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    Friday, August 06, 2004

    Race and Medicine: I was going to post something about this study showing that racial disparaties in medical care are due to geography and poverty, not racism, but Sally Satel beat me to it:

    It is important to recognize that many of the physicians working in black communities are hardworking, committed individuals who make considerable financial sacrifices to serve their patients. As Dr. Bach's team notes, they deliver more charity care than doctors who mostly treat white patients and derive a higher volume of their practice revenue from Medicaid, a program whose fees are notoriously low. They are often solo practitioners who scramble to make good referrals for their patients but who are stymied by a dearth of well-trained colleagues and by limited entrée to professional networks with advanced diagnostic techniques.

    It is long past time to put aside the incendiary claim that racism plays a meaningful role in the health status of African-Americans. The health gap is assuredly real. But growing evidence suggests that the most promising course is to get well-trained doctors into low-income and rural neighborhoods and enable them to provide the best care for their patients--something they will do, it somehow needs to be said, without prejudice.

    She's right. If a similar study were done comparing doctors who practiced in rural communities with those who practiced in suburbs, the findings would likely be the same. Sometimes, you've got to do the best with what you've got.

    UPDATE: Some thoughts from a radiologist:

    I cannot echo the sentiments described on your site regarding this issue enough. Yes, there are physicians who cater only to well paying customers, and frankly those physicians are color blind except for one color, green. They will treat anybody who pays.

    The rest of us, for the most part, are color blind except where the color of the skin may have clinical significance. Practicing in a large radiology group which covers a wide geographic area which encompasses the complete spectrum of American society from urban to suburban to rural, we see it all. Yes, we do have a facility to cater to the needs and comforts of the well insured, this is a necessity because we must survive and if we don't do it, somebody else will . I practiced in a practice in Cleveland where we were prohibited from doing this and we eventually had to fold, because we could not survive, though, we had plenty of work, but NONE of it paid. Our jobs were picked up by the Cleveland Clinic, and I am now aware that they have been named in that lawsuit regarding their tax exempt status and their questionable level of charity care, and my former hospital is named in this suit.

    The majority of our present professional staff sits smack down in the middle of urban neighborhoods, close to everyone. We serve all, no questions asked. I do not know or care abour insurance information when I interpret or perform a study. Most of what I do is very expensive and everyone gets the service if needed whether they can pay or not. If we are so busy downtown that people cannot be served right away, we send them over to our swanky private office so we can take care of them right away. The amount of medicaid and charity care we provide is staggering. If we didn't have those who can pay or are well insured, we could not provide this service, because it COSTS us money to see every patient. If we get nothing back we cannot stay in business.

    That said, we can not be responsible for the behavior and lifestyles of any ethnic subsector of the American population. I cannot force them to show up for appointments, see the doctor when needed, take their medication, or make the correct lifestyle choices. This is America. People may choose freely to live, to die, or how they choose to live.


    posted by Sydney on 8/06/2004 08:15:00 AM 0 comments


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