Appendices – Healthcare Disparities: Exploring Inequities Across the Spectrum
Disclaimer: All names portrayed in this production are fictitious. No identification with actual persons (living or deceased), should be inferred
I had fainted on the subway station, overwhelmed by the sudden wave of pain and dizziness. Now, I was in the emergency room, hoping for some answers. The doctor, a middle-aged man with an air of indifference, entered the room. He glanced at my chart briefly before meeting my eyes. “Well Giselle, according to your blood tests, there does not seem to be anything wrong,” he said matter-of-factly, his tone suggesting that he was settled in his assessment that I was fine.
I cleared my throat, and with my voice barely above a whisper, I responded. “But I’ve been bleeding excessively for eleven days now,” I said, my words carrying the weight of my frustration. “The pain is unbearable, and I can’t go on like this.”
The doctor seemed unfazed by my plea. He leaned against the wall, crossing his arms. “Sometimes, periods can be heavy and painful. It’s nothing out of the ordinary. All women are different, and it is normal to see some variation. You probably fainted from anemia caused by the blood loss. I’ll give you some ibuprofen to help with the cramps, but there’s not much else we can do.”
My friend, who had been by my side throughout this ordeal, could not contain herself, and spoke up. “Doctor, you haven’t even done a proper workup. How can you be so sure it’s just her period?” she interjected, her voice filled with disbelief.
The doctor’s expression grew slightly irritated. “Look, we’ve taken blood samples, and the results are clear. There’s no need for unnecessary tests.” His jaw was set, quite obviously wanting to be done with this interaction. “I assure you, it’s just a heavy period. Women tend to exaggerate their symptoms sometimes to get pain medication. Are you one of those?” He eyed me suspiciously. “The hospital does not make a habit of supporting the drug problems of our patients.”
People of color and women have historically faced systemic biases and stereotypes within healthcare. These biases can unconsciously influence healthcare providers’ perceptions and decisions, potentially resulting in inadequate care. Due to the historical and ongoing disparities in healthcare, patients need to be professional yet assertive, thus strengthening patient autonomy and empowers patients to actively participate in their healthcare decisions.
Advocating for oneself can be crucial due to the pervasive oppressive biases that may downplay or disregard a patient’s concerns- especially for POC women. However, for POC women must conduct their spoken and body language intentionally, yet not be deemed to aggressive or uncooperative. By communicating assertively and professionally, individuals can counteract these biases and insist on the level of care everyone deserves. However it is extremely taxing on these patients to have to advocate for themselves repeatedly in order to receive optimal care. 
My heart sank. It felt as if he did not believe me, as if my pain was inconsequential. Tears welled up in my eyes as I struggled to make him understand. “Please, I can’t live like this. It’s not normal,” I pleaded, my voice trembling with a mix of frustration and desperation. After a moment of silence, my friend spoke up again, her voice steady, but determined. “Doctor, I kindly request that you note the ignored complaints and perform further investigations. Something is clearly wrong, and it’s important to find out what it is.”
Reluctantly, the doctor sighed and agreed to perform an ultrasound. As the gel touched my abdomen and the doctor placed the probe on my abdomen, I prayed for answers: for validation of the pain I had been enduring for far too long. Moments later, the monitor came to life, displaying the image of my uterus. The doctor’s indifferent expression changed to one of surprise. “It seems you have uterine fibroids Giselle,” he finally admitted, his voice filled with reluctant acknowledgement. “They’re likely causing your symptoms.” Relief washed over me, mixed with frustration and a sense of vindication. I was not imagining things. There was a tangible reason for my pain, and it could have been missed. I would have suffered longer, if not for my friend.
As the doctor left the room to discuss the next steps, I clung to my friend’s hand, grateful for her unwavering support. It was a reminder that our voices matter, that we should never settle for being dismissed or misunderstood.
By requesting documentation and additional tests, the patient and their advocate can ensure that their concerns are properly recorded and addressed. This approach can help to substantiate the need for further investigation, and prompt the healthcare professional to take the patient’s symptoms seriously. The doctor both dismissed her pain and symptoms before accusing her of trolling for pain medication, an experience which is quite common for patients of colour or of lower socioeconomic status.
For healthcare professionals, be mindful of how you are communicating: both verbally and with body language. In this story, the attitude of the doctor was dismissive: he still did not apologize for his behavior and sentiments during the interaction. Often healthcare professionals may be ashamed to have fallen short of the high expectations set for themselves, or fearful of the legal and social consequences. Many doctors can feel hesitant to issue apologies to patients because they believe it can open themselves up to liability. Although this is a common sentiment, it has not been proven. Studies have shown that in cases where physicians did give a genuine apology there was no litigation or payouts were significantly smaller. In this scenario and similar ones, an apology can go a long way in letting the patient know that they are heard, understood what was done and the potential outcomes. And the professional will strive to do better in future interactions. Not only do apologies serve the patient well, but it often serves the physician who may feel guilt or remorse at potentially or having caused harm. 
- Myers, H. F. (2008). Ethnicity- and socio-economic status-related stresses in context: An Integrative Review and conceptual model. Journal of Behavioral Medicine, 32(1), 9–19. https://doi.org/10.1007/s10865-008-9181-4 ↵
- Leape, L. L. (2006). Full disclosure and apology—an idea whose time has come. The Physician Executive. ↵
- Loignon, C., Hudon, C., Goulet, É., Boyer, S., De Laat, M., Fournier, N., Grabovschi, C., & Bush, P. (2015). Perceived barriers to healthcare for persons living in poverty in Quebec, Canada: The Equihealthy Project. International Journal for Equity in Health, 14(1). https://doi.org/10.1186/s12939-015-0135-5 ↵