Abstract
For women’s bodies in general and particularly for the Black female body, the way people perceive them is complicated by racial, sexual, and class stereotypes. (p. 43)
I want to give this book its due justice, as Tina Sacks explored an interesting, and mostly untapped, topic for her dissertation and now published work. This book is about Black women, written by a Black woman. Sacks’s background enhances the credibility of the experience and gives an opportunity for Black women to share their stories, viewpoints, and, most importantly, their challenges. Social workers, health care providers, women of color, and those interested in the health care field would find benefit from reading this book. I feel that people should read this book because it sheds light on an often-forgotten population, providing a rich history of the character and experiences of women interviewed. A slim volume, Invisible Visits packs rich history within a quick read, making it more accessible to a general audience.
While the health disparities between Black and White patients in the United States are well documented, Sacks goes one step further in this work to discuss middle-class Black women and their encounters with the health care system. Labeled as invisible, these women are often overlooked in a literature that focuses primarily on those in poverty, the elderly, or the Black male experience. This invisibility can prove detrimental to Black women, as they continue to experience racism, sexism, and classism that downgrades their experiences and quality of care from healthcare providers.
Dr. Sacks held focus groups and one-on-one interviews to capture the rich experiences of Black middle-class women in Chicago. She also investigated what quantitative studies have revealed about race congruence, the concept that Black patients prefer to see Black providers. The reasoning behind these preferences are explored in depth through the interviews and focus groups. While some consider the race of their provider secondary to their competence and bedside manner, others state clear preferences. One woman refused to allow herself or her family to be seen by a non-Black provider because of her great-grandfather’s involvement in the Tuskegee Syphilis Study. The generational trauma endured by these women and their families shapes several aspects of their health care and is reflected in numerous stories shared with Dr. Sacks in the focus groups. Over time, they became aware of how much they had in common. Dr. Sacks details their growing realization that each woman felt she needed to build cultural health capital—to show to the health care provider her level of education and experience from the moment she walked through the waiting room door.
Each chapter opens with a quote from a woman featured throughout the book, showing her struggles and her experiences with the health care system. These quotes reflect the women's frustrations with racist providers, long wait times, and poor service from providers. They describe the importance of “dressing the part” while going to the doctor. This involves using their clothing and accessories to show their privilege, financial status, and social status. Although Sacks does not suggest that Black women should dress a certain way to obtain medical treatment, she highlights that the feeling that one needs to adhere to a dress code underscores a barrier faced by Black women when they encounter the medical profession. Dressing up communicates one’s education, health literacy, and most importantly, access to private insurance. Several Black women stated that communicating their status commanded respect, a signal that poor behavior from staff would lead to repercussions. Even so, there is evidence that even well-educated, gainfully employed Black women do not receive better treatment than those with less education and income. Disparities in pain medication that Black women receive compared to their White counterparts is but one example.
Invisible Visits features participants from a range of ages, incomes, educational backgrounds, and neighborhoods across Chicago. The women presented throughout the book represented a number of occupations: a daycare center owner, an academic with a doctorate in divinity, a successful businessperson with an MBA, and a network manager. Sacks divides these women into lower- and upper-middle-class groups, which facilitated her ability to look at difference within and between groups. The use of focus groups and individual interviews also allowed her to explore more nuances in her data, especially when the focus groups expressed disagreements.
One such disagreement included preferences in the gender and race of their medical providers. Some women had strong preferences for Black physicians, while others showed a preference for wanting the best care they can get. This dynamic was explored with the women who participated in the interviews, Sarah, Tammy, Leona, and Ellen. For example, although Sarah has had physicians from different backgrounds, she praised her son’s pediatrician: “She was beautiful. She was gorgeous. She’s Black. She’s intelligent. Christian” (p. 77), highlighting her preference for a medical care provider who looked like her when it came to care for her son. Leona also showed a similar preference for Black female providers. Tammy insists on a Black doctor and refuses to receive medical care from a White physician. Her great-grandfather had been part of the Tuskegee Syphilis Study and she has a deep mistrust of non-Black physicians. Ellen voiced that her physicians have always been White as she weighs the care provided over the color of their skin. Sacks highlights the importance of their disagreement; much of the literature endorses that Black patients have a strong preference for Black providers. The women interviewed by Sacks challenge this statement.
This book signals the need for more research on the experiences of the Black middle class in other cities and in rural areas. Invisible Visits is special because it contributes to the conversation regarding race and status. They are often still conflated in social research and in our global society. However, this book explores the nuances between them, as well as the interplay between race, status, and their implications for how they affect the care that Black women receive in the medical sector. Social work has a heavy emphasis on low-income populations, and this book serves as a reminder of the largely forgotten middle class. The focus on Black middle-class women gives a voice to a largely overlooked and understudied population.
Ultimately, when these women want to show the medical community that they have status, they alter their behavior and their dress to show that they have education and the means to take care of their health. It is a hard situation for a Black middle class woman. To receive adequate care, you must accentuate your status but in doing so, you distance yourself from other Black people, arguably those most vulnerable among us. It is particularly difficult when you know that doing so makes a difference; medical professionals treat poor, uneducated patients differently than their wealthier counterparts. In a world that still conflates race and class, it is difficult for me as a Black woman to express pride in my race, when each day I make subtle steps to distance myself from certain members of my group.