An Episode of Racism in Medical School. Did It Affect Her Care Years Later?

Introduction: When a Memory Walks Into the Exam Room

Medicine loves clean answers. Fever? Check the temperature. Low oxygen? Start the protocol. Broken bone? Find the X-ray, summon the cast, and try not to write “ouch” in the chart. But some of the most important questions in health care are not clean at all. They are messy, personal, historical, and sometimes deeply embarrassing.

One of those questions sits at the heart of the story behind An episode of racism in medical school. Did it affect her care years later? The title alone feels like a door opening into a room many institutions would rather keep locked. It asks whether a racist lesson in medical training can echo years later when a doctor faces a real patient in real pain.

The original physician reflection, written by Jennifer Adaeze Okwerekwu, MD, centers on a patient with sickle cell disease who arrived in severe pain. The doctor, then a medical trainee, remembered a disturbing earlier lesson from medical school: a teaching moment that framed Black patients and sickle cell pain through suspicion rather than compassion. Years later, while caring for a young woman in crisis, she wondered whether that old message had shaped her own behavior.

That question matters far beyond one exam room. It touches medical education, racial bias in pain treatment, patient trust, and the daily burden faced by people who must prove their suffering before receiving care. In a perfect world, pain would not need a witness stand. In the real world, many patientsespecially Black patients with sickle cell diseaseare too often asked to defend the legitimacy of their own bodies.

The Medical School Lesson That Would Not Stay in the Past

Medical school is designed to train memory. Students memorize anatomy, drug names, lab values, diagnostic criteria, and the particular panic of being asked a question during rounds when their brain has briefly left the building. But medical training also teaches subtler lessons: who is believed, who is doubted, who is “difficult,” who is “noncompliant,” and whose pain is treated as urgent.

In Okwerekwu’s story, the remembered episode involved a racist framing of sickle cell disease and Black patients. The danger was not simply that one person said something offensive. The danger was that the comment entered a learning environment where students were still building their professional instincts. A student may reject the prejudice intellectually, yet still absorb the emotional rhythm of the room: suspicion first, empathy later.

That is how bias often survives in medicine. It does not always arrive wearing a villain costume. Sometimes it appears as a joke, a shortcut, a pattern in chart notes, a raised eyebrow at the nurses’ station, or a casual warning about “drug-seeking” patients. Bias can hide inside efficiency. It can sound like clinical wisdom when it is really inherited prejudice wearing a white coat.

Medical students are especially vulnerable to these hidden lessons because they are learning not only what to know, but how to belong. They watch senior physicians closely. They notice which patients receive patience and which receive suspicion. They learn which questions are safe to ask and which ones make the room go quiet. The hidden curriculumthe unofficial education absorbed through culture, behavior, and institutional habitscan be as powerful as any lecture slide.

Why Sickle Cell Pain Is So Often Misunderstood

Sickle cell disease is an inherited blood disorder that can cause episodes of intense pain, often called pain crises or vaso-occlusive crises. These episodes happen when sickled red blood cells block blood flow, depriving tissues of oxygen. The pain can be severe, sudden, and frightening. It may require fast evaluation, hydration, and appropriate pain control.

Yet sickle cell patients have long reported delays, disbelief, and stigma in emergency departments and hospitals. Many describe being treated as if they are exaggerating pain or seeking opioids rather than managing a serious, lifelong condition. That suspicion has consequences. A patient in crisis does not need a courtroom drama. She needs care.

Black patients are disproportionately affected by sickle cell disease in the United States, and that fact intersects with a long history of racial bias in pain assessment. Research has documented that Black patients are more likely to have their pain undertreated compared with White patients. In one influential line of research, some medical trainees and laypeople endorsed false biological beliefs about racial differences, and those beliefs were associated with less accurate pain assessment and treatment recommendations.

That is not just a historical curiosity. It is a flashing red warning sign. If a clinician has absorbed the ideaexplicitly or quietlythat certain patients are less reliable, less sensitive, or more likely to manipulate the system, then every future clinical encounter may be filtered through a dirty lens. The doctor may still be kind. The doctor may still be intelligent. The doctor may still mean well. But good intentions are not a disinfectant.

