Doctors who look like themselves

When black patients prefer black doctors, the New York Times is sympathetic to them. In the article “A Case for Black Doctors,” Damon Tweedy writes:

As a general rule, black patients are more likely to feel comfortable with black doctors. Studies have shown that they are more likely to seek them out for treatment, and to report higher satisfaction with their care. In addition, more black doctors practice in high-poverty communities of color, where physicians are relatively scarce.

As a psychiatrist, I’ve seen this up close. I’ve frequently been the only black doctor (or one of very few) in clinics with large black populations. Quite often, patients ask to see a black doctor, but the sheer volume of people seeking help prevents me from accommodating most of their requests.

Black patients, compared with those of other races, tend to be far less trusting of physicians and their medical advice. Much of this is rooted in a dark history of experimentation on black people without their consent (the four-decade-long Tuskegee syphilis study is the most notorious modern-day example). Too often, however, this mistrust is to the patients’ detriment. I’ve met countless black people who have either delayed or refused needed treatments because they were skeptical about their physician’s motives and honesty. Some wound up far sicker than they should have been; others died.

Perhaps the most compelling evidence that black patients are more likely to trust black doctors comes from the mental health field, where a patient’s relationship with his or her provider is especially important. Black people have often fared poorly in their interactions with the mental health care system. For example, they are nearly half as likely as whites to receive treatment for diagnosed mental health disorders of comparable severity. When black patients do receive treatment, it is far more likely to occur in an emergency room or psychiatric hospital than it is for whites, and less likely to be in the calmer office-based setting, where longer-term treatment can take place.

In this context, it is easy to understand a 2011 meta-analysis published in the Journal of Counseling Psychology that observed that black people strongly preferred to be matched to black therapists and were more likely to view them favorably, and that these preferences and perceptions translated into slightly better clinical outcomes.

I’m not doubting that there was abuse, in the past, against some black patients, but it’s not reasonable to extrapolate from this to the present era. I seriously doubt that many black patients truly believe they are going to become unwitting participants in some nefarious experiment. The most common reason that is cited for this preference is a common cultural background, and similar communication styles.

There’s nothing wrong with this. But what about white patients preferring white physicians? Unlike with black patients, there’s not much material on this topic; whites are not supposed to feel any solidarity with other whites.

I did find an article in The Medical Blog titled “Many White Patients Don’t Want Black Nurses or Doctors.” Granted, unlike the previous article, this one is framed as a negative; it doesn’t examine whether white patients prefer white doctors, but whether they have an aversion to black doctors. Nevertheless, the implication is that their preference is for one of their own. It reads, in part:

When African-American nurse Tonya Battle of the Hurley Medical Center (NICU) in Michigan was reassigned because a white father didn’t want her anywhere near his newborn child, she was floored. The racist father had made the request after showing the charge nurse a picture of his swastika tattoo. As it turns out, however, Battle is not alone in being discriminated against in this way.

In Battle’s 2012 case, a staff meeting ended with the hospital indulging the racist father and not allowing African-American nurses near the infant. According to Al Jazeera there was even a note posted to alert staffers: “NO AFRICAN AMERICAN NURSE TO TAKE CARE OF BABY.”

Battle later sued Hurley Medical Center for employment discrimination and settled out of court, but this sort of discrimination is far more common than most people think…

Since patients know it’s politically incorrect to be overtly racist, they often make up reasons for getting rid of their black health care providers.

“They come up with different ways to do it. I talked to this one doctor who said there are these older ladies who will say, ‘You know, I want a Jewish doctor, I just think a Jewish doctor is better,” wrote Paul-Emile.

Dr. Meghan Lane-Fall, who is African-American, says the bias impacts black doctors as well as nurses.

So, when black patients prefer doctors of their own race, it’s understandable, and necessary to accommodate them. But when white patients do the same, it’s “discrimination” and “racism.”

Cultural issues aside, blacks can point to the Syphilis study of decades ago. How can whites rationalize their white-doctor preference? The most compelling argument is Affirmative Action. What do you call the medical student who finishes last in his class? “Doctor!” It’s not that black doctors are not qualified, it’s that they don’t have to be AS QUALIFIED as white doctors. This can be an important distinction when your life is on the line.

Astoundingly, the same Establishment that implements Affirmative Action policies, and requires them, will then consider the inevitable reactions to Affirmative Action as “white privilege!” For example, this tolerance.org article:

People do not assume that I got where I am professionally because of my race (or because of affirmative action programs).

By that reasoning, there’s also “poverty privilege.” We can claim that…

People do not assume that I was released early from jail because of my wealthy parents (or because of my access to expensive attorneys).

Another reason white patients might avoid black doctors is that the media, schools and the government (mediagov) has been waging a relentless propaganda campaign to vilify whites as a group. All major newspapers, magazines and television stations (with the exception of FOX – sometimes) depict whites as the source of all evil – and “people of color” as their long-suffering victims. As a result, it’s not uncommon for said “people of color” to act out against whites. Sometimes this takes the form of “random” crime. Other times, it’s in the form of rioting, vocal outbursts – or possibly caring for your white patients a bit less carefully. There’s no way to tell, so why take the chance?