In this MD Newsline exclusive interview with obstetrician and gynecologist Dr. Wendy Goodall McDonald, we discuss the severity of fibroid symptoms in Black patients. We also discuss pain discrimination and pain control in Black patients and other patients of color.
Is fibroid pain worse in Black women? If so, why?
Dr. Wendy McDonald:
“Fibroid pain does impact African American women more than other populations. We believe it has to do with the fact that fibroids grow faster and can actually get larger in African American women. So it’s important to understand that [fact] and also to evaluate and to increase your surveillance of women who have fibroids.[Increased surveillance means] have regular ultrasounds [and] check in with their symptoms every year when they’re seen. Because sometimes the amount of pain and pressure symptoms can change rapidly over time and require interventions younger or earlier than other populations.”
Can you speak about pain control and pain discrimination in ethnic populations?
Dr. Wendy McDonald:
“Pain control in ethnic populations is a supremely important topic when it comes to healthcare disparities. We know based on research and studies among clinicians that pain is treated differently in different ethnic populations. People of color receive less pain medication and are believed less when it comes to expressing how much pain they’re in.
So the first [things] we need to know [are those facts]. Because that understanding and acceptance of those facts will help you to step back and think more about what the person is telling you about what is impacting their lives and how their symptoms are driving their need to even discuss this [pain] with you.
Remember, a large [proportion] of people will not even come to the doctor unless they’re having severe symptoms. So if they say to you, my pain is debilitating, I’m having difficulty walking around during my cycle, or going to work, or caring for my children, believe them, and try to manage those symptoms with whatever potential help may be beneficial. [Such help] could include pain medication that’s prophylactic, where they start medication before their cycle even starts. It could also include something like birth control or GnRH agonists or antagonists.
And the other thing to know about different management strategies is that certain words in certain ethnic populations may trigger concern for their safety. So if you tell a patient, ‘hey, I know your period pain is really bad, but maybe we can try this birth control option to improve it.’ That person may or may not be receptive to birth control as pregnancy prevention, but they may be receptive if you present it as a management [strategy] for their pain symptoms and for their heavy bleeding.
And so delving into—if a person pushes back—what their actual concerns are is supremely important. For example, this [next example] is not related to fibroids, but when I present the flu shot to a number of my ethnic patients, many may push back. And so the first question I ask is, ‘what is your concern about the flu shot?’
So if you present birth control or GnRH agonist and they say, ‘oh, I don’t want that,’ don’t leave the answer right there. Ask them what their concern is so that you can actually deal with their individual concerns and discuss them in order for them to at least understand what they want or what they are refusing.”
Responses have been condensed and lightly edited.