Tag: inequality

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Washington’s Dermatology Divide Is Leaving Rural Patients Behind

26 Best Small Towns in Washington State with Tons of Character - The Emerald Palate

If you live in Seattle, getting a weird mole or rash checked out by a dermatologist might just mean a quick trip across town. But if you live in a small town in eastern Washington—or don’t have a car, reliable internet, or time off work—that same appointment could take months to get and hours to reach. For many people in our state, especially in rural areas, skin care just isn’t easy to access. 

And that’s a problem. Skin conditions aren’t always just about appearance—they can be uncomfortable, painful, or even life-threatening. Skin cancer, for example, is one of the most common cancers in the U.S., but it’s also one of the most treatable when caught early. Yet in rural areas, access to dermatologists is alarmingly scarce—with only 0.085 dermatologists per 100,000 people, compared to 4.11 per 100,000 in urban regions across Washington and Oregon. So why are so many Washingtonians still waiting to get care?

Here’s where teledermatology can help. It’s a fancy word, but the idea is simple: it’s a way for skin doctors (dermatologists) to look at rashes, moles, acne, and other skin issues through photos or video calls instead of in-person visits. Patients can send in pictures of their skin problem or meet with a doctor over a video call to get answers without needing to leave their home.

During the COVID-19 pandemic, teledermatology took off out of necessity—and it worked surprisingly well. Many skin issues are visible, which makes them easier to diagnose from a screen than, say, a heart condition. And patients who used telehealth often said they liked it. It saved them gas money, time off work, and long drives just to get care.

But now that we’re out of the emergency phase of the pandemic, we risk losing a good thing. Not everyone in Washington can access teledermatology easily. In some rural towns, there’s no reliable internet. Some insurance plans still don’t cover online dermatology visits the same way they cover in-person ones. And some people—especially older adults—don’t feel confident using video calls or sending pictures from a phone or tablet.

That’s why we need to do more. If Washington wants to make sure everyone has a fair shot at getting skin care, we need to invest in a few key things:

Better internet in rural areas so more people can use telehealth tools.

Fair insurance rules that cover online dermatology visits just like in-person ones.

Community telehealth hubs in places like libraries or clinics, where people can go for private, internet-connected appointments—even if they don’t have the technology at home.

Help for patients who aren’t used to using apps or video calls, so they feel comfortable getting the care they need.

This isn’t just about convenience—it’s about fairness. Everyone deserves to get medical help, whether they live in downtown Seattle or a small farming town. Skin health affects our comfort, our confidence, and sometimes even our lives. No one should have to wait months, drive hours, or skip care because the system makes it too hard.

Teledermatology won’t replace every in-person visit. Sometimes a mole needs to be biopsied, or a condition needs to be seen under special lighting. But for many common issues, remote care can be just as good—and a lot more accessible.

Washington has the chance to lead the way in making teledermatology part of our normal healthcare system. The technology is here. The doctors are willing. The only question is whether we’ll make the changes needed to connect more people to care.

Where you live shouldn’t determine whether you get timely, potentially life-saving care. Washington has the tools to close this gap—starting with teledermatology. Now we just need the will to use them.

Sources:

Serra-García, Marta, et al. Urban versus Rural Utilization of Teledermoscopy in Self‑Skin Examinations: A Cohort Study in Oregon and Washington. Dermatology Reports, vol. 15, 2023. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10327663/

Rise of Teledermatology in the COVID‑19 Era: A Pan‑World Perspective. Digital Health, 2022. https://pubmed.ncbi.nlm.nih.gov/35154805/

Centers for Disease Control and Prevention. Melanoma of the Skin Statistics. Updated June 10, 2025. https://www.cdc.gov/skin-cancer/statistics/index.html

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The Cost of Being Unheard in Washington’s Healthcare System

          Racism in healthcare is “Undeniable, irrefutable—the data is there.” Those were the words of Dr. Benjamin Danielson, one of Seattle’s most respected pediatricians. In 2020, he resigned from Seattle Children’s Hospital, citing years of systemic racism and prejudice against healthcare workers and patients. Last December, a jury awarded him $21 million in non-economic damages. But his victory is not just personal—it’s a wake-up call for Washington’s healthcare system and a reminder that for many patients of color, being unheard can be fatal.

Dr. Benjamin Danielson: 'Profound trauma and joy can coexist ...
Dr. Ben Danielson

              Seattle Children’s delayed the release of its internal racism investigation for over a year—an act that deeply undermined public trust. That investigation reportedly confirmed the very patterns of racial harm that Dr. Danielson and others had long described. During the trial, the jury was presented with evidence of racial discrimination directed not only at Dr. Danielson but also at his colleagues and the hospital’s patients and families. This reveals a critical truth: racism in healthcare is systemic, institutional, and impacts both providers and patients. When hospitals allow these patterns to persist, they not only fail their staff but also endanger the very communities they are meant to serve.

