Going to the doctor can be nerve-wracking for anyone—especially if you’ve been putting it off for a while or have a health concern you’re worried about. If you’re Black, Indigenous, or a person of color (BIPOC), you might feel a little extra anxiety that racial discrimination could keep your concerns from being heard. There are existing ethnic and racial disparities in health care—for various reasons, health outcomes are worse than for those of white patients.
“Every person who engages with a healthcare team, regardless of background, should feel agency and be an equal participant in conversations and discussions about their health,” says Melissa Simon, MD, the director of the Institute for Public Health and Medicine – Center for Health Equity Transformation at Northwestern University’s Feinberg School of Medicine. “It’s important to acknowledge that BIPOC have more distrust for very valid reasons after having experienced decades of maltreatment from the healthcare system.”
Open communication can help to build back that trust, and it starts with patients feeling empowered to ask questions—and receive thoughtful answers—about their health. A strong relationship with a primary care provider is the foundation for understanding minority health issues and alleviating fears.
9 questions to ask a doctor if you’re Black, Indigenous, or a person of color
While there are various general questions that are important for all patients to cover with their doctor, there are additional things Black, Indigenous, and people of color should ask to ensure their concerns aren’t overlooked or brushed aside.
1. What are my rights as a patient?
There are well-established patient rights that every clinic, hospital, and entity that delivers health care has on hand, often in the form of a pamphlet, Dr. Simon says. Non-minorities receive higher quality care than Black, Indigenous, people of color—even when access factors like insurance status and income are controlled.
Asking for that document can help you recognize if you’re receiving subpar treatment. If you feel that as a patient or a caregiver, your needs aren’t being met or heard, then you can say so directly to your healthcare provider. Or, it can be a good reason to choose another physician—either at that facility or elsewhere.
2. Why do you want to run that test?
Healthcare providers are taught to come up with a list of differential diagnoses or possible causes for your symptoms, Dr. Simon explains. Everything on that list of potential conditions has a set of procedures, such as blood or imaging tests to confirm a specific diagnosis. Healthcare providers don’t always go through the entire list—and why they are ordering certain tests—often because they only have 15 to 30 minutes allotted for each patient. Or, they struggle with the complexity of explaining these possibilities.
“Because of underlying bias and racism of some healthcare providers and health systems coupled with the distrust of some patients (mostly due to decades of historical mistreatment with the health care system and experiences of racism and discrimination), patients of color should indeed feel empowered and feel agency to ask these questions,” Dr. Simon says. “Asking these questions can help patients to better feel that they are being heard by their clinical care providers and these questions help a patient better understand what they personally may have and why.”
3. What will the results of this test or procedure tell us?
“There are many times when patients need guidance and don’t necessarily understand the risks, benefits, and complications of certain procedures, so going through all of this with a provider can leave them feeling a bit reassured,” explains Soma Mandal, MD, an internist at Summit Medical Group in Berkeley Heights, New Jersey. You’re not expected to know everything as far as terms and statistics. Your provider should be your resource and advocate.
Dr. Simon suggests that when a doctor says “This is what I think is going on,” the response from you as a patient should be “Can you tell me whatever else you’re considering that could be going on?” If a test comes out negative and you’re still concerned about the symptoms you’re experiencing, it’s especially important to go over other conditions that could be causing your symptoms, according to Dr. Simon.
4. How many times have you performed this procedure?
Undergoing a procedure can be stressful, but knowing your doctor’s experience with it can help put your mind at ease. In her practice, Dr. Mandal says she sees a lot of women of color in her practice and advises them on what to ask a specialist before undergoing certain procedures and surgeries. And it can be as simple as, “How many times have you done this?”
“This is one of many questions that women of color often don’t ask because they feel like they may come across as demanding or intrusive,” Dr. Mandal explains. “But this is something that’s important for everyone to ask.”
If your specialist is someone who has performed a certain procedure over 1,000 times, you’ll know that they’re confident and comfortable in performing it.
5. Do I need any additional screenings?
White patients are more likely to receive preventive screenings and advice on maintaining a healthy lifestyle through diet and exercise. For example, Native Americans/Native Alaskans are less likely than whites to receive colorectal cancer screening. On top of that, certain minority groups have higher risk for certain chronic conditions, such as diabetes. The rates among African Americans, Latinx, and Native Americans are 2.8 times higher than the average population. Access to health care may also be limited disproportionately given the higher percentage of people uninsured in these groups.
