|09-13-2002, 05:35 PM||#1|
Black Caucus Targets Unfair Health Care
Black Caucus Targets Unfair Health Care
Fri Sep 13, 7:06 PM ET
By Ross Grant
FRIDAY, Sept. 13 (HealthScoutNews) -- How should a doctor approach a patient who is about to die or in chronic pain? And what if that patient is a minority?
Those are the central questions of a forum in Washington D.C. today, hosted by the Congressional Black Caucus ( news - web sites) during its annual legislative conference. The panel members in the forum, made up of seven doctors and a minister, will discuss how blacks and other minorities can get equal options in their end-of-life care and pain management.
"In poor communities, where many minorities live, there is a much higher likelihood that a patient will die in a hospital or nursing home rather than in their homes, which people generally prefer," says panelist Dr. Richard Payne, who runs the Pain and Palliative Care Service at Memorial Sloan-Kettering Cancer Center in New York City.
"I think that people don't deliberately provide lesser care for patients in poorer communities, but the lack of resources in such communities does in fact equate to lesser care," he says.
He points to a handful of studies that illustrate this difference in care. For example, while more than half of all dying cancer patients receive hospice care to help ease their pain, only 7 percent of blacks get such care. This occurs even as the cancer incidence and mortality rates for blacks are higher than they are for whites, according to a report last year by the National Cancer Policy Board.
In affluent communities, such as parts of Manhattan, doctors often spend more time with a patient discussing her end-of-life options or how to alleviate her pain, he says. Because of hospital resources, workloads of doctors and differences in insurance coverage, this isn't often the case in poorer communities such as East Harlem, which Payne frequently visits.
However, the problem isn't just the care that minorities are offered, he says, it's also whether they can communicate their needs to doctors and nurses. Patients need to learn to expect more, and health professionals need to become more sensitive to a patient's preferences, he says.
"People have cultural values or beliefs that affect their preferences for care. Good care should attend to those preferences," Payne says. "We need to teach doctors how to attend to the whole person, and not just their kidney, lungs or heart."
"Often it?s a matter of clinicians and patients speaking a different language and not knowing it," adds Joan Panke, executive director of the DC Partnership to Improve End-of-Life Care in Washington, D.C.
Because of cultural differences that often exist between doctors and minority patients, medical language is often interpreted differently by both sides, she says. While she agrees that inequities in insurance coverage and hospital resources affect the quality of care, she argues that doctors in all settings should seek to be more sensitive to their patients.
"We as health-care professionals have to look at how we present options to different kinds of patients. We need to ask what are their thoughts, cares and fears," Panke says.
She emphasizes that everyone should discuss their preferences for end-of-life care with their families and doctors long before a terminal illness appears.
"These discussions are hard for the physicians, families and patients, but they need to happen. And they can happen anywhere," Panke says.
What To Do
For more information about care at the end of a person's life, visit Last Acts. Meanwhile, the National Medical Association deals with health issues facing blacks.
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