Medical Racism Reference¶

Medical Racism
Abbreviation	N/A
Type	Systemic discrimination / Healthcare disparity
Affected Characters	Andy Davis, Heather Moore
Recognition	Extensively documented in medical literature; roots in slavery-era medicine
Related Conditions	Medical trauma, Pain management disparities, Diagnostic delays

WHAT IS MEDICAL RACISM?¶

Definition: Systemic discrimination against Black patients in healthcare settings, rooted in false beliefs about biological differences, historical medical violence, and ongoing structural racism in medicine.

Key Points: - Systemic, not individual: Not just "bad doctors," entire medical system built on racist foundations - Historical and ongoing: Roots in slavery-era medicine, continues today - Measurable harm: Documented in research - worse outcomes, higher mortality, undertreated pain, diagnostic delays - Intersects with everything: Disability, class, gender, geography

Medical Racism is NOT: - Cultural misunderstandings (it's systemic discrimination) - Individual prejudice only (it's structural) - Past history (it's ongoing, current, daily) - Rare cases (it's pervasive, documented, widespread)

HISTORICAL CONTEXT¶

Tuskegee Syphilis Study (1932-1972): - 600 Black men told they were receiving free healthcare - 399 had syphilis, deliberately left untreated for 40 years - Studied disease progression without consent - Men suffered, died, infected partners and children - Continued 28 years AFTER penicillin became standard treatment - Creates ongoing, justified distrust of medical research

J. Marion Sims - "Father of Gynecology": - Performed experimental surgeries on enslaved Black women - Without anesthesia (falsely believed Black women didn't feel pain the same way) - Without consent (enslaved people couldn't consent) - Built gynecology field on torture of Black women - Still celebrated in medical history until recently

Henrietta Lacks: - Cancer cells taken without consent in 1951 - HeLa cells used in research worldwide, generated billions in profits - Lacks family not informed, not compensated for decades - Black woman's body used for medical advancement without autonomy

False Biological Beliefs¶

Historical Myths (Still Affecting Care Today): - Black people have higher pain tolerance (FALSE) - Black people have thicker skin (FALSE) - Black people's blood coagulates faster (FALSE) - Black people's nerve endings are less sensitive (FALSE)

Current Impact: - Medical students still endorse these false beliefs (2016 study) - Leads to undertreated pain, delayed diagnosis, inadequate care - Racist pseudoscience from slavery era still taught and believed

Era-Specific Implications for Characters¶

Andy Davis (born ~1999, experiences medical racism throughout childhood and adulthood): Andy grew up in the post-Tuskegee revelation era, but the legacy of medical experimentation on Black bodies continued to shape healthcare interactions. His childhood in the 2000s coincided with emerging research documenting pain management disparities—studies showed Black children received less pain medication than white children for identical conditions, a pattern Andy experienced personally with his CP-related pain dismissed as "growing pains." By the time of his seizure-related police violence incident at age 16 (circa 2015), the intersection of medical emergency and police brutality against Black people was gaining public awareness through the Black Lives Matter movement, though this awareness did not prevent his traumatic experience. His adult medical care occurs during an era when studies (2016) documented that medical students still endorse false beliefs about Black pain tolerance—explaining why his ongoing pain remains undertreated despite decades of documentation showing this discrimination exists.

Heather Moore (experiences compounded medical racism as Black woman with CP): Heather faces the intersection of medical racism and medical misogyny that researchers have documented creates worse outcomes for Black women than either factor alone. The 3-4x higher maternal mortality rate for Black women—which holds across income and education levels—reflects how systemic racism in medicine operates independently of individual circumstances. Her experiences occur during an era when this disparity is well-documented and publicly discussed (particularly after Serena Williams's near-death experience postpartum in 2017), yet the documentation has not translated into systemic change. Her CP-related pain faces the "triple dismissal" of being Black, being a woman, and having a disability—each factor compounding the likelihood her symptoms will be attributed to anxiety, exaggeration, or attention-seeking.

