Maren Monsen, M.D., a 38-year-old filmmaker-in-residence and senior researcher at the Stanford University Center for Biomedical Ethics, has received a two-year grant from The Commonwealth Fund to produce a documentary filmentitled Worlds Apartthat will highlight minority Americans' experiences with doctors, health plans, and the health care system in general. Cofunding the project are the California Endowment, the Arthur Vining Davis Foundations, and the Greenwall Foundation.We caught up with the award-winning filmmaker recently to find out more about her new project.
Studies have shown a disparity in the medical care doctors recommend for their white patients and their minority patients. Can you elaborate on this and discuss how your film will illuminate the problem?
Monsen: The level of mistrust and miscommunication between ethnically and racially diverse patients and their providers is much more widespread than we had realized. The accumulation of multiple small episodes result in a dramatic disparity in health outcomes.The film is about "cultural competence" [awareness of and sensitivity to a patients cultural background, including language and health beliefs]. We're following a number of families through treatment at clinics, hospitals, and with specialists.We'll be telling stories of patients' experiences, both good and bad, and how they affect their home lives. The idea is to raise awareness and show examples of the problems.
Can you cite some examples?
Monsen: We're following some African-American families with sickle-cell disease. Some are happy with the care they're getting from clinics that medicate them early and try to keep a pain crisis from building. Others are repeatedly denied pain medication. There's a lot of suspicion of African-Americans, a lot of stereotyping about them being drug-seekers.
There's also a lot of mistrust of the health care system by minorities. For example, an Afghan-American man whose X-rays were lost immediately assumed the hospital was covering up a misdiagnosis of cancer. One African-American patient believed his doctors were tapering off his seizure medication, as opposed to just discontinuing it, because the doctors were trying to make money.
Film can be such a powerful tool, on both an educational and an emotional level. How do you foresee your film being used as an effective eye-opener for the medical profession?
Monsen: One of our findings is that trouble can develop from using family members as translators, which is common in immigrant communities. In one case, a family turned on a daughter for translating a doctor's terminal prognosis for her father. That daughter in turn blamed her sister, whose earlier translation had led the father to refuse chemotherapy.All that happened below the surface, unbeknownst to health care providers.The film is story-driven. It's really about patients and communication and where a lot of the misunderstanding comes in.
PBS, which aired your 1999 Emmy-nominated film The Vanishing Line about the medical response to dying, has expressed interest in broadcasting Worlds Apart. Will your findings also be disseminated in other ways to the medical profession and the general public?
Monsen: In addition to the film, there will be educational videos produced as medical teaching tapes.We also plan to develop a study guide, a teaching manual, and a discussion guide for patient education.