The Institute of Medicine report “Unequal Treatment,” published in 2002, identified healthcare disparities as a longstanding problem. Although this report received significant attention and many organizations have made important strides, healthcare disparities persist.
Disparities in healthcare are a major patient safety and quality concern that have been exacerbated by the pandemic; racial and ethnic minority groups have shown an increased risk of getting sick and dying from COVID-19.
Clinicians and policymakers should view disparities as significant safety hazards on a par with healthcare-acquired infections, falls, or wrong-site surgery. In particular, healthcare providers and physician leaders should consider how structural racism and implicit bias (or overt racism) may play a role in disparities by race, ethnicity, and gender, as described in the examples below.
Misdiagnosis. A physician who believes Black women are more likely to exaggerate an illness may subsequently misdiagnose complaints of chest pain as anxiety instead of a serious heart condition. Similarly, implicit bias may also cause clinicians to attribute a new mother’s symptoms of shortness of breath to anxiety rather than severe hypertension, thus contributing to disparities in maternal mortality.
Inadequate testing and treatment. For reasons that are not completely clear, female patients are less likely than males to receive diagnostic procedures and treatments for cardiac disease, including stress testing, catheterization, and initiation of medication after a heart attack. One study found that Black patients with lung cancer were less likely to receive curative surgery.
One of the best-studied disparities is the differential use of pain medication for Black and Latino patients. This disparity could be due to bias and occurs even when the diagnosis and severity of illness are identical to that of a White patient. One study reported Latinos were less likely to receive pain medications when seen in an emergency room for a long bone fracture.
Non-adherence to recommendations due to mistrust. Mistrust based on decades of racism can cause patients to disregard doctors’ instructions. Patients’ mistrust of an individual clinician, science, or the entire healthcare system may explain lower acceptance rates of COVID-19 vaccines in Black and Latino communities.
Poor communication. Inadequate communication can lead to misdiagnosis, undertreatment of pain, and lack of compliance. Poor communication can become complicated when mistrust is a factor, especially if a patient has limited ability to speak English.
For example, if a patient with limited English proficiency visits a doctor for abdominal pain and the physician fails to communicate through a translator, miscommunication could result in stomach cancer being misdiagnosed as gastroesophageal reflux.
Strategies to Decrease Disparities
The Joint Commission’s recent Quick Safety advisory, “Understanding the Needs of Diverse Populations in Your Community,” offers four strategies to help hospitals and medical centers support their communities:
Make equity a strategic priority within the institution. This requires leaders to leverage policies and practices that embrace anti-racism both within and beyond hospital walls, nurture partnerships and professional pipelines within communities, and intentionally address adverse social determinants of health.(1)
Use a social intervention framework, such as the Centers for Medicare & Medicaid Services’ (CMS) Accountable Health Communities (AHC) model, to help identify the needs of patient populations. The AHC model was designed to address the health-related social needs of CMS beneficiaries. It focuses on screening in five domains: housing instability, difficulty paying utility bills, food insecurity, transportation, and interpersonal violence.
Create a strategic plan for community outreach. The plan should begin with an understanding of an organization’s culture, mission, vision, and values and an understanding of the patient populations that the organization serves.(2)
Support the local workforce. Organizations should make an effort to fill entry-level positions with persons from their communities and provide advancement and professional development opportunities.(1)
Physicians and physician leaders have an economic and moral responsibility to address the health and well-being of their diverse and vulnerable populations. Together, we can make strides to decrease healthcare disparities.
References
Dave G, Wolfe MK, Corbie-Smith G. Role of Hospitals in Addressing Social Determinants of Health: A Groundwater Approach. Preventative Medicine Reports, 2021;21.
Staff. 3 Steps to Define a Hospital’s Role in the Community. Becker’s Hospital Review. July 3, 2013.