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, like all of us, have implicit (and perhaps explicit) biases, most often with respect to race, gender, age, and weight. This may be exacerbated by the fact that medical training emphasizes group-level information, although there is hope that this may be attenuated as personalized medicine gains momentum. These biases have a direct and lasting effect on the patient-physician relationship, eroding the little, if any, trust that may have been there to begin with. As a result, patient-centered communication and shared decision-making both suffer. The biases (particularly implicit biases) also have a direct impact on the treatments given or offered to patients, including therapies, pain management, and referrals to specialists. All of the above factors are only a few examples of how physicians contribute to heath care disparities, result in poorer health outcomes for the most disadvantaged patients.
Targeted research into implicit biases in the healthcare environment is needed firstly to increase awareness. This should also include research focusing healthcare disparities affecting lesser studied minorities such as Latinos, Asians, Native-Americans, and others, the role of SES biases, and research into factors contributing to lack of physician diversity.
This is particularly important in the field of mental health, where the patient-physician relationship is of the utmost importance, and lack of trust in the physician will prevent those needing mental health care from even seeking it in the first place. Moreover, the biases faced by individuals over their lifetime will continue to fuel and exacerbate (or create) any mental health struggles, so awareness of these biases can be a crucial tool in understanding the patient’s needs and forging the road to recovery.
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?
The first structural issue is the one at the root of the problem of lack of physician diversity, that is lack of diversity in medical school education, with regards to both the students and the professors. Not only must diversity be increased, but it must be followed by a change in medical education. This includes increasing awareness of implicit bias through tools like implicit association tests incorporated in the curriculum, emphasizing reliance on empathy and individuation of the patient, and on shared patient-physician decision-making. The role of the physician is not only to provide the best healthcare to the patient, but also to help the patient be his/her best advocate, increasing patient health literacy and numeracy in the process.
This brings us to in-hospital services. Increasing health literacy in disadvantaged patients also means providing the resources to allow this. Decreasing language barriers must be at the forefront of these efforts as it is an independent risk factor for healthcare disparities. For example, informational resources provided in hospitals must be in a variety of languages and adapted to the literacy level of the patient population it serves. Similarly, interpreters must be present and easily accessible in the language that the patient feels the most comfortable speaking.
Along the same lines we must also emphasize the importance of social services in healthcare. This can be done at the medical education level, at the hospital level by increasing support for social services/social workers and collecting social information in HER This is part of more comprehensive health care, and is particularly relevant to mental health. As mentioned previously social factors can create, exacerbate, or trigger mental health challenges, but access to social services is a major barrier to obtaining mental health support.
Finally, efforts must be made to redistribute resources to hospitals disproportionately treating non-White and disadvantaged patients, or the above interventions will not be possible.