Speak Now: Medical curriculum must account for people of color


Twenty-year-old Malone Mukwende, a medical student, created a handbook over the summer that shows how certain medical conditions appear in darker skinned individuals. Mukwende was prompted to do this when he learned about the presentation of certain skin conditions; it was alarming when he found many of these conditions could only be described when presented on light skin. 

This is just one example of the inequalities in the health care field. Students in the field of medicine are taught to recognize certain signs and symptoms, but are only taught how these signs present in certain populations, such as in people with light skin. 

As someone who plans on entering the medical field, and as someone with darker skin, I find this especially horrifying. Every time I read in a medical book that the skin may appear “red” or “pale,” I can’t help but wonder — I know what this looks like on my skin, but if I needed medical attention and my skin was flushed or appeared pale, would medical professionals be able to recognize it? 

study was done with the Tulane University School of Medicine and the University of Oklahoma’s College of Medicine, in which students had to diagnose skin conditions based on pictures and brief descriptions of the pictures. The results were grouped based on the pictures — pictures with lighter skin (Fitzpatrick I-III skin types) versus pictures with darker skin (Fitzpatrick IV-VI skin types). As reported by the Journal of the American Academy of Dermatology, medical students more frequently misdiagnosed patients with darker skin than patients with lighter skin. 

It has also been reported that Black Americans are three times more likely than White Americans to receive a late stage cancer diagnosis. This is because of the lack of representation in medical textbooks, which lead to misdiagnoses. 

It is no secret that medical racism exists, and dermatology is just one field in which the consequences can be deadly. The world is very diverse and there are many people who do not have light skin; the medical field must be able to recognize this. Curriculum for anyone going into the healthcare field should change in order to account for the diversity in our world.  

In addition to the lack of representation, medical racism is also perpetuated by implicit biases that some physicians hold. Research from the University of Virginia shows that Black Americans are generally undertreated for pain in comparison to both White Americans as well as World Health Organization (WHO) standards. The research found this is likely because of certain racial biases. 

Anyone who holds these biases in the medical field endangers the lives of their patients. Part of the Hippocratic Oath is to do no harm; by becoming a healthcare professional, while having these implicit biases, people break that oath. 

And of course, there are cases where these biases are not products of a lack of representation or implicit beliefs; rather they are the products of blatant racism written into textbooks. 

As late as October 2017, a nursing textbook titled, “Nursing: A Concept Based Approach to Learning,” had a section “focused on diversity” and discussed “cultural responses to pain.” Some of the sections discussed how people of Chinese descent may not ask for pain medication as it would distract the nurse from a more important task, how Black people often report higher pain intensity than other cultures and how those of Muslim faith may not request pain medication and instead may thank Allah for the pain. After numerous complaints, Pearson, the publisher, retracted this section of the book. 

Aside from these descriptions being flat-out ridiculous, if anyone entering the health care field actually believes something written here, it could quite possibly endanger patients. 

All medical training programs must review their curriculum, and perhaps even create a specific class to recognize and combat medical racism. Textbooks must include more diverse images for diagnoses and it is essential that accurate material is printed. Everyone, regardless of race and ethnicity, should be entitled to proper health care where they are guaranteed equal treatment. 

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