Did the Episode Affect Her Care Years Later?

The most honest answer is also the most human: possibly. That is what makes the story powerful. The physician did not present herself as a hero immune to bias. She asked whether an old racist lesson had changed how she approached a suffering patient. That self-questioning is uncomfortable, but it is also the beginning of ethical medicine.

In the story, the patient was visibly suffering. Still, the trainee asked many questions before acting. Questions are part of medicine, of course. A careful history can save lives. But the deeper issue is whether the questions were purely clinical or partly defensive. Was the patient being assessed, or was she being made to prove she deserved relief?

That distinction can be hard to see from the outside. It can be even harder to see from inside the white coat. Clinicians are trained to be skeptical because missed diagnoses can be dangerous. But skepticism becomes harmful when it is unevenly distributed. If one patient’s pain is treated as data and another patient’s pain is treated as a negotiation tactic, the system has already failed the second patient.

The physician’s reflection matters because it models a rare kind of professional courage: the willingness to look backward and ask, “What did I learn that I should have unlearned?” In medicine, confidence is rewarded. Doubt is not always fashionable. But the right kind of doubtthe kind that examines bias, not the patient’s humanitycan improve care.

Racism in Medical Education Is Not an Isolated Problem

It would be comforting to treat this story as a one-off: one bad comment, one bad day, one outdated attitude that wandered into a lecture hall and forgot to leave. Unfortunately, research and physician testimony suggest otherwise.

Studies of medical education have found that racial and ethnic discrimination can affect students’ sense of belonging, personal development, professional formation, mental health, and career experience. Black medical students and other students from underrepresented backgrounds have reported discrimination, microaggressions, and the pressure to constantly prove they belong. That pressure is not a motivational poster. It is exhausting.

Medical training is already intense. Students are expected to master massive amounts of information, work long hours, manage emotional encounters, and still somehow locate clean laundry. Add racism to that environment, and the burden becomes heavier and more isolating. The result is not only harm to students; it can also weaken the future physician workforce.

When students from marginalized groups are mistreated, dismissed, or made invisible, medicine loses talent, perspective, trust, and cultural understanding. When all students are trained in environments where racist assumptions go unchallenged, patients lose too. The classroom and the clinic are connected. What is normalized in one can be practiced in the other.

The Hidden Curriculum: Where Bias Learns to Whisper

The official curriculum says things like “respect patient autonomy” and “provide evidence-based care.” The hidden curriculum says things like “that patient is here again” or “you know how these cases are.” One is printed in the syllabus. The other floats through hallways.

The hidden curriculum is powerful because it feels practical. Students learn that real medicine happens in busy rooms, not polished lectures. They learn from tone, body language, shortcuts, and jokes. A single comment from a respected attending physician may weigh more than ten slides on health equity.

This is why anti-racism in medical education cannot be limited to one annual workshop with stale coffee and a sign-in sheet. Students need repeated, integrated, clinically relevant training that connects history, bias, structural inequality, and bedside decisions. They need faculty who can talk about racism without treating the word itself as a fire alarm. They need evaluation systems that reward humility, communication, and equitynot only test scores and speed.

Medical schools across the United States have increasingly begun revising curricula to address health disparities, structural racism, social determinants of health, and bias in clinical care. That progress is important. But the work is not complete just because a lecture exists. A curriculum that teaches equity in the morning and tolerates discriminatory behavior in the afternoon is not a curriculum; it is a mixed message with tuition.

How Bias Shows Up in Patient Care

Bias in health care does not always announce itself dramatically. Sometimes it appears in small differences that accumulate: slower pain medication, fewer diagnostic tests, less shared decision-making, shorter visits, more skepticism, or less warmth in communication. Each moment may seem minor. Together, they can change outcomes.

In pain care, bias can be especially damaging because pain is partly subjective. There is no universal “pain-o-meter” that dings like a microwave when suffering reaches level eight. Clinicians must listen, observe, and trust. When trust is uneven, treatment becomes uneven.

