My first ‘doctor’ was my Mom. She had no training in medicine, but she nurtured and cared for eight children (six strapping, 6 foot plus boys and two girls) until I was well into my teens (I am second oldest) with hardly any help from the formal health system.
Mom had her own formula for physical health and wellness: she cooked two excellent, scratch made meals a day from fresh, often garden grown ingredients that usually included one kind of bean. She insisted upon vigorous outdoor play and was a fanatically clean housekeeper.
Although there were ten of us in our unit, I can never remember the family occupying a house bigger than about nine hundred or so square feet—almost always with rotten plumbing and just one bathroom. With that number of people in such crowded quarters, communicable illnesses were passed along with regularity, no doubt rewarding all of us with strong immune systems.
While Mom had no formal medical training, she had an intuitive sense of what was ailing a child—discerning whether it was something manageable or life threatening. When we were ill, she usually took matters into her own capable hands. Rumor had it that the aunt who raised her was more than a little skilled in the art of roots and herbs. I met that aunt at least twice as a very young boy. The first time was at her home, a strange place with shelves loaded down by jars of dried twigs and leaves. There were wild animals in cages out back. The next time I encountered her was in a nursing home. She was on her deathbed. I mostly remember the smell and not wanting to be there.
But my Mom obviously inherited some of the healing arts from her. Mom was known to boil an herb or weed, producing a tea with the directive, “here, drink this.” Her favorite cures were oils, chiefly castor and cod liver. Occasionally she dabbled in patent medicine, including an unpleasant dark sludge with a grinning charlatan etched on the label. She wielded an enema bottle with terrifying effectiveness. Once when I jumped barefoot over a fence and landed on an ornamental shrub, breaking off a piece of branch in my heel, she operated. The shard came out, leaving a deep puncture. I went to school every day. It took the oozing wound a while to heal, but it did, with no complications. The scar is visible on my heel to this day. I wasn’t lucky. Mom was good. And I trusted her. She could will me to get well.
That trust carried over to the one hospitalization I recall from childhood. My older brother and I had terrible upper respiratory problems as youngsters, and Mom was constantly battling ear infections. Finally, she relented and agreed to have our tonsils removed. We were hospitalized, somebody hacked out our tonsils, and we were left with raw throats on an open ward in a small, segregated hospital with windows looking out over the main street of the segregated black neighborhood in which we lived.
I don’t recall the doctors, but the nurses were wonderful in their starched white uniforms and interesting little caps. They brought us juices and soft foods, cuddling us and taking good care. We trusted them because they were like our Mom—intuitive and gentle, as well as expert. We were unaware of the Jim Crow laws that limited our health care choice to an underfunded, run down, segregated hospital. We felt safe and well cared for. That alone made us feel better, made us confident that things would turn out all right, that we would be well.
In a matter of a decade or so healthcare, along with the society it served, shifted somewhat on matters of race. With the 1964 Civil Rights Act, legal segregation officially ended. It lingered for years after, and eventually transformed into a stealth version of itself, ‘institutional’ racism. Starting in the 1980’s, health care joined the market economy in full, moving from a largely non-profit or small proprietor-operated service to a straight-up, hard cash, transaction driven industry.
Although I personally required little in the way of medical services for most of my young adult life into middle age, and through the early stages of my current antiquity, I observed these changes as they occurred—sometimes engaged in a technical support role, producing language and documents that helped facilitate market encroachment and transformation. Within this emergent healthcare system—a bureaucratic business—dominant elements of society’s common culture, including racism, migrated unchanged into the business structure. My first year of college, on a lark I took an anthropology class and read an essay, “Magic, Science, and Religion,” that described the boundaries separating those three realms of knowledge as being thin and permeable.
From my Mom’s homemade health remedies to the algorithm-driven, cash churning juggernaut of today, that insight has informed my view of healthcare as a system. All three of those realms, along with a considerable amount of hype, are always in play.
I am part of the last generation in this country that will, in terms of demographics, exemplify the social architecture inherited from American colonialism. That is, the demographics of my generation numerically reflect White—chiefly northern European—social and cultural domination. The boomer generation is about 85% White, 11% Black, and less than 5% other. As we die off over the next twenty or so years, we will take to the crematorium (there are too many of us for conventional burial) much of the old colonial culture that underpins our social order.
As a Black member of the last generation shaped by racial apartheid, I was during my teen years, on the leading edge of desegregation. And so early on, I experienced being perceived as “the other”—a being outside the human frame most familiar to my White classmates. This was true even among friendly White classmates (who were the rule rather than the exception). They simply could not imagine how the world in which I had developed as a person, while a subset of the world they occupied—was so utterly different from their own.
