In today’s episode, Taylor is joined by guest Dr. Tina Sacks, an Associate Professor at the University of California, Berkeley, specializing in Racial Inequities in Health. Taylor and Tina discuss the intersection of systemic barriers and self-advocacy in healthcare for marginalized individuals—and for everyone!—as well as tips for finding a primary care doctor who truly cares.
Mentioned in Episode:
Meet today’s guest:
Professor Tina Sacks is associate professor at the University of California, Berkeley in the School of Social Welfare. Her scholarly focus is racial inequities in health, social determinants of health, and poverty and inequality, with a focus on the ways that macro-structural forces, including structural discrimination and immigration, affect health. Her first book, “Invisible Visits: Black Middle Class Women in the American Healthcare System”, is a rare examination of the treatment of middle-class Black women in the healthcare system and demonstrates the ways in which overlapping systems of oppression occur in healthcare settings.
Professor Sacks is also a public scholar, providing content for popular media outlets, including Politico, CNN, and NPR, and co-producing documentary films. In her working experience, she spent nearly a decade working for the federal Centers for Disease Control and Prevention (CDC), where she worked on public health policy with special emphasis in environmental and women’s health programs. She also served as the special assistant to the director of the CDC, as well as legislative director of the Baltimore City Health Department and executive director of a non-profit healthcare organization.
The daughter of a Black woman raised in the Jim Crow south and white Jewish man who was one generation away from the pogroms and concentration camps of Europe, Tina's family of origin exemplified how racism and discrimination constrain joy and possibility. Drawing on the strength of her ancestors, Professor Sacks strives to create a more loving and just world for her beautiful son and all our children.
Connect with Tina Sacks:
Taylor Elyse Morrison
You're listening to Inner Warmup. I'm your host, Taylor Elyse Morrison, Founder and Author of Inner Workout, ICF Certified Coach, and Fellow Journeyer. In 2017, I set out to build a life that didn't burn me out, and I found my life's work in the process. On Inner Warmup, we talk about how self-care and inner work show up in your relationships, your career, your schedule, and then the conversations you have with yourself. We get practical, we get nuance, and we're not afraid to challenge wellness as usual. So, take a deep breath and get curious. This is where your inner work begins.
Taylor Elyse Morrison
Today on the show, we have Doctor Tina Sacks. Professor Sacks is an Associate Professor at the University of California, Berkeley, in the School of Social Welfare. She focuses her research on Racial Inequities in Health, Social Determinants of Health and Poverty and Inequality, specifically looking at the way that structural forces like discrimination and immigration affect health. Her first book called Invisible Visits: Black Middle Class Women in the American Healthcare System was published in 2019. Beyond her scholarly research, Professor Sacks is also a public scholar, and she's provided content for media outlets like Politico, CNN, and NPR, and also co-produced documentary films. In our conversation, Doctor Sacks and I explore the structural issues within the healthcare system and how we can have empathy for our health care providers while still advocating for ourselves. I think you'll get a lot out of this conversation, so enjoy.
Taylor Elyse Morrison
Tina, thank you for being on the show.
Tina Sacks
Thank you so much for having me.
Taylor Elyse Morrison
So, I was telling you this before, but I truly was so thrilled that you were willing to be on the podcast. We are a little bit different than other podcasts in that we, like, are often pitching people and saying, hey, we would love for you to talk about this topic, and then me and the team who puts this together, we, like, cross our fingers and hope that people will say yes. And you said yes. So, yes, this is very, very exciting. And the reason that I wanted to talk to you for this season was we're talking all about building out our support system. And that, especially for me as a black woman, I'm constantly thinking not just can I, like, check the boxes of I should have a primary care doctor or I should have a dentist, but also, can I find providers like a therapist or other people in my support network who are going to see all of me? And I know that's a lot of what you research. You specifically Research Social Determinants of Health and Racial Inequities in Health.
Taylor Elyse Morrison
So, before I ask you a bunch of questions, I just wanna know, like, what drew you to that topic for your research?
