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medpundit |
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Thursday, October 03, 2002The study didn’t limit itself to examining children admitted only to the teaching service. It looked at all admissions, regardless of insurance coverage, and regardless of their prior relationships with their admitting physicians. Here’s the criteria they used for admission: ”Primary criteria for admission to the hospital included concern about possible child abuse or a parent’s ability to care for the child, need for surgical intervention or cast-care teaching for children with femur fractures, delay in time to casting due to significant swelling, young age of the child, and other significant diagnoses or injuries warranting admission.” Now, what sort of families do you think would fall into the category of “concern about possible child abuse or a parent’s ability to care for the child”? It certainly isn’t the urban parents living in gentrified regions of the city who are more likely to be white and more likely to have established relationships with a pediatrician or family doctor. It’s far more likely to be the urban poor who use the emergency room for primary care, and who are overwhelmingly from minority groups. This self-selects for the minority children to be treated with more suspsicion for potential abuse. More of them were probably admitted for that very reason. The results section of the study confirms that the minority children were poorer than the white children. Seventy-percent of the white children had insurance coverage, compared to only eighteen percent of the minority children. It gets even worse. The authors had the cases reviewed blindly by child abuse experts who decided on the basis of the history and the x-rays whether or not each case was likely an accident or likely abuse. The reviewers had no idea what race the children were. By this process, they determined that 12% of the white children’s fractures were due to abuse. The treating physicians, on the other hand, suspected abuse in 22% of white children - nearly twice as many as the blinded reviewers. The results for minority children were similar. The reviewers determined that 27% of their fractures were likely caused by abuse, while the treating physicians thought so in almost twice as many cases - 52%. Notice that even the reviewers who had no clue as to the children’s race, suspected abuse in more minority children than white children, and note that the treating physicians overestimated abuse by the study’s criteria at the same rate in both white and minority children. The real moral of the story is not that doctors are prejudiced against minority parents. It’s that we over-report abuse. This we do because there are laws that require us to report any suspected case of abuse, no matter how shaky the evidence. We can get in big trouble if we don’t. Much better for us, and the child, if we err on the side of caution and mistakenly report a case than if we err on the side of leniency and miss one. The other moral of the story is that there is more child abuse among the poor. That’s no surprise either. There are higher rates of drug and alcohol use and criminal behavior among the poor, too. There are a significant number of people out there who are poor because they can’t keep their personal demons at bay long enough to hold a productive job. And the final moral of the story is that the researchers obviously allowed their own biases to influence the interpretation of their results. They've assumed that any difference in care is caused by race without considering any of the other contributing factors. If they weren't biased, they would have recognized the role poverty played in their findings instead of ignoring it. posted by Sydney on 10/03/2002 08:08:00 AM 0 comments 0 Comments: |
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