Black bodies are dying, and medical schools are partially to blame. Never did I imagine that I would come to the realization that, as a medical student, I was being trained and conditioned to identify and treat conditions predominately in white people. It is time for medical institutions to address how medical school curriculums, which use whiteness as a scale to define normal, contribute to increased rates of mortality and morbidity in Black communities.
In my first two years of medical school, our curriculum focused on training us to be able to compile a comprehensive differential diagnosis based on presenting symptoms. During one of our practice sessions, we received a list of symptoms and I shouted, “Kawasaki disease.” As my classmates smirked (because my answer was a zebra), the ER attending who was overseeing our discussion said something that I will never forget: “You will not diagnose something that is never on your differential.”
Now that I’ve completed my didactic years of medical school, I have become vividly aware that I am being trained to diagnose and treat conditions in white bodies. Black and Brown bodies are an afterthought. This was an especially heartbreaking realization to come to, given that my medical school is located in Chicago, an urban area with a patient population that is predominantly Black and Brown.
I first began to realize this fundamental flaw in my medical education when we learned how to write HPIs. We were taught repeatedly not to include racial or ethnic identifiers because their inclusion can lead to bias. Despite that warning, and research confirming the potential for bias, my school continues to use identifiers — but only used when a clinical case involves a person of color. Examples of cases I received in my first two years of medical school include: a Black single mother of four with colon cancer, a Black Dominican family with sickle cell disease, and a Latina with an epidural hematoma from an incident of domestic violence in the presence of her young child.
These very stereotypical cases teach student doctors early in their careers to typecast people of color, thereby drastically narrowing our differential diagnosis when interacting with these patients. A narrowed differential can lead to delays in diagnosis, which research shows contributes to increased morbidity and mortality in Black people. Additionally, by only noting race and ethnicity when the patient is a person of color, the practice assumes that every other clinical case involves a white person. The effect is, ironically, an expansion of differential diagnoses for white patients. This form of medical education is teaching us how to treat and care for white bodies, while Black and Brown bodies continue to be “supplemental.” It is, inherently, a white supremacist approach.
My suspicions were confirmed when we spent a week studying dermatology. I must have seen at least 100 slides with various skin conditions, and out of those 100 slides, I saw roughly three on Black skin. When I asked our professor, a dermatology attending, how I could identify a particular skin condition on a Black person, she told me that it was a great question. She then proceeded to inform me that I would develop a better understanding if I did a dermatology residency.
What this incident taught me was that learning about skin conditions as they affect white people is expected, basic knowledge for all doctors. Identifying those same conditions on Black bodies requires, for some reason, specialized training. What this means is that out of my class of 200 students, the only people who will be trained to identify basic dermatologic conditions on Black bodies are the approximately five students who match into a dermatology residency. “White” should not be the standard by which medical education is taught. Black bodies should not be an afterthought. Why are medical institutions comfortable with graduating classes of ophthalmologists, internists, family medicine practitioners, and obstetricians that cannot identify basic skin conditions on Black people? This speaks to a racist health care system that values white bodies above all else. I could give countless more examples of how Black bodies in our education are unjustifiably “othered.”
Sadly, before we know it, we will have another generation of doctors who “miss” diagnoses in Black bodies when the reality is that we are not being appropriately trained in the first place. This incomplete medical education does a disservice to every single Black patient. Further, this ingrained limited differential diagnosis for Black patients helps explain why Black people are forced to beg their physicians to believe their symptoms when their condition strays from the “norm.” It also helps explain why Black people are required to get second, third, and fourth opinions. It is, of course, because doctors are not being trained in medical school to treat Black bodies.
Despite the fact that my medical school, like others around the country, is trying to revamp its racist curriculum, the damage has already been done. Cohorts upon cohorts of students have graduated without basic competencies for treating anyone that is not white. In school, we often learn about the social determinants of health, and how they affect both morbidity and mortality in communities of color. It is time to acknowledge that racist medical school curriculums, which emphasize whiteness and neglect Black bodies, continue to perpetuate health care inequities.
The author is a Black medical student in Chicago, Illinois.