Unconscious Bias Shielded Larry Nassar
The country was shocked this week by the sentencing of Dr. Larry Nassar, formerly the USA Gymnastics team doctor and an osteopathic physician at Michigan State University. Dr. Nassar confessed to serial child molestation after being accused of abusing at least 150 underage girls during his career. A piece in The Atlantic argues that Nassar's behavior was sheilded by the tendency of medical providers to doubt female pain. This tendency stems from unconscious bias that labels women as "hysterical," "emotional," and inherently less trustworthy than men.
From the article:
Pain is inherently subjective—it’s impossible to see exactly how much someone is hurting. In the absence of clear physical indicators like a bleeding wound or a broken bone, the degree to which it’s taken seriously correlates with the degree to which the patient is trusted. And women are trusted less than men. With the same symptoms, men are more likely than women to be prescribed painkillers, while women are more likely to go home with sedatives. One study found that women waited an average of 65 minutes in the emergency room to receive analgesics. For men, the average wait was 16 minutes shorter....
Women, more so than men, have to prove there is something wrong with their bodies. Without tangible evidence, women fear proving the stereotypes right—of appearing weak, excessively dramatic. When she was abused by Nassar, Jennifer Rood-Bedford, a former MSU volleyball player, remembers thinking that she didn’t want to seem childish. She said she’d lay there on his table, wondering, “Is this okay? This doesn’t seem right.” She told herself, “Don’t be a baby.”
Trust in the Medical System is Declining
Only 34% of Americans trust the medical system, down from over 75% in 1966. Mistrust of doctors and medical professionals is much higher in the U.S. than in similarly developed countries. Patient mistrust is associated with lower adherence to medical advice, stifled innovation, and inferior response to epidemics.
From the article:
Trust is also critical for patient satisfaction, and makes it more likely that patients keep seeing the same doctor — which can have other positive effects, like fewer emergency department visits.
There are large disparities in trust along socioeconomic and racial lines (often for good reason), and building trust among vulnerable and marginalized patients may be particularly important.
Higher Income Doesn't Improve Health Outcomes for Black Americans
Health disparities between black and white Americans are well-documented, and are often thought to be the result of socioeconomic factors. New research shows that is not the case. In fact, upwardly mobile and highly educated black Americans still suffer worse health outcomes than white Americans who are living in poverty or who lack a high school diploma.
From the article:
[Study co-author Cynthia Colen, an associate professor at Ohio State University,] used decades of research focused on the experiences of middle-class black Americans. According to her data, more money isn't enough to rid black Americans of higher rates of chronic disease or shorter life expectancy. Black women with a graduate education are still at higher risk for pre-term birth and infant and maternal mortality than white women with high school educations. Black women with a Ph.D. and high take-home pay are also more likely than white women who have only a high school diploma to die from birth-related complications.
That finding flies in the face of the assumption by many that racial health disparities are rooted in issues of education and wages. "[When] we talk about racial disparities in health our knee-jerk reaction is to say, 'It's due to exposure to poverty, or exposure to poor neighborhoods, or going to underperforming schools, or not having access to healthy food options,'" Colen says. "Much of the research that I've been doing is aimed at picking that apart. Even among these non-poor populations, you still see racial disparities."
Kentucky Offers Health Literacy Course for Medicaid Access
Kentucky plans to allow continued Medicaid coverage for people who don't meet the state's new work requirements—if they pass a health or financial literacy course. The state claims the tests will "empower individuals to improve their health." But some health policy experts think the plan will increase discrimination and stigmatize the program. According to Atul Gawande, a surgeon and a health care researcher with the Harvard T.H. Chan School of Public Health, “It serves no health benefit whatsoever. You have to be concerned about requirements like literacy tests, which states have a bad history of applying selectively and arbitrarily.”
Approximately one-third of all American adults have health literacy deficits. Poor health literacy is associated with worse health outcomes and increased spending on healthcare. Improving education in this area would benefit the population as a whole, regardless of insurance status.
From the article:
The last large national survey of U.S. adult literacy (including health literacy) was conducted in 2003. One study found that 60 percent of Medicaid enrollees had only “basic” or “below basic” health literacy, meaning, for example, they could not recognize a medical appointment on a hospital appointment form (below basic) or would have trouble understanding why a specific test was recommended for someone with certain symptoms, even when given a clearly written and accurate explanation (basic).
But Medicaid enrollees are not the only ones. Nearly the same proportion of Medicare enrollees also had basic or below basic health literacy. Privately insured people scored better. They are typically younger than Medicare enrollees, and they typically have higher education levels and are less likely to have cognitive impairments than those with public coverage. However, only a small minority even of the privately insured had a “proficient” level of health literacy — meaning, for example, that they could deduce the employee share of health insurance costs from a table that listed that cost as a function of income and family size.