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?
One important way individual physicians contribute to health care disparities in trauma patients is by being unaware of the severity of the structural societal disadvantages that affect many of our patients. For many physicians, their innate advantages (English fluency, healthcare literacy, flexible resources and health insurance) mean that it would be possible- although still challenging- to manage the sequelae of a traumatic injury. As a result, physicians do not always consider how difficult it can be to manage an open wound while homeless, or to leave the hospital with a drain and be unable to speak in one’s native language with a provider in the event of complications. It would be interesting to do a cohort study investigating rates of hospital re-admission and complications between patients with and without structural societal disadvantages. This could be followed up with an in-depth investigation of the causative factors in each case to identify and intervene on the points of vulnerability within our system where patients are most likely to fall through the cracks. The results of this study would increase awareness among individual physicians of the challenges faced by many of our patients.
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?
Health Insurance: My area of interest is in traffic injuries, and in particular the risk factors for pedestrian traffic injuries in vulnerable urban populations and the disparities in their outcomes compared to less vulnerable populations. Following trauma, there is often significant outpatient care that spans months to years and is essential to regaining function. Patients who are underinsured or uninsured are less likely to be able to obtain support services such as physical therapy, speech/cognitive therapy, and wound care. This can result in vulnerable patients being unable to return to their prior level of function, which can severely impact their ability to return to school, livelihoods, and prior living situations.
Language: Navigating the American healthcare system is complex for patients who speak English. For those who don’t, it is substantially more difficult to communicate with providers during the hospitalization and after discharge home. Trauma patients are often discharged with ongoing wound care and drain needs. Managing these is challenging, and particularly so when there is no guarantee of a healthcare provider they can contact with questions who speaks the patient’s language. During the hospitalization, patients who don’t speak English are at a disadvantage due to their inability to communicate fully with the providers and staff managing their care. This may inadvertently worsen disparities between the care received by those who speak English and those who don’t.
Access to flexible resources: Patients with more resources will be less affected after a trauma because they are better able to redirect assets towards managing the sequelae of an injury. For example, patients with savings accounts and a job that provides paid sick leave will experience less financial strain than those who do not have these resources in place. Patients without sick leave will in many cases return to work before they have truly recovered in order to avoid loss of livelihood
Geographic barriers: As I’ve mentioned above, recovery post-injury requires the involvement of specially trained therapists in both the physical and cognitive domains. Patients living in rural or isolated areas are less likely to be able to access these types of therapy.