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Most in U.S. see disparities in care of minority patients

A majority of Hispanics cite language as a barrier to medical care while blacks and other minorities blame discrimination.

By Kathleen Phalen Tomaselli, amednews correspondent. Oct. 20, 2003.

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Several years ago, while working at another hospital, Hilton M. Hudson, MD, now chief of cardiothoracic surgery at Reid Hospital in Richmond, Ind., combed the halls looking for a Spanish interpreter after a nurse sent one of his Hispanic patients home with instructions written in English. "I had to go to his home to make sure the family knew what to do and needed an interpreter," he said. With no interpreter available, Dr. Hudson found a Spanish-speaking janitor to go with him. "We can take their money; we can operate, but not get an interpreter? That's disparity and that's why African-Americans and Latinos perceive differences."

But how widespread is the perception that the U.S. health system is failing minority patients?

Two out of three blacks believe they receive care inferior to that whites receive. One in five whites agree. According to a new public opinion poll, 54% of Americans surveyed believe health care professionals treat minority and white patients differently. Released in September by the Harvard Forums on Health, a project of Harvard University's Interfaculty Program for Health Systems Improvement, the survey cited several reasons for unequal treatment, including cultural and language barriers and discrimination by health professionals.

The results are no surprise to JudyAnn Bigby, MD, a primary care physician and medical director of Community Health Programs at Boston's Brigham and Women's Hospital. But what interests Dr. Bigby, who heads several minority women's health programs aimed at bridging gaps in care, is the high percentage of whites who said disparities exist. "This is important information coming from different sources," she said about the survey results. "People in health care don't like it when there's talk about things like bias and often become defensive. So we need as much data as possible that demonstrate this to us."

Although racial and ethnic disparity in health care has been documented for several decades, the issue didn't hit national radar screens until a few years ago. It now tops Healthy People 2010 goals, and programs to bridge gaps are popping up around the country. In 2002, the Institute of Medicine released Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, which found that minorities receive less care and a lower quality of care. And this Harvard poll -- one in a string of recent reports examining the problem -- further underscores previous findings.

"There is a lot of concern on the part of the American Academy of Family Physicians [and our concerns] are consistent with what the poll shows," said Jim Martin, MD, a family physician from San Antonio and president of the AAFP. "It is indicative of the lousy, dysfunctional, broken health care system in this country. ... It is extremely important we embrace and respond to these issues of disparity."

According to Harvard's poll, 91% of Hispanics say that language is a barrier to equal care; eight in 10 blacks believe that bias -- intentional or not -- is the major reason for disparate care; 75% of Hispanics say it contributes and 22% of whites see it as a major reason.

"People from minority groups believe they are discriminated against," said David Blumenthal, MD, director of Harvard's Interfaculty Program on Health Systems Improvement, who led the poll's grassroots initiative. "It emphasizes the fact of the legacy of distrust that burdens society, and health care is just beginning to realize this."

What to do?

The poll found broad support for several remedies. Topping the list: Health professionals working with minority communities to determine how best to get the health care they need. Outreach is paramount, said Dr. Bigby, pointing to a Boston program that aims to reduce the breast cancer deaths among black women.

"We went to the women first and asked them, 'Why do you think it's this way?' " she said. "The women said, 'Please don't just give us another program about how to take care of ourselves. We have so many things to deal with, like transportation, caring for family.' Things have to change on many levels."

More than half said it was important to punish doctors, hospitals and insurers that have track records of treating people differently based on race or ethnicity. "There was less support for rewarding doctors who make an effort to provide a higher level of care," Dr. Blumenthal said.

Other remedies included offering cultural competence training for medical students and doctors; providing interpreters for non-English-speaking patients; increasing the number of minorities working in the health field; and empowering patients to participate in care and treatment decisions. "If we want a color-blind society, we can't sit passively by, we need to prepare ourselves to care for the culturally diverse," Dr. Blumenthal said. "We need to train ourselves in cultural and language skills. Take a look at the future demographics -- it's Latino, black and Asian. One cannot be complacent about this."

Still, Dr. Blumenthal said most doctors believe they treat all patients fairly, even when there are documented differences in care. "Perhaps it's a subconscious behavior," he says. "Perhaps much more soul-searching is needed as part of the solution."

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