For sickle cell patients, this problem can be particularly cruel. Many patients understand their disease well because they have lived with it for years. They may know what medications work, what warning signs matter, and when a crisis is becoming dangerous. Yet that expertise is sometimes misread as demanding behavior. A patient who says, “This is what usually helps me,” may be labeled difficult rather than knowledgeable.

That is one of the great ironies of chronic illness: patients are told to understand their condition, then sometimes punished for sounding like they do. The system says, “Be engaged in your care,” but occasionally adds, “Not that engaged.”

Structural Racism: The Part Bigger Than One Doctor

Individual bias matters, but the problem is larger than one physician’s memory or one patient encounter. Structural racism shapes access to insurance, transportation, high-quality hospitals, preventive care, specialty care, and trustworthy medical institutions. It affects where clinics are built, which communities face environmental risks, how research is designed, and whose symptoms are taken seriously.

Public health organizations have increasingly recognized racism as a driver of health disparities. The CDC has described racism as a serious threat to public health, noting that it can operate structurally, institutionally, interpersonally, and internally. The American Medical Association has also recognized racism as a public health threat and called for systemic change in medicine.

These statements matter because they move the conversation beyond personal prejudice. Racism in health care is not only about whether a clinician is “nice.” A nice clinician can still work inside an unfair system. A friendly hospital can still have policies that produce unequal outcomes. A cheerful waiting room plant cannot photosynthesize its way out of structural inequity.

To improve care, institutions must examine data by race and ethnicity, listen to patient experiences, standardize pain protocols where appropriate, train staff to recognize bias, diversify leadership, protect trainees who report discrimination, and redesign systems that make inequity predictable.

What Better Care Looks Like

Better care begins with beliefnot blind belief, but respectful belief. When a patient reports severe pain, the clinician’s first posture should be concern, not suspicion. Careful evaluation and compassion are not enemies. They can, and must, sit in the same chair.

1. Listen Before Labeling

Words like “drug-seeking,” “noncompliant,” or “frequent flyer” can follow patients through medical records like burrs on a sweater. Clinicians should use precise, behavior-based language and avoid labels that turn a person into a stereotype. A patient returning repeatedly to the emergency department may not be misusing care; she may be trapped in a system that has failed to provide adequate outpatient support.

2. Treat Pain as Clinically Real

Pain should be assessed promptly and treated according to evidence-based protocols. For sickle cell disease, timely pain management is not a luxury. It is core care. Delays can deepen suffering and erode trust.

3. Teach History Alongside Biology

Medical students should learn not only the genetics and physiology of sickle cell disease, but also the history of racism that affects how patients with the condition are perceived. Biology explains the disease mechanism. History explains why patients may enter the hospital already bracing for disbelief.

4. Make Reflection a Clinical Skill

Doctors are trained to reflect on missed diagnoses. They should also reflect on missed empathy. Questions like “Would I respond the same way if this patient were of a different race?” or “Am I interpreting confidence as aggression?” can be powerful tools. They are not magic spells, but they are better than pretending bias only happens to other people.

Why the Doctor’s Question Is the Point

The question “Did it affect her care years later?” may not have a perfectly measurable answer. But asking it is essential. It shifts the focus from reputation to responsibility. Instead of asking, “Am I a good person?” the physician asks, “Did my training shape my care in a way that may have harmed someone?”

That is a more useful question. “Good person” thinking often leads to defensiveness. “Better care” thinking leads to change. A doctor can be compassionate and still biased. A medical school can be prestigious and still harmful. A hospital can win awards and still leave certain patients feeling unsafe. Adult institutions, like adult humans, are complicated. Sadly, there is no board exam section titled “Congratulations, You Are Now Free of Bias.”

Medicine needs clinicians who can tolerate moral discomfort without collapsing into denial. It needs teachers who correct racist assumptions immediately. It needs students who are empowered to challenge harmful comments. It needs systems that measure equity as seriously as they measure infection rates, readmissions, and billing codes.

