Please read required readings and write your responses and upload to the CLE by 12 pm February 7.
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?
My involvement with research has been primarily in clinical outcomes after management of genitourinary cancers. There is ongoing work in identifying of issues which contribute to health disparities and challenging ‘historical’ beliefs which have formed the basis for notable differences in care. Each of the 4 areas are relevant to my research.
A) Implied and required minimum health literacy level, irrespective of language. In navigating the health system and obtaining care, much of the burden falls on the patient. Understanding your diagnosis, explaining what tests/exams are needed and working with physicians to decide the best treatment all require a minimal level of understanding of health and disease. How are patients expected to understand genetic modifiers of their risk of cancer recurrence if they don’t have a clear idea of what a gene is and what recurrence means for them? Even getting to see a specialist requires that they at least understand why they are being referred and the reason for the visit just to schedule the appointment.
B) Language barrier. Limited time and resources in the hospital setting limit access to trained healthcare interpreters. The easy, and often faster, option is to allow someone without specific training (child, sibling, student) provide translations without any way to measure accuracy.
C) Resource funding and allocation. Patients are often limited or stuck to specific institutions or health centers due to their geographic location or financial status. Even within our own system we may see drastic differences in care which are largely based upon what is available. Although there are avenues to get patients to other centers with more resources, the process is difficult and requires time, which is yet another resource that limited.
D) Accepted barriers to change. This includes not only the resistance of providers to change their workflow/mindset/treatment patterns, but also the large amount of paperwork/bureaucracy that hinders change and progress. This can be seen even from the patient care level in terms of changes in the ‘routine’ management of a patient to making changes in clinic or OR workflow. Each of these are met with so much resistance that many potentially beneficial changes are doomed before they start.
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 by not asking why. With the push for increased efficiency and improved patient satisfaction, the allocation of time and mental energy may be preferentially directed to those patients with the highest perceived returns. The patients that are assumed to be ‘lost causes’ may receive less time with providers, fewer options for treatment and a worse prognosis as a result of inferior care.
Internal investigation within each institution to identify potential differences in treatment patterns and their associations with clinical outcomes could be performed to assess the physician-related contribution to health care disparities. This could allow a basis for interventions such as protocolized recommendations which would be standard for all patients, education regarding evidence-based medicine and further discussion into what perceived obstacles prevent the administration of equivalent care for all patients, within guidelines or the standard of care. Collecting data at an individual-level could then provide additional evidence-based support for statewide and national level interventions.