In mid-March, Karla Monterroso flew home to Alameda, California, after an excursion to Utah’s Zion National Park. Four days later, he began to have a strong, dry cough. My lungs felt sticky.
The fevers that persisted, intermittently, for the next nine weeks increased so much (100.4, 101.2, 101.7, 102.3) that, on the worst of nights, I had to be under a shower of water frost, to try to lower the temperature.
“That night I had written letters to everyone close to me in a diary, what I wanted them to know if I died,” he recalled.
Within a month, new symptoms emerged: headaches and stabbing cramps in his legs and abdomen that made him think he might be at risk for blood clots and strokes, complications that other covid-19 patients had reported in his 30 years.
Still, she wasn’t sure if she should go to the hospital.
“As a woman of color, your emotions and the reality of your physical condition are very questionable. They tell you you’re exaggerating, ”said Monterroso, who is Latina. “So I had this weird ‘I don’t want to use the resources at all’ feeling.”
It took four friends to convince her that she had to call 911.
What happened in the emergency room at Alameda Hospital confirmed his worst fears.
Monterroso said that for most of her visit, healthcare providers ignored her symptoms and concerns. Is blood pressure low? That is a false reading. Your cyclical oxygen levels? The machine is bad. The shooting pains in the leg? It’s probably just a cyst.
“The doctor came in and said, ‘I don’t think there’s much going on here. I think we can send you home, ‘”Monterroso recalled.
His experience, he reasons, is part of why people of color are disproportionately affected by the coronavirus. It is not simply because they are more likely to have front-line jobs that expose them more, and the underlying conditions that make COVID-19 worse. “That’s part of it, but the other part is the lack of value that people place on our lives,” Monterroso wrote on Twitter detailing his experience.
Research shows how doctors’ unconscious biases affect the care people receive. Latino patients (who can be of any race) and African Americans are generally less likely to receive pain relievers or refer for advanced care than non-Hispanic white patients with the same complaints or symptoms. And women are more likely to die in childbirth from preventable causes.
That day in May, at the hospital, Monterroso felt dizzy and had trouble communicating, so a friend and her friend’s cousin, who is a nurse specialized in cardiology, was with her on the phone to help her. The two women started asking questions: What about Karla’s racing heart rate? Your low oxygen levels? Why are your lips blue?
The doctor left the room. She refused to attend Monterroso while her friends were on the phone, she said, and when she returned, all she wanted to talk about was Monterroso’s tone and the tone of her friends.
“The implication was that we were insubordinate,” said Monterroso.
Monterroso told the doctor that he did not want to talk about his tone. He wanted to talk about his medical care. She was concerned about possible blood clots in her leg and requested a CT scan.
“Well, you know, the CT scan is radiation right next to the breast tissue. Do you want to have breast cancer? “, Monterroso remembers the doctor telling him.” I only feel comfortable ordering that test if you say you have no problem having breast cancer. “
Monterroso thought to herself: “Swallow it, Karla. You need to be fine. “Then she said to the doctor,” I’m fine with breast cancer. ”
The doctor never ordered the test.
Monterroso asked for another doctor, a lawyer from the hospital. They said no. He began to worry for his safety. He wanted to leave. Her friends were calling all the medical professionals they knew to confirm that she was not being well cared for. They came to pick her up and took her to the University of California-San Francisco. The team did an EKG, a chest X-ray, and a CT scan.
I want you to know that I believe you
“One of the nurses came in and said, ‘I heard about your ordeal. I just want you to know that I believe you. And we are not going to let you go until we know that you are safe, ”said Monterroso. “I started crying. Because that’s all you want: to be believed. It’s really hard for Him to question you like that. “
Alameda Health System, which operates Alameda Hospital, declined to comment on the details of the Monterroso case, but said in a statement that it is “deeply committed to equity in access to health care” and that it “provides culturally sensitive care. for all”. “After Monterroso filed a complaint with the hospital, management invited her to speak with its staff and residents, but she refused.
