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Research documents disparities, but solutions remain elusive

Studies show differences in outcomes between black and white heart patients, but the process of deciding what doctors should do about it is just beginning.

By Myrle Croasdale, amednews staff. April 4, 2005.

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A series of studies and reports recently released in two health care journals provide overwhelming evidence for something on which many physicians and doctor organizations already agree: Minority patients appear to be getting worse care and having worse outcomes than white patients with the same health problems.

The challenge now is identifying the solution to disparities in care, and physicians' role in any solution.

The research, published in the March 15 issue of Circulation and the March/April issue of Health Affairs, offers various suggestions of how to improve the overall health care system on multiple levels, but the studies acknowledge that remedying the situation is not easy. One part of this complex issue is physicians and their attitudes.

The American Medical Association, the National Medical Assn., the American College of Cardiology, the Assn. of Black Cardiologists and the American Heart Assn. and others are among those working on projects geared toward reducing disparities.

But a survey on cardiologists' attitudes found that while they believed in the evidence documenting these disparities, they saw the problem as one outside of their own practices and hospitals, blaming the health care system in general along with patient compliance and a lack of health insurance.

John C. Nelson, MD, MPH, president of the American Medical Association, agrees that physicians often don't see problems in their practices.

"I think most physicians feel it's for other doctors, not for their practice," Dr. Nelson said. "There's not a doctor out there who'd say, 'I treat patients differently on race.' But the data don't say that. We need to be much more competent."