Health Inequity

Title

Health Inequity

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Identifier

JonesL_03_20140130-Final_Clip10

Publication Date

1-30-2014

Publisher

The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center

City

Houston, Texas

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

Transcript

Tacey Ann Rosolowski, PhD

What are some of the ways in which there is a disconnect and a gap between the patient, the African American patient’s perspective, and the perspective of healthcare institutions?

Lovell Jones, PhD

You make certain assumptions, and it probably crosses all patients, but it varies in terms of culture and background, and also comes not perfectly, but with regard to racial concordance and the level of trust, that you see someone who looks like you, you assume, rightly or wrongly, that that person has some historical background that will make them understand your needs in terms of your care needs.

This has no racial connotation to it, but just to give you an example, because it comes to the perception that black patients are difficult and that’s why you don’t want them to enroll in clinical trials, because they’re not going to follow the regimen and therefore you’re going to lose them and you’re going to lose the number, and your papers are based on the numbers that you get to complete the study, and so forth and so on, and therefore you don’t get the paper published, and therefore, because you don’t get the paper published, you don’t get the right number of publications, and therefore you don’t get the right number of publications, you don’t get promoted and you don’t get grants and so forth. So it kind of escalates up the chain. So in your mind, they’re going to be bad patients, “I’m not going to make an effort to enroll them,” and therefore it’s self-preservation.

There was an individual in the follow-up study we were doing that was related to increasing enrollment of minorities into prevention efforts and then into treatment in five diseases: breast, prostate, colorectal, cervix, and GI. Did I say colorectal? Colorectal, breast. Lung, that was the other one. So those are the five: lung, breast, prostate, colorectal, and lung.

So this individual, we had gotten him enrolled. And to the credit of the physician, I have to say, too, he got it. We talked to him. He got it. That was this individual that the staff did not want to be enrolled because they realized that they didn’t pre-program to get this individual in a clinical trial. And in actuality, he ended up being a difficult patient in the clinical trial. He was labeled a difficult patient because he was a diabetic, and one of the exclusion criterias was uncontrollable diabetes. And they knew when he was enrolled that he had prescriptions for insulin, but his diabetes wasn’t controlled. And they accused him of not taking his insulin medication, and he fought back and said, “I was.” They got in huge arguments and so forth, and he just refused to listen to them, and so he ended up being what they considered a bad patient. What they didn’t realize, and because he was involved in [unclear], because he was involved in navigation of the system that we put forth, what we found out was that he didn’t have a refrigerator.

Tacey Ann Rosolowski, PhD

My god.

Lovell Jones, PhD

So he was taking his insulin medication, but the insulin medication that he was [unclear] wasn’t injection because that costs a little bit more than he could afford; it was the standard that needed to be refrigerated. So he left it out and was taking it.

Tacey Ann Rosolowski, PhD

Right, but it was not working. (laughs)

Lovell Jones, PhD

So we got him a new refrigerator.

Tacey Ann Rosolowski, PhD

Wow.

Lovell Jones, PhD

He became compliant. It was like, “Oh. He’s one of our most compliant patients.”

I’m going, “Well, you know, he was doing what he said he was doing, and you were telling him he wasn’t, and you weren’t addressing the issue. That was why he—.” So it wasn’t him not being compliant; it was other factors that made him noncompliant.

So that’s with regards to the whole issue of African Americans or others in terms of addressing issues that you may not be aware of that’s contributing to the noncompliance.

Health Inequity

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