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?
Individual physicians, like all humans, are influenced by implicit and explicit bias. These biases may directly or indirectly alter they way a physician counsels, treats, or otherwise interacts with a patient. Many articles have been written re racial disparities in patient outcome or parent perception of care in the NICU. Perceived parent education level or SES may directly impact what interventions are offered to a family with a chronically ill infant (ie g tube, trach). A physician’s perception of a family’s SES may also bias the way the physician frames periviability counseling. Unit based teaching re bias for all care providers may be one way to start to address bias in neonatal care.
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 transportation- many families in Malawi rely on public transportation for travel including travel with a sick child. Limited funds may make it difficult to promptly bring a child to care, even when acutely ill, or may require the caregiver to travel long distances on foot with the sick child to get access to safe, public transport.
Distance to hospital/clinical services- as discussed in a previous post, mortality increases from cerebral malaria as distance to hospital/clinical resources increases. Public hospitals tend to be located in larger towns/cities, making travel difficult for families from more rural parts of the community.
Hospital resources: access to basic resources (IV fluids, basic lab services, antibiotics, etc) may be limited and commonly medications may be temporarily unavailable. Many, newer medications are never available (ie anti epileptics like Keppra for children with persistent seizures post phenobarbital and phenytoin).
Access to private insurance: individuals have access to the public hospital in Malawi, which often have limited resources, a higher patient to nursing ratio, and longer wait triage wait times. Individuals with a higher SES often opt to purchase private insurance which allows them and their families increased access to health resources including private hospitals which typically have newer equipment, more access to medication/supplies, and more staff.