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?
Chapman and Brooks candidly encompass how individual physicians contribute to health care disparities. Through implicit and explicit bias, physicians unconsciously alter patient-relationships and engage in disparate treatment decisions that exacerbates unequal treatment. Bias stems from early childhood and reinforced through repeated exposures/portrayals of stereotypes, and poorly informed curriculums during medical training. I am interested in assessing procedural discrepancies among certain ethnic groups, specifically among sufferers of uterine fibroids. Past literature stated that African American women tended to undergo hysterectomies more readily than White women. It would be beneficial to dig deeper into the behavioral processes involved in decision making in regards to this topic (to uncover potential biases). If possible, it would be interesting to conduct a study in which medical students are randomized to a culturally sensitive curriculum regarding care at the start of their training, and analyzing the long term impacts it would have on their ability to hold implicit biases towards their 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?
When I think about structural issues within health care delivery, these four stand out:
-Competitive market in health care services
Within the past couple of decades, health care has arguably transformed itself into an economic entity centered around technology and pharmaceutically-driven treatment. Those who are uneducated or unable to access health care centers with modern resources, miss out on potential treatment options that shorten their burden of disease. The close ties between insurance companies and providers may also play a role in swaying treatment decisions rooted in financial motives, affecting those who are unware of their options.
-Health policy
Health policy is probably the most visible (but also invisible) structural determinant of health care disparities. Some policy is outdated, and may not be culturally sensitive to the needs of specific marginalized groups. Policy is also the foundation by which health resources (i.e. health insurance) are readily available and financed. If congressional representatives do not take into consideration the lived experiences of these people, they may fall through the cracks of a system that is not built to help them.
-Provider linguistic and cultural competency
As diversity among the medical profession slowly improves, there is still a long journey ahead in properly training physicians to interact with patients from different SES and cultural backgrounds.
-Provider availability
There are often limited appointment times a day given the time of year, on-call staff, amount of individuals suffering from chronic conditions. This may disproportionately affect communities that live in poor-resourced hospitals, or rural areas.