Have you ever feared going to the doctor? Is it because of the needles, the procedure, bad news? That kind of anxiety in a clinical setting is known as white coat syndrome; the fear of doctors themselves is called iatrophobia. But, interestingly, the definition of this phobia is characterized by an irrational or abnormal fear of going to the doctor. That's because for many of us, no matter how crummy we feel, we know that doctors are supposed to be healers: their job is supposed to be to give us the best care. But what happens when it isn't this case? What happens if you know that your fear isn't irrational?
Growing up in an Asian-American household, my parents hated taking us to the doctor. Oftentimes, we waited till we were sure that "age-old medicine" and rest weren't curing before going in. Beyond that, my parents took us to an Asian family practitioner who owned his private practice, even though they both could speak English. I've realized looking back that this is not uncommon among my Asian American friends. When my grandmother was battling stage IV ovarian cancer, my parents also requested to have Asian doctors. I know now, that is a form of reverse discrimination, among all the other implicit racial bias I was taught growing up.
This is not to say that the majority of doctors are bad. Not by a long shot. It's simply an effort to understand and spread awareness about why people still fear going to the doctor in this day and age. According to The New York Times, it's not because of Covid-19 but rather the staggering unemployment. But what about people who were unemployed before COVID hit? What about people who feared even before? Their fear is exacerbated by Covid-19.
What exactly is perceived discrimination?
Perceived discrimination is defined as a behavioral manifestation of a negative attitude, judgment, or unfair treatment toward members of a group. As a result of subjectivity, its discussion sparks heated debate. Regardless, it has been scientifically proven that perceived discrimination causes health problems. For instance, according to National Research Council, "negative perceptions of healthcare in general, and perceptions of discrimination in particular, influence when and how people seek care, whether they engage in health-protective behaviors, their willingness to follow medical advice and their levels of psychological distress, self-esteem, and mental health."
The National Research Council further explains that perceived racial discrimination includes both "conscious and unconscious prejudice and stereotyping by providers." This can be in many forms: "the reality that minorities in the United States are likely to receive worse care than their white counterparts, differences in sensitivity to potential racism and its verbal and nonverbal cues, differences in unmet medical needs, prior experiences that shape patients' identities and orientations to health care, and even a sense that "reverse discrimination" against whites may be a factor."
You hear stories of Black Americans who tell their doctors all their credentials when they need critical care--- of their families, who when they did visit couldn't just mourn in the time of unrest, but instead, made sure the color of their skin wouldn't affect the basic adequate care of the patient.
How are discrimination's effects measured?
In one study analyzing the largest state health survey in the U.S, the California Health Interview Survey(CHIS), major ethnic and racial demographics were used along with various public health indicators to compare perceived discrimination across different racial and ethnic groups.
The study also examined responses to the following question: “Was there ever a time when you would have received better medical care if you had belonged to a different race or ethnic group?" The results of this study demonstrated that there are "significant differences in perceptions of discrimination by race, with respondents from non-white groups being more likely to report that they believed they would have received better medical care if they were a different race. 9.7% of African Americans, 8.1% of Native Americans, and 7.5% of Hispanics believed that they would have received better medical care if they were a different race, while only 2.3% of whites reported the same."
This, however, doesn't show the long-term effects of discrimination.
Although outright discrimination is no longer as prevalent as it was in the past, more subtle forms of discrimination still exist. And several other studies have shown its harmful effects on health through hypertension, the risk for certain diseases, psychological distress, etc. The studies do not have a quantitative model of discrimination and its health effects, but they have created models that link the association between the two.
For instance, recent research has deemed discrimination as a "social stressor setting into motion a process of physiological responses (e.g., elevated blood pressure, heart rate, cortisol secretions), and these heightened physiological responses over time can have downstream health effects." This looks like susceptibility to developing cardiovascular diseases overtime, hypertension, overtime. "Similarly, researchers Gee, Spencer, Chen, and Takeuchi have proposed that routine discrimination can become a chronic stressor that may erode an individual’s protective resources and increase vulnerability to physical illness."
Ultimately, studies have shown that discrimination has more than mental effects but physical as well.
What do we do?
This discussion highlights the importance of race no matter how much we can deny that racism doesn't exist. There too many layers to everything, too many cofactors- covariants to how discrimination affects health. But statistics sometimes show us the blunt truth of issues, and it was clear that perceptions of discrimination differed by race.
There are also many other actions that we can take to educate ourselves. As much as it has been said, sign petitions, educate, learn, and listen. It's all still relevant. There are sources to learn more through my last article at https://www.showmestate2020.org/post/how-do-we-fix-racial-disparities-in-healthcare.
Sources
White Coat Syndrome: https://www.webmd.com/anxiety-panic/features/beyond-white-coat-syndrome#1
Perceived Discrimination and Health: A Meta-Analytic Review: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2747726/
Perceived discrimination in U.S. healthcare: Charting the effects of key social characteristics within and across racial groups:
Coronavirus and Healthcare:
Perceptive Discrimination: