 Article
|
|
|
|
Services
|
|
|
|
Google Scholar
|
|
|
|
PubMed
|
|
|
|
LETTER
Tensions in the Racial Integration of Health Care, Then and Now
Samir K. Ballas, MD, and
Roy N. Gay, MD
15 January 1998 | Volume 128 Issue 2 | Page 158
TO THE EDITOR:
We read with interest the paper on hospitals and civil rights from 1945 to 1963 [1] and its accompanying editorial [2]. We wish to indicate that a subset of African-American patients-those with sickle cell disease-continue to be the target of discrimination. Recent studies [3, 4] suggest the existence of a two-tier system of health care in the United States: one for the affluent and another for the poor. Subcategories exist within each system that are based on such factors as race, diagnosis, disease chronicity, and treatment. Patients with sickle cell disease seem to occupy the lowest rank on the scale. Because these patients often have recurrent attacks of acute severe pain, have chronic pain, are poor, and frequently use relatively large amounts of opioid analgesics [5], they have been granted second- or even third-class status by the health care system. In our experience, some of the markers of negativism and their manifestations in the delivery of care to patients with sickle disease include segregation, inadequate coverage, rationing, ultimatums, and procrastination (Table 1).
View this table:
[in this window]
[in a new window]
|
Table 1. Markers of Negative Attitudes and Their Manifestations in the Delivery of Care to Patients with Sickle Cell Disease
|
|
Issues secondary to the manifestations listed in the Table 1 may arise. Thus, patients who are denied treatment in the emergency department because they have exceeded their prescheduled number of visits have no choice but to go to other emergency departments. Such patients are accused of hospital hopping and drug-seeking behavior and are subject to further restrictions and accusations.
We realize that some of these attitudes are expressed by some providers because of faulty perceptions, imitations, or habit. We hope that our letter will be published so that some providers may reexamine their attitudes in the delivery of care to patients with sickle cell disease.
|
Author and Article Information
|
|---|
Jefferson Medical College; Philadelphia, PA 19107
Misericordia Hospital; Philadelphia, PA 19143
1. Reynolds PP. Hospitals and civil rights, 1945-1963: The case of Simkins v Moses H. Cone Memorial Hospital. Ann Intern Med. 1997; 26:898-906.
2. Thomson GE. Discrimination in health care [Editorial]. Ann Intern Med. 1997; 26:910-2.
3. Kahn KL, Pearson ML, Harrison ER, Desmond KA, Rogers WH, Rubenstein LV, et al. Health care for black and poor hospitalized Medicare patients. JAMA. 1994; 271:1169-74.
4. Gronick ME, Eggers PW, Reilly TW, Mentnech RM, Fitterman LK, Kucken LE, et al. Effects of race and income on mortality and use of services among Medicare beneficiaries. N Engl J Med. 1996; 335:791-9.
5. Ballas SK. Treatment of pain in adults with sickle cell disease. Am J Hematol. 1990; 34:49-54.
About Letters
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
|
Article
|
|
|
|
Services
|
|
|
|
Google Scholar
|
|
|
|
PubMed
|
|
|
|
Top
Author & Article Info
References
