Listening and Learning: Systemic Racism, Racial and Sexual Disparities in Women’s Health
Part 3: One Size Does NOT Fit All
I have always had a physically large head. While tests and visits to specialists as an infant showed that I was in perfect health, the size of my head wasn’t something that could be easily forgotten. The most common reminder comes every time that I try on a “one-size-fits-all” hat. The truth is that no matter how hard I try or how much effort I put into squeezing that hat on my head, it just won’t fit. I can personally attest that “one-size-fits-all” doesn’t work for headwear, so why was I so willing to accept the same model for the way we practice medicine?
The way I, and many others, have experienced the healthcare system is relatively one-dimensional. When you have a problem, you go to the doctor, explain your symptoms in the most cut-and-dry fashion possible, and are given a treatment based on what appears to be your top concern. We’ve been conditioned to separate ourselves into neat boxes of symptoms that can be examined and treated uniformly. Separate treatments for separate symptoms. The problem is that these boxes have been constructed by the majority and for the majority, which exacerbates health inequities across racial and socioeconomic divides. This is an issue that spans our healthcare system as a whole and is particularly notable in women’s health.
When I got to Duke and began studying the history and current implications of these disparities, I started to question everything I had previously known about women’s health. I learned that the pain of Black women is often an afterthought cemented in the fallacy that we can handle more pain than our White counterparts. I listened to stories from women of low socioeconomic status who didn’t have the resources to seek care. I researched the barriers to care that disproportionately affect the LGBTQ+ community. I dedicated my time to finding the voices that had long been silenced. The effort that I put into these studies led to me examine my own experiences within the healthcare system. Had my concerns been brushed aside because I was a woman? Had my queerness negatively impacted my care? Had I been treated based on a racial stereotype? Had the system failed me?
In considering these factors, I realized that the system hadn’t failed me — at least not in a way that was obvious enough for me to notice. I’ve been fortunate enough to fit the mold of what the healthcare system thought I “should be.” I realized that I hadn’t had any memorable experiences of healthcare professionals having the time to understand me as a person before treating me, but then again, I hadn’t needed them to. The uniform treatments worked for me. I was told to fit myself into boxes labeled “one-size-fits-all” when in reality, they were “one-size-fits-most.” But because I fell into that “most,” it was easy to convince myself that “all” was a fair label.
Recognizing my complacency in this situation seemed like something that should have come easily to me. After all, I had tried to explain to my fair share of friends, family members, and store workers that a “one-size-fits-all” hat simply would not fit on my head. It has never failed that their trust in the validity of a tag was unwavering until they watched me attempt to put the hat on. They had no reason to question a system until they saw for themselves that it didn’t work.
The jump from “one-size-fits-me (and everyone that I can see)” to “one-size-fits-all” is convenient, but we shouldn’t have to personally witness or experience the flaws of a system to understand that it is failing.
If I tried to squeeze myself into a hat that clearly wasn’t fitting, it would be easy to tell myself that the hat is the wrong size and that I needed to get a different one that was better catered to my head shape. I know that when it comes to hats, “one-size-fits-all” is a false sentiment. This knowledge gives me the power to stay away from these labels and hope that one day we will move away from them altogether. The obstacle that so often arises in women’s health is that we don’t know that “one-size-fits-all” is disingenuous. It is much easier to convince ourselves that there is something wrong with us rather than the boxes we are told we should fit in.
The solution isn’t as simple as stretching the borders of “one-size-fits-all” to make it more inclusive, because the issue isn’t just that our one size is too small or too exclusive. The issue is that we are trying to fit everyone into the same box regardless of its size. If there is any hope of closing the racial and socioeconomic divides in women’s health, we have to move away from the idea that patients need to fit an agreed upon mold to be treated. Rather than being separated into conveniently manageable boxes, each patient needs to be treated as an individual and not merely as a collection of symptoms.
The reality is that one size does not fit all, and that shouldn’t be our goal. The boxes that we are taught to fit ourselves into aren’t broken; they are functioning exactly as they were intended. What’s broken is the idea that we should be trying to fit ourselves into boxes in the first place.
Continue reading the “Listening and Learning: Systemic racism, Racial and Sexual Disparities in Women’s Health” series:
Part 5: Moving Beyond the Movement
Part 7: Opening My Eyes