Journal of general internal medicine
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Cervical cancer is an important cause of cancer mortality in black women. Pap tests may prevent such deaths, but poor, rural black women are relatively less likely than others to be screened. In order to understand why that is so, the authors surveyed 149 women in three rural North Carolina counties. ⋯ Variables independently associated with not having a recent Pap test included: having no identifiable source of medical care; having more than one source of gynecologic care; having an internist provide gynecologic care; and perceiving psychological barriers to Pap tests and pelvic examinations. Income, educational level, and health insurance status were not associated with having a recent Pap test. Although access to care remains a problem for some, better use should be made of the medical care encounters available.
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To investigate whether medical housestaff report race information differently during case presentations of black patients and white patients, a prospective observational study was performed. Without informing housestaff, a chief resident recorded data during consecutive case presentations over two months. For each presentation, the data included: 1) whether, where, and how often race was identified; 2) whether certain prospectively selected, "possibly unflattering characteristics" were mentioned; and 3) whether any "justifying" diagnoses were considered during presentation or subsequent discussion. ⋯ Race was more often specified prominently and repeatedly during presentations of black patients. Among patients to whom "possibly unflattering" characteristics were attributed, race was more likely to be specified for blacks (10 of 10) than for whites (4 of 9). These case presentations appeared to show a subtle bias.