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?
As this week’s readings showed, implicit biases can cause physicians to subconsciously provide differential health care to their patients, resulting in poorer outcomes in minority and low SES patients. Perhaps what is most disquieting about implicit biases is that it exists in virtually every physician, no matter how well meaning they are. Chapman offers two main strategies to combat our implicit biases: using specific, individuated patient information and consciously envisioning the patient’s perspective. These strategies were shown in studies to decrease differential treatment, but are not yet part of standard training required by all healthcare professionals across America. In my area of interest, head and neck cancer, surgical resection is an important part of treatment. In a recent Cancer article, the authors found that non-Hispanic black patients were less likely than white patients to be offered surgery and to receive surgery. It would be interesting if using the strategies Chapman had outlined would help in reducing this disparity. Surgeons could be required to undergo racial biases training for several years after which treatment disparities could be re-assessed.
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?
1) Lack of diversity in physicians: In the paper mentioned above, the authors also found that non-Hispanic black patients were more likely to refuse a recommended surgery, a finding that has been consistent across multiple studies in other cancer types. Fears of exploitation by medical professionals are salient issues in the non-Hispanic black community, a fear founded on decades of targeted medical mistreatment/abuse. By increasing diversity in physicians, perhaps more trust can be built between this historically mistreated population and the medical community.
2) Lack of bias training: racial bias training is, not to my knowledge, a requirement in all medical centers. Implicit biases head and neck surgeons may be contributing to treatment disparities, which can be partly assuaged with training.
3) Transportation/access to care: head and neck surgeons are typically located at specialized medical centers. The distance increases inaccessibility for lower SES patients, perhaps resulting in more advanced disease at time of diagnosis and subsequent worse outcomes.
4) Low health literacy/numeracy: Increased refusal to surgery may be due to lower health literacy/numeracy. Surgery has been proven to confer survival benefit over chemo/radiotherapy. However, patients who are inadequately educated would be more likely to refuse surgery despite its proven benefits.