saw whatever (white) doctors were on the docket that day. When he became much sicker, we needed an immediate appointment. We found one at the care clinic on the far more Black and Brown end of town, just a couple of blocks from our house. This time my husband was not the only BIPOC person in the waiting room; Black and Brown office staff, nurses, caregivers, and other patients surrounded him.

A young, white, nine-months-pregnant resident saw him this time and knew that he wasn't well, that he didn't have pneumonia, and that it certainly wasn't allergies. She spent time with him, asking questions, taking tests, waiting for results, and ordered additional tests when she wasn't getting the answers she needed. When she let him go, it was with a promise to call as soon as the rest of the tests were in, and she admonished me to watch him closely.

Early the next morning my husband handed me the phone as her voice soothed, Don't panic, but drive him directly to the ER. Pulmonary emboli (PE) straddled both of his lungs in a saddle formation. The condition had been developing for months — since before his first diagnosis of "allergies" and since before he had "walking pneumonia."

Why had the two previous doctors not seen the signs? Do they not know that Black people suffer deep vein thrombosis, including PE, at rates 30-60% higher than whites? Had the doctor who saved his life not taken the time to confront the implicit bias that keeps so many other white caregivers from hearing Black people's pain, he wouldn't be here with me today.

Throughout his sickness, the racism continued, during his hospital stay and in follow-up appointments. He recovered, and we came to understand that a PE diagnosis dictates a mortality rate twice as high for Black than white patients. And even though one particular lifesaving doctor (who went into labor a handful of days after diagnosing my husband) was wonderful, he left that healthcare system so he can choose his doctors outside of the HMO's roulette wheel. We are privileged that my job provides us with that choice.

When our non-BIPOC friends and family have heard this story, I have felt their pause: "Was it really racism that almost killed your husband?" they ask. After all, they point out, my husband is a middle school principal who used to work in diversity, equity, and inclusion; an Ivy League graduate with multiple degrees; a light-skinned, soft-spoken man who escapes into his fantasy books, cooks five-star meals, revels in family game nights. In short, he isn't their stereotype of a Black man. How could he have received the same racism that paralyzed Jacob Blake, that killed George Floyd, that murdered Breonna Taylor?

Implicit in their skepticism is the idea that my husband couldn't have experienced such racism because he's done everything "right." And by this they mean he is "like them." But just as they deny the racism he experienced, they deny the racism they express. This might not be the explicit kind (they swear they're not that kind of folks) but rather the implicit type. And the implicit kind kills people, too. By denying it they also deny their own role in perpetuating that racism.

I am a race practitioner and scholar — my whole professional life is dedicated to the eradication of racial disparities — yet I have been unable to even pen a letter to the doctors who failed my husband. My husband and I have been unable to document the very types of complaints I help others process, script, and register daily. This is the first time we have shared his experience beyond a few friends and family and the first time in print. What good would it do, we have told ourselves.

Instead, we spend our days grateful that he is alive. Alive unlike Eric Garner, who was murdered by the police as he cried out "I can't breathe"; alive unlike Andre Maurice Hill, who was murdered by the police as he investigated a noise outside his garage; alive unlike Dr. Susan Moore, who was murdered by racist medical neglect.

And part of expressing my gratitude for his life is sharing my husband's story — with the small hope that his story might just change something.

Ralina L. Joseph is Presidential Term Professor of Communication, the Director of the Center for Communication, Difference and Equity, and Associate Dean of Equity and Justice in Graduate Programs at the University of Washington, Seattle. She is the author of three books on race and is currently writing a new book titled Interrupting Privilege.

Featured imageis attributed to Vanessa under a Creative Commons 2.0 license (CC BY-NC-ND 2.0).