Historical Timeline Affecting Both Characters: - 1932-1972: Tuskegee Study creates justified multigenerational distrust of medical establishment - 1951: Henrietta Lacks's cells taken without consent—exploitation continues for decades - 1970s-1990s: Growing awareness of medical racism, but minimal systemic change - 2016: Study documents medical students still believe false claims about Black pain tolerance - 2017-present: Black maternal mortality enters mainstream discourse but outcomes don't improve - Ongoing: Andy and Heather navigate a system where the racism is documented, studied, publicized—and persists

MANIFESTATIONS OF MEDICAL RACISM TODAY¶

PAIN MANAGEMENT DISPARITIES¶

Research Findings: - Black patients receive less pain medication than white patients for same conditions - Black children in pain less likely to receive pain medication than white children - Black patients' pain rated as less severe by medical providers - Implicit bias affects pain treatment decisions

Mechanisms: - False beliefs about pain tolerance - Assumptions about "drug-seeking" behavior - Distrust of Black patients' pain reports - Racial bias in pain assessment

Andy's Experience:

Andy's Pain Reality: 8/10, muscle spasms severe, can barely move
Doctor's Response: "Let's try Tylenol first" (inadequate for CP pain)
White Patient Same Condition: Prescribed muscle relaxants, stronger pain meds immediately

Andy Asks for Stronger Pain Relief: Labeled "drug-seeking," note in chart
White Patient Asks: Seen as appropriate self-advocacy

Heather's Experience:

Heather in ER: Severe pain, muscle spasms
Doctor: "Are you sure it's that bad?" (questioning her pain report)
Heather: (Having to perform pain, prove she's suffering)
Doctor: "Let's see how you do with ibuprofen" (insufficient)

White woman same age, same condition: Adequate pain management first visit

DIAGNOSTIC DELAYS AND DISMISSALS¶

"It's All in Your Head": - Black patients' symptoms dismissed as anxiety, stress, exaggeration - Diagnostic testing delayed or denied - Serious conditions missed until advanced stages

Intellectual Disability Assumptions: - Andy (85th percentile overall, 92nd percentile English): Doctors assume intellectual disability based on CP + being Black - Intelligence questioned, talked over, excluded from own medical decisions - Medical providers address Cody (white partner) instead of Andy

Example - Andy:

Doctor speaks to Cody: "And how has HE been managing his medications?"
Andy, sitting right there: "I can answer that myself."
Doctor, still to Cody: "Is HE compliant with the treatment plan?"
Andy: "I'm. Right. Here."

Doctor finally addresses Andy, speaks slowly, uses simple words, as if to a child.
Andy (92nd percentile English, published writer): Subjected to this. Every. Appointment.

MATERNAL MORTALITY DISPARITIES¶

Statistics: - Black women 3-4 times more likely to die from pregnancy-related causes than white women - Holds true across income and education levels - Serena Williams nearly died postpartum due to dismissal of her symptoms (and she had resources, fame, knowledge)

Causes: - Pain and symptoms dismissed - Complaints attributed to anxiety, exaggeration - Medical racism + medical misogyny intersection - Implicit bias affects treatment decisions

Relevance to Series: - If Heather or other Black women characters have children: This risk is real - Medical professionals may dismiss serious symptoms - Advocacy required, doesn't always work

AUTONOMY DENIAL¶

Talking Over, Around, Instead Of: - Medical providers address white family members instead of Black patients - Decisions made without patient input - Patient's knowledge of their own body dismissed

Andy's Experience:

Andy knows his body, his CP, his seizure patterns after 25+ years.
Doctor (who met Andy 10 minutes ago): "I think we should change your medication."
Andy: "That medication hasn't worked for me before, caused severe side effects."
Doctor: "Let's try it anyway."

