Doctors dismissed a Black physician’s postpartum heart attack as heartburn. Now she’s helping other women push back.

Dr. Jonisha Brown with her husband, Eugene, and their sons Ellis, 6, and Ethan, 10. (Photo courtesy of Dr. Jonisha Brown.)

By Michael McElroy

June 10, 2024

Dr. Jonisha Brown founded BirthRight to empower Black pregnant women to speak up when doctors seem to ignore their concerns.

[Note: This is part of Cardinal & Pine’s series on Black maternal health. For more, click here.]

Some Black pregnant women are ignored in hospital waiting rooms because they are quiet. Others are dismissed as “difficult” because they are too loud.

White doctors are more likely to misdiagnose serious complications in Black women than they are with white women, a trend immune to a patient’s money or education.

These all add up to a maternal death rate that is three times as high for Black women as it is for White women.

Dr. Jonisha Brown, a family physician and professor in Charlotte, knows this beast all too well. She has studied it in the field, and from inside its jaws.

After she suffered a heart attack following the birth of her second child, doctors suggested she had heartburn, and almost sent her home without treatment. Soon after, she founded BirthRight, a non-profit organization that works with communities to educate and empower Black mothers before and after they give birth.

In her organization’s work over the last few years, she said, she learned that her story is not an anomaly.

This is the Black maternal health crisis in the United States.

‘I was misdiagnosed’

Brown and her husband Eugene, have two sons, Ethan, 10, and Ellis, 6.

Ten days after Ellis’ birth, delivered by C-section, Brown was sitting on her couch when she felt intense pressure in her chest, she told Cardinal & Pine last month.

Her pregnancy had been otherwise smooth and healthy, she said. She would later learn the heart attack sprung from “a very rare condition” called spontaneous coronary artery dissection SCAD, where sudden tears develop in the artery wall, causing blood to pool behind the walls, creating an obstruction.

She went to the hospital right away, knowing something was wrong. Brown, Dr. Brown, told the nurse her symptoms and that she was afraid something serious was taking place.

Brown was sweating profusely and told the nurse she’d vomited several times.

The nurse, a white woman, told her to sit in the waiting room.

When she was finally seen, doctors there dismissed her symptoms as gas or a panic attack.

They tried to send her home before her bloodwork came back.

“Long story short,” Brown said, “I was misdiagnosed.”

Brown had already been working with underserved communities, she said, but her experience made personal what had, until then, been clinical.

“There’s this misnomer out there that these bad outcomes are because women are not educated or are not following up with primary care doctors or have unhealthy lifestyles – and that is not the case,” she said.

The emergency room nurses and doctor did not take her seriously, she said, until another doctor, a friend who’d come to check on her, took one look at her face and demanded that she be taken back immediately.

Her friend was a white man.

RELATED: ‘Black pregnant women say white doctors don’t listen to them. Here’s one NC woman’s story.

‘Oh, this might not go well.’

After her experience, Brown founded BirthRight, a non-profit organization that works with communities to educate and empower Black mothers before and after they give birth

Brown spoke with us at length about her story, the systemic causes of the Black maternal health crisis, and what women can do about it.

The following interview has been lightly edited for length and clarity.

Cardinal & Pine: As a doctor, did you recognize your symptoms for what they were or could be?

I thought I was having a blood clot, which is very common after pregnancy. And with me being previously healthy, a heart attack just was not in my mind at all. I didn’t even call the emergency, because I was like, ‘we can get there, we’ll be okay.’ So no, I didn’t know.

You said SCAD is rare, does that mean that some doctors don’t know about it and so it’s something that could go undiagnosed or misdiagnosed for reasons unconnected to the Black maternal health crisis?

The thing that is rare in spontaneous coronary artery dissection is the cause of the heart attack. But my symptoms were pretty classic symptoms for a heart attack.

By the time I got to the emergency room, I was vomiting and having profuse sweating, which is what we call diaphoresis – these are things you can’t make up.

I told them I’m having chest pain, shortness of breath. I just gave ’em the list and I said, something’s wrong, something is not right. I’m having this feeling of impending doom, which is actually a symptom in medicine. So I told them all of that. They sat me in the waiting room. So unbeknownst to me, I’m having a heart attack waiting in the waiting room, that’s inappropriate. And I am like, I can’t even stand up. I’m in so much pain.

Did anyone come check on you?

I went back to triage, which is where they kind of take your initial vitals, and my blood pressure was pretty high. And the lady was like, ‘hmm.” I was like, okay, I’m trying to stay with it because at this point I’m in so much pain that I’m struggling to even talk and I’m letting her know this. So they did all that initial work and they sat me back in the waiting room. And this is the sad part, which I don’t always share because it can really emotionally trigger people.

But I have a close friend who was actually at my home that evening when this all started happening. He’s a white male, we are very close. He went through residency together. He was coming to see my new son and when I went to the emergency room, he came to check on me. We were both physicians in this hospital system, so we had full access to the hospital. So he came to the emergency room and he took one look at me and went back up to the desk and said, ‘She’s a physician. Here she is. Something is not right with her. She needs to go back right away.’

And that was the only reason why I went back to see a physician when I did.

When I got into the room to see the physician, they ended up wiping me off to get the leads on and everything because I was going through so much physically they gave me pain medicine, which is what you’re supposed to do when someone’s having a heart attack. And after I could sit there and talk to him, he says, ‘Well, what do you think is going on?”

And I’m like, ‘I need you to tell, I need you to help me. I honestly don’t know.’ I thought it was a blood clot triage. We realized it wasn’t a blood clot. So now I’m confused, I don’t know. And that’s when he was saying, ‘Well, maybe you’re having heartburn or a panic attack.’

