When I came to Columbia, I was surprised to find that apprehension about using Columbia Medical Services, known to most students as Health Services, was common. Although I heard reasonable complaints about the appointment scheduling algorithm and wait times, as a person living with chronic illness, the general reluctance to use Health Services seemed like a waste of a valuable opportunity. This is not to say that using Health Services is easy, but that the effort required to do so may be a worthy sacrifice for its rewards.
The first time I went to Health Services, I was 18 and more excited about a doctor’s appointment than I had been in years. I still carried my old wallet, which has since been relegated to my drawer of important documents, and to which I then added a business card from each doctor I saw. I opened that wallet recently, and counted out 22 cards. To be fair, a few are duplicates, and two have hand-written referrals to other doctors on the back. One has a doctor’s cell phone number. Three are from Columbia Health Services. And none of them is from the last two surgeons who performed procedures on me.
Because I was 18 and hadn’t yet heard my symptoms described as those of a chronic illness, I would take a doctor’s business card like usual, explain my story like usual, and hope for a diagnosis like usual. At the time, my expectation for a worst-case scenario was hearing that my symptoms were inconclusive. A few years later, the worst-case scenario would be hearing that I wasn’t physically sick, but instead that my symptoms were in my head. When the doctor at Health Services started asking me when I had most recently partied and what types of drugs I took, I had no frame of reference for my disappointment.
I had never before seen a doctor (and haven’t seen one since) who assumed that my symptoms were related to drug use that I had failed to disclose. I wondered whether he thought the question was appropriate for any Columbia student—that it was possible that there was a drug culture on campus that I hadn’t encountered yet. Mostly, I feared that I had been singled out due to my race, and that a doctor on campus might have the power to jeopardize my education.
When I share my struggles with navigation through the health care system with my mother, she dissuades me from speculating that my treatment (or lack thereof) is the result of being a black woman, despite the openness with which family discusses the possibility of other, less sinister, forms of discrimination. After spending years insisting that she didn’t want a dog, she and my sister recently applied to adopt one from a local shelter. The other day, she wondered aloud about why they hadn’t been sent a response and casually said, “Eh maybe—” and cut herself off. I prompted her with, “What, maybe they don’t approve black people?” She laughed and said “I don’t know, maybe.” I asked why she openly acknowledged that she speculated about the ways racism impacted her life but insisted that I shouldn’t. She said, “You’re young and I don’t want you to have to think like that, to be worried about that.”
I don’t want to worry about how racism impacts my experiences with doctors, but I’ve found that acknowledging the relationship between racism and health has helped me adjust my expectations. For over a decade, studies have shown that black Americans are regularly undertreated for pain compared to white patients. Studies show that there is a “racial empathy gap,” that people of all races, not just doctors, assume; that “relative to whites, blacks feel less pain because they have faced more hardship.” I never want to think that racism is the answer to the lingering questions that I have about my treatment in doctors’ offices, but to ignore its possible role seems just as callous.
Recent studies that have found that racism itself, whether or not it occurs in the context of health care, has negative effects on health, and has made conversations about individual health care experiences far more difficult. Studies have found that everyday forms of discrimination experienced by black Americans are “stressful life experience[s]” that have negative effects on health similar to those caused by other types of stressful experiences.
One such study performed a meta-analysis that specifically studied racism as a determinant of health, reviewing hundreds of existing studies and articles that analyzed the relationship between reported racism and physical and mental health. It found that regardless of age, sex, birthplace, and location, reported racism was associated with poorer mental health and poorer physical health. Although my mother and I are both reluctant to presume the existence of a causal relationship between racism and individual experiences with doctors, the very nature of our speculation on racism suggests that it is a unique stress that may influence our health.
Despite my concern that my encounter at Health Services was indicative of forms of racial discrimination systemic to American health care, I continued to try to use it to my advantage. Last fall, I had an appointment that might have saved my life. Instead of extensively describing my symptoms, I described possible diagnoses that other doctors had given me. I asked for a recommendation for a surgeon, and was recommended to a Columbia alumnus. That surgeon got another Columbia alumnus to review my case, someone whose department had previously refused to take me.
The inconsistency between my experiences with Health Services is likely the result of the structural problems with American healthcare, including the ways in which everyday racism impacts health outcomes. I advise that everyone go to Health Services and learn about and acknowledge the ways in which Health Services can fail us, to better frame conversations about its possibilities.
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