No Equity, No Quality

Conerly speaker focuses on health disparities

For Dr. Joseph Betancourt, the exposure to health disparities came at an early age. Born in Puerto Rico, he and his family moved to New York City, where he became fluent in English as well as Spanish. Indeed, his command of English was such that at the age of 7, he was pressed into service as interpreter for his Spanish-speaking grandmother’s doctor visit.

At the end of the visit, despite Betancourt’s best efforts, it was clear to him that his grandmother and the doctor had not made a connection necessary for a real exchange of information. It was only later that he realized the barriers to that exchange included not only language but cultural mistrust and complacency.

Although the experience sparked in Betancourt an interest in becoming a physician, at that point he probably didn’t foresee himself becoming one of the nation’s top authorities on health disparities. But based on that reputation, he was invited as the keynote speaker for the Wallace Conerly Health Policy Symposium April 30.

And he delivered. Despite an early morning start time dictated by the speaker’s hectic schedule, more than 200 faculty, students and administrators, including retired Vice Chancellor Conerly himself, turned out to hear Betancourt’s masterful analysis of the topic.

He also brought good news. “There’s a lot of promise and a lot of potential around this issue,” he said. “I’m going to share a little sunshine with you.”

An assistant professor of medicine at Harvard Medical School, Betancourt is director of the Disparities Solutions Center at Massachusetts General Hospital. The DSC puts the emphasis where Betancourt says it needs to be – on solutions – since the problem has been well-described.

He linked the problem of health disparities closely with health-care quality. For all patients, he said, the health-care system delivers on its promise of quality 54 percent of the time. For patients who are “different,” that seemingly low number is substantially lower.

“Equity is an essential part of quality,” he said. “At the end of the day, we have to figure out how to deliver quality health care regardless of ethnicity, culture or class.”

Though there are many social determinants of disparate treatment, such as education, income and environmental factors, Betancourt said the health-care community should focus most on factors it can directly control.

He said there were three “lessons” that would go a long way to addressing the problem. The first is communication.

“Patients who understand us and who we communicate with do better,” he said.

He believes medical schools need to pay more attention to developing communication skills. “The art of medicine has shifted from getting to know your patient to getting to know the labs and other tools.”

The second lesson is to become more aware of stereotyping in clinical decision-making. All health-care professionals, no matter how culturally sensitive, make snap judgments based on race, gender and age, he said. These “cognitive shortcuts” come into play even more when the provider is stressed, time-constrained or multitasking.

The third lesson has to do with mistrust. Health care isn’t provided in a vacuum, he said. Health-care workers have to be aware of the social and cultural history of a place, including race relations, and how that affects perceptions. Sometimes, just putting on the white coat “puts mistrust front and center in that room.”

Beyond sharpening these provider-level skills, health-care institutions can do much to promote equitable treatment through systems of care, he said. Promoting workforce diversity and providing interpreter services, for example, are not only “at the core of who we are as professionals,” they can be “good for the bottom line.”

The Conerly Symposium, which included lunchtime breakout sessions, was sponsored by the Schools of Medicine and Nursing and the Division of Multicultural Affairs, with financial support from the Bower Foundation and the Vicksburg Medical Foundation.

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Tom Fortner

2009-05-11 00:00:00 18915