Our interactions were therefore limited to the assumptions and ideas that animated their world—easy enough for me as I was thoroughly acculturated to mainstream norms. The notion that “my world is your world” is easy for bearers of the dominant culture. There is automatic resistance to the idea that society’s idealized image of itself is false. The videotape of George Floyd’s murder appears to have breached that wall of resistance to some extent. Nevertheless, marginalization and hateful regard appear to shade practically every aspect of Black men’s treatment in medicine and health care. It is a generator of suspicion and distrust toward the health care system, and a major factor in differential health outcomes where Black men rank dead last in most categories.
Within the antiseptic wrap of clinical protocol, it isn’t always easy to detect naked prejudice in health care relationships (as opposed to sociopathic compulsion, slovenly indifference or mere incompetence). It isn’t easy to discern whether decisions are made or advice is given based on sound “scientific” grounds or shaped by the cultural blind spots and personal biases of the health care provider.
Most Black people have an intuition or “radar” about these things. For my part, I have not had a White male provider with whom I easily related, although I attach high value competence and expertise regardless of the source. Granted, given my mostly good health history, the sample is small, but this is a wariness shared by most other Black men I know. The distrust goes to an instinctive understanding that the person evaluating you probably cannot imagine the details of everyday life that make your world different from theirs, and in which the assumptions drawn from their world may be less valid or even worthless in assessing the factors bearing on your life and well being. Yet their culturally bent assumptions, diagnoses, and therapeutic choices enter the record as “scientifically” grounded professional wisdom.
My best formal health care relationship was a brief encounter with a Black doctor working in a low-income urban clinic in a “bad” neighborhood. At the time I was in my late 50’s, and like most of my adult life, without medical insurance. I chose to have annual check-ups in these “ghetto” clinics because I paid in cash and their rates were usually subsidized by some source or another, so were much cheaper than mainstream providers. I would have a full blood workup done and a complete physical examination.
This doc, about ten to fifteen years younger, only asked three or four well constructed questions to get a deep set of responses about my personal and family health history, recent issues, and current concerns. He knew what to ask and how to ask. He took his time, and looked me in the eye, affirming that we were equals—that he was there to help as a trained specialist, not a superior being passing judgment or a cog in a meat grinder pushing through patients to meet arbitrary management objectives.
Toward the end of the session, I lay on the examining table, shirtless. “Ok, we’re done,” he said. I went to rise up. He stopped me, indicating I should lie back down. Then he indicated with a hand gesture that I should rise up more slowly. I did. He pointed to a ridge in my abdomen. “That’s a ventral hernia,” he said. Then he explained what a ventral hernia was, and how mine did not appear to require surgical intervention. I had been having what I believed to be thorough annual check-ups for more than twenty years, yet this congenital condition had not previously been noted. I thought to myself, this guy is really paying attention; he really cares.
But that was a one-off visit. He was one of just two or three Black male doctors I have encountered. The bond of trust we established in that forty or so minute session gave his advice great credibility—advice about blood pressure monitoring, diet, exercise, and regular check-ups that had extra impact because of his attentiveness. I don’t know whether he graduated at the head of his medical class, was considered a brilliant clinician, or anything else about his credentials. I don’t even recall his name. But the fact that we established a deep and trusting rapport made him in a single forty-minute encounter, one of the best doctors I have ever had.
The relative absence of Black doctors from medicine—and their sometimes shameful treatment by peers—is a legacy of this country’s long history of excluding Black people from competing in the American economy, in business, in the workplace, and especially in the high-income professions. If that doesn’t change, regardless of George Floyd, nothing is going to change.
Racism isn't personal and people shouldn't regard it as such. Individuals don't have the power to sustain differential social outcomes based on skin color over a period of centuries. That is achieved through The State, through the very structure of society and the quite intentional working of its institutions. Individuals may not even comprehend that seemingly "normal" choices and behaviors are predicated on a racially biased culture and mediated by structurally oppressive institutions, yielding the disparities so obvious in our society.
And that's the problem.
It's the "normality" of the choices and behaviors that produce the outcomes. And in our competitive, exclusionary social order that is a zero sum scenario. Certain people have comfortable, privileged lives because others do not. Change will not happen without making those comfortable and privileged uncomfortable and less privileged. That’s why change is hard.
Very well done (Doctors and Relationships). I wondered what your parents were like, and now have a picture of your mother's personality and talents. The doctor you portray is impressive. Here's an interesting twist ... most (well, perhaps the majority) of the GP doctors in my Midwestern town are Indian. I have had two good ones, a woman and a man; that is, they communicated well and I trusted them. They come from quite a different world (mostly) than their mostly white American clientele. As you say, expertise and competence go a long way; but it's crucial to be able to trust that the doctor cares and understands the world you live in.