More than 1,000 hours. That’s how long the two of us — both Black women doctors in Los Angeles — have spent in the chair of our friend and hairstylist Sharone.
It’s not easy to find a good stylist who understands Black hair, but Sharone has a gift. When Medell met Sharone 17 years ago, she knew she’d met a kindred spirit, and she has styled her ever since.
When Medell came to work with Elaine at MLK Community Healthcare, Elaine knew she was an outstanding physician who would be critical to her hospital’s mission of bringing quality care to South Los Angeles. But she needed to know one thing: Who did Medell’s hair? She wanted to lean into the natural texture of her hair and thought Medell’s looked amazing. It wasn’t long before she was in Sharone’s chair, too.
Over years, a couple of hours at a time every two weeks, the three of us became friends. We trusted and confided in Sharone — a mother and grandmother, and a model of grace and professionalism. Curly highlights one year, sleek blow-outs the next. Sharone understood that in a world that judges Black women harshly, appearance has meaning. She took care of us.
Then, a couple of years ago, Sharone found a lump in her breast. It was our turn to care for her.
As doctors working to change America’s separate and unequal health care system, we know how serious breast cancer can be for Black women. Although prevalence is slightly lower, outcomes are much worse, with a 41 percent higher mortality rate than for white women. We had to intervene.
We also understand the legitimate reasons Black Americans distrust the health care system, and how that can interfere with treatment. A recent study shows that 30 percent of Black women reported mistreatment during maternity care, and earlier research associates experiences of racial discrimination with pregnancy complications.
The earliest appointment Sharone could get to see a primary care doctor was weeks away. A few weeks can mean the difference between life and death; delays in diagnosis are a huge factor in breast cancer outcome disparities.
Elaine arranged for Sharone to see a physician in her medical group right away. The doctor, a man of color, listened to Sharone’s concerns and took action. He immediately ordered a mammogram, and within a few days, she had a biopsy referral.
The biopsy didn’t go as smoothly. After a long drive, Sharone’s experience was less than ideal. The specialist told Sharone she would place a metal marker in her breast that couldn’t be removed. Sharone wasn’t comfortable and had questions. A metal marker? What was that for? The doctor became combative and told her she needed to do what she was told.
Sharone agreed to the biopsy; she knew she needed a speedy diagnosis. But she did not consent to the marker. She left that experience feeling guarded, dismissed and unheard.
“I was facing death and felt like I was losing my choices,” she told us. “I needed to be treated like a person with opinions and feelings. I had to trust other people with my life, and the only thing I could hold on to was my ability to choose.”
Trust in health care is often one-sided. As doctors we expect our expertise to be trusted and revered. Too often doctors dismiss the patient’s expertise, perspective and preferences.
Sharone calls this an issue not of trust but of positioning. What worked for her was when doctor and patient could come together as human beings, with mutual respect for one another’s expertise: the doctor as an expert in medicine and the patient as the expert on their experience.
Ideal doctor-patient positioning is about respectfully listening to patients and gaining their trust, by centering their concerns and preferences. It helps when doctors look like the patients they serve, with doctors who have themselves experienced the unique pressures and biases people of color encounter in a white-dominated culture. But the lesson applies to all of us.
Shortly after Sharone’s biopsy, we got heartbreaking news: She had triple negative breast cancer, among the most aggressive and difficult to treat. Her tumor was in stage two, but it had not yet spread to other parts of her body. It was critical for Sharone to get into treatment as quickly as possible.
Within a week, Medell helped Sharone get into treatment at UCLA Health.
Medell joined Sharone for several medical appointments, serving as mediator and supporter. “They were excellent doctors,” Sharone later told us. “Each doctor came in and explained the process. They were very professional.”
But there were setbacks.
Sharone had an allergic reaction to the initial medical treatment. “That first day of chemo, it almost killed me,” she said. “After that, I didn’t want to continue, but I knew I had to continue. I knew as long as I had breath, I would continue to fight for my life and for my family.”
Then Sharone’s treatment plan changed. Her body wasn’t responding fast enough. Her doctor recommended two additional rounds of treatment. Chemotherapy is tough on the body and mind, and Sharone wasn’t sure she needed all of it. We gently encouraged her. Sharone finished the treatments.
Today, two years after her initial diagnosis, Sharone is healthy. She caught the cancer before it spread and got effective treatment quickly.
Our counsel also helped her stick with her treatment. Having friends guide her through the challenging mazes of the health care system helped ensure Sharone did not become one of thousands of Black women lost too soon to breast cancer each year.
But the fact that we had to intervene is a sign that our system is broken and needs to change.
Everyone deserves access to high-quality care, empathetic physicians and a supportive community. Without these things, we will continue to see health inequities among Black women and other people of color.
“If the two of you hadn’t been there to support me and speed things up, I probably would’ve received care,” Sharone told us. “But, I don’t think I would have survived.”
Dr. Elaine Batchlor runs the award-winning MLK Community Healthcare in South LA, and has been published in The Atlantic, The Washington Post and Los Angeles Times.
Dr. Medell Briggs-Malonson is chief of Health Equity, Diversity and Inclusion for the UCLA Health System and associate professor of emergency medicine at the David Geffen School of Medicine at UCLA.