Tina Sacks
Yeah. Thank you so much for your interest in it. And so, what drew me to this research was really my own lived experience. Obviously, as a black woman. I also really became deeply curious about this in ways that I hadn't anticipated, or I could have never known I was becoming curious about as a child and as a teenager growing up in a mixed family, an inter-racial inter-faith family. So, my mother is black from, you know, Mississippi, part of the great migration, then it came to Chicago like many other people. And my father is, a first generation Russian Jewish immigrant whose parents were from what is now Belarus. So, growing up, it was very clear to me that people - that my mom got treated differently than my dad did, and it made me really wonder about things.
Tina Sacks
Right? So I grew up in this on the south side of Chicago, and my mom was diagnosed with breast cancer when I was in high school and then again in college and her experience in the healthcare encounter, seeking out opinions, trying to get a diagnosis of her breast cancer, it became very clear to me that there were some barriers that she faced that I anticipated that my dad and his family would not face. And so, I just became very curious about that all throughout college, and I thought I would be a Psychologist, but it turned out that I wasn't really interested in that per se. I was much more interested in the how the social world really either amplifies or constrains people's opportunities in this world. And so, I ended up studying social work and health policy and worked in public health and then eventually went on to get a PhD where I - so I could study more deeply the kinds of things I was interested in.
Taylor Elyse Morrison
It's so fun to hear people's journeys and how you you knew that you have this lived experience and this interest and thought maybe Psychology, but pulled the thread and were able to get to the heart of this research topic. And this topic that you've researched and written a book about is related to what we're exploring this season about building our support systems. And we were trying to figure out how to frame this episode because there are so many medical professionals and doctors that you could see. But when we narrowed it down, we came to think about the primary care doctor because, hopefully, most of us have a primary care doctor that we are able to see. And I say hopefully because for me, that's actually been so hard to, A, find a primary care doctor, not even worrying about if they're a good fit, but, like, I've had primary care doctors who then leave and they go to a different hospital, and then they're not covered to or hospital group, what however that works, and then they're not covered by my insurance or have someone who's just kind of meh. Or I found this one guy. He was this incredible black man. He also had ADHD.
Taylor Elyse Morrison
He just like got me and then he moved. I was like, no, you are my perfect primary care doctor and you're gone. So, finding them is hard. Keeping them is hard. And I guess what I'm wondering as someone who has looked at how people interact with the health care system. What would you call out as some things that we could be looking for in our primary care doctors?
Tina Sacks
So, you know, I think one of the major challenges I'll try to get to some solutions. But I think one of the major Challenges are all of the things you just addressed. It is very hard to find a primary care provider that a person that you can feel comfortable with. And part of that, you know, really has a lot to do with the health care sector in general and the pressures that are on that primary care Physicians are under, they don't make as much money as many other specialties, And there just aren't as many of them, and they work longer hours and different things. So, the practice setting for them is not as favorable for many people who wanna go into medicine to make a lot of money. And so, I think in terms of looking for them, it's all of the same kinds of things that one might look for when you're trying to decide on other kinds of professionals. And I do think how you feel with them is a really big part of this. And so, trying to establish a relationship with them and how you feel about them, I mean, sort of your embodied feeling when you when you go to see them, How do you feel in their presence? How do they make you feel? How do they interact with you? Do they take some care to ask you? How do you wanna be addressed? How should we speak to each other? Just someone who's attending to your humanity in addition to the fact that you are presumably a body that needs some kind of treatment, right, and some sort of scrutiny.
Tina Sacks
Because I think a lot of what happens in the health care encounter in the health care space that's particularly challenging for me is that there's so much scrutiny. I mean, you're going there presumably for them to evaluate, scrutinize, and treat you. Right? And so, there's so much power involved in that, and at least for me, a lot of anxiety. It's very anxiety provoking. What if they find out something's really wrong with me or did I - I didn't follow their orders. I didn't follow the instructions. There's so much of that that's involved in the health care space, such that in my view, it makes it almost impossible to create a healing environment, because it's really an environment of scrutiny and speed. And providers are often, you know, evaluated on how quickly they can get someone in and out of their office because they have so much pressure to churn many people.