Most of all, it needs to remember that every patient encounter is shaped by what came before. A patient brings her medical history. A doctor brings training, memory, culture, and assumptions. The goal is not to pretend those influences do not exist. The goal is to examine them before they quietly make decisions.

Experiences Related to Racism in Medical School and Patient Care

Stories like Okwerekwu’s resonate because they sound familiar to many people in medicine. A Black medical student may walk into anatomy lab, lecture, or rounds and immediately sense that she is being evaluated on two levels: as a student and as a representative of her race. That double scrutiny is not part of the official curriculum, but many students know it by heart.

Consider a common experience reported by students from underrepresented backgrounds: being mistaken for transport staff, housekeeping, or a family member while wearing the same badge and white coat as everyone else. The mistake may be brushed off as harmless, but repeated moments send a message. You do not quite fit the picture some people have of “doctor.” Over time, those moments can create vigilance. Instead of focusing only on learning, the student also monitors tone, posture, facial expression, and whether speaking up will make her seem “angry” or “difficult.” That is a lot of extra software running in the background.

Another experience involves classroom discussions about race-based disease risk. Without careful teaching, students may walk away thinking race itself is the biological cause of illness, rather than understanding how ancestry, environment, stress, access, discrimination, and structural inequality interact. When race is treated as a shortcut rather than a social and historical category with limited biological meaning, clinical reasoning can become sloppy. Sickle cell disease, hypertension, kidney function, maternal mortality, and pain care have all been affected by oversimplified thinking about race.

Patients feel the consequences. A Black woman with severe pain may enter the emergency department already rehearsing how to sound calm enough to be believed but urgent enough to be treated. A sickle cell patient may bring records, medication history, and specialist notes, not because she enjoys paperwork as a hobby, but because she has learned that credibility sometimes needs backup singers. A parent may dress carefully before taking a child to the hospital, hoping appearance will influence how staff interpret concern. These are not small inconveniences. They are survival strategies inside a system where trust has been damaged.

There are also experiences of repair. Some physicians describe moments when they recognized a biased assumption in themselves and changed course. A resident may notice that a team is spending more time debating whether a patient is exaggerating than treating the pain in front of them. A nurse may challenge a dismissive comment during handoff. A medical student may ask why a patient’s own report is being doubted. These moments matter because culture changes through repeated interruptions of the old script.

Patients also remember clinicians who broke the pattern. The doctor who sat down. The nurse who said, “I believe you.” The resident who reviewed the care plan without making the patient feel accused. The attending who corrected a biased comment in real time. None of these actions require superhuman virtue. They require attention, humility, and the willingness to treat dignity as part of the treatment plan.

In the end, racism in medical school can affect care years later if it is absorbed, normalized, or left unchallenged. But the reverse is also true: honest reflection, better teaching, and accountable systems can affect care years later in a better direction. The lessons physicians carry forward do not have to be the worst ones they received. They can choose to unlearn, relearn, and practice differently. That choice may not erase the harm done in the past, but it can change what happens when the next patient walks in hurting and asks to be believed.

Conclusion: The Lesson Medicine Must Unlearn

An episode of racism in medical school is never just an episode. It is a seed. If ignored, it can grow into clinical suspicion, delayed care, and damaged trust. If confronted, it can become a turning pointa reason to teach better, listen harder, and build systems that do not ask patients to prove their humanity before receiving help.

The story behind An episode of racism in medical school. Did it affect her care years later? is powerful because it refuses the easy ending. It does not say, “One doctor had a bad memory, but everything worked out.” Instead, it asks readers to sit with uncertainty. Did bias shape the encounter? Could the patient have received faster comfort? What did medical training teach that should never have been taught?

Those questions belong in every medical school, hospital, clinic, and health system. Not as a performance. Not as a trendy slogan. As patient safety work. As professional ethics. As basic human decency with a stethoscope.

Medicine cannot heal what it refuses to diagnose. Racism in medical education is one diagnosis the profession must keep naming, studying, and treatinguntil patients no longer have to wonder whether the person holding the chart truly believes their pain.

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