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    Health-Care Bias Not Just Black and White

    Sex, Location Are Also Factors in Popular Knee Replacement Surgery

    Blacks Underserved

    In February, another group of researchers measured race as a factor in which patients had knee replacement surgery and found that blacks underwent the procedure significantly less often than whites. They note in the journal Medical Care that white patients were significantly more likely to have had a family member or friend who had received joint replacement and therefore had a 'good understanding' of the procedure, while black patients were more likely than their white peers to believe that joint replacement would entail "at least moderate pain" and severely impair their ability to walk, at least temporarily.

    "Before the Skinner study, most people who cared about this issue were wondering how much of this problem was due to bias on the part of the caregiver, or a distrust of minority patients toward their doctors -- but the mix of those and other factors wasn't clear," says James Knickman, PhD, of the Robert Wood Johnson Foundation, who wrote an accompanying editorial. "It turns out that it sometimes doesn't matter if you're black or white; it's geography and gender that matter."

    The new study is useful because it adds those two new dimensions to help explain why minorities get worse treatment, says H. Jack Geiger, MD, ScD, of the City University of New York Medical School, a longtime researcher on how race affects health outcomes.

    "It's especially useful because black men have the worse health status of any population group in the U.S.," he tells WebMD. "This study indicates that it will take a systematic effort by everyone -- government programs, physician organizations, and grassroots groups -- to collect data for recording race and ethnicity for various types of care and procedures, so we know what's being done to whom and what needs to be fixed."

    Take a Stand

    What does this study mean to you? No matter your race, sex, or ZIP code, it's important to be a proactive patient -- whether you need a joint replacement or another procedure.

    "The best ammunition you have as a patient is to try and track down as much information as you can about a particular procedure," Skinner tells WebMD. "If you have information on the risks and benefits, you will have a better time getting information than if you are passive. For this procedure, even if your primary care doctor doesn't have an 'in' with an orthopaedic surgeon, if you want the surgery, being persistent is really important in your getting it."

    Knickman tells WebMD that this study illustrates the need to shop around: "If you live in an area where you are nervous about the quality of health care, go to another hospital, especially for an elective procedure and if you're on Medicare. The key is to ask a lot of questions."

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