That’s when I realized, ‘Oh, this might not go well. I might not get the care that I need right now.’

The only thing that ended up saving me, which is part of the algorithm to treat chest pain, hospitals are required to do blood work if they come in with chest pain. And so that’s what ended up saving my life was that that was followed correctly.

You turned your experience and training into an effort to help inform and empower others, but what has your experience taught you those things?

What was very interesting to me was my response after he said those words of heartburn or panic attack. I literally shut down. Here I am, this Black physician, I’ve done all this stuff. I’m a professional, I know about underserved medicine and everything. But in that moment, number one, I shut down and I didn’t know what to say. I didn’t know what to do. And that really stuck with me. If I’m struggling in that way, how much more are other people struggling in that space? Rightfully.

And so one of the biggest things I do is talk about tools for self-advocacy. And believing in yourself, believing yourself so much that you press people when they try to write you off into something that’s more easily explained or easier for them.

I mean, the physician that [misdiagnosed] me, he was not flippant, he was not dismissive, he was really just going through the process. And I think it showed me how bias does not have a mean face or an angry face.

Then what are some of the nameable mechanisms of the systemic part of this bias? I mean if implicit bias is this thing that is even in the people who obviously want to save lives, if it still exists in them unknown, unrecognized, unseen, then what are some of the reasons it’s there?

The system was meant to operate well for certain types of people. And I think I don’t have a name for that, but it’s just the general process that automatically puts certain people in the right position to get appropriate care.

And I like to always say this when I’m teaching residents or medical students, but whatever percentage of a type of person exists in the general population, it also exists in medicine. People don’t become different because they are a doctor. I think that’s the thing that coupled with the system of healthcare really leads to these very egregious, terrible health outcomes for Black women who are double minorities in a sense. So I think that’s why we’re struggling the most because racially we are historically marginalized and then also gender wise, we have been historically marginalized. So I think that’s why we’re seeing the outcomes as they are.

Study after study show that white doctors are more likely to dismiss the concerns of Black women, in part, because of the persistent myth that Black women have a higher pain threshold. Are the studies right? Do many doctors really believe that?

So that is very true and that’s in the literature where people have said that they felt that Black women don’t experience pain like their white counterparts. And yes, documented in the literature that Black women often don’t receive the pain medication they have requested.

And they have done studies of electronic medical records and there are more negative descriptors in Black women’s notes compared to their white counterparts, almost like setting up this kind of breadcrumb kind of trail to paint a picture of someone without them even recognizing it. And it’s very pervasive. Everyone reads a note in medicine. So having these negative descriptors in your medical notes makes it even more likely that a Black woman won’t be heard.

Or even saying this patient has “complaints” as opposed to these are her “concerns,” or that a patient’s “noncompliant.” These are trigger words in medicine. This patient, we don’t know why she’s not taking her medicine. Or this patient came in screaming and yelling, she might be in pain. So all these little tidbits that kind of start to cause someone to be discriminated against can even happen in the documentation. And it’s been shown that that happens more often in the case for Black women than white women.

This sounds like these biases paint a picture that says Black women just aren’t doing what they’re supposed to do and that’s why they’re in trouble all the time.

People are dismissive of what they don’t understand. I don’t believe I was experiencing explicit bias. I think the person was really trying to understand. But even in that, I think there was an inability for him to relate to me in a way that allowed him to take the extra steps to kind of push further through his medical decision-making.

I don’t know if you saw recently in the literature, but it says if any person is treated by a Black physician, their health outcomes, comparing apples to apples, are better than if they were cared for by a non-Black physician. Definitely Black people fare better when they are cared for by a Black physician. And people also have better health outcomes when they’re cared for by women. A lot of that to me speaks to understanding someone else’s situation, being able to relate, being able to put yourself in someone else’s shoes.

It sounds very simple, but in a lot of these instances it’s because someone is not, they’re taking in the information but they’re not really hearing it. They’re not really listening to what the woman is saying.

What is BirthRight’s mission?

We are a 501 C3 nonprofit organization and what we do is awareness and education predominantly. And that education usually starts with us doing a self-advocacy workshop, teaching community members how to advocate for themselves in the healthcare space when they might be coming up against bias and discrimination. And on the other side of that, we still participate more academically in research and consulting projects.

What is your guidance to people? What can we tell women? What should they be doing? What can be done about this?

If that is directed at talking to Black women? The first thing I would say is trust your intuition. If something’s not right, keep saying that something’s not right. Don’t just shut down. Let everyone know that you are needing help. And if that person doesn’t give it to you, then you ask them, who is another person that you can talk to to get the help that you need?

Then what is the message to healthcare professionals who may be worried about this or who have never once thought about it? What is the message to them?

Honestly, it’s the message that I tell myself every time that I see a patient, because this is not a Black, white issue. We all have bias across things other than just race and ethnicity, but other areas as well. And what I strive to remember is that I need to listen to every single patient, hear what their concerns are, and also how it’s impacting them. And then also not rush to a quick end. Leave that medical decision making open, making sure that you’re not allowing bias to cloud that process to the extent that you’re having premature closure, but really hearing the patient and making sure that you are going through the appropriate steps as we all learned, to make sure that you’re crossing all your T’s and dotting all your i’s to make sure you’re not missing something.

I think we need to fix policies. We need to fix the healthcare system. I think they are the ones that are, and I’m in the system, but I’m just saying the system itself is the thing that needs to change. But until that time, we have to not let others shut us down.

Author

  • Michael McElroy

    Michael McElroy is Cardinal & Pine's political correspondent. He is an adjunct instructor at UNC-Chapel Hill's Hussman School of Journalism and Media, and a former editor at The New York Times.

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