Easy in, tough out: the dam of health-care racism

Abstract

Until the 1980s, the practice of turning away patients on the basis of their ability to pay, without evaluating or treating them, was legal and frequent in US hospitals. A 1986 study at Cook County Hospital, a public hospital in Chicago, noted that 89% of patients transferred from private hospitals to their facility were Black and Hispanic, and 87% of them were transferred because they did not have adequate insurance. Mortality was disproportionately high among those transferred, likely due to delays in stabilisation and definitive care. This practice was ultimately disrupted—although it continues today—not by institutions recognising its unethical nature and voluntarily halting it, but by the passage of the federal Emergency Medical Treatment and Active Labor Act, which requires hospitals to stabilise and treat patients before transfer, irrespective of insurance status. It took an act of Congress to change this fundamentally racist, inequitable practice. Introducing The PenumbraThere are few topics that cause as much discomfort as inequities, particularly those related to race, gender, and other social identifiers. As a frequent lecturer, I've found the issue of how inequities shape one's experience in the health-care system, whether as a patient or in the workforce, often elicits avoidance, dismissiveness, defensiveness, or even anger. Health-care curricula typically neglect discussion of structural racism or sexism, and relegate race, sex, gender, gender identity, sexual orientation, and disability to the vague and misplaced category of risk factors. Full-Text PDF Parenting in the time of COVID-19Before COVID-19, you could put any two physician parents together and we'd have a shared narrative of all our “fails” as we juggled hospital work with child rearing: missed teacher conferences, late sign-ups for activities, being the only one who didn't attend the field trip. These were all crises in the Before Times. Our lives changed abruptly with COVID-19. The ways we educated, enriched, and entertained our kids were obliterated overnight. For many parents, child care evaporated, as did the endless march of activities that helped to keep our kids happy. Full-Text PDF