Hospitalized Blacks Get Less Treatment than Whites, Cleveland Plain Dealer Analysis States
African-American patients admitted to U.S. hospitals receive less medical treatment than white patients, according to an analysis by the Cleveland Plain Dealer. In analyzing patient discharge records from 1996 through 1998, the paper found that physicians were "slightly" more likely to either "just order tests for blacks or administer no treatment at all." The treatment provided to blacks was often "less substantial" than that received by whites. In addition, in several "highly specialized" areas of medicine, there were racial disparities between the level of care received. For example, the Plain Dealer found that blacks who suffered from heart disease and several types of cancer were less likely than whites to receive an "attempted cure," even when nearly two dozen other factors influencing medical care were taken into consideration. About 7% of hospitalized blacks received shots as their primary treatment -- nearly twice as many as whites -- and blacks were "much less likely" to receive lifesaving and costly treatment following a heart attack, such as angioplasty or bypass surgery. Elderly blacks were less likely to receive "life improving" procedures, such as hip replacements, compared to whites.
The Plain Dealer found that black patients were less likely to receive medical treatments in part because they were more frequently uninsured. The paper cites hospitals and doctors who call the issue social and economic. Dr. Elizabeth Marcus, who treats mostly black, Hispanic and Asian women as head of Chicago-based Cook County Hospital's breast oncology clinic, said, "If you do not have health insurance in this country, you are screwed." Dr. William Hicks, a black physician who has practiced in Columbus, Ohio, for more than 20 years, said, "I've not seen overt differences in how patients are treated. I would hate to think doctors either consciously or unconsciously are withholding or undertreating patients. I think it's more socio-economic factors." However, others say that skin color does influence the level of care patients receive. Robert Mayberry, an epidemiologist at the Morehouse School of Medicine in Atlanta who recently received a federal grant to study how poor, chronically ill black patients are treated in America, said, "Even when you remove other factors that may play a role -- severity of illness, insurance status and preference of the patients -- there's still something about their skin color that affects how patients get treated." Marcus suggested the disparity could be attributed to a misperception about medicine among some minorities. She said that many blacks believe that "if you're not in pain, you're not sick and don't need a doctor." Another misperception is that "any time you biopsy a cancer, it will spread, so you should leave it alone." This mistrust of medicine was evidenced by the Plain Dealer's finding that blacks disregarded their doctor's advice and walked out of the hospital nearly three times more frequently than whites.
Addressing the Issue
Speaking to the Plain Dealer, Henry J. Kaiser Family Foundation President Drew Altman suggested that health professionals and patients should be educated about racial disparities in medical care. He said, "Without saying that there's racism ... or anything intentional happening, given the data, it wouldn't be a bad thing if every medical professional thought twice and tried a little harder to make sure they were doing what should be done the next time a 50-year-old black woman with heart disease walked into their office." Dr. E. Harry Walker, director of Cleveland-based MetroHealth Medical Center's urban and suburban satellites, suggested that a larger population of black doctors could help assuage the problem. "Some patients are intimidated going to a doctor outside their race," he explained. But Walker noted that it is "unlikely the number of blacks going into medicine will increase anytime soon." African Americans are more than 12% of the U.S. population, but make up only 4% of U.S. physicians (Davis et.al., Cleveland Plain Dealer, 12/17).