A new randomized controlled study about treating appendicitis should serve as a reminder of the importance of treating all patients equitably, the president of Oregon Health & Science University writes in an editorial published today in The New England Journal of Medicine.
Danny Jacobs, M.D., M.P.H., FACS, a general and gastrointestinal surgeon and past editorial board member of the journal, writes that each patient should be informed of all the pros and cons of receiving antibiotic treatment rather than a laparoscopic appendectomy for uncomplicated appendicitis.
“I believe that most providers would recommend surgical treatment for uncomplicated appendicitis if that option is available,” he writes. “I know I would.”
With the COVID-19 pandemic potentially constraining the use of operating rooms or other resources nationwide for “non-essential” procedures, Jacobs suggests that clinicians should avoid encouraging treatments to vulnerable populations that may not be in their overall best interest – in the context of the patient ultimately making the decision.
“The pandemic has highlighted ongoing, dreadful health care disparities in the United States and the adverse impact of social determinants, as well as structural bias and racism, on health and health outcomes,” Jacobs writes. “It will be important to ensure that some people, in particular vulnerable populations, are not offered antibiotic therapy preferentially or without adequate education regarding the longer-term implications.”
Jacobs, who was invited to write the editorial, has been active in highlighting disparities in health care among communities of color that also happen to be disproportionately impacted by COVID-19.
As the leader of Oregon’s only academic health center, Jacobs emphasized the important role of academic medicine to ensure that all patients – without regard to factors such as ethnicity, race or sexual orientation – receive the highest standards of care, including a full explanation of all the benefits and risks of various courses of treatment.
“The worry would be, not so much at OHSU, but in general whether there is some bias that might alter what is presented or recommended to patients,” Jacobs said. “This is a point in history for academic medicine to look at all of our tools, outcome measures and the like, to make sure they can be appropriately applied to every population.”
Jacobs, who has performed scores of appendectomies in his career, said OHSU has a leadership role in working to eliminate disparities in health care.
“As we go forward to address structural racism, we need to make sure our studies, tools and devices equally represent all the populations that will be served,” he said.