VOICES FROM INSIDE THE SYSTEM

‘We All Deserve Equal Access to Health Care’

This rheumatologist is working against a health care system plagued by implicit bias and inherent discrimination

Photo: PickStock/Getty Images

Voices From Inside the System is a new GEN series where we interview people who have had firsthand experience in industries with especially fraught histories of systemic racism and inequity. We asked our subjects to think deeply about the role they played and the work they did. We asked them why they stayed or why they left, how they might be complicit, and if they thought they — or anyone — could fundamentally change the system.

Magdalena Cadet, 44, is a rheumatologist based in New York committed to educating Black women about their health. Racial disparities in health care often lead to fatal outcomes for Black women. Pregnancy-related deaths are four to five times higher for Black women than white. And studies show as much as 60% of those deaths could have been prevented. Cadet spoke with journalist Melinda Fakuade about how the health care system fails its patients of color.

I was close to 30 years old by the time I completed my medical training. My dad’s a doctor, and I have a few family members who are doctors. I just remember looking at him when I was younger, thinking how much he enjoyed improving people’s quality of life. As I got older, I knew that I wanted to do the same. I was a competitive figure skater, dancer, and athlete, so rheumatology deals with conditions involving the bones and joints and muscles. I was amazed at how the body could repair itself, but also intrigued by the immune system and how they are great in attacking viral viruses. But it can also turn against itself, leading to autoimmune diseases.

When I was in medical school, I met a young girl who was diagnosed with lupus. She was African American and in her twenties. Because of her lack of education about the autoimmune disease, she passed away at an early age from complications. At that point, I knew that I was interested in educating females, and especially Black females, about this disease and the complications, such as heart disease and diabetes. Because of implicit bias and inherent discrimination in the health care system, providers may not be as open to educating patients. It’s multifactorial. I think it’s been present for so long, and I think it’s been seen across generations.

Hopefully, in the future, the health care disparity gap will be reduced. But I don’t think it has improved much. In rheumatology, I deal with patients with autoimmune diseases such as rheumatoid arthritis and lupus. These two diseases are really important because of the inflammation in the joints. There’s also systemic inflammation leading to early heart disease, heart failure, lung disease, hypertension, kidney disease, diabetes. What I have seen over and over again is that many times the patients will come to me, even though I’m a specialist, and I end up being the one to provide them information about their primary care, such as blood pressure screenings, diabetes screenings, cervical cancer screenings, or even family planning.

Having more Black physicians or minority physicians in the health care system alone can do a lot of good.

Usually, with a white patient who has high blood pressure, there’s an intervention that happens, whether the patient has to come back in a few weeks to get a blood pressure screening check, a hemoglobin check for diabetes, or maybe lifestyle factors will be discussed with the patient. What I have found in a lot of my minority patients is that they have not had this intervention done. When asked whether they have been told about complications of the disease or the things that they can do lifestyle-wise to improve health, many of them say their doctors never spoke to them about modifications. Some say that their doctors never even spoke to them about their disease in general.

We also know that Black females experience higher maternal and fetal mortality rates than white women. A lot of women are not educated about the possible complications of pregnancy, such as pre-eclampsia, or if asked if they have fibroids. A lot of these women are sent to nonelective C-sections versus maybe carrying on with a vaginal birth. Additionally, many minority patients haven’t been asked about depression or anxiety symptoms, which I find is not the case in non-Black patients. And if they are depressed or have anxiety, medications are less likely to be provided to these patients. So I know by the time they come to me, they have a primary care physician who has not necessarily addressed these issues.

Some of these health care biases may stem from providers thinking Black patients have little education, so they may not be able to understand the concepts, or that they are poor and can’t afford the medications, or that they don’t have adequate enough health insurance to be engaged in prevention care. I also feel that if you’re a woman in general, even without being a minority, you’re often dismissed. For example, women may present differently than men in terms of a heart attack or depression. Sometimes they have somatic complaints, and some of these providers just do not take these women seriously.

Hopefully in the future, the health care disparity gap will be reduced. But I don’t think it has improved much.

There needs to be people of leadership, especially Black leaders, who can speak about their experience and also demand that cultural competency training programs are implemented in the health care system. Because once you start at the top, other medical staff will have to follow suit. It’s also important to have these training programs to point out that people do have biases at every level.

But it also starts in medical school, too. Having more Black physicians or minority physicians in the health care system alone can do a lot of good. Once patients see that there are other physicians that look like them and might empathize more with them, they might be more trusting of the health care system. I was very fortunate that I attended a medical school that has gone through transitions. The original school actually was one of the first schools that accepted women into their medical school class. My particular class actually had a good amount of minority medical students. I do feel that in general, though, there needs to be more minority teachers, whether it’s in the basic sciences or clinical rotations. There should be rotations where students get to participate in communities that may have disparities or may not have access to care.

But I know Black female medical students deal with racism and microaggressions: Not being picked on surgical rotations, not being picked to scrub in on the surgery over and over again, when I was just as competent as the next person. Even as I have progressed in my career, although I had great qualifications, I’ve had to really ask to be a medical director over and over again and prove why I need to be there.

Recently, I was part of the campaign called Share the Medical Mic on Instagram, where Black female physicians took over the accounts of non-Black physicians so we can speak about topics like the disproportionate effects of maternal mortality in Black patients, the institutional racism in medicine, the disproportionate effects of diabetes and Covid in Black communities. If we don’t get physicians and providers and people in the health care institutions to acknowledge this issue exists, then these statistics will just keep getting worse.

This interview has been condensed and edited for length and clarity.

Melinda Fakuade is a culture writer in New York. Her work has appeared in The Outline, The Cut, Vox, and elsewhere. Follow her on Twitter @melindafakuade

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