Healthcare providers working with LGBTQ+ communities need to understand how systems of oppression function across multiple axes. Dr. Vanessa Grubbs' Negligent by Design doesn't explicitly address queer or trans health, but it provides essential frameworks for understanding how Medicine elevates certain bodies—white, straight, cisgender—as ideal while systematically harming everyone else.

Grubbs, a nephrologist and founder of Black Doc Village, draws on 25 years of clinical experience to demonstrate how, "Medicine has been at the forefront in the effort to 'prove' that the races are distinct, and the White race is better." Anti-Blackness isn't an unfortunate side effect of American healthcare—it's the foundational design. The book exposes three interconnected problems: medical practice that is "race based" (making different treatment decisions for Black patients), "race disregarded" (medical textbooks failing to show how conditions present on dark skin, leading to misdiagnosis and death), and "race denied" (institutions refusing to acknowledge racism exists, resulting in fewer Black physicians and worse patient outcomes).

This isn't about individual bias or isolated incidents. Grubbs argues that racism in medicine is the standard of care, woven into diagnostic criteria and hospital infrastructure. People are still being taught harmful, incorrect ideas about Black bodies, with magnified impacts on multiply-marginalized patients.

The book refuses comfortable solutions like cultural competence training. Instead, Grubbs calls for cultural humility—"a lifelong learner model" requiring practitioners to be "flexible and humble enough to acknowledge what they do not know and adopt an honest process of self-critique and self-awareness to challenge their own attitudes toward people from different backgrounds." This demands "redressing the power imbalances in the physician-patient dynamic" and "developing mutually beneficial and non-paternalistic partnerships with communities on behalf of individuals and defined populations."

Most critically, this work "requires an acknowledgement that physician responsibility should extend beyond individual patient care to advocacy within the community to change policies and practices that drive the determinants of health, causes of disease, and the efficacy of health care provision." Negligent by Design "is a call to action that concludes with a playbook on how we can force Medicine to behave differently—regardless of what the powers that be say. This book will strengthen advocates' resolve, inform all people of what is happening throughout the halls of Medicine, and show them what they can do about it."

Much as Medicine works to elevate whiteness, it similarly elevates cisness and straightness. Healthcare providers can't rely on diversity statements or competence checklists. The work requires understanding the harmful history of these systems in which we live and work, developing genuine humility about professional knowledge limits, and committing to advocacy beyond individual patient encounters. Anti-Blackness is foundational to how Medicine constructs and polices bodies, making Negligent by Design essential reading for dismantling healthcare's intersecting systems of violence.