Health care's racism problem

the AAFP says doctors have to be educated in racism, or something to that effect. Actually, that has been part of medical school in recent years, along with multicultural sensitivity. It wasn't there when I attended 50 years ago, of course: Heck, up to a few years before I attended, my medical school had a black quota (one or two token blacks allowed in) and a Jewish quota (too many applied so they limited how many could attend), and NO women admitted.

and the problems of blacks trying to get medical care was a big problem: Private docs left the neighborhoods as they got more black residents because of crime (stealing narcs). Many also left in frrustration, or joined local HMOs, because of low reimbursement and high amount of complicated paperwork required if you see a large percentage of people on Medicare or Medicaid.

But you know violence and robbery against medical personnel isn't a black problem per se: My office in Idaho was robbed for narcs and money, and despite being a misionary in two war zones, the only place I ever got shot at (My windows shot out with a high powered rifle, which missed me because I slept on the floor in a different room) was in South Dakota...and Lolo always carried a pistol in his car when he made house calls in the wilds of Appalachia.

Similarly, thanks to regulations, defensive medicine, and the need to document every unimportant thing to get payment has made the practice of medicine worse.

Doctors do like it when patients are appreciative, and when they get a decent salary. But the big change in medicine is the application of the big business model to medicine; you know, talking to patients is not "efficient" and you might not be paid if you take too long discussing trivia with your patients, even though this investment in time and friendship means an increase in trust in the physician, and often means you know the real problem behind the visit (e.g. pregnancy in a teenager, spousal abuse, etc.).

 In private practice, I could write off the bills of my poor patients and even supply them with medicine, but now HMOs and their ilk won't let patients be seen if you don't have that insurance, and a lot of docs wouldn't see Medicare/Medicaid patients because it required a lot of paper work, paid poorly, and you often had your bill turned down for missing a box, or you might be "audited" if the reviewer didn't like what you die (I handled two of these cases for Lolo: One was an infection they said should have been treated outpatient, even though it was in Appalachia and she lived alone miles away and had no transport; another asked why he didn't ask a psychiatrist to see the patient for "anxiety", when there was no psychiatrist at that hospital: indeed, the nearest psychitrist was 30 miles away and took weeks to get an appointment, and GPs took care of most people with anxiety and other routine psychiatric problems, and probably better than the psychiatrist, since we usually knew the reason behind the panic attacks (again, things like spousal abuse, a druggie son stealing money, a unexpected pregnancy in the patient or her daughter, or an unfaithful husband).

I mainly worked in rural medicine, among poor white/Hispanics and later I worked in the IHS. There were many problems: The main one is that we had to work long hours, with little support for problems.

Referring folks was a problem because of distance, money, etc. I left the USA before Obama care so don't know if it was better.

but prejudice against ethnic minorities was the big problem, even in "Minnesota nice": And this prejudice/ cultural insensitivity included all races. 

And in the inner city, I suspect it is worse, because at least in rural areas, we usually got to know our patients, whereas in big city "clinic", it meant sitting and waiting for a doctor who often a stranger (and often from an upperclass upbringing or from overseas, so even the best motivated might not recognize the cultural nuances). 

you know, if you are white and you sit too long, or the doctor misunderstand you, or seems to dislike you and stays quiet, or ignores what you are saying, you figure he/she had a bad day or maybe you are at fault.

But if you are black (or even Hispanic like my sons) you attribute the problem to racism. And I'm not sure this isn't true in many cases.

referral of our Objibwe patients was always a problem because often they didn't make eye contact and might not ask questions. Indeed, many simply didn't keep their appointments at all, even though we often supplied transportation for referrals to distant hospitals.

And if there was so much misunderstanding that can be interpreted as prejudice against AmerIndians, and poor whites, and Hispanics, the racism, which is often subtle and due to the cultural gap, is worse.

so what is being done? paying the bill helps, but not if the clinics nearby are substandard (been there, done that) and full of people who are overworked and can't take time with their patients. Don't believe me? Ask anyone who gets care from the VA or IHS.

Reminds me of when there was another scandal about poor care in Philadelphia General hospital: when the report was handed to the mayor, he said: if it's that bad, close the place down. So he did, and since the poor had Medicaid or Medicare, they obtained care from the private sector.

I think Trumpieboy essentially said the same thing about the VA: if they can't get care in a timely manner, let them use the private sector.

as for the IHS: the dirty little secret is that in some areas, the Indian casinos have allowed the tribal authorities to run their clinics and hospitals: this was just starting when I left the USA and it was a big improvement.


so what are the plans for the inner city discrepancy in medical care?
here it is, in CEO speak:

we’re confronting the healthcare disparities, including addressing chronic conditions and investing substantial sums in minority serving medical institutions. We have medical institutions in some areas of our country that are a disgrace. I was going to say not up to standard. They’re much worse than not up to standard. They’re a disgrace. Take care of it.

yes and that includes the VA and IHS hospitals, at least in the past when I was still in practice, this was the case. Presumably it includes inner city health care, but I have no expertise in that.

 of course, the devil is in the details. But Trumpieboy was a CEO and probably has a plan or two up his sleeve. 

The problem is that every news report about the plan starts with a paragraph of snark and innuendo, and will not report anything positive about the plans, so it's hard to see if the actual plans will work.

so it's hard for me to judge this from 12000 miles away.