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NEGLIGENT BY DESIGN

North Atlantic Books, a California-based nonprofit publisher
Paperback and audiobook release date September 2, 2025

ABOUT THE BOOK

Unequal access to care. Misdiagnosis. Mistreatment. Medical gaslighting. An increasing number of studies show the profound impacts racism has on communities of color—particularly Black Americans. But these disparities in health care and wellbeing are not the result of a handful of uninformed or malicious doctors: racism in the medical system is institutional, woven into the very fabric of diagnostic criteria and even hospital infrastructure. Medicine denies fair treatment to Black patients not in error…but by design.

Drawing from extensive research, in-depth interviews with medical students and resident physicians, and over twenty-five years of experience as a medical doctor, Dr. Vanessa Grubbs argues that the reason racism in medicine continues to go unchecked is because it is in fact the standard of care. Any attempts to dismantle medical racism through “placebo” efforts such as forming diversity committees or releasing statements condemning racism will fail, she says, because they don’t address the reality of how the institution of Medicine has been, and continues to be, negligent when it comes to the treatment of Black people.

Dr. Grubbs skillfully unpacks the three core problems of how our health-care system currently considers the race of patients, which she identifies as being “race based,” “race disregarded,” and “race denied.”

When medical diagnoses and trainings are race based, they lead doctors to make different treatment decisions for Black patients, and create a dangerous disadvantage.

At the same time, medical textbooks and trainings may inappropriately disregard race in cases when it does matter, like failing to include pictures of how rashes may appear differently on light and dark skin—leading to misdiagnosis and death.

And finally, many medical institutions still deny the extent to which racism is an issue at all, resulting in fewer Black physicians and disastrous outcomes for Black patients.

Calling on her medical colleagues to join her in working against the negligence of American medicine, Dr. Grubbs lays out a pathway to true equity and inclusion in health care: getting to the root of the underlying fears and insecurities that have led to racist medical negligence; recruiting and retaining a diverse physician workforce; and forcing Medicine to commit to the cultural humility necessary to rebuild, not just replaster, a broken institution.

Based on her 25 years as a physician and extensive research, Vanessa Grubbs powerfully reveals how racism is deeply embedded in the very design of American medicine. She exposes the systemic negligence toward Black people, driven by overt race-based practices and covert assumptions of whiteness. Both a bold critique and a call to action, Negligent by Design challenges readers—especially in the medical community—to confront long-denied truths and build a more equitable and inclusive future.

—Dorothy Roberts, 2024 MacArthur Fellow and author of Fatal Invention: How Science, Politics, and Big Business Re-create Race in the Twenty-first Century

"Negligent by Design is a searing exposé of how medicine perpetuates harm under the guise of care. Dr. Vanessa Grubbs does not shy away from addressing the racism and racial negligence embedded within our medical institutions and offers a clear call to action for those who are ready to disrupt the status quo. This book is a powerful tool for change and a critical contribution to the conversation on racial justice in healthcare."

—Uché Blackstock, MD, author of Legacy: A Black Physician Reckons with Racism in Medicine

In “Negligent by Design”, Dr. Vanessa Grubbs uncovers the pervasive racial biases embedded within the U.S. medical establishment. She highlights how influential white physician administrators allow their prejudices to shape decisions regarding the health of Black communities. This systemic bias perpetuates the longstanding negative trajectory for healthcare outcomes among Black people, commonly referred to as “health disparities.”

Dr. Grubbs’ storytelling reveals the structures and relationships that uphold and justify race-based medicine, with its differential treatment protocols and the resulting consequences for Black people.

She is a much-needed witness within the medical field, affirming the palpable racism and disrespect systematically suffered by Black patients.

For those unfamiliar with the science and language of medicine, Dr. Grubbs explains how race is misunderstood as a social construct and consequently misapplied as if it were a scientific category.

She exposes how these deeply flawed ideas are taught to medical students and doctors in training, perpetuating mistreatment and misdiagnosis of Black patients. As the field of medicine advances, it further legitimizes the structural racism that is responsible for withholding from Black and other racially oppressed people full entry into the life of society. By keeping out of reach the resources that make it possible to achieve liberation, we continue to see the absence of Black trainees, doctors, and leaders in numbers that could transform the health of Black communities.

“Negligent by Design” is a major contribution to continuing efforts to acknowledge and rectify medical racism in its many forms, and to ensure that the field of medicine represents the most important principles of the long struggle for equality and justice.

— Angela Davis, Black feminist scholar, author, and activist.

HUNDREDS OF INTERLACED FINGERS

Hundreds of Interlaced Fingers, an Imprint of HarpersCollinsPublishers

Hardcover and e-Book released June 2017

Paperback released June 2018

ABOUT THE BOOK

A young, hopeful doctor’s memoir—an unforgettable love story and an informative journey into the world of medicine and kidney transplantation that ultimately asks: What does it mean to let go of something that you love, even if it is life itself?

When Vanessa fell in love with Robert, she had no idea that the relationship would thoroughly transform her life. Robert suffered from end-stage kidney disease, which required him to endure years of debilitating dialysis to stay alive, at least until his failed organ could be replaced by a kidney transplant. Although Vanessa was a primary care doctor, she developed a deeper understanding of the difficulties Robert faced with dialysis and in finding a donor. Despite their being early in their relationship, she volunteered one of her own kidneys—and discovered that she was a match. This life-affirming experience forged a bond that would become a pillar of Vanessa and Robert’s marriage—and the beginning of her new career.

Motivated by Robert’s experience and her newfound knowledge, Vanessa became a nephrologist—a kidney doctor—and discovered far more about the realities of the specialty. Shaped by Vanessa’s remarkable experiences as a doctor, a woman of color, a mother, and a kidney donor, Hundreds of Interlaced Fingers is a love story, an exposé, and a clarion call for us all to consider the dualities of both loving and letting go.

“Dr. Grubbs’ extraordinary story reminds us all of the Samaritan function of being a physician. Not only did she train as a kidney specialist because of the man she loves, but also gave him one of her kidneys. This gripping, heartfelt memoir is a deeply insightful look at health care in America as experienced by doctor and patient.”

ABRAHAM VERGHESE, author of Cutting for Stone

“Part memoir, part medical guide, Dr. Vanessa Grubbs has written an unforgettable journey of the way love, health, and illness affect us all—doctors and patients. If you loved Jessica Zitter’s Extreme Measures or Atul Gawande’s Being Mortal, Dr. Grubbs’s beautifully written book will connect with your heart and soul. Her book is a wonderful guide for people facing kidney disease, complete with information on how to navigate the health care system.”

ANGELO VOLANDES, Harvard physician and author of The Conversation

“Hundreds of Interlaced Fingers is a love story—love for a man, love for the profession of medicine, love for humanity, love for life. In the sure hands of Vanessa Grubbs, it is a story told beautifully, courageously, and honestly. You’ll never forget Vanessa and Robert, and you’ll never view medicine quite the same way again.”

ROBERT WACHTER, MD, author of New York Times bestseller of The Digital Doctor

"With courage, honesty and hard-earned medical wisdom, Vanessa Grubbs takes readers on a journey through her own evolution as a doctor, a researcher of health disparities and a kidney donor. This beautiful memoir of love, illness and healing reflects on some of the deepest conundrums of medicine today —including uneven access to treatment and the challenges of caregiving.  A probing book for professionals and all of us who will be patients."

Sharon R. Kaufman PhD, author of Ordinary Medicine: Extraordinary Treatments, Longer Lives and Where to Draw the Line