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?
The “Hidden Curriculum” article by Brooks really resonated with me and reminded me of many similar experiences where both explicit and implicit bias negatively impacted a patient’s care. As Brooks discusses at the end of the article, I think one of the ways that individual physicians contribute to health care disparities is through implicit bias. I first heard about this in college when we were asked to take the implicit association test (IAT), discussed in the Chapman article. As discussed, I think the race IAT was the most common one that other people had taken, though now have expanded to include many more tests on implicit bias, including weight, skin tone, age, gender-career, sexuality, and disability. Physicians use heuristics in clinical decision making, but in doing so, can perpetuate stereotypes and worsen health care disparities. As an internist and primary care doctor, I think about how to mitigate some of these health disparities. Overall, I think appointment times need to be longer for everyone, but especially for patients who have language discordance with their provider to account for the time needed for translation. I think we need to have a more diverse workforce to reflect the diverse patients that we serve. I think physicians need to take the time (and be given time) to understand a patients’ goals as well reasons for not agreeing to medications/interventions we suggest, rather than brushing patients off as non-adherent or combative without fully understanding their values. I think physicians need to be aware of the potential for implicit bias in their patient interactions, and be more mindful of the potential impact of implicit bias on their decisions and way they are treating and interacting with 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?
a) Language discordance with providers-Not having interpreters easily accessible or available for patients at their visits in order for physicians and patients to better communicate, can worsen disparities. So many times health care providers use family members, staff, or their own limited skills in that non-English language in order to communicate, which leads to worse care being provided to patients, who may not feel comfortable asking questions if they do not understand or are not able to communicate their questions or concerns.
b) Financial barriers-Having either no or less than ideal insurance may limit patients’ abilities to access healthcare in the first place. And then on top of that, doctors don’t talk to patients about the cost of every doctor’s visit, lab test, imaging, prescription medication. But many patients face decisions about spending on medications vs other essentials such as rent and food. Not addressing the impact of the cost of care can lead to worsening health disparities.
c) Educational materials that do not account for health literacy or language preference-The AMA recommends that educational materials be written at the 5th to 6th grade level; though many times, medical education, including consent forms are written at the high school or college level. If patients are unable to access information in their preferred language at a reading level they can comprehend, their care and health may be negatively impacted.
d) Access to clinic appointments-Many clinics (including mine) only have visits during the weekdays and only during business hours. For patients who have to work and aren’t able to take time off during a weekday, this limits their ability to see a doctor.