16-year-old Sahana Ramesh’s tragic story reinforces the implicit racial biases embedded in our healthcare institutions. Sahana was a bright and healthy teenager living in Bothell, Washington, when she developed painful rashes and swelling on her face, hands, and feet. Her family urgently took her to the ER at Seattle Children’s Hospital, where she was diagnosed with DRESS—a rare and severe drug reaction. 

Discrimination and negligence at Seattle Children's hospital led to teen's death, family alleges in lawsuit | CNN
Sahana and her mother

As her symptoms worsened, her parents desperately called the hospital 16 times and sent 22 emails in search of answers. Yet despite Sahana’s exacerbating health and her family’s urgent pleas, they were repeatedly downplayed by clinicians. By the time she and her family were taken seriously, it was too late. Sahana’s death is not an isolated incident—it is part of a pattern in which the concerns of patients of color are too often dismissed or deprioritized. “Evidence shows that if Sahana and her parents had been white, they would have had a better chance of getting admitted to the hospital,” as the Rameshs’ attorney, Martin McLean, asserted. Her story, like Dr. Danielson’s, reveals the life-threatening consequences of implicit bias and institutional neglect.

         These disparities extend beyond emergency care and into specialized fields like dermatology, where racial bias begins in medical training. “Physicians must identify conditions from photos of skin in textbooks or shared in the classroom. But most of the patients in those images are white, and only 4.5% of the images show dark skin,” states dermatologist Jasmine Onyeka Obioha, MD. As a result, clinicians often struggle to diagnose conditions in patients whose appearances and symptoms fall outside of the narrow standards they were taught, leading to higher rates of misdiagnosis among patients of color. In fact, “Women and racial and ethnic minorities are 20% to 30% more likely than white men to experience a misdiagnosis,” said Johns Hopkins professor David Newman-Toker. This becomes especially dangerous in communities like South Seattle, where many families of color reside and access to dermatologists familiar with diverse skin tones remains limited.

        To begin addressing these failures, Washington’s healthcare institutions must change structurally. Hospitals like Seattle Children’s must promote an ethnically inclusive workforce and improve patient advocacy systems—so that when families like Sahana’s speak up, they are heard, regardless of their background or race. Medical schools—including the University of Washington—must diversify their curricula by incorporating diagnostic imagery that equitably represents all skin tones—not just white skin.

      Beyond a legal reckoning, the Seattle Children’s verdict was a stark reflection of the failures embedded in our healthcare institutions. If we don’t respond with urgency and structural reform, we risk repeating the same harm to the patients, families, and communities who need care the most. 

Bibliography

Recht, Hannah. “Misdiagnosed: Women and People of Color Face Widespread Medical Diagnostic Errors.” KFF Health News, 26 Feb. 2024, https://kffhealthnews.org/news/article/medical-misdiagnosis-women-minorities-health-care-bias/.

Cedars-Sinai. “Why Skin Issues in Patients of Color Are Neglected, Mistreated.” Cedars-Sinai Newsroom, 1 Mar. 2023, https://www.cedars-sinai.org/newsroom/why-skin-issues-in-patients-of-color-are-neglected-mistreated/.

Crowder, Madison Wade. “Bothell Family Alleges Racism at Seattle Children’s Hospital in Daughter’s Death.” KING 5 News, 12 Dec. 2023, https://www.king5.com/article/news/investigations/investigators/bothell-family-alleges-racism-seattle-childrens-hospital-daughters-death/281-50d708b3-3b06-422b-a19a-cc3b766d82b6.
Schroeter Goldmark & Bender. “Jury Awards Former Seattle Children’s Doctor $21M in Race Discrimination Lawsuit.” SGB Law, 19 Dec. 2024, https://sgb-law.com/news/jury-awards-former-seattle-childrens-doctor-21m-in-race-discrimination-lawsuit.

Williams, Race and Justice Reporter Erica. “Dr. Ben Danielson Speaks out on Systemic Racism in Health Care.” KING 5 News, 18 Dec. 2020, https://www.king5.com/article/news/community/facing-race/doctor-ben-danielson-seattle-childrens-hospital-systemic-racism-health-care/281-94b16198-3c41-4db8-96d1-1dfc257d98e5.

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Why Skin of Color Still Gets Misdiagnosed — and How We Can Fix It

13,400+ Black Man At Doctors Office Stock Photos, Pictures & Royalty-Free Images - iStock

In 2012, Lauryn Taylor—a Black woman—was misdiagnosed with eczema. Another doctor thought it might be vitiligo. Then came guesses like pityriasis alba or macular hypomelanosis. But none of them were right. In reality, Lauryn had skin cancer—and it took nearly 10 years to get the correct diagnosis.

I'm a Black Woman and My Skin Cancer Was Misdiagnosed for Years
Lauryn Taylor


Let that sink in — for nearly a decade, Lauryn lived with a misdiagnosis while her skin cancer went untreated, simply because her condition wasn’t recognized on darker skin.

