From Unequal Treatment to Quality Care
Authors: Risa Lavizzo-Mourey, John R. Lumpkin
Journal: Annals of Internal Medicine (2004)

Perspectives3 August 2004From Unequal Treatment to Quality CareFREERisa Lavizzo-Mourey, MD, MBA and John R. Lumpkin, MDRisa Lavizzo-Mourey, MD, MBAFrom the Health Care Group, The Robert Wood Johnson Foundation, Princeton, New Jersey.Search for more papers by this author and John R. Lumpkin, MDFrom the Health Care Group, The Robert Wood Johnson Foundation, Princeton, New Jersey.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-141-3-200408030-00011 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail We congratulate the American College of Physicians (ACP) on its position on racial and ethnic disparities (1). The position is comprehensive and consistent with the ACP's mission and can be a model for other specialties and disciplines. The emphasis on enhancing cultural competency is worthy of note because of the role such competency can play in improving outcomes. As noted in the position statement, competency among all health care professionals and support personnel is critical to achieving better outcomes. Not only must practicing physicians be diligent in acquiring cultural competency skills through continuing education, they must ensure that those supporting them in their practices do the same.Translation services are essential to providing culturally competent care because they are key to communication when the clinician and the patient do not speak the same language. Evidence shows that professional translation services are associated with improved patient satisfaction and adherence, as well as improved provider satisfaction (2). For these reasons, clinicians should use professional translators and should consider them to be essential participants in clinical encounters with patients who do not speak the same language. We should not rely on volunteers, who are often family members, friends, or untrained support staff, because this is not consistent with best practices for culturally competent care. Unfortunately, payers do not reimburse for interpretive services, but this shortsightedness does not absolve clinicians of the professional responsibility to provide them. The ACP has taken a strong and commendable position on reimbursement of translation services, especially for Medicare, Medicaid, and the State Children's Health Insurance Program (SCHIP). To make progress on its agenda for racial and ethnic disparities, the College must place this issue at the top of its policy agenda. Effective communication is a prerequisite for high-quality care.Cultural competency training and interpretive services are good foundations for eliminating racial disparities in health care, but they are just a good beginning. We must also focus our efforts on addressing the subtle forms of bias, such as stereotyping. Many aspects of bias are based on an unconscious cognitive adaptive strategy—stereotyping—that enables people to make sense of a complex environment. But stereotyping can also negatively affect communication between the patient and physician. As noted in the Institute of Medicine report “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care” (3), research on stereotyping and practical approaches to eliminating it is an essential part of the comprehensive, long-term set of solutions required to eradicate racial and ethnic disparities.Closing the gap by eliminating the disparities in care between racial and ethnic groups and white populations in the United States is not enough. Unfortunately, even when we close the gap, we will not achieve an acceptable level of care for many conditions. For example, Cooper and Hickson (4) demonstrated disparities between minority and white children enrolled in Medicaid in getting corticosteroid therapy after an emergency department visit. Sadly, the rates of follow-up therapy for all groups fell far short of the ideal. The ACP's leadership and strong commitment to closing the gap and raising the bar are commendable. If the ACP can translate its excellent position statement into a sustained program to change practice, it can make a difference for all patients in this country.References1. Racial and ethnic disparities in health care. A position paper of the American College of Physicians. Ann Intern Med. 2004;141:226-32. LinkGoogle Scholar2. David RA, Rhee M. The impact of language as a barrier to effective health care in an underserved urban Hispanic community. Mt Sinai J Med. 1998;65:393-7. [PMID: 9844369] MedlineGoogle Scholar3. Smedley BD, Stith AY, Nelson AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Acad Pr; 2002. Google Scholar4. Cooper WO, Hickson GB. Corticosteroid prescription filling for children covered by Medicaid following an emergency department visit or a hospitalization for asthma. Arch Pediatr Adolesc Med. 2001;155:1111-5. [PMID: 11576005] CrossrefMedlineGoogle Scholar Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: From the Health Care Group, The Robert Wood Johnson Foundation, Princeton, New Jersey.Disclosures: None disclosed.Corresponding Author: Risa Lavizzo-Mourey, MD, MBA, The Robert Wood Johnson Foundation, PO Box 2316, College Road East and Route 1, Princeton, NJ 08543-2316; e-mail, [email protected]org.Current Author Addresses: Drs. Lavizzo-Mourey and Lumpkin: The Robert Wood Johnson Foundation, PO Box 2316, College Road East and Route 1, Princeton, NJ 08543-2316. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoThe Patient's Role in Reducing Disparities Sherrie H. Kaplan and Sheldon Greenfield Diversifying the Racial and Ethnic Composition of the Physician Workforce Neil R. Powe and Lisa A. Cooper Will Racial and Ethnic Disparities in Health Be Resolved Primarily Outside of Standard Medical Care? Theodore Pincus Racial and Ethnic Disparities in Health Care Metrics Cited byExamining Migrants’ Health From a Gender PerspectiveLack of Evidence for Racial Disparity in 30-Day All-Cause Readmission Rate for Older US Veterans Hospitalized with Heart FailureDisparities in the Early Adoption of Chemoimmunotherapy for Diffuse Large B-cell Lymphoma in the United StatesRacial Differences in the Presentation and Outcomes of Chronic Lymphocytic Leukemia and Variants in the United StatesRacial differences in the presentation and outcomes of diffuse large B-cell lymphoma in the United StatesUnderstanding why rheumatoid arthritis patient treatment preferences differ by raceTransforming Clinical Practice to Eliminate Racial–Ethnic Disparities in HealthcareRecommendations for Teaching about Racial and Ethnic Disparities in Health and Health CareWally R. Smith, MD, Joseph R. Betancourt, MD, MPH, Matthew K. Wynia, MD, MPH, Jada Bussey-Jones, MD, Valerie E. Stone, MD, MPH, Christopher O. Phillips, MD, MPH, Alicia Fernandez, MD, Elizabeth Jacobs, MD, MPP, and Jacqueline Bowles, MD, MSCEParallels and distinctions between health care quality improvement and health care disparities reductionRacial Differences in the Incidence and Outcomes for Patients with Hematological MalignanciesRacial, Ethnic, and Socioeconomic Disparities in Estimates of AHRQ Patient Safety IndicatorsInequality in Health Care: Unjust, Inhumane, and Unattended!Talmadge E. King Jr, MD and Margaret B. Wheeler, MD 3 August 2004Volume 141, Issue 3Page: 221KeywordsChildrenCommunication in health careCorticosteroid therapyEmergency departmentHealth careHealth care qualityHealth disparitiesHealth insuranceMedicarePopulation statistics ePublished: 3 August 2004 Issue Published: 3 August 2004 Copyright & PermissionsCopyright © 2004 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...