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Tensions in the Racial Integration of Health Care, Then and Now
- Samir K. Ballas, MD; and
- Roy N. Gay, MD
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
TO THE EDITOR:
We read with interest the paper on hospitals and civil rights from 1945 to 1963 [1] and its accompanying editorial [2]. We wish to indicate that a subset of African-American patients-those with sickle cell disease-continue to be the target of discrimination. Recent studies [3, 4] suggest the existence of a two-tier system of health care in the United States: one for the affluent and another for the poor. Subcategories exist within each system that are based on such factors as race, diagnosis, disease chronicity, and treatment. Patients with sickle cell disease seem to occupy the lowest rank on the scale. Because these patients often have recurrent attacks of acute severe pain, have chronic pain, are poor, and frequently use relatively large amounts of opioid analgesics [5], they have been granted second- or even third-class status by the health care system. In our experience, some of the markers of negativism and their manifestations in the delivery of care to patients with sickle disease include segregation, inadequate coverage, rationing, ultimatums, and procrastination (Table 1).
Issues secondary to the manifestations listed in the Table 1 may arise. Thus, patients who are denied treatment in the emergency department because they have exceeded their prescheduled number of visits have no choice but to go to other emergency departments. Such patients are accused of hospital hopping and drug-seeking behavior and are subject to further restrictions and accusations.
We realize that some of these attitudes are expressed by some providers because of faulty perceptions, imitations, or habit. We hope that our letter will be published so that some providers may reexamine their attitudes in the delivery of care to patients with sickle cell disease.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
