Commentary on medical news by a practicing physician.

  • Epocrates MedSearch Drug Lookup


    "When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov

    ''Once you tell people there's a cure for something, the more likely they are to pressure doctors to prescribe it.''
    -Robert Ehrlich, drug advertising executive.

    "Opinions are like sphincters, everyone has one." - Chris Rangel

    email: medpundit-at-ameritech.net

    or if that doesn't work try:


    Medpundit RSS

    Quirky Museums and Fun Stuff

    Who is medpundit?

    Tech Central Station Columns

    Book Reviews:
    Read the Review

    Read the Review

    Read the Review

    More Reviews

    Second Hand Book Reviews


    Medical Blogs


    DB's Medical Rants

    Family Medicine Notes

    Grunt Doc




    Code Blog: Tales of a Nurse

    Feet First

    Tales of Hoffman

    The Eyes Have It


    SOAP Notes


    Cut-to -Cure

    Black Triangle



    Kevin, M.D

    The Lingual Nerve

    Galen's Log



    Doctor Mental



    Finestkind Clinic and Fish Market

    The Examining Room of Dr. Charles

    Chronicles of a Medical Mad House



    Health Facts and Fears

    Health Policy Blogs

    The Health Care Blog

    HealthLawProf Blog

    Facts & Fears

    Personal Favorites

    The Glittering Eye

    Day by Day


    The Business Word Inc.

    Point of Law

    In the Pipeline


    Tim Blair

    Jane Galt

    The Truth Laid Bear

    Jim Miller

    No Watermelons Allowed

    Winds of Change

    Science Blog

    A Chequer-Board of Night and Days

    Arts & Letters Daily

    Tech Central Station





    The Skeptic's Dictionary

    Recommended Reading

    The Doctor Stories by William Carlos Williams

    Pox Americana: The Great Smallpox Epidemic of 1775-82 by Elizabeth Fenn

    Intoxicated by My Illness by Anatole Broyard

    Raising the Dead by Richard Selzer

    Autobiography of a Face by Lucy Grealy

    The Man Who Mistook His Wife for a Hat by Oliver Sacks

    The Sea and Poison by Shusaku Endo

    A Midwife's Tale by Laurel Thatcher Ulrich



    American Academy of Pediatrics

    General Health Info

    Travel Advice from the CDC

    NIH Medical Library Info



    Thursday, February 23, 2006

    Class vs. Race: Sally Satel and Jonathon Klick make a good argument for the role of socioeconomics in health disparaties:

    The most recent report from the Agency for Healthcare Research and Quality suggests this is so. It examines, separately, quality by race and quality by income. It says that “remote rural populations” receive poor care, and “many racial and ethnic minorities and persons of lower socioeconomic positions” receive suboptimal care. In short, white people who live in these areas get bad care too; conversely black people living in majority white areas tend to get good care.

    Much has been made of the need for greater sensitivity in the doctor-patient relationship. Common sense dictates that patients benefit when they trust their physicians and interact with them productively. But the remedies for unsatisfactory doctor-patient relationships do not reside in racial sensitivity training for health-care professionals, affirmative action in medical-school admissions, or the specter of Title VI (civil-rights) litigation — all avenues of redress that have been advocated.

    Since class makes a much greater contribution to heath care and health status than does race, sound solutions should target all underserved populations. Low-income patients benefit from many factors: a strong safety net provided by the federally funded community health-care system (guaranteeing a usual source of care); grassroots outreach through black churches, social clubs, and worksites; patient “navigators” to help negotiate the system; language services; and efforts to get more good doctors into distressed neighborhoods. Seemingly simple innovations, such as clinic night hours, mobile clinics, and more extensive use of school nurses, could be a great boon to patients with hourly wage employment who risk a loss of income, or even their jobs, by taking time off from work for doctor’s appointments.

    Having practiced in smalll, poor rural areas and in large suburban areas near tertiary care centers, I can attest that it's location, location, location that matters most in healthcare. Financial barriers also play a role. It's often difficult for people in manual labor positions or service positions to get time off to take care of health needs - be it getting an MRI done or visiting a specialist. At least, that's a frequent excuse I hear, even out here in the suburbs.

    But Satel and Klick are exactly right. It's a misuse of government funds to mandate racial sensitivity training for health professionals when the real problem is access to care. And, it speaks more of the biases of those designing the solutions (ahem, public health officials, politicians) than it does of the biases of healthcare providers.

    posted by Sydney on 2/23/2006 09:44:00 AM 4 comments


    You must have the life skills of dedication, discipline and self-denial to keep healthy especially if you have a chronic medical condition. You must also have those life skills to keep our of poverty.

    It would be more valuable to treat these health disparates as a life skill problem rather than a class or culture problem.

    By Blogger Jake, at 12:36 PM  

    Don't forget those who were affected by Katrina. As hurricane victims struggle to rebuild their lives, one of the most immediate needs is access to medical care. Congress has the power now to help the children, elderly, sick or people who have lost their jobs to get the health care they need by temporarily covering them under the federal Medicaid program -- without red-tape and hassles.
    Take action to help hurrican victims get medical access!

    By Anonymous Anonymous, at 2:43 PM  

    Yes, you need cultural sensitivity...but the real barrier is philosophical.
    Yuppies believe in the religion of health, eat right, don't smoke, exercize, and see their docs for minor problems.
    I'm from working class background...you see the doc when you think you might have cancer, or when a routine thing gets too bad...partly it's money, partly it's time, and partly it's a fatalistic approach to life, the idea that if you are going to die, you'll die, and fate/God is in charge...so why worry? There are more important things to do...

    By Blogger boinky, at 2:14 AM  

    i think economics is one of the largest reasons for poor healthcare among the lower classes, being one of them.. after working many years as an ICU nurse.. i now find that i struggle to pay for healthcare.. even though i have a pricey private ppo and medicare.. i recently had to make the decision to forgo an MRI because my cost would have been 1000.00.. which would have been required to be paid out in 3 mo.. i do not have an extra 330 dollars a month to spare. when i tried to make other arrangements to pay over a 6 mo period..(still be difficult but not impossible). i was told no dice.. this is real .. this is healthcare in america

    By Anonymous Anonymous, at 9:18 AM  

    Post a Comment

    This page is powered by Blogger, the easy way to update your web site.

    Main Page


    Home   |   Archives

    Copyright 2006