Misdiagnosis isn’t just a medical error—it’s a public health crisis with endangering consequences. Diagnosis of the wrong condition can delay the proper treatment, allowing the condition to worsen over time. Dermatologists may prescribe particular creams or medications that can cause irreversible damage.

It’s also emotionally draining. Patients may feel frustrated or anxious when their ‘treatments’ are not working, leaving them feeling hopeless and dismayed. In desperation, patients will keep paying and returning for medical consultations and buying the wrong products/treatments. This becomes a heavy financial burden.

These are licensed physicians, right? Why are so many of them misdiagnosing patients?

“Probably no doctor is intending to do worse on any type of person, but it might be the fact that you don’t have all the knowledge and the experience, and therefore on certain groups of people, you might do worse,” says Northwestern University professor Matt Groh. In fact, it’s not the dermatologists’ fault — it’s the education system. 

“A large part of dermatology education involves visual recognition,” states dermatologist Jasmine Onyeka Obioha, MD. “Physicians must identify conditions from photos of skin in textbooks or shared in the classroom. But most of the patients in those images are white and only 4.5% of the images show dark skin.” As a result, most medical students don’t know how to identify the skin conditions of patients of color, leading to a disparity in misdiagnosis among racially and ethnically diverse populations. 

However, the misrepresentation of racially/ethnically diverse populations extends beyond dermatology textbooks, reflecting a broader, systemic issue within clinical education and diagnostic training. “Women and racial and ethnic minorities are 20% to 30% more likely than white men to experience a misdiagnosis,” said Johns Hopkins professor of neurology David Newman-Toker. This astounding statistic reveals the racial/ethnic disparities embedded in the foundations of medical training. 

It’s no wonder why physicians often struggle to diagnose conditions in patients whose appearances and symptoms fall outside of the narrow standards they were taught.

What can we do?
In order for us to promote racial equality in dermatology/health care and prevent misdiagnoses, we must:


Reform medical education:
As only ~4.5% of dermatology images feature darker skin, we need to bring that number up to at least 30%. This number ensures equitable inclusion and representation of racially and ethnically diverse populations. 

We need to incorporate modules tailored to diagnosing and treating conditions presented by racially and ethnically diverse populations into the medical curriculum.

Advocate for change:
Acknowledging the issue and the devastating statistics is the first step. Now, to turn awareness into action, we must collectively raise our voices, educate others, and advocate for meaningful change. People of color deserve to be treated with dignity and equity in the healthcare system.

Available resources:
https://guides.ucsf.edu/c.php?g=1081119&p=9159811

https://skinofcolorsociety.org/
https://www.aad.org/member/career/diversity

Bibliography:


1. UCSF Library. Health Disparities and Skin of Color in Dermatology. University of California San Francisco, 2022, https://guides.ucsf.edu/c.php?g=1081119&p=9159811.

2 Skin of Color Society. Home. https://skinofcolorsociety.org/.

3. American Academy of Dermatology. Diversity, Equity, and Inclusion in Dermatology. https://www.aad.org/member/career/diversity.

4.  Miller, Korin. “Doctors Told Me My Skin Cancer Was Eczema for Almost a Decade.” Prevention, 28 May 2021, https://www.prevention.com/health/health-conditions/a36230501/mycosis-fungoides-misdiagnosis/.

5. Kim, Sophia, et al. “Diagnostic Performance of Dermatologists and General Practitioners in Skin Diseases on Diverse Skin Tones.” Nature Medicine, vol. 29, 2023, pp. 1941–1948. https://www.nature.com/articles/s41591-023-02728-3.

6. Loftus, Peter. “Misdiagnosed: Women and Minorities Face Higher Risk of Harm from Medical Errors.” KFF Health News, 15 Dec. 2023, https://kffhealthnews.org/news/article/medical-misdiagnosis-women-minorities-health-care-bias/.

7. Cedars-Sinai. “Why Skin Issues in Patients of Color Are Neglected, Mistreated.” Cedars-Sinai Newsroom, https://www.cedars-sinai.org/newsroom/why-skin-issues-in-patients-of-color-are-neglected-mistreated/.

8. Pew Research Center. Facts About the U.S. Black Population. 9 Feb. 2023, https://www.pewresearch.org/race-and-ethnicity/fact-sheet/facts-about-the-us-black-population/.

9. Massachusetts General Hospital. Skin Assessment in Patients with Dark Skin Tone. Munn Center, Apr. 2023, https://www.mghpcs.org/MunnCenter/Documents/weekly/apr-23/Skin-Assessment-in-Patients-with-Dark-Skin-Tone.pdf.

10. Trafton, Anne. “Doctors Struggle to Diagnose Diseases in Patients with Darker Skin.” MIT News, 5 Feb. 2024, https://news.mit.edu/2024/doctors-more-difficulty-diagnosing-diseases-images-darker-skin-0205.

11. TEDx Talks. “Why Doctors Misdiagnose Skin Conditions on Darker Skin.” YouTube, uploaded by TEDx, 7 Oct. 2022, https://www.youtube.com/watch?v=2JUQo-PnY2g.