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?
Individual physicians contribute to health care disparities through both explicit and implicit bias. Implicit bias occurs without conscious awareness in medical decision making, which in turn perpetuates disparities in care. The article by Chapman introduces two methods to reduce implicit bias by physicians, including individuating and perspective-taking.
I think applying the methods employed in the COPD study regarding individuation would be important to understand implicit bias in interstitial lung disease, since making this diagnosis very heavily relies on individuated information such as exposures, pulmonary function testing, imaging studies, and pathology results. Sometimes, as a tertiary care center, we do not have all of this information at the initial visit, and I think implicit bias could be evaluated in a similar manner to the COPD study with and without some of this information present to the physician in order to determine if medical decision making differs.
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 structural issues within health care delivery are implicated in health care disparities:
1. Access to insurance, both through policy (who is eligible for Medicaid and Medicare) and employment
2. Access to specialty care in rural areas
3. Referral to specialty care
4. Access to formal interpreters for non-English speaking patients
Access to specialty care is a current focus of my research in interstitial lung disease. As a tertiary care center, patients often have to travel quite far to receive ILD specialty care. Further, research has shown that early referral for ILD care demonstrates improved outcomes, potentially leaving this group of patients who live in rural areas vulnerable to worse outcomes. Further, there is currently not a comprehensive model to deliver care to these areas (so that the patient does not need to travel), either through providing clinics in the area or through telehealth (though telehealth has been established in many other diseases).