The Health Divide: Why do Black women keep getting dismissed by their doctors?
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Three months after receiving a clean bill of health from her cardiologist, marathon runner Dawn Roberts was participating in a 5K with her son when she suddenly felt a sharp pain in her chest.
“It was the first time I’ve ever felt a pain like that, and I have been a runner since middle school,” said Roberts, who lives in Philadelphia.
She immediately called her cardiologist, explained her symptoms, and he arranged for further tests. Despite her insistence that something was wrong, he gave her a clean bill of health and referred her to a neurologist.
“I felt like he didn’t believe me, but I knew this was not in my head,” Roberts said. “I know my body, and I knew something wasn’t right. I was scared.”
Over the next few months, Roberts, 55, experienced chest pains when she briskly walked to work or climbed a flight of stairs. The pain became so severe that she stopped running out of fear that something bad might happen.
Roberts sought a second opinion by consulting a virtual cardiologist, who advised her to find another heart specialist in her hometown.
When she found a different cardiologist and saw her for an appointment shortly after Christmas in 2019, this doctor — who was an Indian woman — genuinely listened to Roberts’ concerns.
She had Roberts run on a treadmill for about 10 minutes, just like the first cardiologist did, and noticed nothing unusual. However, when she asked Roberts to run fast and stop suddenly, she discovered the problem: Roberts had a 99% blockage in her left anterior descending artery, which can cause what’s known as the "widowmaker heart attack."
Roberts’ experience reflects a larger issue. Black women have long voiced concerns about being unheard by their physicians. Studies support these perceptions, and have shown that some doctors perceive Black women as overly emotional about their pain or assume they have a higher pain tolerance.
(Photo provided by Dawn Roberts)
In Roberts’ case, when her first cardiologist — a white male — dismissed her symptoms, he placed her in grave danger.
“I could have had a heart attack or worse,” she said. “I could have died.”
After discovering a critical blockage in Roberts’ artery, her new cardiologist performed an emergency procedure that involved accessing her wrist to insert a stent to open the blocked artery.
Roberts was advised that she could resume running in two weeks, but she chose to wait a month before returning to the sport she loved.
After receiving a clean bill of health, she contacted her first cardiologist's office to inform them that they had missed her widowmaker. She never received a follow-up call.
“That’s OK, though, I know I would never go back to him again,” she said.
When implicit bias leads to worse treatment
Roberts underwent her medical ordeal in 2019. Since then, the communications strategist and wellness consultant has encouraged Black women to advocate for themselves during doctor visits.
During the National Association of Black Journalists convention in Cleveland in August, Roberts encouraged women to write down any questions they have for their physicians, to ensure their concerns are addressed. If they feel something is wrong and the doctor dismisses them or fails to acknowledge their worries, she advised them to seek a second opinion.
“We know our bodies, so don’t be afraid to pursue further evaluation," she told a room of some 30 Black health journalists.
Janice Sabin, a research professor who studies implicit bias at the University of Washington in Seattle, told Today that pain is an area ripe for implicit bias, and cultural differences can affect how people show their pain and how doctors understand these expressions. This can determine how a doctor chooses to manage a person’s pain.
“If a person is bleeding, you can figure out how much blood is lost. But someone who has lower back pain, for example, it’s a very subjective measure,” Sabin said.
A 2019 study published in the American Journal of Emergency Medicine analyzed more than a dozen previously published studies on pain management and found Black patients were 40% less likely to receive medication for acute pain compared to white patients and 34% less likely to be prescribed opioids to manage such pain.
"The reasons for these disparities are likely complex and multifold and may include factors such as implicit bias, language barriers, and cultural differences in the perception and expression of pain and institutional differences in ERs that serve mostly Black and Hispanic patients," said Dr. Andrew Meltzer, senior author of the study and a researcher at George Washington University School of Medicine and Health Sciences in Washington, D.C.
Tito Izard, an African American primary care physician who practices in Milwaukee, traces deeply entrenched health disparities in the medical field back to the historical injustices of slavery. He points in particular to the persistence of harmful stereotypes, notably the misguided belief that Black individuals possess thicker skin and have a higher pain tolerance compared to their white counterparts.
Izard also pointed to pervasive misconceptions surrounding Black women, such as the damaging stereotypes that portray them as excessively sexualized and less intellectually capable than white women. These unfounded beliefs continue to influence attitudes and behaviors in health care and beyond.
Roberts acknowledged the reality that Black women often face societal expectations to be unyielding and to persevere through life's challenges. This narrative demands a form of strength that can become ingrained over time. However, when health care providers adopt this belief about their patients, it can lead to biased care and worse outcomes.
A tennis legend ignored by her doctor
Some people may view a doctor ignoring a Black woman's symptoms or complaints as simply a class issue rather than a racial disparity. But examples abound of affluent, high-profile Black women not being taken seriously by health care providers.
Tennis star Serena Williams shared her own experience of life-threatening complications that she believed were initially overlooked after the birth of her daughter in 2017.
After having an emergency cesarean section, Williams experienced shortness of breath. Given her history of blood clots, she recognized the symptoms of a pulmonary embolism. She informed the nurses that she needed a CT scan and a blood thinner, but they dismissed her, suggesting she was confused.
The doctor performed an ultrasound on her legs, which showed no blood clots. However, when Williams began to cough, a symptom caused by the embolism, it resulted in her C-section incision rupturing, requiring additional surgery. A subsequent CT scan revealed several small blood clots in her lungs.
Williams has been vocal about her experience and has highlighted the issue of medical bias, particularly in the context of maternal care for Black women.
This is one of the reasons why Black women in the U.S. are nearly three times more likely to die from pregnancy or childbirth-related causes compared to white women.
Roberts, the heart patient, said that since she shared her story, dozens of Black women have come forward with similar experiences of being ignored by their doctors.
“This is a serious issue that we need to address because it’s occurring everywhere,” she said.
Knowing that heart disease runs in her family, Roberts has already had her son tested. This awareness will not only aid him in his health journey but also provide him with essential information that doctors cannot ignore in the future.
As health journalists, it’s our responsibility to highlight the experiences of people of color who feel overlooked by the medical industry. We need to understand the long history of unethical medical practices, ongoing discrimination and implicit bias among health care providers. These are the stories that help us put a human face on the systemic inequities in health care. And they can help foster a well-founded sense of caution and self-advocacy among Black women navigating the medical establishment.