HMS Professor Speaks on Minority Care

Racial misperceptions often cause minorities to receive less thorough medical care than non-minorities, a Harvard Medical School (HMS) professor said last night at an Adams House talk.

Dr. Joseph Betancourt, in a speech called “Unequal Treatment: Confronting Racial/Ethnic Disparities in Health Care” said both doctors and patients contribute to the disparities in care.

Betancourt’s talk was based on the results of a study he co-authored for the Institute of Medicine, part of the National Academy of Sciences.

Some minorities refuse certain types of treatment, he said, noting that many of his Hispanic patients, for example, were less likely to accept flu shots.

Also, he said doctors often prescribe care simply based on the race of the patient instead of individual symptoms.

Betancourt quoted studies showing that 100 more African-Americans per 100,000 die from heart disease and cancer than do whites, and that doctors were more likely to recommend cardiac catheterization testing for white men than black women even when their symptoms were identical.

“Despite the advances that we’ve had in medicine, some people have not benefitted as much,” he said.

Betancourt said that he believes that communication between doctors and patients is one of the main barriers.

Even when discrepancies in socio-economic status and access to care were controlled for, the study showed that disparities in health care for minorities still exist, which Betancourt attributed to miscommunication during care.

“Communication is central to quality care,” he said.

He drew from his experiences acting as a translator for his grandmother, a Puerto Rican immigrant, during her doctor visits.

“She was able to communicate with him, but her perception of medicine was so drastically different from [the doctor’s],” he said.

Betancourt said he hopes to increase awareness of the problem, but said doctors are reluctant.

They engage in what he referred to as the “not me phenomenon,” placing the blame elsewhere.

“It’s something that we as providers don’t want to mention, don’t want to accept, but it’s true,” he said.

Studies have shown that stereotyping takes place most often in situations that are stressful, under time constraints and involve multitasking—all conditions common to many doctors’ offices.

Betancourt said he hopes medical education will reduce stereotyping. Currently, only 6 percent of doctors in the U.S. come from African-American, Hispanic, and Native American populations, and very few classes in medical school address issues of cultural awareness, Betancourt said.

“Everyone wants a piece of the curriculum, so it’s challenging,” he said. However, he said he thinks that within 25 years, the situation could be greatly improved.

Betancourt’s talk was sponsored by the Harvard Hippocratic Society and the Initiative in Health Policy.