Mama Might Be Better Off Dead: Book Review.

        The inability of doctors to effectively communicate with their economically disadvantaged patients is another factor that works to heighten the inequities of the health care system.  The subconscious use of occupational parlance by medical practitioners often results in baffled patients, who sometimes misunderstand or do not fully apprehend the extent of the ailments that afflict them.  For example, Robert believed that he was prescribed medication, but the pills actually turned out to be vitamins (202). Doctors however, aren’t the only ones who contribute to the lack of effective communication.  Further barriers between patients and doctors exist, for example, a great plurality of Black patients, Jackie being one, carry with them a general distrust of the white establishment; being that most doctors are white, this certainly has an effect on the communication that transpires during visits to the hospital (202). Patients’ misunderstandings then, can often be attributed to these barriers of communication.

        If all of the previous things sounded bad enough, the economically disadvantaged are also often relegated to the care incompetent medical staff.  For instance, the superlative of incompetent would not even be able to capture the ineptitude of Dr. Marino, who even failed a basic review by his co-workers (72).  The review team deemed Dr. Marino as unfit for practice and even recommended that he consider revising his practices (72), yet he was allowed to practice on economically disadvantaged patients.  It is alarming to see that doctors who lack basic competence in their field of practice are allowed to treat unknowing patients.  This is one of the most salient examples of the inequalities that the poor confront.  Treatment administered by doctors of ill repute is something that patients from higher socioeconomic statuses would never tolerate. One has to begin to wonder then how inequities such as these ever transpired in a country that advocates equality for all. In addition to occupational incompetence, many doctors haven’t been fully assimilated into the American way of life. They are often unaware of the norms and folkways that guide the lives of many of their patients, and are often unable to successfully comport themselves in their occupational milieus.  Profiles of the doctors at Mount Sinai hospital verify that none were born in the United States, which could definitely effect communication between them and their patients (230).  The inadequacies that characterize the Medicaid and Medicare programs, the issues of communication problems between doctors and economically disadvantaged patients, and the issues relating to the general incompetence of some medical practitioners are just some of the issues illustrated in Abraham’s work. This anecdotal evidence is certainly not an exhaustive list. With such visible inequalities as these being uncovered, one can be sure that Abraham’s has only exposed the tip of the proverbial iceberg.  

        Laurie Kaye Abraham gives an outsider a comprehensive, detailed look at the lives of the Banes, through whom she reveals the inequities of the American health care system. I believe that the scholarly value of her piece is inestimable. Through her detailed accounts of the activities of the Banes family, one is not only able to see the inequalities such as the ones proffered above, but we are also able to view the struggles that our nations most disadvantaged citizens are forced to endure on a daily basis.  For instance, Jackie cuts down on the usage of Mrs. Jackson’s pills in order to save money (59).  For a great plurality of the nations economically disadvantaged, medical exigencies come secondary to basic struggles for subsistence. Abraham’s revelation of the seemingly endemic inequalities of our healthcare system will hopefully facilitate the beginning of a long due discourse on how to combat this problem of epic proportions.  

One might be led to reason that because Abraham only saw the story from one family’s perspective that she might not have enough evidence to make generalizations. Abraham however, was able to obtain additional information from a broad array of actors in the health care occupational continuum.  For instance, Abraham was able to speak with numerous doctors in order to obtain information on the availability of care for Mrs. Jackson’s illness (60-76), or as Abraham followed Robert to the dialysis treatment, she was able to converse with patients who were in situations analogous to that of the Banes family (179-197).  One additional source of information that Abraham used to support many of her claims was Sister Mary Ellen.  Sister Mary Ellen gave accounts which described how the social workers she worked with were overworked, which often resulted in clients receiving poor services (43). Sister Mary Ellen supplies information on how equally misinformed the poor and rich are about Medicare and Medicaid (48). She reveals that most of the populace is unaware of how much the bureaucratization of health care has affected the quality of services (49). By successfully using additional sources, which includes many of the actors found in the social services arena, readers can have confidence that Abrahams has fully exhausted her sources of information, and that we have an accurate depiction of America’s health care crisis.

So far I have commented on the positive side of Abraham’s work, but there was one part of the book in which Abrahams’ objectivity could be questioned.  Abraham described one of the situations in which a medical resident could not find a vein of Mrs. Jackson to insert an IV (76); she made it seem as if the resident was indifferent to the pain being suffered by the elderly woman.  Abraham used such words as “probed” (76) and “grabbed” (76), all of which had a very negative connotation.  Abraham employs the usage of negative words to portray these doctors as cold, unsympathetic machines who exist to make the lives of poor citizens more painful that they already are. Her criticisms bound on the border of superfluity at times, and become somewhat redundant and unfruitful. Yet one should be able to understand why she unleashes her reservoir of emotion. Her passion for her work is unequivocally apparent, which compensates for her slight bias.

The economically disadvantaged are severely cheated out of adequate healthcare.  Programs such as Medicare and Medicaid, which are intended to aid the poor, while on a superficial level seem to be adequate, fail to take into account that other factors stemming from impoverishment may affect who is able to take advantage of the available programs.  Even for those who are fortunate enough to go to the hospital, they still face many problems once they begin to be treated. Many of the economically disadvantaged lack the requisite social and cultural capital (due to institutionalized racism, unequal education, etc.)  that is required to effectively communicate with medical practitioners and to fully understand the ailments that afflict them. In any case, a change in the health care system is in short order. One can only hope that Laurie Kaye Abraham’s book Mama Might Be Better Off Dead will encourage public debate on this issue, which would hopefully address this problem with the utmost expediency.