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Saturday, October 2, 2010

Health Care Disparities Today

I was recently asked for my opinion regarding racial disparities affecting the treatment outcomes for cancer patients.  I will say first off in response that one of the leading causes of delayed diagnosis stems from a problem that permeates America... Industries continued attempts to make statistic conform/fit to prove a case .

While over all statistics may indicate minorities are not receiving equal care I think further review of statistics would clarify that this distinction in a broader sense is related more to income, education and cultural disparities than purely race.

I have not been overly impressed with medical services at the primary care level myself, kick backs from pharmaceutical companies have skewed results and make care at this level impossible to determine any racial basis to claims of inferior care.

All too often patients present with long standing problems and are sent home with one form of anti depressant or another as a first level treatment. For a person like myself with insurance we may be willing to pay for these office visits enough times until we reach a point where we INSIST(IE what some may call Flipping out on our doctor in outrage) on further testing to determine what is wrong.

But, If I have limited income and children, who need dental and doctor care I am not going to be able to play the expensive visit the doctor to hear MMhhmm, yes, uh-uh, try this pill game so the Dr.'s office can gather statistics on the new pill more than one time, so care often ends up delayed for serious conditions. This may also be why ER visits are so high for some, especially in cases of conditions that have a tendency to flare up or go into remission.

Depending on ethnicity, there are also remedies and beliefs that may play a role, confounding determining quality of treatment issues.

Another distinction perhaps is the flipping out that I mentioned, or more precisely the ability to stand up for yourself and demand better. I think many economically disadvantaged people, those with linguistic challenges, or lower levels of education, etc. may not communicate as well to explain the health problem, they may hesitate to question or when needed yell at their doctor... the man is educated, socially superior, he is supposed to know best, if he says i'm fine I must be, etc.. Many have an ingrained personal class distinction issue, they feel there is no hope of fair treatment and so do not insist.

In this respect from the primary level of early diagnosis, I feel doctors are somewhat at fault, BUT, I still do not think it is racial based, the root lying more in disparities between education, culture, and finances. Whether you're rich, poor, white, black, insured or not, at the primary level the dr's do not discriminate who gets a pill. Time and again at the primary care level they will try a pill first for everyone they can if the patient presents in anything but a severe, obvious and/or debilitating condition.

I feel that Once diagnosed with cancer it is a different story. Upon diagnosis every oncology team member I have met 100% wants to save his patient, regardless of color, income or cultural beliefs.

Again communication plays a key role in a successful treatment regimen, and again education levels, culture and income are factors.

Patients need to make every treatment appt, they need to take meds as directed and on time, they need to be able to communicate changes and symptoms.

If you meant Within the scope of strictly cancer treatment : Here I see poverty, education and lifestyle choices as more of a barrier than race as the cause of the disparity between successful treatments and survival rates.

One of the greatest disappointments I have heard expressed the most by oncology team members is the fact that treatments are missed. One patient disappeared for over a month without contacting his doctors. It was later found out his car had broken down and he had no back up support system to deal with transportation. Another lady, during summertime did not have babysitters, under 11 years old children can not come in for chemo treatments, so she was missing treatments.

Time and again it seems to come down to they could not get there because of financial difficulties, and treatment was affected not by race but by poverty.

Lastly there is a population that lifestyle choices like continued alcohol and drug use for example, confound treatment success rates.

 I  agree that Yes prejudice does exist, it is not gone, it should be, but I just don't think it is the main issue here, it is broader than racial prejudice.

Many of our problems in health care, and our economy in general stem from overuse/ abuse of statistical analysis to attempt to solve problems or to promote an ideal or sell a product.

There are Too many people trying to make statistics fit what they are trying to prove, instead of looking at the statistics and seeing what they prove.

Well that's all I got, hope I have not offended anyone:)

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