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 can contribute to health care disparities through so many avenues, this question really makes me stop and realize just how narrow the tightrope is between providing equal care to all patients and allowing for health care that causes health care disparities. There are so many numerous ways, the “A Silent Curriculum” reading really displayed some gross examples of biases and behaviors that contribute to health disparities. Using language barrier to allow students in, to perform procedures to the more malignant and maligned racism seen in the ED examples, these actions all continue to set distance between the patient and the healthcare system, forming barriers between patients and access to equal and excellent care, thus creating disparities. As a primary care physician, I think about how we can work to decrease this effect would be to decrease the amounts of patients seen each day, allowing for longer appointments, and increase the access to in person interpreters. (Obviously this decreases amount of patients that can be seen, so much physicians or providers are also needed). I believe these things would potentially decrease this effect because I hypothesize that a lot of these disparities are created from lack of time to truly approach a patient with equality. When you have to see patients that are language discordant, not familiar with the US health care system, face many more social determinants of health, providers do not have the time to properly deal with these multitude of problems, so I believe devoting more time, and giving more resources could decrease these disparities. How to approach this from a research perspective would be difficult, but I think you could look at the health disparities present before these interventions and study them after several years after the intervention has been in place, so for instance, average a1c’s before and after, average SBP before and after, smoking prevalence etc.
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?
I think 4 structural issues that might contribute to health disparities in healthcare are as follows:
1. Clinic Times: Clinics are often only open 9-5pm, with very limited evening hours and/or weekend availability.
a. I think this might contribute to health care disparities as patients with the most need and the lowest SES are often working multiple jobs and it is very difficult to make it to appointments
2. Available appointments:
a. I think another thing that cause a lot of issues is follow up. 15 minutes often is not enough to address all of patient’s complaints, especially one that tries to go to the doctor as few times as possible to save time and money. Thus, patients are often told to follow up because it is just not physically possible for the physician to handle all of the problems, follow up sometimes may not be able to happen for months due to the availability of the provider and thus they might not even show up
3. Health Care Billing
a. Lowest SES classes often have the poorest insurance plans. With large deductibles, effectively making health insurance catastrophe insurance. Patients avoid going to the doctor because they can’t afford the co-pay or they do not want to get the bill because their deductible is too large.
4. Language discordance
a. Our clinics are based around English. We are working to change this, but there is very little Spanish, Chinese, etc available in our clinical settings to help patients who are not native English Speakers. Furthermore, the availability of inpatient interpreters is dismal, and often the phone line interpreters are overwhelmed with long wait times to use certain languages. These can all lead to poorer care and health disparities.