Andy's expertise about his own body: Dismissed
Doctor's 10-minute assessment: Valued more

Informed Consent Violations: - Procedures done without full explanation - Risks not fully disclosed - Coercion into treatments - Historical legacy (Tuskegee, forced sterilizations) creates distrust

POLICE CALLED DURING MEDICAL CRISIS¶

The Deadly Reality: - Black patients having medical emergencies (seizures, mental health crises, pain episodes) → Staff calls police instead of providing care - Police escalate, harm, sometimes kill Black people in medical crisis - Happens in hospitals, supposedly "safe" spaces

Andy's Experience (Age 16):

Andy, seizure in public. Post-ictal (after seizure): confused, disoriented, trying to orient himself.

Bystander calls 911. EMTs arrive, try to restrain Andy (still disoriented).
Andy resists (not understanding what's happening, brain still rebooting from seizure).

EMTs call police. "Combative patient."

Police arrive. See: Black teenager, appears "non-compliant," unclear speech (CP + post-ictal state).
Police escalate. Restraints, force, violence.

Andy (having medical emergency) treated as threat.

Result: Medical trauma, PTSD from what should have been medical care. Learned healthcare + police = danger.

Ongoing Impact: - Andy terrified of medical emergencies in public - Knows seizure could get him killed - Wears medical alert, carries information, takes every precaution - Still not enough—racism overrides medical need

Why This Happens: - Medical staff perceive Black patients as threatening - Implicit bias: Black patient in distress = dangerous, not vulnerable - System fails Black patients, calls violence instead of providing care

ANDY'S CUMULATIVE EXPERIENCE WITH MEDICAL RACISM¶

Childhood¶

Pain Undertreated: - CP pain dismissed as "growing pains" - Adequate pain management denied - Learned to minimize pain (reporting it didn't help)

Intelligence Questioned: - Teachers, doctors assumed intellectual disability - Placed in special education despite high intelligence - Fought for appropriate education

Autonomy Denied: - Parents talked over him - Medical decisions made without his input - Body treated as object, not person with agency

Teenage Years¶

Seizure + Police Incident (Age 16): - Medical emergency became police violence - PTSD from incident - Learned: medical crisis in public = danger

Ongoing Pain Dismissal: - Adolescent pain attributed to "acting out," "seeking attention" - Pain management inadequate throughout development

Adulthood¶

Every Medical Appointment: - Intelligence assumed low (despite 92nd percentile English, published work) - Doctors address Cody instead of Andy - Pain undertreated compared to white patients - "Drug-seeking" assumed when asking for adequate pain relief

Emergency Room: - Treated with suspicion - Pain questioned - Cody's presence helps (white partner = credibility) but shouldn't be necessary - Fear of police being called

Cumulative Trauma: - Medical settings = threat - Hypervigilance during appointments - PTSD triggered by medical environments - Delays seeking care (justifiably fears mistreatment)

HEATHER'S EXPERIENCE WITH MEDICAL RACISM¶

Medical Racism + Medical Misogyny¶

Intersection: - Black woman = pain dismissed even more than Black men - Symptoms attributed to anxiety, hysteria, exaggeration - "Angry Black woman" stereotype weaponized against self-advocacy

Reproductive Healthcare: - If Heather seeks reproductive care: additional discrimination - Black women's maternal mortality 3-4x higher - Pain during procedures often undertreated - Autonomy in reproductive decisions questioned

Specific Manifestations¶

Pain Dismissed: - "Are you sure it's that bad?" (requiring proof of suffering) - Inadequate pain management - Having to perform pain to be believed

Talked Over: - Medical providers assume incompetence - CP + Black + woman = triply dismissed - Expertise about own body disregarded

INTERSECTIONS: MEDICAL RACISM + DISABILITY¶

Compounded Assumptions¶

Andy: - CP = assumed intellectual disability (ableism) - Black = assumed less intelligent, more threatening (racism) - Intersection: Doubly dismissed, doubly discriminated against

Pain: - Disability = pain assumed exaggerated or psychosomatic - Black = pain assumed less severe, higher tolerance myth - Intersection: Pain severely undertreated

Autonomy: - Disability = autonomy denied, decisions made by others - Black = medical decisions made without consent (historical pattern) - Intersection: Andy excluded from own medical care

Specific Examples¶

Medication Management:

Andy manages complex medication regimen (seizure meds, muscle relaxants, pain meds).
Andy knows what works, what doesn't, side effects, interactions.

