You did everything right.
You made the appointment. You showed up. You described what was happening as clearly as you could. And still, you left the doctor’s office feeling like the full picture of what you came in concerned with never quite made it to your conversation.
That experience isn’t in your head. And more often than not, it isn’t just about one provider having a bad day. It’s about how the system itself is built, and who that system was built to serve.
We asked Black clinicians and health leaders working inside these systems the harder question:
Not just what patients should do differently, but what healthcare keeps getting wrong.
Here’s what they told us.
Most of us assume that what’s in our medical records is a neutral account of our health history. But Dr. Danielle McCamey, DNP, ACNP-BC, FAAN, FAANP, Assistant Professor and Associate Dean for Clinical Partnerships & Innovation at the University of Maryland School of Nursing, wants us to understand something important about how those records actually work:
“Even clinical documentation can be stigmatizing. You’ll often see words like ‘non-compliant’ or ‘difficult’ when in reality, what’s being labeled as non-compliance may be driven by social drivers of health that contribute to inequities in access to care, medications, or resources. The chart follows that patient everywhere.”
— Dr. Danielle McCamey, DNP, ACNP-BC, FAAN
Think about what that means in practice. There’s that one rushed visit with the provider who didn’t take the time to understand your situation, and that version of you goes into every future appointment before you even open your mouth.
It’s not just about how providers see us. It’s about the decisions that get made, or don’t get made, based on what’s already in that file.
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Here’s something most of us don’t know: a significant amount of the decision-making about your care happens in conversations you are never part of.
Dr. McCamey describes what that actually looks like:
“A significant amount of care is coordinated behind the scenes, completely separate from the patient. Decisions are being made, factors are being considered without the patient actively included in that collaboration. And that’s where a lot of the inequity actually lives — in the conversations at the nursing station, in the hallway, in the handoff — where the patient has no voice and often no idea those decisions are being made.”
That’s why representation in the room matters — not just culturally, but clinically. Who is in that hallway conversation, and who is at that nursing station, directly shapes what gets prioritized for your care.
Our silence gets misread, but so does our strength.
We’ve been taught to be strong. To handle things. To not complain. And in a healthcare system that was never designed with us in mind, that strength can work against us.
Dr. McCamey points to something that happens in clinical settings constantly:
“Interpreting silence as understanding, or stoicism as comprehension or consent — these nuances in verbal and non-verbal communication directly influence how a provider shapes their thoughts, feelings, and behaviors in the moment. And that impacts care.”
When we don’t ask questions — whether because we’re overwhelmed, or because the environment doesn’t feel safe enough to ask — the system reads that as everything being fine. It moves on. And we go home still carrying whatever we came in with.
Dr. Sharrón L. Manuel, MD, fertility specialist with Keck Medicine of USC and HRC Fertility, sees this play out in ways that have real consequences:
“Care is often being triaged through assumptions before it ever reaches evidence. Decisions about urgency, severity, and even credibility are sometimes made in the first few minutes — before labs, imaging, or a full history.”
In other words, before you’ve had a real chance to explain what’s going on, someone has already started forming a picture of you. That’s not a bug in the system.
And for many of us Black patients, those early assumptions can shape the rest of the encounter before a full picture is ever established.
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This one hits close to home for a lot of us. You go in knowing something is wrong. The tests come back fine. And suddenly you’re the one who feels like you have to prove it.
Dr. Manuel explains why this keeps happening:
“When labs are ‘normal,’ many women don’t land anywhere in that system, and their symptoms can be minimized or treated in isolation instead of being recognized as part of a larger picture.”
Standard clinical frameworks are built around patterns such as what most people present with and what tests typically detect.
But our bodies don’t always perform for the test.
System breakdowns don’t always begin inside the hospital walls. Sometimes they begin long before a patient ever enters the system.
Alain Raymond, PA-C, a cardiothoracic surgical physician assistant with Aya Locums, works in a specialty where delays can quickly change outcomes:
“Some patients wait too long to seek care. Sometimes their care becomes more complicated because of that wait. Pre-hospital, health education seems to no longer be a thing prior to being sick and needing care.”
The breakdown isn’t always inside the hospital. Sometimes it starts well before we ever get there.
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None of this is meant to make us feel like the deck is so stacked it’s not worth trying. It’s meant to help us walk in knowing what we’re actually navigating. Then, we can navigate it better.
Dr. McCamey is clear about what patients can do with this knowledge:
“Your mistrust is valid and it makes sense. Finding a provider who reflects your experience or your community when possible is not a luxury — it is a clinical strategy.”
Dr. Chasity Jennings-Nunez, MD, FACOG, Site Director for the OB Hospitalist Group in Los Angeles, reminds us that we also have leverage most people don’t use — your insurance company’s patient advocate or ombudsman exists specifically to help you file complaints and resolve concerns. Providers take those complaints seriously.
And Dr. Manuel puts it in the simplest terms possible:
“Bring support when possible. Name your concerns clearly and early, even if they feel small. Ask what is being ruled out, not just what is likely. These small shifts can significantly change the trajectory of your care.”
— Dr. Sharrón L. Manuel
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The system is imperfect. That’s not an excuse for it, it’s just the truth of what we’re working with right now. And the more clearly we understand how it actually operates, the better equipped we are to demand what we deserve inside of it.
You are not a passive recipient of whatever care you’re handed. You are a participant. You have a history, a voice, and the right to be part of every decision being made about your body.
Dr. LaKeischa Webb McMillan, an integrative OB-GYN and hormone specialist, puts it this way:
“You are not just receiving care. You are curating your healthcare team. If it doesn’t feel collaborative, it may not be the right fit. You deserve to feel heard, respected, and part of the decision-making process.”
Walk in knowing that, and don’t leave without being heard.
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