There is evidence that harmful products such as unhealthy food, alcohol, and tobacco are disproportionately marketed toward Black, Indigenous, people of color. Over-consumption can lead to health problems including heart disease, liver problems, and lung cancer. These factors combined may mean that you need additional exams or tests at your yearly physical to catch any issues early, when they are most treatable. If you don’t have health insurance, you can find free clinics in your area here.
6. How can I reduce my COVID-19 risk?
Coronavirus has disproportionately affected Black, Indigenous, people of color. Racial and ethnic minority groups are at higher risk of getting sick and dying from the novel coronavirus, according to the Centers for Disease Control and Prevention (CDC). A variety of factors contribute to this risk—from discrimination to distrust of the healthcare system. Candid conversations with your healthcare provider can help to alleviate some of those fears and reduce your chances of infection.
“There are still a lot of people who don’t want to be tested, so by asking questions and understanding why this testing is being done, why masks are important, how contagious the virus is, etc., you can understand that it’s being done in order to give you the best care possible,” Dr. Simon says.
7. Would you recommend a second opinion?
This is a question you may bring back to your primary care provider after getting a diagnosis from a specialist. A second opinion can help to confirm what the first doctor may have said and bring you additional peace of mind that the care plan is the best course of action. “If it’s a particularly lengthy procedure or the diagnosis is serious, such as a joint replacement, or it’s a non-life-threatening condition that would require surgery, I always advocate getting a second opinion just to back up that initial recommendation,” Dr. Mandal says.
Certain procedures are over-performed for Black, Indigenous, people of color. One example is unnecessary hysterectomies, which can come with the risk of urinary incontinence as you get older and have statistically been over-performed in Black women. Caesarian sections have also been over-performed in Black women even when they haven’t proven to be medically necessary, according to a 2017 study.
In other cases, care is substandard. Procedures like joint replacements are actually performed on Black patients less than in white patients, and Black patients are also less likely to receive cardiac catheterization even though heart disease rates are higher. Asian Americans are less likely than whites to receive recommended hospital care for pneumonia. “In these situations, I’ll sit down with my patients and educate them as to why (a certain procedure) may not be needed and what other procedures may be available that weren’t even offered to them,” Dr. Mandal explains.
8. Can we schedule another visit?
If you don’t agree with what you’re hearing and don’t have enough time in your visit, you should ask to set up another appointment to continue the conversation.
White patients often ask more questions and request additional info, according to Dr. Simon, while BIPOC patients tend to feel unheard or not listened to in healthcare settings. Socioeconomic background also plays a major role in terms of how much a person asks questions to their providers. “It’s important for all patients to ask for another visit if they don’t feel like there is real resolution to what they are feeling,” she says.
You can also ask the doctor to point you toward more information or materials for you to review on your own so you can learn more about your potential situation before coming back to discuss your additional questions and concerns.
9. What other patient resources are available to me?
Most community health centers, clinics, and hospitals have a patient services department where you can voice and attempt to resolve certain concerns, or seek a second opinion from an alternate provider. Some hospitals also have health learning centers, similar to libraries, where staff can help you find information about your concern or diagnosis and help you better communicate your concerns with your healthcare provider.
Additionally, all hospitals, healthcare institutions, and clinics have some kind of financial support department or service in place. BIPOC have less access to healthcare than Whites—the rates of uninsurance or under-insurance are higher. If you get a bill from the hospital, you’re concerned that your insurance isn’t going to cover everything that you need, or you don’t have insurance and you’re concerned about how much something is going to cost, you can often speak to the financial services department about it. If you don’t have insurance, you can try to negotiate a lower price or see if there are other resources available that could be applied to your bill for the services you’re receiving.
The bottom line
The conversation between a healthcare provider and patient is crucial to build trust and confidence from the patient’s perspective that their provider actually listens, cares, and is genuinely concerned.
“At the end of the day, you are your own expert on you,” Dr. Simon says. “It’s key to know that you have every right to be heard and that your feelings are valid.”