Doctor wants to change medications.
Andy: "I've tried that before, had severe side effects."
Doctor: "Let's try it anyway."

Andy's 25+ years of experience with his body: Dismissed
Doctor's assumption: Black disabled patient can't accurately report experience

Communication:

Andy has CP-related stutter (motor-based, NOT cognitive).
Doctor speaks to him like a child.
Andy (brilliant, articulate writer): Has to prove intelligence every appointment.

Stutter + Black + CP = Assumed incompetent
Reality: 92nd percentile English, published author, managing complex medical conditions successfully for decades

MEDICAL RACISM IN RESEARCH AND TREATMENT DEVELOPMENT¶

Research Disparities¶

Underrepresentation in Studies: - Medical research historically focused on white patients - Treatment protocols developed for white bodies - Effectiveness and side effects may differ across populations - Black patients underrepresented in clinical trials

Distrust of Medical Research: - Tuskegee legacy creates justified distrust - Historical exploitation without consent - Ongoing exploitation (Henrietta Lacks) - Participation in research requires trust medical system hasn't earned

Treatment Access¶

Barriers: - New treatments less available in predominantly Black neighborhoods - Specialists less accessible - Insurance disparities - Geographic barriers (medical deserts)

Quality of Care: - Hospitals serving predominantly Black communities often under-resourced - Equipment older, staff overworked - Outcomes worse even for same conditions

WRITING MEDICAL RACISM¶

Show Systemic Nature¶

Not Just Individual Prejudice:

❌ Bad: "Dr. Smith is racist, but Dr. Jones is nice, so Andy gets good care from Dr. Jones."

✓ Better: "Dr. Jones seems kind, listens more than others. Andy's pain is still undertreated compared to white patients. The system is broken, even well-meaning doctors operate within racist structure."

Cumulative, Ongoing:

Not one dramatic racist incident, but constant microaggressions and discrimination:

- Doctor addresses Cody instead of Andy (every appointment)
- Pain medication insufficient (every time)
- Intelligence questioned (constantly)
- Assumptions made (unrelenting)

Death by a thousand cuts, plus occasional major violence (police called during seizure).

Show Andy's Expertise and Agency¶

Andy Knows His Body:

Andy had researched his medication options, understood the pharmacology better than some of his doctors. Twenty-five years of managing CP gave him expertise medical school didn't teach.

The neurologist dismissed his concerns anyway. Spoke to Cody. Andy gritted his teeth and repeated himself, louder.

Andy Advocates (Shouldn't Have To, Does Anyway):

"I need adequate pain management." Andy kept his voice level, professional. He'd learned the performance—respectful, non-threatening, armed with medical terminology.

If he sounded angry (and he was), he'd be labeled difficult. If he pushed too hard, they'd call security. If he advocated too much, "drug-seeking" went in his chart.

Walking a tightrope. White patients didn't have to.

Show Cody's Role (And Its Limits)¶

Cody as Translator/Shield:

Cody repeated what Andy had just said. Same words.

The doctor listened this time. Nodded. Considered it.

Andy had said the same thing thirty seconds ago. Cody's white face made the words credible.

Andy loved Cody. Hated needing him for this.

Cody's Presence Helps, Shouldn't Be Necessary:

"I shouldn't have to bring you to be taken seriously," Andy signed to Cody later.

"I know." Cody's face reflected the same frustration. "It's not fair."

It wasn't. Andy went to appointments alone sometimes, on principle. Paid for that principle with worse care.

Cody Learning to Advocate Without Taking Over:

Early on, Cody had jumped in too quickly, answered for Andy, tried to protect.

