Negligent by Design - by Vanessa Grubbs (Paperback)

Book Synopsis

A searing critique of medical racism and a powerful call for health-care professionals to make real change in their field, written by a leading activist and doctor

Unequal access to care. Misdiagnosis. Mistreatment. Medical gaslighting. An increasing number of studies show the profound impacts racism has on communities of color--particularly Black Americans. But these disparities in health care and wellbeing are not the result of a handful of uninformed or malicious doctors: racism in the medical system is institutional, woven into the very fabric of diagnostic criteria and even hospital infrastructure. Medicine denies fair treatment to Black patients not in error...but by design.

Drawing from extensive research, in-depth interviews with medical students and resident physicians, and over twenty-five years of experience as a medical doctor, Dr. Vanessa Grubbs argues that the reason racism in medicine continues to go unchecked is because it is in fact the standard of care. Any attempts to dismantle medical racism through "placebo" efforts such as forming diversity committees or releasing statements condemning racism will fail, she says, because they don't address the reality of how the institution of Medicine has been, and continues to be, negligent when it comes to the treatment of Black people.

Dr. Grubbs skillfully unpacks the three core problems of how our health-care system currently considers the race of patients, which she identifies as being "race based," "race disregarded," and "race denied."

• When medical diagnoses and trainings are race based, they lead doctors to make different treatment decisions for Black patients, and create a dangerous disadvantage.
  
• At the same time, medical textbooks and trainings may inappropriately disregard race in cases when it does matter, like failing to include pictures of how rashes may appear differently on light and dark skin--leading to misdiagnosis and death.
  
• And finally, many medical institutions still deny the extent to which racism is an issue at all, resulting in fewer Black physicians and disastrous outcomes for Black patients.
  

Calling on her medical colleagues to join her in working against the negligence of American medicine, Dr. Grubbs lays out a pathway to true equity and inclusion in health care: getting to the root of the underlying fears and insecurities that have led to racist medical negligence; recruiting and retaining a diverse physician workforce; and forcing Medicine to commit to the cultural humility necessary to rebuild, not just replaster, a broken institution.

Review Quotes

"Negligent by Design is a major contribution to continuing efforts to acknowledge and rectify medical racism in its many forms, and to ensure that the field of medicine represents the most important principles of the long struggle for equality and justice."
--Angela Y. Davis

"A searing exposé of how medicine perpetuates harm under the guise of care."
--UCHÉ BLACKSTOCK, MD, New York Times best-selling author of Legacy: A Black Physician Reckons with Racism in Medicine

"Applying her twenty-five years as a physician and extensive research, Vanessa Grubbs, MD, powerfully reveals how racism is deeply embedded in the very design of American medicine. Both a bold critique and a call to action, Negligent by Design challenges readers--especially in the medical community--to confront long-denied truths and build a more equitable and inclusive future."
--DOROTHY ROBERTS, author of Fatal Invention and a 2024 MacArthur Fellow

About the Author

Dr. Vanessa Grubbs is an internist, nephrologist, kidney donor, physician-scientist, and author of Hundreds of Interlaced Fingers: A Kidney Doctor's Search for the Perfect Match. Dr. Grubbs is from Spring Lake, North Carolina. She is a Duke University undergraduate and medical school alum and completed her nephrology specialty training at UCSF, where she became a faculty member. While maintaining a clinical and research practice, she distinguished herself as a leading voice in nephrology, palliative care, and racial disparities. She left UCSF in 2019 but continues to publish in medical journals and speak at academic institutions. Currently, Dr. Grubbs is a part-time primary care physician, runs "Real Kidney Talk with The People's Nephrologist" on YouTube, and, in 2022, she founded Black Doc Village, a non-profit organization dedicated to actively advocating for Black trainees and physicians. She lives in Oakland, California with her husband, and recipient of her left kidney, Robert Phillips.