Health care workers are too fast to say a Black patient is a ‘hard stick’

I was moments away from a routine screening colonoscopy when it happened again. The warm and professional pre-procedure nurse began preparing for intravenous insertion. She tied the tourniquet loosely around my arm, took a quick glance, and untied it within seconds. “I can’t find a vein. You must be dehydrated,” she said, moving immediately to the back of my hand.
I paused. I didn’t feel dehydrated. Yes, I had followed the bowel prep instructions, consuming only liquids the day before, but I had no signs of dehydration. I knew my body. I knew my veins.
I asked her to try my other arm instead, explaining that IVs in the back of the hand are unnecessarily painful. She obliged, and the moment she placed the tourniquet, a vein became clearly visible. I could tell she was hesitant. But she inserted the IV successfully, and my procedure went on as planned.
That moment stayed with me not because of the IV itself, but because of the familiarity of that exchange. The quick assumption that my body — not her technique — was the problem. The way the explanation came instinctively, as though it were an unavoidable fact. It was an example of quiet, unspoken bias in patient care — one that too many Black patients know all too well.
Racial bias in health care isn’t always blatant. It doesn’t always look like a refusal to treat or a catastrophic mistake. Sometimes, it’s a sigh. A glance. A provider who stops trying just a little too soon. These interactions seem small, but they aren’t. They shape how Black patients experience medicine — from minor procedures to life-or-death situations. And they contribute to the very health disparities the medical profession claims to be working to eliminate.
Venipuncture and IV placement are some of the most routine procedures in health care. Providers perform them daily, often without a second thought. But for Black patients, these experiences can become moments of medical mistrust. Difficult venous access — the medical term for “hard sticks” — is a real clinical challenge. But I didn’t meet the criteria for it. So why was the first explanation that my veins weren’t cooperating rather than her approach needing adjustment?
In the limited literature available, nurses have cited “dark skin” more often as the rationale for an IV attempt failing than for one succeeding. Darker skin does not inherently make venous access harder; it becomes a convenient explanation when things do not go as planned.
I’ve heard countless stories from Black patients describing blood draw horrors — being poked multiple times, told their veins are “rolling,” or that they are “difficult sticks.” I’ve seen patients start avoiding care altogether because of these repeated experiences.
I know, because I’ve spent years on both sides of the chair. As a physician assistant and public health professional, I’ve placed thousands of IVs. I’ve also been the patient watching a provider struggle, hesitate, and ultimately stop trying.
These bias-driven assumptions don’t just happen with IV placement. They happen everywhere in medicine. In a 2023 survey, 35% of Black adults said they have been treated unfairly or judged by a health care provider because of their race. These numbers aren’t abstract. They show up in who gets adequate pain management, who gets diagnosed correctly, who gets their symptoms taken seriously. They show up when a Black woman’s pain is minimized even during childbirth. They show up when a provider assumes a Black patient isn’t following instructions. And they show up when a routine IV placement is fumbled and explained away rather than corrected.
The result? Eroded patient trust. Delays in care. Worsening health outcomes.
Whenever racial bias in health care is called out, the response is predictable: more implicit bias training. But training alone won’t fix this. Awareness without action changes nothing.
Medical and nursing educational institutions need to go beyond “cultural competence” and require practical, reinforced bedside training that accounts for racial differences in patient care. This includes proper venipuncture techniques for all skin tones — not as an afterthought, but as a core clinical skill. Hospitals and health systems must go beyond training sessions and create accountability structures that ensure providers are not rushing through care, making assumptions, or cutting corners. There should be real-time feedback loops where bias-related complaints are taken seriously, reviewed at the leadership level, and result in meaningful policy changes.
Health care providers — nurses, physicians, and allied health professionals — must actively interrogate their own biases in real-time and ask: Am I giving this patient the same effort I would for someone else? Have I adjusted my technique before blaming the patient’s hydration status? Am I really looking?
These moments add up. They have consequences — life-changing ones.
Jahidah La Roche, M.P.H., P.A., is a physician assistant and public health professional with two decades of clinical experience, focusing on bias, health equity, and culturally responsive care for Black women.