Pain. It is one of the few things that connects all human beings. Whether it is physical or emotional, everyone experiences pain at some point in their lives. It shapes our character, gives us resilience, and elicits our empathy. It’s quite sensible to think that pain doesn’t discriminate based on gender, race, sexuality, religion, and class. However, human perception does. Unfortunately, there is a point at which pain and perception intercept.
There is no question that racism has been prevalent throughout the history of humankind, and it is certainly not unique to American society. But in a human-centric field like medicine, racism should have no place. Yet, it exists, both overtly and covertly. This has led to the development of numerous myths that prevent minority communities, especially the Black community, from receiving the care that they deserve. One such myth is that Black people biologically have a higher pain tolerance.
This myth has existed since the times of slavery when African people were forced to exist in unsanitary and unsafe conditions, and as a result, were believed to have developed increased pain tolerance and immunity. Dr. Samuel A Cartwright, a prominent pro-slavery physician, wrote that Black people bore a “Negro disease [making them] insensible to pain when subjected to punishment”. He also claimed that they have “thicker skulls and less sensitive nervous systems”. Despite immense research having been done into Black anatomy, only to discover that there are no major biological differences in our bone density and nerve sensitivity, it is disheartening to note that a study by the University of Virginia found that even today, medical professionals and students believe in these false myths (1), which translates into the way that they treat patients.
Today, we see that this myth is propagated due to two additional reasons: firstly, doctors may have worries about medical noncompliance if painkiller drugs are given to Black people because of assumptions about their recreational drug usage. Secondly, they may believe that the degree of pain itself is being exaggerated, and thus may refuse to provide adequate treatment. Today’s attitudes towards race and pain are not as direct or aggressive as they once were. However, they are much more insidious and just as deadly.
The most obvious consequence of this myth is that it impedes a physician’s ability to provide adequate care. A 2000 study at Emory University found that in Atlanta, 74% of White patients with bone fractures received painkillers compared to 57% of Black patients, despite them reporting similar levels of pain (2). A 2015 paper found that Black children with appendicitis were significantly less likely to receive pain medication (especially opioids) than their White counterparts (3). And in 2020, the shocking case of Dr. Susan Moore’s treatment brought this issue further into the spotlight. Despite being a medical doctor herself, when she was admitted to a hospital for COVID-19, her physician didn’t trust that she was accurately describing her pain, and said that he felt uncomfortable giving her more narcotics. She was discharged, and in a matter of weeks, she lost her life. It may not surprise you to hear that Dr. Moore was a Black woman.
Furthermore, a lack of attention to a patient’s physical pain can lead to acute emotional trauma which is expressed differently by each person. One may express the trauma through anxiety, rage, depression, low self-esteem, shame, and guilt. It also provokes stress about their present condition and potential future complications. This overbearing amount of worry can lead to the worsening of the patient’s physical condition.
The financial impact this has is also not to be forgotten, as complications in their treatment and healthcare can take a huge toll on their finances, thereby reducing their ability to afford more care in the future. For example, according to an article by the AAMC, the largest racial disparity in terms of treatment of pain was observed in conditions like headaches and migraines. These are pains that could be signs of a broad range of conditions ranging from chronic stress headaches all the way to a malignant tumour in the brain. When a physician doesn’t believe in a patient’s pain, they may not even consider the more deadly factors causing the headache. And if these complications are not diagnosed at the right time, the cost of care could spike astronomically, such as from $50,000 (grade 3 glioma) to over $100,000 (grade 4 glioma) (4).
Apart from the individual, it also affects the community as a whole. Not only does it deepen the racial tensions in modern American society, it also breeds a feeling of mistrust in the medical system as a whole. A 2000 study from Johns Hopkins University found that Black cardiac patients were “significantly more likely to report mistrust” in their physicians than White cardiac patients, one of the reasons being their personal experience with racism (5). After all, doctors are respected in our society because they have the ability to save lives. However, if the doctors are the ones who perpetuate such a nonsensical myth, it reflects on how broken the system is and how much mending it needs. Such rumours make us question if modern medicine even upholds the fundamental right of a human being to receive unbiased, high-quality healthcare.
Now, onto what can be done to fix it. The first step towards finding the solution to a problem is acknowledging that it exists. Starting from science classes in high school, as well as through medical school, students need to be made aware of these false assumptions that we make about one another because more often than not, it’s not a group of aggressively racist old doctors that conspire to kill all Black people. It’s a set of implicit biases that many of us may not even be aware of, that need to be called out and nipped in the bud. We need to encourage pathways for minority communities to enter the medical field as clinicians, teachers, and researchers, so that we, as people who simply do not experience what Black patients do, are able to learn and correct ourselves.
In an increasingly diverse world, medicine can not afford to leave people behind. Healthcare needs to be a system for people, all people, to access the help that they need to live the healthiest lives that they can. Baseless, racist myths have no place in a system held up by the pillars of science and compassion. So this Black History Month, do what you can do to learn about the issue, because even if you can’t change the system, at least you can help acknowledge what’s broken within it.
Written by Navya Bhartia
1. Hoffman, K. M., Trawalter, S., Axt, J. R., & Oliver, M. N. (2016, April 4). Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. US National Library of Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4843483/
2. Josefson, D. (2000, January 15). Pain relief in US emergency rooms is related to patients’ race. US National Library of Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1128742/
3. Goyal, M. K., Kuppermann, N., & Cleary, S. D. (2015, November). Racial Disparities in Pain Management of Children With Appendicitis in Emergency Departments. JAMA Pediatrics. https://jamanetwork.com/journals/jamapediatrics/fullarticle/2441797
4. Raizer, J. J., Fitzner, K. A., Jacobs, D. I., Bennett, C. L., Liebling, D. B., & Luu, T. H. (2015, January 1). Economics of Malignant Gliomas: A Critical Review. JCO Oncology Practice. https://ascopubs.org/doi/full/10.1200/jop.2012.000560
5. LaVeist, T. A., Nickerson, K. J., & Bowie, J. V. (2000). Attitudes about racism, medical mistrust, and satisfaction with care among African American and white cardiac patients. US National Library of Medicine. https://pubmed.ncbi.nlm.nih.gov/11092161/
6, Eligon, J. (2020, December 23). Black Doctor Dies of Covid-19 After Complaining of Racist Treatment. NewYork Times. https://www.nytimes.com/2020/12/23/us/susan-moore-black-doctor-indiana.html
7. Sabin, J. A. (2020, January 6). How we fail black patients in pain. AAMC. https://www.aamc.org/news-insights/how-we-fail-black-patients-pain
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