Achieving Equity and Parity in Otolaryngology Care

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NEW ORLEANS—Third-generation African American physician Dana M. Thompson, MD, MS, professor and division head of otolaryngology–head and neck surgery at the Ann and Robert H. Lurie Children’s Hospital of Chicago and Northwestern Fienberg School of Medicine, said she faces racial discordance on an ongoing basis with most of her patients, colleagues, students, mentors, sponsors, and all of her bosses.

Her John Conley, MD Lecture on Medical Ethics, “Achieving Parity in Otolaryngology Care: The Ethical Obligation Beyond Care Access,” presented September 15, 2019, at the American Academy of Otolaryngology–Head and Neck Surgery (AAO–HNS) Annual Meeting in New Orleans, showed how her African American patients and those in other underrepresented groups also face this type of discordance in the American healthcare system every day.

“If we are anthro-culturally different from our patients and we see our patients through the lenses of our biases, we risk not understanding their values, expectations of their care, and their needs,” Dr. Thompson said. “This partnership is our ethical responsibility to our patients to help them live healthier lives and achieve health equity.”

Dr. Thompson’s presentation also covered how the effects of American slavery, segregation, capitalism, and individual biases interfere with equity and parity in medicine and otolaryngology. She offered a way forward for physicians based on an examination of personal values and advocacy efforts that can have an impact on equity and parity.

Medicine’s Dilemma: Cost, Access, and Quality

Access to healthcare, Dr. Thompson said, is a function of several factors, including the availability of personnel and supplies close to where a prospective patient lives or easily accessible by transportation. It also means care that is timely, affordable, understandable, and respectful of the patient’s culture. According to Dr. Thompson, healthcare expectations of Americans are those anthro-cultural beliefs and values espoused by the middle class, who value advanced technology, expedited care, and access to the highest possible form of care delivery, despite the diagnosis.

“That leads us to medicine’s dilemma: infinite needs versus finite resources,” Dr. Thompson said, citing the work of the medical economist William Kissick, MD, who was active in drafting Medicare and authored Medicine’s Dilemmas (Yale University Press, 1994). Dr. Kissick coined the phrase “Iron Triangle of Cost, Access, and Quality” to explain that if there were a triangle where cost, access, and quality each represented an angle, expansion of any one of the angles would almost always compromise one or both of the other two.