Andy had (gently) corrected: "I need you to back me up, not speak for me."

Now, Cody waited. Let Andy lead. Stepped in only when Andy was being ignored, amplified Andy's words without replacing them.

Still a tightrope. Still shouldn't be necessary.

Show Emotional Impact¶

Exhaustion:

Every appointment drained him. Not just physically (pain, travel, waiting), but emotionally. Preparing to fight to be heard. Preparing to prove his humanity, intelligence, pain. Every time.

White patients walked in, got care, left. Andy walked in, performed respectability, fought for basics, left exhausted whether he got adequate care or not.

Anger:

Andy was tired of being patient about his own pain. Tired of politeness in the face of discrimination. Tired of managing white people's comfort while his body screamed.

He stayed calm anyway. Anger got Black men killed.

Fear:

Seizure in public = potential death sentence. Not from the seizure (those he could manage), from the police who might be called.

Andy carried information, wore medical alert, took every precaution. Knew it might not matter. Racism overrode medical need too often.

Grief:

Sometimes Andy mourned the alternate universe where he was white. Where his pain was believed. Where doctors listened. Where seizures meant medical care, not police.

He didn't want to be white. He wanted the medical system to not be racist. One was impossible. The other should be possible, wasn't.

WHAT NOT TO DO¶

❌ Don't Make It Individual Prejudice Only¶

Avoid: - One racist doctor as villain, other doctors fine - Solving medical racism by finding "good" doctor - Portraying as rare, exceptional incidents

Instead: - Show systemic nature (even "nice" doctors within racist system) - Multiple manifestations across providers, settings - Ongoing, cumulative harm

❌ Don't Make White Character the Savior¶

Avoid: - Cody "saves" Andy from medical racism - White character teaches doctors not to be racist - Medical racism solved by white intervention

Instead: - Andy is expert on his own body, primary advocate - Cody supports, amplifies, but doesn't replace Andy's voice - Medical racism not "solved," navigated with ongoing effort - System change requires structural intervention, not individual "good white people"

❌ Don't Sanitize or Minimize¶

Avoid: - Downplaying severity of medical racism - "It's getting better" false optimism (it's ongoing) - Making medical racism about hurt feelings, not material harm

Instead: - Medical racism kills, causes measurable harm - Pain undertreated, diagnoses delayed, outcomes worse - Historical and ongoing, not improving fast enough - Real, serious, deadly consequences

❌ Don't Use Trauma Porn¶

Avoid: - Graphic, repeated scenes of medical racism for shock value - Focusing on white characters' reactions to racism Andy experiences - Making Andy's suffering spectacle for white guilt/education

Instead: - Show impact without exploitation - Center Andy's experience, not white characters' feelings about it - Balance showing reality with respecting character dignity - Can reference experiences without graphic detail every time

❌ Don't Ignore Intersections¶

Avoid: - Treating Andy's experience as only about race (ignoring disability) - Treating only as disability (ignoring racism) - Separating oppressions that work together

Instead: - Show how racism + ableism compound - CP pain undertreated BECAUSE Black (racism affects disability care) - Assumed intellectual disability BECAUSE CP + Black (ableism + racism) - Cannot separate—intersections multiply harm

❌ Don't Make It Andy's Job to Educate¶

Avoid: - Andy patiently explaining medical racism to white characters - Andy managing white guilt, comforting white characters - Emotional labor of education falling on Andy

Instead: - White characters educate themselves (research, listen, learn) - Andy can share when he chooses, not obligated - White characters process their feelings with other white people, not demanding Andy's emotional labor

MEDICAL RACISM WRITING CHECKLIST¶

When writing scenes involving medical racism, check:

Accuracy: - [ ] Medical racism portrayed as systemic, not individual prejudice only - [ ] Reflects research on pain disparities, diagnostic delays, autonomy denial - [ ] Historical context acknowledged (Tuskegee, forced experimentation, ongoing legacy) - [ ] Cumulative nature shown (ongoing, constant, exhausting)

