Anthropologist Christine Gray, Ph.D., became a healthcare activist when her daughter was diagnosed with a sarcoma in 2003. First in a five-part series on gender disparities in health care.
My greatest irritation when I first moved to this large agricultural city more than a decade ago was the health club, where childcare hours were organized around the schedules of “ladies who lunch.” For this privilege, the “ladies” paid extra. In terms of dues, men and women were more than equal. Men had a steam room, women, not. Weight machines were calibrated for men, not women. Television channels featured men’s sports, with the occasional concession to some lame idea of women’s interests (cooking). The most memorable scene: an elderly gentleman abruptly switching television channels, triumphantly announcing to a room full astonished (female) patrons that he had to “check his stocks.” This was equality, 1990s style.
Switch scenes to the enlightened, delightful, family-oriented Strawberry Music Festival at Camp Mather in Yosemite that same decade. Lined up at dawn for gourmet coffee, men and women alike talked of stock portfolios or the latest book contract. Nary an eyebrow raised at the “equal” restrooms and shower facilities. Lines to the men’s facilities were short or nonexistent. Women, a stone’s throw away, waited patiently in the cold and mud, children in tow.
How deeply are these notions of “equality” embedded in our health care system today, particularly, if, as hospital CEO Paul Levy suggests, healthcare is decades behind other enterprises in terms of adopting effective process improvement methods? How do we identify these disparities? How do we remedy them, particularly if either operation entails . . . disruption.
Response to the “Spin”
Response to the “Spin” series on the crazy-making quest for a second opinion on an abnormal mammogram was mixed, as was the response to the companion piece on possible and extensive gender disparities in the early detection of cancer.
Two tennis partners, both businessmen, agreed that the medical profession was decades out of date on information technology (IT). Having had considerable experience in this regard, both characterized physicians as “terrible businessmen.” Wes, a professor in accounting, recalled having to fill out a paper questionnaire for a new GP. This he found profoundly ridiculous from a business standpoint.
Did he speak up?
No. He went along and filled out the questionnaire. He did not favor confrontational tactics, he said, besides which he thought remedies lay in another direction: encouraging medical schools to teach basic business principles so physicians would encourage IT innovation rather than resist it.
What would he do if his doctor omitted a critical diagnostic test, a PSA blood test, for instance?
Change doctors, of course.
Had that ever happened to him?
Blank look.
Would he not find the prospect of having constantly to second guess his physician a trifle disconcerting? Should any patient be put in the position of constantly having to switch doctors due to omission of basic tests?
Another friend, roughly Wes’s female equivalent in terms of race (white), class (upper-middle), occupation (professional) and age (Baby Boomer) had a far different response. For years, she and her husband shared the same GP, Bonnie wrote. Her husband, as he aged, was sent for all kinds of tests. For her, nothing. Her husband insisted that a family history of cancer and heart disease accounted for the referrals. Her mother suffered from terrible osteoporosis, Bonnie said, yet their physician, young and prominent, never thought to ask.
She finally insisted on being tested for osteoporosis, after which she was diagnosed with osteopenia and put on medication. Adding insult to injury, the new physician found a heart murmur and sent her for an EKG. The insurance company refused to pay for the new medication (or indeed any new medication) without a fight. Her response: “I hate them all.”
“Of course, dear, you challenged his authority” said Diane, a woman in her 70s, response to the story of the bombast (and implied threats) of the radiology specialist when asked to commit his opinion to writing. Despite her wealth, sincere good manners and standing in the community, Diane expects little of physicians. She has learned to mask her anger, a cultural habit of African Americans most recently, and notably, dropped by U.S. Attorney General Eric Holder.
Next: Oprah’s “Secret” about Menopause