Getting to Equal: Strategies to Understand and Eliminate General and Orthopaedic Healthcare Disparities

Abstract

The 2001 Institute of Medicine report entitled Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care pointed out extensive healthcare disparities in the United States even when controlling for disease severity, socioeconomic status, education, and access. The literature identifies several groups of Americans who receive disparate healthcare: ethnic minorities, women, children, the elderly, the handicapped, the poor, prisoners, lesbians, gays, and the transgender population. Disparate healthcare represents an enormous current challenge with substantial moral, ethical, political, public health, public policy, and economic implications, all of which are likely to worsen over the next several decades without immediate and comprehensive action. A review of recent literature reveals over 100 general and specific suggestions and solutions to eliminate healthcare disparities. While healthcare disparities have roots in multiple sources, racial stereotypes and biases remain a major contributing factor and are prototypical of biases based on age, physical handicap, socioeconomic status, religion, sexual orientation or other differences. Given that such disparities have a strong basis in racial biases, and that the principles of racism are similar to those of other ''isms'', we summarize the current state of healthcare disparities, the goals of their eradication, and the various potential solutions from a conceptual model of racism affecting patients (internalized racism), caregivers (personally mediated racism), and society (institutionalized racism).

Racial and Ethnic Diversity in Orthopaedic Surgery Residency Programs

“…During the past several years, many authors have espoused the benefits of achieving diversity within the orthopaedic workforce [24][25][26][27][28][29][30][31] . Diversity is thought to be desirable for several reasons.…”

Defining Racial and Ethnic Disparities in THA and TKA

“…We will focus on patient and provider factors as system-related factors are difficult to isolate or solve. From the patient's perspective, barriers to equal care include differences in socioeconomic status; variations in patient recognition of symptoms; thresholds for seeking care; effective communication of symptoms to a provider who understands their meaning; expectations of care; racial and ethnic differences in patterns of self-care; and with regard to TJA, familiarity with procedures, expectations of postoperative outcomes, the influence of prayer on willingness to undergo surgery, and perception of symptoms and adherence to preventive measures and medications [14,30,40].…”

Competencia del estudiante de medicina para respetar las creencias y la cultura del paciente

“…Son, sin duda, reflejo de prejuicios y estereotipos sociales trasladados al campo profesional. Todo apunta a que debemos trabajar con los alumnos desde un principio para evitar que estos prejuicios se consoliden y lleguen a generar problemas de asistencia en la vida profesional, promocionando estrategias de formación como las comunicadas en el ámbito de las emergencias médicas [14], la psiquiatría [15,16], la odontología [17], la traumatología [18], etc.…”