Andy's Agency: - [ ] Andy is expert on his own body - [ ] Andy advocates for himself (even when shouldn't have to) - [ ] Andy's intelligence, competence clear - [ ] Andy's voice centered, not talked over by narrative

Systemic Nature: - [ ] Not just one "bad" doctor - [ ] Even well-meaning doctors operate within racist system - [ ] Institutional policies, implicit bias, structural racism shown - [ ] No easy fixes or individual solutions to systemic problem

Emotional Impact: - [ ] Exhaustion from constant navigation of racism - [ ] Anger (justified, not vilified) - [ ] Fear (realistic, based on real dangers) - [ ] Grief for what should be (care, dignity, safety)

Intersectionality: - [ ] Racism + ableism shown as compounding - [ ] CP + Black = specific manifestations of discrimination - [ ] Class, geography, other factors considered - [ ] Cannot separate race from disability in Andy's experience

Cody's Role: - [ ] Supports Andy, doesn't replace Andy's voice - [ ] Amplifies, doesn't take over - [ ] Presence helps (unfortunately) but shouldn't be necessary - [ ] Not white savior, partnership

Avoid These: - [ ] No individual prejudice only (show systemic) - [ ] No white savior narratives - [ ] No sanitizing or minimizing harm - [ ] No trauma porn or exploitation - [ ] No ignoring intersections - [ ] No making Andy educate white characters - [ ] No "it's getting better" false optimism - [ ] No single dramatic incident replacing ongoing reality

Representation: - [ ] Consulted sensitivity readers (Black disabled people ideally) - [ ] Researched medical racism extensively - [ ] Centered Black voices, experiences, scholarship - [ ] Acknowledged this is beyond own lived experience (if not Black disabled person)

RESOURCES¶

Historical Context¶

Medical Apartheid by Harriet A. Washington - comprehensive history of medical experimentation on Black Americans
Tuskegee Syphilis Study documentation (CDC, bioethics journals)
J. Marion Sims and the history of gynecology
The Immortal Life of Henrietta Lacks by Rebecca Skloot

Current Medical Racism Research¶

"Racial Bias in Pain Assessment and Treatment Recommendations" (2016 study on false beliefs about biological differences)
Black maternal mortality research and statistics
Pain management disparities across racial groups
Implicit bias in healthcare settings

Disability Justice and Medical Racism¶

Sins Invalid - disability justice framework including racism
Harriet McBryde Johnson's work on disability and race
Vilissa Thompson (Ramp Your Voice) on disability, race, intersection
Imani Barbarin (Crutches & Spice) on disability and racism

Black Disabled Voices¶

Center Black disabled people's firsthand accounts
Listen to experiences, not just academic research
Blogs, memoirs, advocacy work by Black disabled people
Sensitivity readers essential for this topic

FINAL NOTES¶

Medical Racism is Real, Deadly, and Ongoing

This is not historical. This is not rare. This is not individual prejudice only. Medical racism is systemic, measurable, and kills Black people every day.

Andy's Experience is Not Exceptional

Everything Andy experiences in this series reflects real, documented patterns: - Pain undertreated - Intelligence questioned - Autonomy denied - Police called during medical emergency - Cumulative trauma from medical settings

These are not exaggerations. These are the norm for Black disabled people.

Writing This Requires Responsibility

Research extensively
Consult sensitivity readers (pay them)
Center Black voices
Don't exploit trauma
Show reality without sanitizing
Acknowledge this harm is real, ongoing, unacceptable

Remember:

Andy deserves medical care that respects his humanity, intelligence, autonomy, and pain. The fact that this is not the default is medical racism. The fact that Cody's white presence helps Andy get better care is medical racism. The fact that Andy has to perform respectability to avoid being labeled difficult or drug-seeking is medical racism.

None of this is Andy's fault. All of this is the medical system's failure.

Write with accuracy, respect, and commitment to showing this reality.

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