Tina Sacks
So, I think this is a very tall order, and I think that there are Many structural barriers to having a great relationship with a primary care provider, but I do think trying to check into how the person makes you feel, not just their credentials and expertise, but in addition to those, how do they make you feel when you're with them. And if you can feel relatively comfortable, that is a huge, huge part of trying to establish a functional relationship.
Taylor Elyse Morrison
Thank you for that. And I appreciate you calling out some of what primary care providers are up against so that we can have a little bit of empathy for them. Like, I didn't necessarily know that primary care doctors made so much less like, I know Surgeons, and, like, certain type of Surgeons tend to make the most money, but I didn't realize that primary care providers were making a lot less. So that's helpful for me to know - I don't wanna say hierarchy, but where things are stacking in the medical field and also some of those things that are going on behind the scenes where they are having those pressures to move really quickly. And that's not to say that it's right, but it's also the most optimistic part of me wants to believe that there are lots of great primary care providers who are trying to do the best they can with the pressures that they're under, which is not to say that there are also people who maybe don't care as much as about their patients as they should be caring. The other thing that really stood out to me was you saying like, them taking the time to talk to you and really understand where you're coming from. The primary care provider that I was just raving about, that was what stood out to me. Like, I had gotten so used to coming to a doctor's appointment and, like, trying to, like, almost verbally bomb it.
Taylor Elyse Morrison
Here's everything I think that is wrong with me. I know that you're not gonna stay with me that long, so let me just, like, get through it. And he said, you know what? Let's take a step back. Hi. I'm John. Nice to meet you. And I was going because I was having some issues with my voice, and I was pretty scared because I - I use my voice a lot on the podcast as a coach, as a facilitator. And I didn't know if my livelihood was in jeopardy.
Taylor Elyse Morrison
And he just really, like, took a moment to sit with me in that and was like, I understand why this is so scary for you. I also really value the work that you're doing in the world, talking about self-care and well-being. And I have never had that experience in a doctor's this before. I felt like I was in the twilight zone, which made it all the worse when then he moved to Iowa. And I was like, am I ever gonna get that experience again?
Tina Sacks
So true. It's so hard. I've had other people tell me that too. You know, I had a good doctor and the person actually cared about me and then they left. And, again, you know, this goes to some of these structural barriers in our health care system that make it difficult for providers to stay in one place or maybe even stay in places like, in major cities, right, where it's pretty expensive, they might especially for Ethno-racial minorities who might have a lot of loans. It's very expensive to go to medical school, then you go into a specialty that's not as highly paid, and then how do you pay that back? So, they're all of these financial peculiarities that are built into the health care system that make it difficult, I think, on both the provider side and the patient side to establish a decent human relationship.
Taylor Elyse Morrison
I'm wondering If you have any tips or anything that you found useful, either for the upfront work of finding a provider or questions that we can ask as we're evaluating, is this person the right fit for me? I also before you dive in, I do wanna call out the importance of noticing how you feel in your body, but I'm wondering if there's anything beyond that.
Tina Sacks
So, I think word-of-mouth is really helpful to ask around and try to get to see if you can establish a relationship with a provider that your friend or colleague or someone you trust or someone who's similarly situated, right? Because there is no question that race and gender and immigration and ability and age and money, class. All of these things matter enormously in the health care sector, in the health care encounter, and often play a huge role in how people get treated. So, I do think asking around is really important. And aside from that, getting recommendations, I think trusting yourself, and this goes back to what I had just said, you know, like, your embodied experience or sensory experience of the person, I think, matters. You know, some providers will try to signal on their physician pages in an HMO or PPO setting or whatever where you can go and search for a provider. They'll try to signal certain things there like particular training sometimes providers who have master’s in public health are interested in more population level health and have a little bit more training than a Physician who does not have that.
Tina Sacks
So, they have a training in a different way of thinking, a different way of being with their patients, and sometimes that can be helpful if you can look for additional kinds of training. I know here at UC Berkeley and at UC San Francisco, there's actually a joint medical program. And students in that program. They're getting medical degrees, but they're also being trained in the humanities and in critical theory and in critical race theory and in gender studies. And so those people - those students will go on to be providers who have thought very carefully about how Social Inequity, and all kinds of inequities play out in that examination room. And so, looking for those kinds of markers can be helpful, but there just aren't that many people that follow that training path, to be frank. But that's one thing to look for.
