Clinical Uncertainty and Healthcare Disparities

The Institute of Medicine Report, Unequal Treatment: Confronting Racial and Ethnic Disparities, affirms in its first finding: Racial and ethnic disparities in health care exist and, because they are associated with worse outcomes in many cases, are unacceptable. The mechanisms that generate racial and ethnic disparities in medical care operate at the levels of the health care system and the clinical encounter. Research demonstrates the role of health care system factors, including differences in insurance coverage and other determinants of healthcare access, in producing disparities. Research also shows, however, that even when insurance status and other measures of access are controlled for by statistical methods, racial and ethnic disparities persist. These disparities remain when researchers try by various methods to control for patients\u27 clinical characteristics. Disparities are especially well documented through comparisons between white patients and African Americans and Latinos, but they are believed to affect other minority groups. As a result, many members of minority racial and ethnic groups receive less or inferior care. The purpose of this Article is to explore how one factor we regard to be key-provider and patient uncertainty about clinical decisions--contributes to disparities arising from the doctor-patient encounter