SUMMARY: Physicians are no less susceptible to prejudice than others with a similar level of education - including lawyers. Substandard care may arise when their caregivers disapprove of or dislike and consequently discriminate against their patients. Skillful enquiry at Examinations for Discovery may provide corroboration that prejudice caused or materially contributed to substandard care.
Race and ethnicity There is abundant US research evidence of racial discrimination in the provision and delivery of medical services. 1 [] This indictment has provoked corrective action in delivery of health services generally, 2 [] in emergency medicine 3 and in the management of chronic pain. 4
Gender Sexist discrimination in a number of aspects of the investigation and management of coronary artery disease has been documented in the clinical research literature. 5 []
Age Despite research evidence to the contrary, general practitioners attribute to lack of therapeutic benefit their failure to treat depression and suicidal ideation in the elderly with the same vigour as they do in younger patients. 6
Obesity. The obese experience societal prejudice and discrimination, often as the greatest burden of their condition, 7 [] and such discrimination is self-evident to a casual observer of a proportion of caregivers in an Emergency Department. Such prejudiced attitudes have been documented in a minority of nurses. 8
Sexual orientation The medical and nursing professions are not free from homophobia. This prejudice may impact collegial relationships as well as patient care. 9
HIV-infected A substantial minority of sufferers correctly or incorrectly perceive prejudice by caregivers, physician in particular. 5 Further research is needed to determine to what degree such perception is justified. 10
Drug and alcohol abuse Clinical assessment of acute alcohol intoxication and chronic alcohol abuse is demonstrably inaccurate when compared with blood alcohol concentration and the Short Michigan Alcohol Screening Test and CAGE questionnaire. 11 "...Patients with a negative blood alcohol concentration were more likely to be falsely suspected of intoxication if they were either young, male, perceived as disheveled, uninsured, or having a low income..."
Conversely, an intoxicated patient who has suffered a head-injury may have his depressed Glasgow Coma Scale score wrongly attributed to the intoxication. 12
Addiction Patients who are narcotic-addicted are frequently diagnosed as drug-seeking without adequate evaluation of potentially serious symptoms. 13
Practical PointerSubstandard care may be caused by, or materially contributed by, prejudice arising from patient characteristics that are correctly or incorrectly perceived to be chosen. |
Substandard care may arise when their caregivers disapprove of or dislike and consequently discriminate against their patients.
Language Racial and ethnic prejudice may be compounded by language difficulties and cultural misperceptions.
Personality disorder Patients who suffer from a personality disorder are more prone to cursory assessment 14 because of the discomfort of the caregiver in dealing with them. 15
Aggression Patients with acute or chronic traumatic brain injury, hypoglycemia and other metabolic conditions may be combative and/or verbally aggressive.
Mentally ill People with psychiatric conditions also develop physical illnesses but their symptoms may be attributed prematurely to psychiatric origins.
Colleagues
Physicians commonly have varying degrees of difficulty in providing medical services to fellow physicians and even nurses with whom they work. They are prone to make unwarranted assumptions about the degree of knowledge and understanding of their colleague-patients, and to cut corners.
Attractive
Patients who are unusually attractive to a caregiver are not only at risk of sexual violations but may also be treated in a non-standard fashion. The health professional may not want to hear or believe some personal facts that conflict with their fantasies about the patient and thereby make an erroneous diagnosis. On the other hand, s/he may uncharacteristically and dangerously over-investigate in a misguided attempt to achieve a near-perfect outcome.
Practical PointerCommunication difficulties may contribute to substandard care in a number of ways |
Skillful enquiry at Examinations for Discovery may provide corroboration that prejudice caused or materially contributed to substandard care.
Plaintiff and claimant counsel may suspect, rightly or wrongly, that their clients have suffered substandard care and/or discriminatory medical decisions as a result of prejudice.
Examinations for Discovery can be structured to uncover such prejudice and discrimination. Avoiding direct confrontation, counsel can thereby document prejudicial attitudes and unexplained deviations from caregivers' professed standard management.
It is self-evident that, in the absence of similar prejudices in the judge, such demonstration will strengthen the claimant's position.
Practical PointerPrejudice and discrimination can be uncovered at Examinations for Discovery, without confronting in an alienating style |
Copyright © 2009 Electronic Handbook of Legal Medicine