Taylor Elyse Morrison
Thank you. I feel like we got a little insider knowledge of something that as we're filtering, If you can, I will say I know how hard it can be to filter through those profiles? But if you're willing to do the little extra look, it sounds like it could be worth it.
Tina Sacks
I think so.
Taylor Elyse Morrison
I wanna shift slightly because I feel like I've been wearing the hat of the optimist and being as generous as possible. Like, these people, they genuinely do have a lot on their plates, and it is helpful for me to be empathetic with their situation. And there are a lot of things that are less than useful with the way that the medical system treats people, specifically the more marginalized identities that you hold. And when I was doing research for this conversation and thinking about who I wanted to talk to, I actually found you because you were quoted in an article about medical gaslighting. So, before we ask some more questions around that, I love to clarify terms.
Taylor Elyse Morrison
Can you tell us what medical gaslighting is?
Tina Sacks
Sure. So, this - it's interesting because it's a relatively new term that sort of comes up in kind of everyday language, but it essentially refers to the idea that when a person goes to the doctor and they report and they give this history, this is what I think is going on with me. In a medical gaslighting situation. The provider presumably just says, you know what? I don't think so. That's not what it is. And invalidates the person's lived experience of what they think is going on with their own body. They also, given the kind of power differential that is just necessarily in place when you go to a doctor and you're the patient and they're the doctor, sometimes they you know, in the context of medical gaslighting, they will also make you feel sort of crazy that, oh, well, it can't be that. I mean, what do you know? It can't be that kind of condition. How would you know? It's essentially just another way of dismissing a person's lived experience and relying on a certain kind of knowledge, which is thought to be superior to the knowledge of a person who's walking around in their own body.
Tina Sacks
Right? So that this sort of medical school training, which is obviously based in science, but also absolutely based in white supremacy, Heteropatriarchy. All of those things, there is a sense that the physician given this training is both neutral, objective, and always correct. And that is obviously not the case because Physicians are just human beings like their patients.
Taylor Elyse Morrison
Thank you for laying that out. I can think of examples in my own life, examples in the lives of people that I love. I guess the example I'm most comfortable sharing is my freshman year of college. I was unwell. I was not feeling well the whole semester, and I kept going back and being like, something is wrong. And then it was like, oh, it's just a sinus infection. Turned out I had an abscess in my lung, like, a pretty large shafts that's in my lung. I had to ended up having to be on antibiotics for a really long time to get rid of it.
Taylor Elyse Morrison
It was kind of scary. They were testing me for tuberculosis at one point. Like, once they it finally got so bad that people started taking me seriously. And I did feel crazy. I was like, it's not just a cold. It's not just a sinus infection. Something is wrong with me. But it took so long for people to believe me that something was wrong.
Tina Sacks
That's right. I'm so sorry that that happened to you, and your experience is very common. It's very common. And it falls along the usual suspects of race and gender and particularly their intersection. Right? And so, and then also if you add, youth, you know, like, you're a young black woman, and they just tend to kind of dismiss things for a new for a variety of reasons. But I had a woman in my study who was also - her symptoms began to emerge in college. She was complaining of knee pain. She was really, really in agony, and she went for 15 years trying to get someone, 15 years trying to get a provider to believe her, and they just kept - this was a young black woman, and they just kept telling her, you're fat.
Tina Sacks
You need to lose weight. That's why your knees hurt. And it turned out that she had two slow growing tumors in her knee, and she almost lost her leg.
Taylor Elyse Morrison
Oh, my goodness. It's so infuriating. And it makes me sad. And I'm even as we're sitting here, like, I'm thinking of examples that I forgot of I know something common that happens in black women is fibroids, and that can be something that can be ignored. There is a woman that I knew who ended up getting huge. I think one was the size of the grape of a grapefruit, and I think the other was the size of, like, a soccer ball. And she just lived that, and it took them so long to believe her. It really frustrates me that this is people's experience.
