Dr Sanjay Gupta Gets Medicine and Race Exactly Wrong
I’m not a Sanjay Gupta fan. As an Indian-American medical student who has an interest in communicating medicine to the public, the comparison comes up from time to time.
He’s got a 2 minute short up on CNN.com here. Read the URL, it’s more than a little sensational, referring to “medical apartheid,” and the video itself isn’t much better.
It tells the sad story of Rev. Gary Spears, who had an infected paper cut. He also had diabetes, undiagnosed, and untreated. The video implies that Rev. Spears wasn’t diagnosed with diabetes, and consequently, didn’t receive appropriate care because he’s black.
They even cite a study pointing out that doctors DO let race influence their decisions – there are studies that show that if shown videos of two patients with the same symptoms, doctors are more likely to run more tests on the white patient. Personally, I don’t doubt that doctors let race influence their decisions – we are merely human – but that study in particular is somewhat contrived.
I’ve always said, no medical advice online – because I can’t see, question, and examine the patient myself. These studies rely on videos so that doctors can’t ask more questions, and can’t examine the patients. This is not our routine, this is not our job. We do not diagnose video tapes. We diagnose people, who are in front of us. When not doing our actual job, I suspect that hidden biases like race prejudice would be more likely to influence our decisions. Even if you accept this study, it may not say anything about Rev. Spears. Please note, I don’t deny that race CAN inappropriately play a role in health care decisions. I just deny that this is an obvious case of such a problem.
Rev. Spears went to the ER for his papercuts. The video says he went to the ER, twice, and was directed to an outpatient clinic run by the hospital. To my ear this means one of two things.
- Some ERs run a side-clinic to treat non-emergency issues. My own institution has one of these. These clinics are NOT primary care clinics.
- He went to the ER and was discharged, with followup to an outpatient clinic with a primary care doctor. I doubt this one, because if he had been directed to a primary care doctor after the first ER visit, why would he have gone back to the ER?
In scenario 1, it’s not surprising that his diabetes wasn’t diagnosed. If you go to the ER with an infected finger, it’s just an infected finger. Why would I run extra tests to check for diabetes? Rev. Spears has insurance, and should follow up with a primary care doctor after we discharge him anyway. The ER is not a primary care clinic. ER doctors are not primary care doctors. Their job is to stabilize the patients who would otherwise die, and to diagnose and treat acute issues.
Lots of people get diagnoses of chronic diseases like diabetes in the ER. However a finger infection isn’t a complaint that makes me think “oh he’s a diabetic,” it’s a complaint that makes me think “oh he has an infected finger.” Certainly, it’s possible that the doctor should have asked more questions and elicited that diagnosis. Their failure to do so doesn’t strike me as racist. Let’s not attribute to racism that which can be attributed to apathy or limited scope.
In scenario 2, if he WAS followed up with a primary care doctor (which this video doesn’t really say), this doctor absolutely should have diagnosed the diabetes. Almost all inlet forms for primary care practices involve questions about the symptoms of diabetes that Rev. Spears had – polyuria (peeing a lot) chief among them. Most primary care doctors seeing a patient for the first time will explicitly screen by history for diabetes, hypertension, and heart/arterial disease, among other things. If they didn’t, this too doesn’t imply racism. Let’s not attribute to racism that which can be attributed to incompetence.
Sanjay Gupta should know all of this. He’s a doctor. He’s a neurosurgeon so this isn’t exactly his bread and butter, but he’s a doctor. He knows the division of labor in the health system, and he should at least check on the standard of care for a situation before reporting on it.
Incidentally, I hope to make this the first in a new feature that I’m calling “Exactly Wrong.” In “Exactly Wrong”, I’ll be calling out public figures in the media telling it like it isn’t, or (humor me) getting it exactly wrong about medicine.