Wednesday, July 22, 2009

CNN Report on Aparthied in Medical Care in New York City - a follow-up note

(The message below was posted on Anderson Cooper's blog in response to many comments recieved about the show that aired on July 20 on AC360. It is scheduled to air again on Saturday July 25 on Dr. Sanjay Gupta's House Calls)

My name is Dr Neil Calman and I was the physician interviewed by Dr. Gupta for the segment on racism in medical care. For those of you who may have missed it you can see it by clicking on the link below:

First, I would like to express my appreciation to CNN, Anderson Cooper, Dr. Sanjay Gupta and his senior producer Caleb Hellerman for a thoughtful and accurate portrayal of the difficulties people of color in New York (and certainly in other parts of the country) have in obtaining good medical care. This report was the result of an investigation of the named hospitals in New York City done more than a year ago and which formed the basis of a complaint to the New York State Attorney General.

I also sincerely appreciate the many comments on CNN’s blog from patients – many of whom were not Black - who were also misdiagnosed, mistreated or otherwise received inadequate care and concern for their medical problems. These stories require our attention as American’s receive grossly inadequate care while our country spends 2 to 3 times more per person than some other countries that achieve far better outcomes and whose residents live longer and healthier lives. That is why we need health reform and need it now. It also speaks to the need for more primary care physicians – so every person in America that wants one, can have an ongoing, supportive relationship with one main provider who cares for almost all their medical needs and advocates for them when they need to see a specialist or when they need specialized care or a special procedure.

I want to address the issue that being Black is not what the CNN story was about but rather was the same story that could be told by poor or uninsured white people as well. Telling the story of only a few Black ministers in the Bronx was not meant to suggest that the problem was exclusively one faced by people of color. The people interviewed were just examples of over 100 phone calls made and recorded by our researchers who looked at how people were sorted into different models of care in New York City based upon the type of insurance they have. In New York City, because of the predominance of Blacks and Latinos among the uninsured and those on Medicaid, sorting people of color into systems with less well trained providers, no continuity of care, no emergency call systems and no communication back to the patients primary care provider – all contribute to the inadequate medical care that many receive and contribute to the poorer health outcomes Blacks experience.

Some people say that its all about education – or poverty – or lack of insurance. In fact, imagine that each of these things – education, financial well-being and good insurance coverage – are all things people need to get the best medical care. And also imagine – what hundreds of published studies have shown – that race, independent of all these other factors, is a predictor of poorer health care processes and poorer outcomes. If you imagine this, then you can understand that the question is not which of these factors is more important – but how many strikes do you have against you when you seek medical care. Race is one factor and being Black or Latino is one strike. Being poorly educated is another strike – especially when that means a poor understanding of the diseases that are important in your own preventive care plan, your family’s health or the diseases most prevalent in your community. Lack of financial means may create a situation where you put off, sometimes indefinitely, needed preventive care measures or put off buying the prescription drug not covered by your health plan. And being uninsured is a fourth strike as it is the greatest predictor of bad health outcomes.

Racism in health care is a common experience of people of color so let’s stop saying that race does not matter. We know it does. It is one very important factor in why people get bad medical care. . So is poor education, poverty and lack of insurance.

Our health care system needs to do better. We need to fight racism in medicine wherever it occurs and that is what the CNN story is about. We also need to get health reform passed now! That will largely fix the insurance issue. We need many more primary care physicians so everyone can have a trusted physician they know over time and who will care for all their basic medical needs. And we need a better campaign to educate all America about the importance of preventive care, good care for their chronic illnesses and about the health behaviors that can help them lead healthier and longer lives.

As President Obama points out – this is not a debate over politics. Everyone knows we need to fix our very broken health care system. Everyone has a horror story to tell somewhere in their personal experience or the experience of their friends or family. We have to do better than this and we can.


Nancy said...

God bless you.

ally pye said...

How do I become a follower of your blog?

Anonymous said...

Race and socioeconomic status are not the only determinants of how someone is treated during a doctor visit. Women are also often discriminated against. For some reason, the medical industry thinks we are too stupid to take care of ourselves and demonstrates this through such practices as holding our birth control pills as ransom until we submit to gynecological exams. I, for one, refuse such exams on religious grounds and am often harassed by doctors because of this. In fact, during a recent doctor visit to obtain another medication, a NP whom I'd never seen before was harassing me over not having a gyno exam and over not having any blood work done. If our health and best interest were really what they had in mind, they would check us for heart disease (kills more women yearly than female cancers do) or blood clotting (a known side effect of BC pills). Withholding my pills and causing an unintended pregnancy could be far more dangerous than any side effects of the pills themselves. In contrast, males aren't harassed about having prostate exams or other male-specific tests run and aren't required to submit to any testing prior to receiving Viagra or other sexual enhancement drugs. Such harassment destroys the dr/patient relationship and makes people reluctant to seek care in the future.

