Health care disparities are a longstanding problem as summarized by the 2002 Institute of Medicine report “Unequal Treatment.”  While the report received significant attention and initiated strides forward, health care disparities persist.

Clinicians and policymakers must view disparities as significant safety hazards as critical as health care-acquired infections, falls, or wrong site surgery. In particular, they should consider how structural racism and implicit bias (overt racism) may play a role in health care disparities by race, ethnicity, and gender, as described in the examples below:

1. Misdiagnosis

If a physician believes Black women are more likely to exaggerate an illness, he or she may subsequently misdiagnose complaints of chest pain as anxiety instead of a serious heart condition. Similarly, implicit bias may also cause clinicians to attribute a new mother’s symptoms of shortness of breath to anxiety rather than severe hypertension, which could partly explain disparities in maternal mortality.

2. Inadequate testing and treatment

For reasons that are not completely clear, female patients are less likely to receive diagnostic procedures and treatments for cardiac disease, including stress testing, catherization, and initiation of medication after a heart attack. One study found Black patients with lung cancer are also less likely to receive curative surgery.

3. Non-adherence to recommendations due to mistrust

Decades of racism, lack of trust and overt mistrust can cause patients to disregard doctors’ instructions. Patients may mistrust an individual clinician,  science, or the entire health care system. This may explain the lower rates of  acceptance of COVID-19 vaccines in Black and Latino communities.

4. Poor communication

Inadequate communication can lead to misdiagnoisis, undertreatment of pain and lack of compliance. Poor communication can also become complicated especially if a patient has limited ability to speak English. If a patient with limited English proficiency visits a doctor for abdominal pain and the physician fails to use a translator, miscommunication could result in a patient with severe disease (e.g., stomach cancer) being misdiagnosed as gastroesophageal reflux.

What can health care organizations do? 

A new “Quick Safety” advisory from The Joint Commission, “Supporting safe, equitable care during the COVID-19 pandemic,” reviews requirements and initiatives to address health care disparities, as well as provides recommended safety actions for health care organizations to decrease barriers from providing equitable care during the pandemic.

For more information contact Maureen Lyons at The Joint Commission at [email protected] or (630) 792-5171.