When You’re Not a Straight White Male
Because I’m a nurse, when I think about the dignity of a country I think about its healthcare system first, especially how it takes care of its most vulnerable people. Still, today, we have a great deal of work to do. Systemic oppression, implicit bias, and outright discrimination—realities now more likely to be scrutinized across public spheres—exist in the world of medicine.
Racism in healthcare is measurable. So are sexism and cultural insensitivity. If the healthcare system is good at one thing, it’s keeping a paper trail—meaning there’s a record of every patient test result, intervention, and outcome, and those records can be analyzed across populations. When we want to see how we’re doing in matters of health equity, the data is there to pull from—and it reveals that we are failing patients by many measures.
Research confirms that 40 percent of the time, black and Hispanic patients do not receive breast cancer treatment in line with guidelines.1 All women experience misdiagnosis disproportionately to men.2 Just under half of senior citizens have their pain dismissed by care providers as an expected part of aging.
“So which minority groups are you addressing in this book section?” my friend Maya asked over coffee last winter, and I started to rattle them off: women, people of color, refugees, immigrants and asylees, people of lower socioeconomic status, transgender people, people with a history of trauma, sexual minorities, religious minorities, senior citizens, people with disabilities . . .
I could have kept going, highly caffeinated and really on a tear at this point. She stopped me and asked the most intuitive, obvious question, which had slipped my mind while I was rambling: “When it has to do with being a patient, minorities are the majority, then?”
Yes. They are. We are. Many of us are minorities in some way, and most of us will at some point be vulnerable to discrimination in the care we receive. American healthcare, like many aspects of modern life, is most accessible and has the best outcomes for men who hold power. My intent is not to collapse all identities that are not straight, white, and male, nor to imply that the challenges they face in the healthcare system are the same. Rather, I hope to convey that care is constructed for—and most accessible to—the straight, young-to-middle-aged, abled, affluent white man.
Within the healthcare profession, there’s a lot of talk and not enough action when it comes to these inequities. There are conferences and publications, but not enough mobilizing. And despite the prevalence of studies to the contrary, we too often think we’re doing an okay job, that we, as a healthcare community, have transcended these malevolent practices, subconscious and otherwise.
My goal with this section is twofold.
First, I hope to inform you about the modes of discrimination still functioning in modern medicine—to help you recognize them, name them, and mitigate their impact on the care you and those around you receive. Second, I hope to help you see healthcare as a lever to address social justice. Public health advocacy can only go so far until everyone (especially those with an advantage) understands the ways the system subjects their friends, neighbors, community members, and fellow citizens to inferior care. If you can’t trust a system to take care of those who are most vulnerable, you shouldn’t trust it to take good care of you. It’s important for all of us to get curious, look around, and find ways to effect change.