DURHAM -- A few months ago, I went to a local urgent-care clinic to have a doctor check out my leg. I had injured it playing pick-up basketball, and with two very small children at home, a serious injury at this stage of life meant donating my high-top sneakers to charity. Within a few minutes, the nurse called me back to get a brief medical history and measure my vital signs. On her way out, she told me that it was a slow day at the clinic and that the doctor would be in shortly.
The doctor entered moments later. His eyes scanned me from head to toe, and it was only then that I realized how poorly I had dressed for the occasion. In haste, I had put on a fleece pullover and sweatpants, with slightly mismatched socks and an old pair of slip-on shoes. As I was about to discover, and should have already known, this was no way for a black man to present himself to a clinic.
With his eyes on his clipboard, he verified the information the nurse had obtained. He then took a glance at my injured leg, comparing it with my other leg.
"You're fine," he said. "Probably just a bruise or sprain. Just take it easy for a while."
And that was it. He was about to leave when I made it known I wanted more from him:
"I really just want to make sure I don't have a fracture. Last summer I walked around with a sore hand for three days before I got an X-ray that showed a left third metacarpal fracture."
He looked up and established eye contact for the first time. "Are you a medical person?"
I told him that I was a doctor. A smile came across his face as he asked me about my field, and we shared medical stories. He then went about putting my leg through various motions and assessing my ability to walk: the basic stuff he should have done from the beginning.
"I think you are right that it would be a good idea to get an X-ray on your leg."
Almost immediately, a nurse escorted me to the basement where X-rays were taken. Afterward, the doctor took five minutes to review the results with me, which showed only the early signs of knee arthritis. He offered a brace and crutches, along with prescription pain medicine.
It is widely known in medicine that doctors get special treatment when they seek care. But it's one thing to get a personal message about test results or even an after-hours appointment and quite another to receive a different standard of care. As I left the clinic, I could not help but feel that the blend of my race and attire had put me in an inferior category in the doctor's mind.
It has been 15 years since I first entered the world of medicine. During that time, several groups - including the esteemed Institute of Medicine - have made national news issuing reports that detail differential treatment based on race, whether it's blacks receiving lower rates of specialty cardiac care, higher rates of leg and foot amputations or, in my field of psychiatry, shorter visits for psychotherapy.
I've always felt that the disparities have as much to do with social class as they do with race. After all, doctors are among societies' wealthiest and most educated, and my experience has shown that we tend to show preferences toward those who are most similar to us. On the flip side, doctors have certain types of patients they don't particularly like. And while the majority of us are able to overcome this bias, some are not, and still other doctors are unaware or in denial of their biases. And therein lies the real danger to historically maligned African-American patients, especially those of lower socioeconomic status.
In the end, the doctor's initial impression was correct; I had a deep bruise. With a few weeks of rest, the pain receded. But I was struck by the fact that he would so eagerly change his approach once he discovered that I was different from his first impression. Initially, he saw a relatively young black man dressed quite casually, and I suspect his mental filter told him that I was not educated, perhaps seeking addictive pain medications and not likely to comply with medical treatments.
Over the past few decades, medical schools and physician training programs have implemented cultural competency initiatives and stressed increasing the numbers of black doctors to help remedy health disparities. While this may be a welcome start, there are several other factors beyond the scope of any individual doctor - expanding insurance coverage and greater patient education to name two - that are needed to make real change. Perhaps in the meantime, the best lesson is to wear a collared shirt and slacks to the doctor, or at the very least, a pair of matching socks.
Damon Tweedy, M.D., is a physician at Duke University Medical Center.
