Sometimes research and didactic reporting confirm facts that we all know well since they’re part of our lives. That’s certainly true for me when it comes to racial disparity in health care. My observations as a physician have convinced me that black patients receive worse care than do whites. Three studies reported in the latest New England Journal of Medicine have once again resurrected the matter. This is an important issue for me; as a black man and a physician, I straddle both camps.
In one study, age-standardized rates of nine surgical procedures performed on white and black patients were compared. Proportionately, heart-bypass operations were offered 10 percent less often to black men than to white men, and 5 percent less often to black women than white women. This was also true of coronary angioplasty: more whites than blacks received it. There were more deaths of blacks in hospitals after heart attacks than deaths of whites.
The rest of the procedures included the high-cost repair of an abdominal aortic aneurysm, back surgery, neck artery surgery, total hip replacement, knee replacement, valve replacement and appendectomies. (Strangely, more blacks had ruptured appendixes at the time of surgery.)
Between 1992 and 2001, the disparity in coronary artery bypass, total hip replacement and surgery of the neck arteries increased.
Black Americans have a much lower life expectancy and worse health outcomes than white Americans. More than 600 studies document that even when indicated and needed, black patients are denied high-cost surgical procedures. Many attempts to reduce racial disparities in health care have been made at the federal level, by the National Institute of Health and the Department of Health and Human Services, as well as 34 states.But the new studies show little has changed over the last 40 years. In fact, in 2003 a call went out from the Institute of Medicine for the health care system to take on the challenge of eliminating racial disparities.
“The system is perfectly designed to get the results it does,” former U.S. Surgeon General David Satcher wrote. “This complex system is consistently producing predictable results,” he added: needlessly high black American mortality.
Many white physicians are unaware of this racial gap in health care results. As late as 2004, only one-third of cardiologists agreed that “clinically similar patients receive different cardiovascular care based on what their race and ethnic background is.”
Since poor and middle-class blacks – educated, insured and with access to physicians and good medical facilities – are impacted, the cause must lie in the health care providers who treat some while withholding care from others.
Medicine allows a doctor to choose from a variety of therapies. When there’s a hierarchy of therapies, the physician has the discretion to offer more or less. We continue to trust in the power of youth to reform and renew society. In medicine, however, new generations – predominantly female – haven’t helped change the dynamics of race and medicine. Blacks are on the losing end.
American medicine has traditionally been tainted by racism; clearly it hasn’t totally emerged from the swamps of bigotry. Medical schools and specialty training programs select candidates not for their humanity and empathy. Academic superiority doesn’t always equate to the most merciful and just physicians.
The solution has to be better information; better black education; greater vigilance by the community; and the establishment of black church/medical society liaison groups. Blacks must know that they have a right to a second opinion; that a doctor’s verdict isn’t always final; and that doctors are sometimes imperfect.
The medical world must clean its soul of bigotry and racism by emphasizing empathy and charity as integral parts of health care. That a segment of the American populace looks at the profession with jaundiced eyes is bad for medicine. What many blacks want to see is medical justice.
Pius Kamau of Aurora is a thoracic and general surgeon. He was born and raised in Kenya and immigrated to the U.S. in 1971. His column appears on alternate Thursdays.
