Throughout this week, I have been talking about three, seemingly, separate factors that go into the conversation about pain (i.e., patient, provider, and system). However, I think these three factors really aren’t separate and, in this post, I want to show how these three factors really interact with one another.
We, as humans, are continuously learning, growing, responding, reacting, and changing our thoughts, feelings, and behaviors. If someone says something to you, you need to do something in response (even if that response is ignoring it and moving on). Likewise, we bring experiences into interactions which cause the other person to respond in some way.
That is all a preamble to get into what I REALLY want to say. When people end up acting a certain way, it likely isn’t because they were born that way, but rather because they adapted to be that way. And, of course, we all do also have our own thoughts and ways of acting and aren’t so incredibly
influenced by our social world—we are allowed to have our own thoughts regardless of what happens to us—but I think it would be farfetched to say that we are completely separate from our social worlds.
So, when it comes to the review on racial/ethnic differences in pain, the pain experience, and treatment, we really should keep this thought in mind. This is particularly true when it comes to individual patient factors. The majority of the literature suggests that people of color (POC) tend to engage in thoughts and behaviors that ultimately lead to worse outcomes, on average.
Why would people ever decide, “I am going to do something that is going to make my life worse and not actually help me?” They wouldn’t. People do things because they think it is the right thing and it has been shown to be the right thing in their lives.
Because there is such known bias and discrimination on the basis of race/ethnicity, people have to adapt. This is true in society generally. This is also true in the specific case of medicine. I mean, let’s not forget that modern medicine has made progress literally AT THE EXPENSE of POC and
marginalized communities more generally (e.g., as unknowing test subjects, as victims of maltreatment/malpractice for the sake of understanding the negatives of medicine or the lack of treatment). That hasn’t gone away either. These thoughts still live in our world today, in part, leading to worse treatment options and quality of treatment on multiple levels within the American system.
These thoughts and experiments that have been conducted have also likely led some doctors to think that there ARE actual biological differences that systematically occur on the basis of race/ethnicity (e.g., that Black Americans have thicker skin and a higher pain tolerance).
These thoughts and experiments have also likely led to ideas that doctors are allowed to dismiss a patient’s pain. This dismissal and neglect of care toward POC’s pain leads to increases in later-stage health issues that could have either been prevented or treated through treatment options that are more likely to be effective and safe.
And even if there is trust between POC patients and doctors, there is veritably less access to healthcare for POCs on the whole. POCs are less likely to have health insurance. This highly limits the options to speak to and get the care of medical providers. Moreover, there are more POCs on government funded programs like Medicaid and Medicare, which limits the amount of facilities available as well as the types of care available. For patients with particular needs, they may be bounced around from hospital to clinic to specialist office. Who has time for that? Who has the money and patience? Especially if at each of those places you are talking to people who just really don’t care or don’t believe you (among the most common complaints of POC about their medical providers).
Given the points above, POC patients have had to adapt. Often this means taking the matter/pain condition into their own hands and not trusting the medical field. This is where all of the patient factors come into play: catastrophizing, religion, stoicism, exercise, positive thinking, etc. I’ll talk about a couple of them below.
Catastrophizing (thinking in extremes) is not how anyone wants to live their lives. No one wants to constantly be thinking that if any little thing goes wrong then that is the end of life. Or constantly think how they will never get help. Or anything like that. But, experience can make people turn to this. If your doctor is not helping you or not listening to your concerns, you may turn to catastrophizing.
People who do this often tend to have worse outcomes in general, yet we do it anyway!
One way to think of this is to think about why someone is doing it. Are they trying to be heard (because they haven’t been before)? Are they trying to get support and be helped (because the support they should have received from the doctor didn’t come)? Why would they do it? And why would this be more likely the case for POC? I think the points I have already made about bias and discrimination definitely is one contributing factor that should not be neglected.
Undoubtedly, a similar set of situations and experiences likely would lead to an overreliance on religion or becoming stoic. But there are a couple of additional reasons for why people, particularly POC, may do this.
Religion is so tied to culture that is a part of ethnic background. It is can be a source of support and relief in times of distress. And also, guess what, if people found other options that were actually more helpful/beneficial/therapeutic/nourishing, they would probably go to those other sources. That isn’t the
case for medicine, however. Some people still think, even though religion and medicine don’t have to be separate, that religion will the better option. If nothing else, at least during worship, they will be listened to rather than ridiculed potentially in front of a doctor.
And that is the thing, there are so many unknowns when it comes to medicine especially if you don’t have experience with it either directly or through others in your social network like friends and family. There is comfort in being able to turn to something that you at least know and has also likely made you feel better in the past. Religion can tend to lead to better outcomes too such as more well-being! But it can also contribute to worse pain outcomes (e.g., if you are prolonging seeing a doctor).
There may even be social pressures to turn to religion. If your parents are telling you to pray rather than go to the doctor or even forbid you from going to the doctor’s office, then you have to make a choice. For some people that choice is obviously to take care of themselves. For other people that choice is obviously that they will listen to their family and turn to religion, especially if that is how you grew up. Both make sense and are valid. And all of this is something to consider in the pain experience.
The reasons for why people turn to stoicism (or not showing emotions) deals more with wanting to not let others down, at least for POC. If you have to take time to deal with your pain, you are potentially not making money anymore, or taking care of the other duties you need to in order to provide for your family. This isn’t such a bad thing. It isn’t because someone would rather feel pain than get help. But someone may rather put aside pain and put aside expressing it to better tend to their family. Unfortunately, some things can’t just be put aside and need to be directly addressed through professional medical help.
My hope is that through reading this, we all can think a little more before blaming people/religion/culture/race/intellect or anything else when it comes to health disparities. At the very least, consider all of these things together. If you were oppressed and made to feel like your thoughts and opinions (and objective pain) doesn’t matter, would you keep seeing the person that is inadequately addressing your needs?
My guess is no. But I could be wrong.