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The Stress of Systemic Poverty Is Killing Us

Racial minorities experience shorter lives, but until we can fix economic inequality there’s an easy way to improve this health crisis: better listening skills among doctors.

By Darlene K. Drummond


(Photo: Joe Raedle/Getty Images)

Physicians have known for years that racial minorities, especially African Americans, experience shorter lives because of a higher-than-average prevalence of maladies like kidney disease, heart disease, stroke, diabetes, and hypertension.

My own family is a picture of poor health: my sister and I have experienced diagnoses of obesity, diabetes, multiple sclerosis, hypertension, breast cancer, kidney cancer, and stroke due to anesthesia. All of these happened before the age of 50.

There are many reasons for the health crisis among African Americans, the stress of systematic poverty being chief among them. But there is one major contributing factor that is much easier to fix than economic inequality and it lies within the everyday power of American doctors: better listening skills.

Research consistently shows that black patients — especially those who are poor or perceived as less sophisticated — receive less attention from their doctors during office visits.

Unfortunately, this inattentiveness may result in unnecessary deaths. African Americans die faster for multiple reasons. Among them:

  • They are more likely to receive less desirable procedures like amputation as a consequence of diabetes and end-stage renal disease. Rates of amputation are 3.6 times higher for African Americans than for whites, and they are twice as likely to undergo above-knee amputation, according to a 2002 report from the Institute of Medicine.
  • They are more likely to be enrolled in lower-end health plans characterized by higher per capita resource constraints and stricter limits on covered services, according to the Kaiser Family Foundation’s “Health Coverage for the Black Population Today and Under the Affordable Care Act.”
  • They are 41 percent less likely to receive a major procedure for treatment of colorectal cancer, according to a study published in the American Journal of Gastroenterology. Despite 20 percent higher rates of in comparison to whites, African Americans receive 28 percent fewer sigmoidoscopic examinations — a considerably more advanced diagnostic procedure than barium enemas.

I experienced this bias personally. After several sleepless nights, I went to a neurologist about a constant buzzing in my ears. The neurologist’s diagnosis was multiple sclerosis. The conclusion was that I should “consider taking a steroid and adapt” and talk with my family doctor, who only shrugged and referred me back to the specialist. No other treatments were offered, no readings recommended, and absolutely no time taken to discuss how I felt about the diagnosis.

We could simply conclude that these are incompetent doctors, but the underlying stereotype of “blacks don’t take care of themselves” is pernicious. Why continue with an approach that obviously is not working? We must disrupt this archaic model and adopt a more ecological perspective.

In the traditional biomedical practice of medicine, the focus is solely on the doctor-patient interaction in which the doctor controls the conversation by asking specific questions about signs and symptoms, examines the physical body, and then issues a directive for treatment. Most of the questions asked by the doctor are closed-ended and designed to be answered with one word — yes or no.

An ecological approach values the voice of a patient in addition to that of the doctor. The communication would be collaborative and much more patient-centered — a dialogue instead of a questionnaire. This is more complex and time-consuming but can be mainly handled through an intake conducted by a physician’s assistant or a nurse.

A doctor’s appointment should result in more than a summary of tests results, a prescription for drugs, and a mandate to eat healthy and exercise. Shortcuts for gathering patient information must be avoided. Time invested in the beginning of a doctor-patient relationship will be cost-effective in the long term and result in better health outcomes in the African-American community.