2.7.17 HW

2.7.17 HW

by Faby -

1) Structural issues within healthcare delivery: 

  • Many states in the south refused to expand Medicaid-- exacerbating already existing health disparities. 
  • Low numbers of minority physicians 
  • More patient-doctor time needed to overcome language barriers/proper use of interpretation services and ensure patients are receiving high quality of care regardless of language 
  • a lot of the information delivered to patients assumes a baseline health literacy and numeracy understanding- discharge instructions, medication schedules, risk/benefit conversations that rely on understanding probabilities and risk calculations 

For my project- which deals with preferences for decision-making around prenatal genetic testing, of particular relevance is having a more diverse physician workforce, issues around accommodating language needs and how to do a better job of counseling patients with low numeracy. For medical decisions that are values and preference sensitive I think it is important to have physicians that are language concordant and familiar with patient's culture. In cases where this is not possible, more time should be devoted to overcoming language barriers in order to adequately counsel patients and elicit preferences. 

2) Physician-level contributors to disparities: 

-as reading outline: beliefs about biological differences between black and white patients 

-refusing to use proper interpretation services for a variety of reasons: belief your spanish is "good enough", not enough time, can't find the interpreter phones, etc. 

-implicit bias 

Regarding my research topic for decision making around prenatal genetic testing, I would find it interesting to conduct interviews with physicians about their thoughts about this type of decisions and how they engage women- specifically women that may want more provider input and women with limited English proficiency. 

 

Re: 2.7.17 HW

by Christine Dehlendorf -

Thanks Faby - obviously this week is very relevant to your area of research! I absolutely agree that adequate time is crucial, and that not having this can lead to health care disparities, especially in an area as complex and nuanced as prenatal genetic screening. I like your idea of engaging with providers to use them to help identify solutions to the problem you have identified in your research around worse care for those with low numeracy. Most often providers want to do the right thing, but don't have the time to think about it and aren't aware of the numerous ways in which our systems reinforce unequal care. In terms of interpersonal influences, I would also add that  beliefs about not only biologic differences, but also assumptions about cultural differences could influence care in your area, and lead to health care disparities by not providing personalized care.