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?
I think the Chapman et al. and Hoffman et al. articles did a good job of showing some great examples of how physicians contribute to health care disparities through both explicit and implicit bias. As a medical student, I trained alongside attendings and residents who did not think Latinx patients should get the same amount of pain meds as white patients. This meant that medical students who were on these services learned this behavior. No questions asked which continues to increase health disparities. One area that I am interested in is family planning and although there’s some great research that has been done I would like to see some research done on physician’s perceptions of young women (ages 13-24) who do not want birth control but prefer to use Emergency Contraception. I am interested in the stereotypes that this brings up as well as in the quality of care that these young women receive once their physician is aware of this information. I have heard many comments around this and it is likely due to implicit bias.
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?
The following 4 structural issues might contribute to disparities: 1) the very limited time that physicians have for a medical visit. These time constraints can reinforce stereotypes and thus health disparities. For example, there is a patient who is not taking her medications as prescribed and thus her diabetes is not controlled and the physician may just label her as non-compliant and think that the patient does not care about her health. When in reality, she may not be able to afford her medications and is too embarrassed to tell the physician or she simply does not understand how to take the medicine. 2) Lack of physicians of color. Research has shown that patients of color tend to feel more comfortable with physicians of color and as in the Chapman article, and thus there may be less implicit bias. But not only do patients of color benefit so do non-patients of color. If a white patient has a Black or Latinx doctor this may help disrupt their beliefs that people of color are criminals, lazy etc. 3) Universal health insurance. Having practiced in health systems where many patients do not have health insurance has limited their ability to take care of themselves since for many it is about choosing between paying for a doctor’s visit vs food. 4) Housing. I believe that many patients’ health can improve if they are housed in clean, safe and affordable places.