Thanks all for your responses to the session on Week 5 about health care disparities! You all did a great job of engaging with the uncomfortable reality of our health care system.
I encourage you to read Chi Chu’s and Tina Vu’s posts. Chi used the lens of dialysis (with a focus on in-home vs. in-center dialysis), and Tina Vu applied the concepts to intensive care in a nuanced way. I encourage you to read both of their posts!
One issue that came up in a few posts was how important it is to make the connection between structural issues and provider-level issues. Hunter Holt made the great point that a lot of health care disparities are related to a “lack of time to truly approach a patient with equality”, and went on to say that “When you have to see patients that are language discordant, not familiar with the US health care system, face many more social determinants of health, providers do not have the time to properly deal with these multitude of problems, so I believe devoting more time, and giving more resources could decrease these disparities. How to approach this from a research perspective would be difficult, but I think you could look at the health disparities present before these interventions and study them after several years after the intervention has been in place, so for instance, average a1c’s before and after, average SBP before and after, smoking prevalence etc.”
Carol Tran further made a great point of the role of evidence based algorithms to guide care as a strategy to minimize the impact of implicit bias.
Chris Albach expressed an important perspective around the need to focus on accountability to decrease and address bias – explicit or implicit – rather than focusing only on documenting on it. From the post: “I have a hard time justifying increased research in this area, when we already have substantial knowledge that this is a dangerous and pervasive problem, with easy and straightforward solutions. In my long and frustrating time navigating the reporting process, I have found most administrators extremely hesitant to confront and prevent this behavior in any meaningful way. I have discovered that most physicians will go to great lengths to protect other physicians, at the cost of patient care, and that this toxic loyalty prevents any substantive change in decreasing or eliminating physicians exerting discriminating control over their patient's bodies.”
There were many great points about structural barriers. One that wasn’t highlighted was the distribution of high quality systems/providers, which I know we talked about a bit in class and wanted to make sure you didn’t forget.
Overall the following were mentioned (with attribution of less commonly mentioned factors to specific individuals):
- Diversity in health care providers
- Lack of access to child care/willingness to allow children during visits (Stephanie Frazin)
- Lack of transportation
- Challenges in navigating bureaucratic systems
- Geographic distribution of health care systems
- Appointment/clinic times and opening hours
- Short visits
- Lack of connections with social services, including poor availability of wrap around services for those without resources (Jack Taylor)
- Lack of accountability with payment structures/performance improvement to incentivize high quality care (Chi Chu)
- Lack of anti-bias training (Michelle Lee)
- Inaccessible educational resources
- Lack of continuity of care/frequent care transfers, causing increased disorganized care, creating increased risk for bias to impact care and difficulty for patients to navigate care (Safyer Mckenzie-Sampson)
- Health care policy (this can show up by impacting structures in diverse ways, many of which are listed above)
Thanks all!