Wednesday, September 24, 2008


It is impossible for a man to learn what he thinks he already knows.


Every once in a while, you learn something about yourself you would rather not learn.

I consider myself to be an open, compassionate, and caring physician, not unlike most physicians. Oh, sure, there are times when I don't spend the time necessary for a complete understanding of a patient's problem, and, of course, there are other times when I don't know how to negotiate the barriers between a non-English speaking patient and myself. Still, my training and background equip me perfectly for working with patients from all backgrounds, right?

This week, while at the annual meeting of physicians in my specialty, I attended a session entitled, “Cultural Competency, Health Literacy, and Health Disparities.” The presentations opened my eyes.

There is no secret that people of color, the underinsured, and the disenfranchised in the US have higher rates of cancer, poorer survival, and delays in accessing the health care system. This was reinforced by the data presented.

What shook me was that we physicians are both knowingly and unknowingly complicit in this disparity. One study of California physicians indicated that, given the same indications for tonsillectomy in a child with commercial insurance and one with Medicaid, the physicians would be less likely to offer the procedure to the child with Medicaid. Despite this, a national survey found that we believe that we treat all patients equally, regardless of insurance status. Obviously, these findings are at odds with the other. It is possible that we are lying to ourselves.

A recent study in my specialty demonstrated that the vast majority of surveyed physicians were not familiar with the term, “Health Disparities.” As I listened to the discussion at the meeting, it seemed apparent to me that we need to not only make middle-aged white male physicians (like me) more effective, we must enlarge our ranks with physicians who come from the affected cultures.

Attracting people into a specialty, especially one that is encountered by only a fraction of medical students is a challenge. By being intentional, however, Otolaryngology has become a surgical “specialty of choice” for an increasing percentage of women over the past 20 years. Given the discussion after the presentation, I hope we will strive to make it a specialty of choice for people of color, as well.

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