Monterroso believes his experience is an example of why people of color fare so badly with the pandemic. “Because when we go to seek care, if we defend ourselves, we can be treated as insubordinate,” he said. “And if we don’t defend ourselves, we can be treated as invisible.”
Unconscious bias in healthcare
Experts say this happens routinely and regardless of the doctor’s intentions or race. For example, Monterroso’s doctor was not white.
Research shows that all physicians, all human beings, have biases they are not aware of, explained Dr. René Salazar, assistant dean of diversity at the University of Texas-Austin School of Medicine.
“Am I questioning a white man in a suit who comes in looking like a professional when he asks for painkillers in the same way as a black man?” Salazar wondered, pointing out one of his possible biases.
Unconscious bias often appears in high-stress settings, such as emergency rooms, where doctors are under tremendous pressure and have to make fast and critical decisions. Add in a deadly pandemic, in which science changes day by day, things can get complicated.
“There is so much uncertainty,” he said. “When there is this uncertainty, there is always a level of opportunity for the bias to break through and have an impact.”
Salazar used to teach at UCSF, where he helped develop training on unconscious biases for medical and pharmacy students.
Although dozens of medical schools are resuming training, he said, it is not done as often in hospitals. Even when dealing with a negative encounter like Monterroso’s, the intervention is usually weak.
“How do I tell my doctor, ‘Well, the patient thinks you’re a racist’?” Salazar said. “It’s a tough conversation: I have to be careful, I don’t want to say the word about race because I’m going to push some complex buttons. So it starts to get really complicated.
A data-driven approach
Dr. Ronald Copeland said he remembers that physicians also resisted these conversations when they were students. Suggestions for workshops on cultural sensitivity or unconscious biases received backlash.
“It was seen almost as a punishment. It’s like, ‘You’re a bad doctor, so your punishment is that you have to go get training,’ explained Copeland, who is Kaiser Permanente’s chief of equity, inclusion and diversity in healthcare. (KHN is an editorially independent program from KFF, which is not affiliated with Kaiser Permanente.)
Now, Kaiser Permanente’s approach is based on data from patient surveys that ask if the person felt respected, if the communication was good, and if they were satisfied with the experience.
This data is then broken down by demographics, to see if a physician can score well in respect and empathy from non-Hispanic white patients, but not from black patients.
“If you see a pattern that evolves around a certain group and it is a persistent pattern, then that tells you that there is something that comes from a culture, an ethnic group, a gender, something that the group has in common, that you are not boarding, Copeland said. “Then the real work begins.”
When doctors are presented with their patients’ data and the science about unconscious bias, they are less likely to resist or refuse, he added. In their healthcare system, they have reframed the goal of training around providing better quality care and getting better outcomes for patients, which is why doctors want to do it.
“People are unfazed,” he said. “They are eager to learn more about it, especially about how to mitigate it.”
Still feel bad
It has been almost six months since Monterroso first fell ill and he still does not feel well.
Her heart rate continues to increase, and doctors told her she might need gallbladder surgery to treat gallstones she developed as a result of covid-related dehydration. She recently decided to leave the Bay Area and move to Los Angeles so she could be closer to her family during her long recovery.
He declined Hospital Alameda’s invitation to speak with his staff about his experiences because he concluded that it was not his responsibility to fix the system. But he does want the broader health system to take responsibility for systemic bias in hospitals and clinics.
You acknowledge that Alameda Hospital is public and does not have the kind of resources that Kaiser Permanente and UCSF have. A recent audit warned that the Alameda Health System was on the brink of insolvency. But Monterroso is the executive director of Code2040, a nonprofit on racial equity in the tech sector, and even for her, she said, it took an army of support to be heard.
“90% of the people who are going to go through that hospital will not have the resources that I have to face them,” he said. “And if I don’t say what is happening, then people with far fewer resources are going to have this experience and they are going to die.”
This story is part of a partnership that includes KQED, NPR, and KHN.
Remdesivir, the drug approved to fight the coronavirus created in North Carolina
READ MORE WAB NEWS