1) How do individual physicians contribute to health care disparities? Thinking about an area of health care of particular interest to you, what research do you think could be done to either understand the effect of individual physicians on health disparities, or to decrease this effect?
Physicians may certainly contribute to health care disparities through conscious and unconscious biases towards any patient encounter based on their own previous experiences and presumptuous assumptions/judgments.Although identifying these biases are often complex, a better understanding of one’s own natural tendencies with respect to greater appreciation for the wider diversity of the patient’s background and experiences will lead to improved and sensitive care for others.
An example in my field of interest is providers may think black communities may not want to participate in colorectal cancer (CRC) screening due to attitudes of “disgust” and therefore be less vigilant over patient recruitment and multistep completion. In turn, patients who feel that they are being perceived (prejudice) or treated differently (discrimination) due to race can be less likely to receive chronic disease screening (lower screening utilization), less likely to adhere to cancer screening guidelines/instructions, be like likely to attend future clinical visits, and more likely to put off future care recommendations by their physicians which further perpetuates health care disparities.
To explore racial disparities in CRC screening, an observational study with a questionnaire could be utilized where the providers a given a list of patients with standard demographics and ask who would they screen for CRC and who would they not. We would then compare the reasons across each patient groups to determine if there is differentiate provider screening preferences via logistical regression.
2) Structural issues within health care delivery are implicated in health care disparities. Please brainstorm 4 structural issues that might contribute to these disparities. Which of these are relevant to your particular area of research, and how?
Access to insurance: decrease in clinic visits [CRC is a multistep process hence cost component] for up to date CRC screening – earlier detection reduces risk of cancer mortality
Linguistic barriers: working with the health safety-net, CRC awareness may be reduced and CRC instructions may be difficult to comprehend and follow through the multistep process.
Geographic access: similar to access to insurance, decrease in clinic visits [logistics in transportation and time spent due to clinic care distance] for up to date CRC screening – earlier detection reduces risk of cancer mortality
Access to flexible resources: more resources (e.g. money, power) may allow some to be able to avoid disease and have a greater access to medicine and treatment, hence, be more up to date in their health outcomes including screening.
*As alluded to in my previous assignments, linguistic barriers may potentially posse the most relevant structural issue in CRC screening within the SF health safety-network. Although this is not the only structural issue, this conclusion was reach through community primary clinic providers and local patient advisory boards.