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 t