Negligent by Design

A searing critique of medical racism and a powerful call for health-care professionals to make real change in their field, written by a leading activist and doctor

Unequal access to care. Misdiagnosis. Mistreatment. Medical gaslighting. An increasing number of studies show the profound impacts racism has on communities of color—particularly Black Americans. But these disparities in health care and wellbeing are not the result of a handful of uninformed or malicious doctors: racism in the medical system is institutional, woven into the very fabric of diagnostic criteria and even hospital infrastructure. Medicine denies fair treatment to Black patients not in error…but by design. 

Drawing from extensive research, in-depth interviews with medical students and resident physicians, and over twenty-five years of experience as a medical doctor, Dr. Vanessa Grubbs argues that the reason racism in medicine continues to go unchecked is because it is in fact the standard of care. Any attempts to dismantle medical racism through “placebo” efforts such as forming diversity committees or releasing statements condemning racism will fail, she says, because they don’t address the reality of how the institution of Medicine has been, and continues to be, negligent when it comes to the treatment of Black people. 

Dr. Grubbs skillfully unpacks the three core problems of how our health-care system currently considers the race of patients, which she identifies as being “race based,” “race disregarded,” and “race denied.”

• When medical diagnoses and trainings are race based, they lead doctors to make different treatment decisions for Black patients, and create a dangerous disadvantage.
  
• At the same time, medical textbooks and trainings may inappropriately disregard race in cases when it does matter, like failing to include pictures of how rashes may appear differently on light and dark skin—leading to misdiagnosis and death.
  
• And finally, many medical institutions still deny the extent to which racism is an issue at all, resulting in fewer Black physicians and disastrous outcomes for Black patients. 
  

Calling on her medical colleagues to join her in working against the negligence of American medicine, Dr. Grubbs lays out a pathway to true equity and inclusion in health care: getting to the root of the underlying fears and insecurities that have led to racist medical negligence; recruiting and retaining a diverse physician workforce; and forcing Medicine to commit to the cultural humility necessary to rebuild, not just replaster, a broken institution.