Posted by: notdeaddinosaur | February 27, 2009

It Takes Two to Tango

I don’t usually get ticked off about stuff I pick up from Kevin, because as a fellow Family doc, he usually gets it. This time I’m afraid he missed the boat.

The topic is racial disparity in colon cancer screening. Apparently a study showed that in an all-Medicare population (ie, one in which access was not an issue) whites are still more likely to receive colonoscopy than black or Hispanic patients.

Kevin jumps to the standard conclusion:

…physicians need to be vigilant in offering the same treatment options and screening tests to minority patients.

Two words: Puh. Leeze.

I am hypervigilant about offering appropriate screening recommendations to all my patients regardless of race, gender, age and brand of sneaker. What I find — and what the quoted article itself explicitly acknowledges — is a huge variability in the ACCEPTANCE of my recommendations:

The researchers said that a combination of socioeconomic, healthcare access, and cultural factors likely explain the disparity in colorectal cancer screening, with the relative importance of each factor varying by race.

No one wants a colonoscopy. I do my best, equally with everyone, to talk them into it. Many remain reluctant. How is this my fault?

My reaction here is similar to my thoughts upon reading all those studies about how we doctors aren’t doing a good enough job telling our patients to quit smoking. Researchers survey smokers and ask them things like,

  • Did your doctor tell you to stop smoking?
  • Would you stop smoking if your doctor told you to?

How many patients are going to answer truthfully:

  • Hell yes, every time I walk in the door he’s up my ass about quitting.
  • Don’t matter what no one says; I’ll quit when I’m good and ready and not until then.

Of course not. You’re going to get something more like:

  • Why no; I don’t remember him saying anything about it at all.
  • Certainly. I have great respect for my doctor and would take his suggestions very seriously.

Conclusion: Bad doctor. You need to spend more time talking to your patients about smoking cessation.

It takes two to tango. I can “recommend” until I’m blue in the face. My powers of persuasion are pretty darn good, but patients have a responsibility here too. Although I’d love to see more direct studies of patient attitudes and specific ways to address them, I will settle for the acknowledgment that we doctors aren’t necessarily to blame for these kinds of observed disparities.


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