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?
-Language discordance between patients and providers – even with translating services, which are often not utilized as much as they should be, it is harder for patients to receive optimal healthcare when they do not speak the same language as their provider
-Racial discordance between patient and provider – implicit bias effects all healthcare providers and can be most extreme and is most common when the provider is white (racially mainstream) and the patient is a minority, though minority providers can also demonstrate significant implicit bias as well. The racial make up of American providers does not reflect our patients, and the curriculum of medical training is determined largely in part by white medical doctors from the early 20th century and is still set by the largely white group of doctors in charge of medical institutions.
-SES discordance between patient and provider – once again implicit bias effects all healthcare providers and most providers come from higher SES backgrounds given the expense of medical training and the resources required to be a “competitive” applicant. The SES make up of American providers does not reflect our patients.
-Clinic hours – clinic hours tend to be during the day which is an impediment to those who unable to take time off work to go a healthcare appointment. Patients most affected by this tend to be lower SES which exacerbates disparities.
I think that racial and SES discordance between patients and providers are most relevant to my area of research as those effected by violence in the Oakland were more likely to be a minority and more likely to be homelessness.
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?
Individual physicians contribute to health care disparities through implicit (and sometimes explicit) bias, which affects their work (and thus patients) in a variety of ways. Medication prescribing patterns, diagnostic lab sending rates, referral rates, and diagnosing patterns are all affected by bias, as well as general demeanor, health beliefs, empathy, and advocacy. I think it would be interesting to have monthly reports sent out to ED physicians about their differences in prescription patterns, cath lab and stroke lab activation by patient age, sex and racial groups and how they compared to the larger physician group, similar to how quality metrics are sent out. This may help ED physicians examine their own and their group biases.