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?
Discrimination and unconscious biases both contribute to health care disparities. Physicians in pediatrics and adolescent medicine specialties may underdiagnose eating disorders in individuals with lower SES, racial/ethnic minorities, and those with overweight/obesity, due to the misperception that these individuals are less likely to experience eating disorders (as well as the misperception that eating disorders do not affect males, resulting in a potential health difference). Having physicians review a set of written cases manipulating each of these variables could be presented to physicians to determine the likelihood of additional screening, diagnosis, referral, etc. Having them talk through their thinking process may help to elucidate some of the thinking errors and biases resulting in underdiagnosis.
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?
Mental health policy. Mental health policy is a significant structural determinant of health care disparities, given that policy impacts how care is delivered and certain socioeconomic groups or racial/ethnic groups are more likely to be negatively affected by certain policies. For example, the amount of initiative, planning, and organization that it takes to make an appointment in the public mental health system and the delays in accessing treatment due to the way patients are prioritized will affect some patients more than others. Given the specialized, coordinated approach required for appropriate eating disorders treatment, having policies that support and facilitate medical and mental health coordination may help to diminish health disparities, but they do not exist at present.
Appointment scheduling waits. Wait times to be able to speak to someone for a primary care visit are often extremely long, which may disproportionately disadvantage low SES groups because their jobs would not allow them to be on hold for 1 hour+, whereas those with higher SES may have more flexibility and privacy to be able to afford to be on hold for this amount of time. Due to difficulties with scheduling, patients within these families may be more likely to require ED hospitalization due to lack of adequate outpatient management.
Language Barriers. Further, making an initial appointment when a scheduler/receptionist does not speak one’s language is time-consuming and difficult, and may result in miscommunications. Once at a clinic visit, technically patients have the right to receive care in their own language, but the reality is far from this ideal. Coming back to policy, there is not appropriate compensation for visits with interpreters (given that these take much longer), which can lead to poor (rushed) care or increased provider burnout, which will in turn lead to poor care as well.
Treatment requirements. Parents with full-time jobs in lower SES groups may not have the same flexibility that higher SES families have with respect to benefits to leave FMLA or other time off to care for their ill child, and additional work is missed due to inconvenient appointment times. Eating disorders also require a full family approach, which is not often possible. However, the structure of the treatment provided was created for higher SES groups with more flexibility, and the system would need to provide additional support for lower resourced families in order to make treatment feasible.