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?
The Silent Curriculum article by Brooks concisely articulates many of the physician violences that contribute to health care disparities. Reading the article is an uncomfortable reminder of personal experiences from my training and practice.
I'm very interested in intrapartum care contribution to maternal morbidity and mortality. Traumatic birth experiences have been associated with poor maternal outcomes. The Fernandez article has me wondering if a similar study of parturient-birth worker language concordance would be associated with decreased birth trauma. As an obstetrician, I find communicating across language divides, especially in high acuity or emergent situations, extremely challenging. I see the way communication is foreshortened during these situations when an interpreter is required.
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?
As is true for other marginalized medical needs, transgender medicine has several structural issues. Notably, insurance coverage and payment for the healthcare needs of transgender people is limited, including routine care and care directly related to gender transition. Second, there is a lack of education in the care of transgender people. In a study I completed of graduate medical education requirements in 2016, requirements for training in the care of transgender people was mandated in 0 of 28 core ACGME medical specialties and 1 of 122 subspecialties. There is a lack of sex and gender identity data (SOGI) in most health datasets. Regarding SOGI data, the current president and secretary of health and human services have described the collection of this information as superfluous. The lack of this information limits ability to study the well-being and health needs of transgender and gender nonconforming people. Finally, transgender people are still made to meet normative gender roles informed by racism and heterosexism to access transition related care. Compulsory heterosexuality and state mandated sterilization are still required in several European Union countries for legal recognition of self-identified gender.
I am particularly interested in improving SOGI data in health data sets. I am currently involved in several projects using computational phenotypes to reliably identify trans/gnc people from health data that does not include SOGI data. This is a promising strategy for circumventing the systemic lack of these data.