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 contribute to health care disparities silently in s variety of ways than we can imagine. For example, in my research regarding the barriers to colorectal cancer screenings for the older-aged South Asian population in the Bay Area, we conducted focus groups to better understand the issues this community faces when gettin screened. Our initial hypothesis for the low screening tool usage rates was the cultural stigma that this community might have against the practice of colonoscopies. However, our conversations with this community revealed that it was actually the language barriers that older aged, South Asian members from immigrant populations face when interacting with non-native language speaking physicians. These members were simply unaware of the screening options available to them because they could not understand their own physician. The lack of Hindi/Punjabi/Gujarati fluent speakers in the medical facilities available to these members in their area was a major contributor to the increasing barrier to CRC screenings. Another way that physicians contribute to healthcare disparities is by neglecting to holistically view a patient's lifestyle when assessing their health outcomes. For example, if a African-American male from a poor SES background comes to the hospital with severe hypertension, the physician may fail to ask deeper questions regarding his lifestyle and background, which are actually factors that contribute to the way he takes care of himself. Failing to consider these variables may negatively impact the treatment options and health assessments that the physician provides to the patient, which further creates disparities for a member of an at risk population.
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 healthcare: Access to CRC screenings and tools is largely contingent upon health insurance and a patient's coverage and financial ability to afford the cost associated with the tests. This is a structural issue because there are many people who continue to live without healthcare insurance, especially in areas without education or proper information on ways to navigate the complicated insurance industry.
Language Fluency: As I mentioned earlier, language barriers between patient and physician interactions greatly impact the way healthcare is delivered to individuals. If a patient is unable to communicate their medical history and lifestyle/understand the medical literacy and terms provided by the physician, this interaction can be more detrimental than effective. The foreign language barrier, layered with the language of medicine can post difficulties for patients. This barrier can be lifted by the ability of a physician to understand and communicate the medical language in a patient's fluent language.
Spatial/Geographic: Patients in rural areas without accessibility to advanced hospital resources or clinics may have difficulties in booking and traveling to appointments for colonoscopies and completing follow up engagements.
Access to health education: patients in vulnerable areas may not have access to outreach or health literacy programs in which community health workers or physicians engage with members to spread information regarding preventive healthcare techniques. For example, our community intervention was to connect South Asian UCSF physicians to South Asian community centers by holding outreach programs during the senior citizen programs at these recreation sites.