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?
- Concentration of academic medical centers in large urban cities which are inaccessible for those in rural areas or do not have the resources to travel to these medical centers to access advanced care that is not available in community hospitals.
- Majority of health clinic (e.g. MD offices, dentists) are available during regular business hours only (9am-5pm). Non-salaried persons, particularly in lower wage hourly jobs, may be unable to take time off from their jobs to attend to their health needs. Routine primary and preventative care has a direct effect on health. Only EDs and after-hour urgent cares are not sufficient to meet health care needs.
-Lack of multi-lingual staff to communicate with patients from all background and languages. Language lines are available but they’re not as good as health care providers that are able to speak a patient’s own language.
-The 15 minute clinic visit and lack of follow up care with people in their homes and their own environment. Education alone (especially from a pamphlet and a chat) isn’t enough, we need to understand the cultural, social, and environmental factors that are influencing health, individual to the patient.
The last one is the most relevant to my own research into advance care planning and end-of-life decision making. It’s a difficult topic with so many different influences that it is impossible to get to in short visits.
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?
-Clinicians are humans and humans have biases, there’s no way around it. I’ve been a nurse for almost 20 years and have worked with many physicians, they are far from perfect. My area of research is end-of-life care and death is a scary topic that still has a lot of stigma. Physicians are trained to treat and save, not many of them are well versed in discussing what to do when there is no cure. I’ve noticed that oncologists are not the best in discussing palliative and end of life issues, they’re primary goal is to treat cancer with chemotherapy. I would like to do a study with oncologists and their attitudes and comfort with palliative care and advance care planning. It would be interesting to see if oncologists who are better at having these discussions have more patients that opt to do less aggressive chemo and instead pursue more palliative care options.