Health care is supposed to be a place of safety and healing, yet too often it becomes a site of dismissal, doubt, and unequal treatment for patients from marginalized communities. Long waits, minimized pain, delayed testing, and biased assumptions continue to shape medical encounters across clinics, emergency departments, and hospitals. These patterns are not just frustrating, they can be dangerous, even life-threatening.
For patients who already know their bodies, their histories, and even the science behind their conditions, the gap between what they report and how they are treated can feel especially stark. That’s why learning how to advocate for yourself, calmly, firmly, and with a paper trail, is one of the most powerful tools you can carry into a medical encounter.
What Bias Can Look Like
- Pain undertreatment: Black patients are more likely to have their pain dismissed or inadequately treated due to false beliefs about biological differences.
- Emergency department disparities: Black patients sometimes face longer waits and lower triage acuity ratings than white patients with similar symptoms.
- Maternal health inequities: In 2023, Black maternal mortality remained more than twice as high as for white women, at 50.3 deaths per 100,000 live births.
- Technology blind spots: Devices like pulse oximeters often overestimate oxygen levels in patients with darker skin, risking delayed care.
- Algorithm bias: Some hospital tools used to determine who qualifies for extra support have underestimated Black patients’ needs.
My Story: Dismissed in the ED
I once went to the emergency department with severe abdominal pain. I was wearing my fleece embroidered with my professional role, “Infection Prevention Epidemiologist,” a clear signal that I had a background in public health.
Still, I was treated as if I were a drug addict and before any lab or imaging results were back, I was discharged by a rude resident who told me it was “likely STD/STI-related.” I was not offered an ultrasound. I wasn’t seen by an attending physician. And I was told this despite having zero history of any sexually transmitted infections nor any confirming test results.
That day made clear to me: credentials, professionalism, and composure don’t shield Black women from bias in health care. It also underscored the importance of having the tools and language ready to advocate for yourself, even when the system tries to dismiss you because two days later, I received a personal call from the president of the hospital apologizing profusely and asking that I refrain from reporting the incident…I still reported it.
Real-World Examples You Might Encounter
1. The “leading question” trap (pain management)
- You: “My pain is an 8 out of 10. I can’t sleep.”
- Clinician: “Is there something specific you’re looking for?”
This sets you up to name a drug, so later they can write, “Patient requested opioids.”
How to respond:
“I’m not requesting a specific drug. I’m asking for treatment that matches my symptoms. What are all the evidence-based options we can consider?”
2. Emergency care dismissal
- Scenario: You arrive in the ED with chest pain. Staff suggest it might be anxiety and delay ordering an EKG, even though chest pain is a red-flag symptom.
- Why it matters: Black women’s cardiac symptoms are more likely to be misattributed to stress or anxiety, increasing the risk of missed heart attacks.
How to respond:
“Because chest pain can indicate a heart attack, I want an EKG and cardiac enzymes documented as part of the evaluation.”
3. Maternal care minimization
- Scenario: You’re postpartum and report severe headaches and swelling. The clinician says, “That’s normal after delivery.”
- Why it matters: These are warning signs for preeclampsia, a leading cause of preventable maternal death.
How to respond:
“I understand some swelling can be normal, but these are red-flag symptoms for preeclampsia. I’d like this documented and evaluated right away.”
4. Technology blind spot
- Scenario: You’re triaged in the ED for shortness of breath, and the pulse oximeter shows normal oxygen saturation. Staff reassure you and send you to the waiting room, despite worsening symptoms when you walk.
- Why it matters: Pulse oximeters can overestimate oxygen in people with darker skin, leading to delayed treatment.
How to respond:
“Because oximeters can misread on darker skin, could you confirm with a repeat test or another method?”
5. Algorithmic bias (hospital setting)
- Scenario: A risk-scoring tool doesn’t flag you for follow-up, even though you have multiple chronic conditions.
- Why it matters: Some algorithms historically underestimated Black patients’ needs by using health-care spending as a proxy for illness burden.
How to respond:
“Given my medical history, what criteria are being used to decide whether I qualify for extra support?”
Self-Advocacy Strategies
- Ask for documentation: “Please note my exact words about my pain/symptoms in the chart.”
- Request denial documentation: “Please note in my chart that I requested [lab test, imaging, or referral] and it was denied.” This creates a paper trail if your condition worsens later.
- Get credentials: “Could I have your full name and license number for my records?”
- If asked why: “In case my lawyer requires it—it’s easier to ask now than later.”
- Push for clarity: “What diagnoses are we ruling out? What’s the timeline for tests and results?”
- Request escalation: “I feel dismissed. I’d like a second opinion, and please document that request.”
- Bring an advocate: In maternal care or serious hospital stays, a doula, partner, or trusted friend can reinforce your voice.
Where to Report Discrimination
If you experience racial discrimination in a hospital:
- Inside the hospital: Patient Relations or Compliance Office.
- State health department: File a formal complaint with your state’s licensing agency.
- Federal level: U.S. Department of Health & Human Services, Office for Civil Rights (OCR)
- Accreditation: The Joint Commission.
- Legal support: State Attorney General, civil rights groups (e.g., NAACP Legal Defense Fund), or an attorney.
Tip: Again, always request in writing that denied labs, imaging, or referrals be noted in your chart. This creates a clear record.
Why the System Resists
It’s not only individual bias that creates these moments. Many patterns are driven by the financial incentives of insurers and pharmaceutical companies. Insurers profit by limiting testing, treatments, and hospital stays. Pharmaceutical companies profit by pushing certain drugs over others and hoarding patents. These pressures filter down into how some clinicians practice: shortcuts, suspicion, and outright denials that can put patients at risk.
Recognizing that resistance doesn’t make it easier, but it helps you see the bigger picture. When your request for a reasonable test is denied, it may be about profit margins as much as prejudice. This is why creating documentation and demanding transparency are so powerful: they leave less room for financial or biased motives to go unchallenged.
Final Thoughts
Even when you show up as an expert in health care, bias can strip away dignity and compromise care. That’s why calm precision, clear requests, and documentation are so vital. Minority groups, black women especially given the stats, deserve evidence-based medicine without prejudice. All.People.Do. Until institutions change, the best protection we have is to advocate, fiercely and unapologetically, for ourselves and our health.
References
Centers for Disease Control and Prevention. (2025, February 1). Maternal mortality rates in the United States, 2023 (NCHS Health E-Stats). https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2023/Estat-maternal-mortality.pdf
Hoffman, K. M., Trawalter, S., Axt, J. R., & Oliver, M. N. (2016). Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between Blacks and Whites. Proceedings of the National Academy of Sciences, 113(16), 4296–4301. https://pmc.ncbi.nlm.nih.gov/articles/PMC4843483/
Johns Hopkins Bloomberg School of Public Health. (2024, July 8). Pulse oximeters’ racial bias. https://publichealth.jhu.edu/2024/pulse-oximeters-racial-bias
Obermeyer, Z., Powers, B., Vogeli, C., & Mullainathan, S. (2019). Dissecting racial bias in an algorithm used to manage the health of populations. Science, 366(6464), 447–453. https://www.science.org/doi/10.1126/science.aax2342
Stillman, K., et al. (2024). Socio-demographic disparities in emergency department triage and wait times. Annals of Emergency Medicine. https://www.annemergmed.com/article/S0196-0644%2824%2900651-6/fulltext
Lence in Layers 