Anonymous said...

Racism is alive and well in all walks of life. Skin color and sex do matter in treating people. I have a Ph. D. in Molecular genetics from Univ. of Michigan. Yes. I am American woman scientist of Indian origin. However, if I do not tell my academic achievements most physicians in this country would think that I know next to nothing. I let them know up front about my research in basic medical sciences so that they would not look down on me. I usually see women physicians that too people of Indian origin. Physicians have a complex in this country. It is the research in basic Medical sciences that help them to be better physicians. They should learn to treat people of all colors with respect and give them the best possible medical care


Anonymous said...

I second your findings and opinions. I am a non-white, have company provided insurance, affluent and upscale. But that has not stopped me from receiving low grade treatment from white doctors. It may be improper to label all white doctors as racist, however a significant majority are arrogant and are jealous to see non-whites making six figures. It even hurts their ego, when we question about the treatment or tests.One reason is why i prefer Asian,Indian or Black MDs. They have patience, give good explanations and their regimen are way superior than their white counterparts. No wonder why every time i visit Asia, i get full check up there. Wish i could do these every 3 months instead of dealing with redneck MDs here.
Unfortunately i am stuck with a white dermatologist in CT and no non-white are practicing here. Once i asked a candid question about vitamin supplements (Folic acid,Niacin) and DHT blocker to arrest my hair fall, the MD got visibly agitated and downplayed my questions. White doctors are good at practicing defensive medicine, poor quality practice. Just look at booming Medical tourism in Mexico and Asia. Time to climb down from their high horses as they are just empty suits.

Mo Reiter said...

I just read this article on CNN. I worked in a Veterans hospital where I could see even white veterans treated better then minorities. This coming from an institution who claims that all veterans should receive top care because of their service.

I am glad you did not lose your toe.

Anonymous said...

I am an African American man in my late 20s who was born with Glucose-6 Phosphate Dehydrogenase (G6PD) Enzyme Deficiency, a type of anemia affecting 20% of black men--giving us immunity against many types of cerebral malaria. Most people have no clue they have the gene which is FAR more common than sickle cell. My own research in medical journals and on the web has shown that many black men discover they have it if they join the military or go to jail. I had no idea I had it until very recently, although I recall my first attack at age 6 after eating beans. The rash, nose bleeds and fever cleared,but I developed severe skin and nasal allergies. For a decade or more, doctors told me there are no allergy tests and that I should just take benedryl. At 18, I received a near fatal dose of tetracycline. When I began working in Equatorial rain forests, I knew to avoid tetracycline as a daily malaria prophylaxis, opting for the $8 per pill Malarone (the only choice for G6PD sufferers). My insurance companies refused to fill the MD's full script for 6-month, 3-month, 1-month, and 2-year trips. Luckily, as white colleagues on tetracycline and locals fell ill with malaria, I never got it. I did get rashes and severe sinus infections from tonic water, beans and Chinese food. It wasn't until 2008, at 26 years old, that an allergist under my short-lived A+ insurance gave me dozens of skin blood and urine tests before concluding G6PD deficiency. I should have been diagnosed when I was born with jaundice, but even with 2 parents in the health industry, it went undiagnosed for decades. Unfortunately, I moved to England last year, where doctors know nothing about black people. As a result, I became severely ill at the hands of my public NHS doctors. My white female doctor was dismissive and refused to send me to specialists, but changed tone once I became severely anemic from an Rx she had given me. My South Asian specialist, who works under a dismissive white Englishman, is actually a God-send, as I could have suffered enormously without my Indian doctor's help. So while choices and options are limited but free in the UK, a foreigner who is also black (and covered under NHS) gets far more inferior coverage than a white Brit. These are issues to explore in the public option which Obama is now trying to offer in the US. Ironically, a print-out of my most recent UK blood test read "results assume caucasian race." Across the globe, we need doctors who either look like their patients or who care enough to study health differences with respect to gender, race and age. If genetics and DNA mean anything to biochemistry and medicine, we have to think outside of the Eurocentric box.