Big Medicine can’t hide patient inequities by calling them ‘disparities’ in care

mom-300x171Big Medicine can paper over its troubles with basic fairness by slapping fancy terms on them: take “health and gender disparities,” for instance. But doctors, hospitals, and the rest of us can’t make medical care more equitable, accessible, safe, and affordable without looking at inequities, square on.

That’s why the New York Times, Washington Post, and Associated Press deserve credit for recent deep digs into the struggles of women, poor women, and especially black women with modern medicine:

Excerpts from these stories may give readers a taste for more.

Here’s one from the New York Times Magazine:

The United States is one of only 13 countries in the world where the rate of maternal mortality — the death of a woman related to pregnancy or childbirth up to a year after the end of pregnancy — is now worse than it was 25 years ago. Each year, an estimated 700 to 900 maternal deaths occur in the United States. In addition, the [federal government] reports more than 50,000 potentially preventable near-deaths … per year — a number that rose nearly 200 percent from 1993 to 2014, the last year for which statistics are available. Black women are three to four times as likely to die from pregnancy-related causes than their white counterparts … — a disproportionate rate that is higher than that of Mexico, where nearly half the population lives in poverty — and as with infants, the high numbers for black women drive the national numbers.

Here’s a slice from the Washington Post, on mother Rebecca Chandler’s struggles with her disturbed daughter before the hosptial dumped her on the street:

If Chandler took Rebecca to a hospital during a manic episode, explaining that her daughter needed help, the hospital staff could ask Rebecca whether she promised to take her medication. If she agreed, she wouldn’t get admitted. After all, there was nothing physically wrong with her. Chandler couldn’t understand it. Nurses would listen to Rebecca talk about extraterrestrial travel and insist there was nothing they could do for her. Because of privacy laws, she couldn’t get basic information about her daughter, and was only able to get legal guardianship in March. ‘The whole situation was like Homer’s Odyssey, she said. Before she stopped taking her medication in 2016, Rebecca was hospitalized twice, her mother said. After she stopped, she went to the emergency room or was hospitalized about 10 times, and her mother called the police on her three times. Police were as unwilling to intervene as the hospitals.

And this from the AP:

In recent months, Hollywood moguls, elite journalists and top politicians have been pushed out of their jobs or resigned their posts in the wake allegations of sexual misconduct. In contrast, the world of medicine is often more forgiving, according to an AP investigation. When the doctors are disciplined, the punishment often consists of a short suspension paired with mandatory therapy that treats sexually abusive behavior as a symptom of an illness or addiction, the AP found. Decades of complaints that the physician disciplinary system is too lenient on sex-abusing doctors have produced little change in the practices of state medical boards. And the #MeToo campaign and the rapid push in recent months to increase accountability for sexual misconduct in American workplaces do not appear to have sparked a movement toward changing how medical boards deal with physicians who act out sexually against patients or staffers.

These stories may be too easily dismissed or ignored by some, who may argue they’re just about “those people who are not like us.” Partisans have made it too easy to divide Americans, especially on health care, into the haves and have-nots. The strident debate on the Affordable Care Act has made it somehow more acceptable to look down on the poor, to accept the notion that big differences in health care — determined by wealth or even where we live — are freshly acceptable.

In my practice, I see the harms that patients suffer while seeking medical services and their heart-wrenching struggles to access and afford safe, excellent medical care. It’s unacceptable that in a country with as much wealth and as many resources as we have that sound, appropriate medical care seems to many a privilege rather than a right. We can’t accept medical care that is separate and unequal. We have a long way to go, including opening our collective eyes to the big issues we need to address.

Photo credit: © Creative Commons: Milan Nykodym, Czech Republic

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