1) 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?
i) Physician / patient gender discordance for invasive and potentially embarrassing procedures, like a female patient undergoing a gynecologic exam or colonoscopy with a male physician
ii) Patient information materials created in English for a White audience. Even when the materials are translated into other languages, they are rarely “trans-created”.
iii) Lack of translators or having to use family members as translators may limit discussions of treatment options or discourage patients from questioning their doctor’s decisions.
iv) Refusal of many physicians and clinics to accept new patients who do not have private insurance.
àLink to my research: I study colorectal cancer screening, where there are clear differences in access to and uptake of colonoscopy screening, and these differences are best studied between African Americans and Whites. Differences in screening rates are thought to contribute to higher cancer mortality for African Americans in every age group. Because colorectal cancer screening is mostly opportunistic (proposed by physicians when they have time), I think that language and cultural barriers, as well as assumptions about how people prioritize their health, likely play an important role. Often patients without insurance worry about downstream costs of discovering a cancer through screening, or the repercussions of missing work or arranging transportation for a colonoscopy.
2) 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?
As mentioned, physicians can contribute to health care disparities in primary care by not proposing preventive care to certain patients. For example, with colorectal cancer screening they may assume that certain patients have more ‘important’ things to worry about and so shouldn’t / or wouldn’t want to undergo colonoscopy. Physicians may not want to take the time necessary to explain why screening is beneficial or reassure people from minorities that screening is safe and not very painful or embarrassing. They may assume that someone who smokes or is obese wouldn’t want screening tests or to discuss weight loss, even though these same people are at higher risk for colorectal.
One way to study these differences would be to video tape primary care physicians performing health maintenance ‘check-ups’ with patients of different races and study what prevention tests are proposed, how they’re explained and how patients react. However this approach would be very expensive. Another would be to mail questionnaires to both White and minority patients to ask whether their doctors have previously discussed screening or cancer prevention with them. However, there could be significant bias in who responds to such a survey.