Taylor Elyse Morrison
And there's two questions. So, there's a question that we ask a lot at Inner Workout, which is, is it the self or is it the system? And a lot of times it's both. And it's - I like to use that as an opportunity for us to realize, like, what is within our control and what is something that's at work that's larger than us. So, in this context, like, there are clearly systemic things happening, again, especially the more marginalized identities that you hold, where the cards might be stacked against you in terms of a medical provider really believing you. And, also, when I look back at my younger self, I wish I would have had more confidence to stand up for myself, and advocate for myself. So, while acknowledging the systemic realities, I'm wondering what we can do to be advocating for ourselves in medical settings. Are there ways that we can be preparing? Are there things that we can be saying or doing to make our voices heard?
Tina Sacks
It's such a good question, and I think it goes back to what you were saying about advocating for yourself. This is why I always try to think about touching into what your body feels like, because I think that as people as a society, we're often disconnected from the more sentient, sort of like our bodies and what our bodies are telling us. Right? That you feel anxious or whatever. You know, you have a "gut feeling", but we've been trained to ignore that for a very long time. And particularly, the more marginal identities you have, you almost have to disconnect from that to move through the world. Right? Because if every time you were being slighted or treated differently. You might not be able to move through the world and manage that if you were always, you know, if you were always in sort of this heightened state of awareness. So that said, I think taking someone with you to a doctor's appointment, particularly if it's one that is particularly challenging for you or if there's a diagnosis that you might be given.
Tina Sacks
Something that's very meaningful. You know, not necessarily you're going to get a blood draw but something that you really need first of all, you need moral support, but you also need someone to listen for you. Because when things are - when you're anxious and you're in a doctor's office and you might be undressed and then you have this power differential and you're literally physically vulnerable, sometimes just having another person in the room can help with that quite a bit. So that's something I always recommend people do is to, if possible, take someone with you even into the exam room so that they can both be your moral support, but also listen for you because when you're anxious, sometimes you can't really attend to what the person is saying. You miss things because your mind is just going all over the place. So those are a couple of things. And I think certainly when it comes to advocating for yourself, trying to be the best source of information about yourself. I think that matters.
Tina Sacks
So really doing your research about what you think is going on with your body and presenting it to the provider in a way that presumably doesn't harm their ego. I think this is something you have to be really and even the empirical literature bears this out that for black women and other racial minorities, you have to be careful about this because sometimes providers consider this to be an affront to their authority. But I do think being a very credible witness to your own experience and being a partner with the physician or other provider and trying to figure out what's going on and then make treatment decisions together is really important. And I think that's one of the ways those are some ways that you can advocate for yourself in this, even in the face of these kinds of systemic barriers.
Taylor Elyse Morrison
I really like that. And I think especially during the pandemic, and it was understandably trying to minimize spread, access to being able to bring someone else with you was limited. But now even though COVID is still spreading, but we're more able to bring people with us, and so I love that reminder. And I like that reminder too of being a credible witness. I know something that's been helpful for me in the past is and I kind of mentioned it when I was talking to about that primary care provider is, like, having a list of things that I wanna share. And if there's, like, anything that I can think of that might be relevant. Like, here's what I've noticed. I'm having this issue with my voice.
Taylor Elyse Morrison
This is how long I've been noticing that it's going on, and it's helpful for me to do some of that thought. And I tend to be more of an internal processor. It's helpful for me to do more of that thought beforehand so that I can come in. I have the information. I have notes to reference almost similar to what you're talking about with another person being able to listen for you. It almost allows me to do my past self to be supporting my present self to say, like, okay. You have almost everything that you need to answer the questions they're likely going to ask. And, yeah, I haven't found that perfect mix because just as someone who has a lot of anxiety, I need to not WebMD things too much.
Taylor Elyse Morrison
And, also, I like to be informed, but I don't wanna come in and have the doctor think, oh, she's just trying to do my job or, oh, she's just being anxious or hysterical if we wanna use some of the historical terms that have been used against women. So, I feel like I do a dance where I'll say my symptoms and then try to notice if they start going down the same path that I started going down. And if not, try and insert some questions to get them to tell me why they do or do not think this thing is a possibility. And it's sad that this is a dance that we have to do, but it is a dance that I've done.
