More than Skin Deep

In the vital field of medical education, textbooks are more than mere academic resources. They are the bedrock upon which future healthcare providers build their understanding of human health and disease. Yet, there’s a critical and often overlooked flaw in these educational cornerstones. The stark underrepresentation of Black patients poses a real and pressing problem in medical training and, consequently, patient care. In fact, a 2018 study of general medicine textbooks found that less than 5% of these textbooks included depictions of dark skin tones. This gap in medical literature is not just an issue of diversity and representation. It’s a significant shortfall in preparing medical students for real-world clinical practice.

The visuals and descriptions in these texts predominantly feature ailments as they appear on lighter skin. This leads to a skewed perception of disease presentation, especially evident in dermatology. In this field, the appearance of conditions like rashes, lesions, or infections can vary significantly between darker and lighter skin tones. The failure to represent these differences adequately can lead to misdiagnosis or delayed treatment for Black patients. Such oversights can have serious, even life-threatening consequences.

Beyond skin conditions, the absence of Black representation cuts across various medical disciplines, from cardiology to oncology. This lack of diversity reinforces a narrow, biased view of medicine. It inadvertently positions white patients as the norm and marginalizes the experiences and health issues of Black individuals. Even the word cyanosis – which is used to denote a lack of oxygen in the body – assumes light skin as the default as darker skinned patients do not turn blue when they are oxygen deprived. It also fails to account for the unique socio-cultural and genetic factors that might influence the health of Black patients. This oversight ignores the broader context of systemic racism and social determinants that disproportionately affect their health outcomes.

This educational gap has dire implications in a healthcare system already riddled with racial disparities. Black patients often receive lower quality care and face higher mortality rates for numerous conditions. This disparity is exacerbated by a healthcare workforce that is not adequately trained to recognize and effectively treat conditions in Black patients. Such a gap perpetuates a cycle of inequity and mistrust in the medical system.

To remedy this, a comprehensive revision of medical curricula is imperative. Such a revision should go beyond the mere addition of images of Black patients. It should involve a fundamental rethinking of how medical education is structured. This change would ensure healthcare providers are prepared to competently serve a racially diverse population. It entails integrating a wide range of clinical presentations across different ethnicities and skin tones. It includes training in understanding the social and cultural contexts that impact health.

Additionally, the medical community must confront and actively work to dismantle the implicit biases that such a lack of representation fosters. This involves a commitment to ongoing education in cultural competence and anti-racism. Healthcare professionals need to be equipped to provide care that is not only clinically effective but also culturally sensitive and equitable. The inclusion of Black patients in medical textbooks is not a mere token of diversity. It is an essential step towards reducing systemic biases in healthcare and ensuring equitable care for all patients.

Chikodi Ohaya

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Chikodi Ohaya is a member of The University of Arizona College of Medicine – Phoenix, Class of 2025. She graduated from California Lutheran University with a degree in Biology. She is a first-generation Nigerian immigrant and a former teacher who is proficient in American Sign Language. Chikodi is also passionate about health disparities and photography and enjoys road trips to scenic destinations.

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