The L-Suite examines the diverse ways in which Latinx professionals have built their careers, how they’ve navigated notoriously disruptive roadblocks, and how they’re attempting to dismantle these obstacles for the rest of their communities. This month, we're talking with Dr. Carla Williams, an OB-GYN, about racial discrimination in the medical field and her efforts to put patients first.
A negative experience with a pediatrician changed Dr. Carla Williams on a personal and professional level.
“The pediatrician that came to visit us and take care of my daughter was getting into what medical insurance we had, and [asked] if we had Medicaid,” she tells Refinery29 Somos. “He said he didn’t take care of patients who use Medicaid as an insurance because he wanted to take care of people who are productive members of society.”
Before this incident, Williams, an OB-GYN in Mount Vernon, New York, was well aware of microaggressions and racial discrimination in the medical setting. Patients, friends, and family members had told her their horror stories. But when the Afro-Dominican doctor experienced it firsthand as a new mother, it prompted her to make shifts in her life: She decided to deliver her other children at home instead of in a hospital, and she became more empathetic to her patients’ needs.
Unfortunately, moments like the one Williams encountered are not rare within health care. Race-based discrimination is so prevalent that the Centers for Disease Control and Prevention calls racism “a serious threat to the public’s health.” Non-white people in the U.S. are more likely to deal with preventable disability, disease, and death because they do not receive the same quality of care as white patients. And despite the fact that more people have health insurance because of the 2010 Affordable Care Act, disparities in health care continue to persist among communities of color.
This gap is particularly alarming in Williams’ field. For the most part, giving birth carries more risk for non-white birthing people. For every 100,000 live births between 2014 and 2017, the mortality ratio was 41.7 for non-Latinx Black women, 28.3 for non-Latinx Indigenous women, 13.8 for non-Latinx Asian or Pacific Islander women, 13.4 for non-Latinx white women, and 11.6 for Latinx women, according to the CDC.
Doctors like Williams are working to make health care more equitable for every kind of patient. For the Afro-Latina OB-GYN, who was first drawn to the medical field because she wanted to help people, this means adopting a holistic approach, listening to her patients, and dedicating sufficient time to them. It also means joining Health In Her HUE, a platform connecting Black women and other women of color to compassionate physicians, and the New York State Birth Equity Improvement Project, which aims to make the system more just for Black women, who are eight times as likely to die in childbirth in New York City.
While the inequality within health care requires systemic change, there are a few things that Williams is doing to improve the experiences of her patients. We asked her about the challenges of working through discrimination and microaggressions in the medical environment and how she is putting people first. From recognizing her patients' autonomy to supporting them if they need to report misconduct, Williams identifies issues and offers solutions.
Encourage patients to exercise their autonomy.
Of the average 10,000 babies born in the United States every day, about a third of them are delivered via Cesarean section. However, the World Health Organization reports that this number should ideally hover around 10% to 15%, meaning there are many unnecessary C-sections happening every day.
While doctors are there to provide guidance and make professional recommendations, Williams thinks it’s important that medical professionals understand their suggestions aren’t “necessarily the right way to go, but just a way to go.” Patients have autonomy and should express their own preferences to their doctors.
“Something that needs to be unlearned … [is] treating the patient as your child,” she says. “You know, [telling them], ‘Do this. Do that. This is what you have to do.’ No, that’s not what the patient has to do. That’s the choice that they have—one of the choices.”
To help avoid this, Williams suggests that doctors inform patients of all their options and give them the necessary information so they can make an informed decision. According to her, education is necessary for patients to advocate for themselves.
Connect with your patients.
Williams wants her patients to feel heard, and she attempts to create a safe space from the very first meeting. “From day one, [they should] feel like you’re listening to them, and you’re dedicating time to them. It’s not a quick five-minute visit, but you’re actually sitting down looking your patient in the eye, and really getting to know that person and what their concerns are. It starts there.”
Williams has developed great relationships with her patients, some of whom have become friends. Still, the most rewarding part of her job is when her patients thank her for the care she provided.
“It sounds simple, but really that’s my calling. My vocation in life is to help women and birthing people when they have their babies,” she says. “When I see a mom who's happy—who says that was the best experience of their lives, that they don’t regret anything that happened, that they look back at their experience with joy, and that they’re happy that I formed a part of it—that’s when I’m the proudest.”
Building a relationship with a patient can start before meeting them. Patients may turn to reviews or friends’ recommendations to find a doctor with whom they feel comfortable. They may even study bios to get an idea of what to expect. Williams often schedules brief conversations with her patients over the phone before meeting them in person. Doing so allows patients to get a better and earlier sense of their doctor.
Report microaggressions and racist behaviors.
At Montefiore Medical Center, where Williams works, she has not witnessed racial discrimination or other unacceptable behavior. However, it’s something many medical professionals come across because, as Williams says, some doctors and medical personnel do not believe these issues exist.
“Some medical providers don’t think that this [is] real,” she says. “The No. 1 thing that I would encourage them to do is to educate themselves and to listen. There’s a lot of people putting in the work to educate others and make them aware of what’s going on. The first step that a lot of people need to do is realize that, more than likely, you do have your own biases, and we need to take a second to listen and learn. That’s how we’re going to take the first step to effectively reduce the disparities. That’s what I encourage everyone to do: to realize that the problem exists, and perhaps part of the problem is within yourself.”
Similarly, she says it’s important to report co-workers who behave inappropriately. Williams says when she witnesses a microaggression or racism, she'll first address it with the individual in a non-confrontational way. Then, depending on the severity of the situation, she’ll also report it to her higher-ups.
She encourages patients to take a similar approach when dealing with microaggressions and prejudice, and hopes more medical professionals can help guide them through a process that might not seem straightforward. By creating a safe space—for example, taking their preferences into consideration, listening to them, and not brushing off their concerns—patients might feel comfortable opening up if they face mistreatment.
“There’s always going to be a way in a hospital setting to report these kinds of situations,” she says. “Encourage them [to do that] because it’s the only way that providers will become aware and change their ways."
For example, if a patient doesn’t feel heard by a nurse, then they should speak to a nurse manager. If the nurse manager doesn’t respond, then they can speak to a doctor. If a doctor isn’t responding, then they can go to their boss. "[They] should keep escalating,” Williams says.
Health In Her Hue is a Black-owned business selected as part of Black+, an initiative by VICE Media Group and The National Urban League to support Black Entrepreneurs with free marketing and mentorship opportunities.