Tina Sacks
Absolutely. I've done it many times too. I've done it for my son. I absolutely. This is an experience I think many people have, and it is - it's like Yeah. I don't like to go down the rabbit hole of WebMD, both because I am very anxious when it comes to medical issues. And also, because out of context, what you find online can be very harmful. Right? I mean, that's the tricky thing about self-advocacy in a health care setting.
Tina Sacks
Because for all of the problems and all of the challenges, we go to physicians because they have specialized knowledge that we do not have, and they have a context of understanding how to put information together that we don't have, and that's why we go to them. So that's really the challenge, and this is why this is so tricky because, you know, I could look up something on WebMD, but I don't know anything about the context or how it works with X or Y, but the physician presumably does. So, I think it's just all sort of a condition of being human that we have to kinda - we do the best we can and then - do your best, leave the rest.
Taylor Elyse Morrison
A good life motto. I have one more question for you. I'm wondering, given your experience, your lived experience, and your research, if you could tell everyone listening one thing about working with a medical provider. Like, one thing that you want them to know or remember or hold on to, what would that one thing be?
Tina Sacks
I would say to trust yourself. If there was one thing, It would be trust yourself, and particularly for people who, again, as we've already discussed, people who've been marginalized for a long time are trained to believe others more than themselves in many ways. And I think trusting yourself And knowing that although the provider has this specialized training and knowledge that we just discussed, you are the only person living in your body, and you really oftentimes know things that they cannot know. So, you really have to trust yourself and be open to what they're telling you, obviously, and to work with them as a team, but to never forget your own voice and your own feeling of, you know, my body is telling me this, and how can we work on that together?
Taylor Elyse Morrison
I love that reminder. And that's something that applies in this medical context, but it's also just a good reminder for life to trust yourself and know that all of the people in your support system are there to help support your self-expertise, not to override it. And, again, it's more nuanced when these people, these medical providers are bringing in specialized knowledge that unless you are a doctor, you likely do not have. But it should support what you know, what you have felt, what you know to be true in your body. I think if I were to offer one piece just from my own medical experiences, I want people to know that you're allowed to ask questions. I did not feel like I was allowed to ask questions in the doctor's office. I felt like it speaks to this power differential that you talked about. Like, I just went there, and they told me what was wrong.
Taylor Elyse Morrison
They scrutinized to use your language. And then I'm just supposed to be like, yep. Okay. I'm gonna do exactly what you say. And what I've learned is I've gotten older and unfortunately, had a negative experience is that I can ask, like, can you tell me more about why, or can you point me to a place where I can learn more about that. I just wish I would have asked more questions and not been so afraid. But, also, like you said, I was young. I didn't know.
Tina Sacks
And these systems are really set up to make you feel the power differential. And what happens when there's a power differential? It's silencing, and that's the point. So, we have to also give ourselves grace. We're all doing the best we can. Most providers are doing the best they can, and so are the patients. And but, yeah, to speak up, ask questions, and to trust kind of your gut instinct about your own body, I think, are really important takeaways.
Taylor Elyse Morrison
Well, I so appreciate you taking the time to have this conversation. If people want to learn more about you and learn more about your work, where can they find you?
Tina Sacks
So, you could find me at UC Berkeley School of Social Welfare. And if you just Google my name, Tina Sacks, and UC Berkeley School of Social Welfare. You will find more information about me.
Taylor Elyse Morrison
And we will also link to your book in the show notes. Thank you.
Taylor Elyse Morrison
Thank you so much for being on the show, Doctor Sacks.
Tina Sacks
Thank you so much. I really appreciate it.
Taylor Elyse Morrison
Inner Warmup is a collaborative effort. It's hosted by me, Taylor Elyse Morrison. Danielle Spaulding provides production support, and it's edited by Carolina Duque. If you enjoyed this episode, share it with a friend. And if you're looking to continue your Inner Work, our free Take Care Assessment is a great place to start. On that note, take care.