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?
This week’s reading highlighted the perils of physician bias, which manifests in explicit and implicit forms and directly impacts the care of patients. The explicit forms (like language barriers) may be logistically challenging to address but are more identifiable, while the implicit forms are both logistically challenging and, at times, difficult to both identify and modify. I was struck by the statistic from the Chapman paper that indicated pro-white bias is formed by the age of 3 throughout the world, and I think this underscores the severity of the challenge in addressing implicit racial bias, as this unconscious belief system is solidified before most of us even have conscious memories. Ultimately, individual physicians working in small teams drive the care of patients, so reversing these deep-rooted biases is essential for every single individual physician.
In transplantation, the decision to waitlist a potential candidate is both highly subjective, and at times, can impact whether patients live or die. Transplant centers typically have “selection committees” who review potential candidates during weekly meetings and review indications, contraindications, medical histories, and social histories. Anecdotally, the outcomes of these meetings can be disparate depending on the surgeons and transplant medicine physicians who are in attendance. Usually the thought is that some physicians are more aggressive than others, but it would be interesting to see if the outcome would be different if the selection committee was blinded to factors such as gender or race.
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?
- Density of healthcare facilities (urban vs. rural communities)
- Healthcare literacy as related to occupations, education, and community
- Access to primary care/preventatitve medicine
- Language barriers
My research focuses on access to transplantation. This is specifically impacted by the location of transplant centers (almost exclusively in urban locations with some outreach satellite locations), healthcare literacy, and access to primary care/preventative medicine. All of these factors limit accessibility to resource-limited communities, and healthcare literacy and primary care access are related to early referrals for evaluation for transplant.