Just Medicine

October 15, 2015
A densely written proposal for reducing discrimination by white physicians, nurses, and other health care personnel against minorities seeking medical services. Matthew (Law/Univ. of Colorado) opens with a shocking statistic: according to one estimate, nearly 84,000 more minority patients die annually "due to health care disparities" and "inferior medical treatment" compared to "their white counterparts." Drawing on social science studies, many of which are cited here, the author gathers evidence of implicit bias before, during, and after the clinical encounter, and she argues forcefully that this can and must be changed. A co-founder of the Colorado Health Equity Project, a medical legal partnership, Matthew tackles this important issue in disconcertingly repetitive prose filled with the jargon of the social sciences. Matthew presents a "Biased Care Model" with clunky charts of "physician and patient communication mechanisms" depicting how "physician's stored clinical and social knowledge of a patient's group" leads to "racially/ethnically disparate health outcomes." Quotes from various health care providers and excerpts from interviews with patients reinforce her message and lighten the sociolegal passages at times, but too often her presentation becomes discouragingly challenging for casual readers. Having presented a thorough picture of the problems facing minorities in the health care system, Matthew proposes a solution: reform of specific sections of the Civil Rights Act of 1964, which she claims would provide a legal and moral basis to hold liable those who unconsciously discriminate and would help to establish a new standard of care in medicine. Health care providers, hospital administrators, insurers, and those involved in civil rights law will find food for thought here; general readers will be better served by Damon Tweedy's Black Man in a White Coat: A Doctor's Reflections on Race and Medicine (2015).

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