1) 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 can contribute to health disparities in many ways. First, the bias (conscious or unconscious) produced by them believes, could affect the recommendations, information or treatment to the patients. For example, the misperception from the provider about the food of a Latino patient with diabetes could affect the recommendations given to that patient. Second, the "moral beliefs" of the health care provider related to who deserves the treatment and who doesn't, could also increase the disparities. One example on the reading was about a cardiac surgeon who told to one of the authors that "he was not going to treat patients who were just going to go out and do drugs." It suggests that the ethnicity or certain characteristic of the patient could influence the beliefs of the provider about the behaviors of the patient. In diabetes, the type of treatment (insulin vs. oral medication) could also be influenced by the provider believes regarding patient's characteristics; for example, that Latinos or African-American are less educated and therefore, they will be less likely to have adherence to insulin treatment. Another individual physician that can contribute to health care disparities, as Fernandez et al. nicely described, was the miscommunication because of the patient's lack of proficiency in English.
2) 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?
· Lack of diversity among the providers. Having providers from different ethnicities could help to have a better understanding, and prevent ethnic disparities
· Lack of education on health disparities among the trainees. Given that the bias can be unconscious, improve the training on medicine schools (such as having a REQUIRED course of health disparities) and in that way future providers will be aware of the health care disparities.
· Fragmentized health care system. The fact that patients can have the health care depending on their health insurance could explain the health disparities between institutions. I don't know much about the health system in the US, but my understanding is that it is possible that white non-Latino people have better health insurance and they can have access to hospitals with a high quality of health care, compared to those who don't have health insurance or have Medicare. In Mexico we also have a health system fragmentized and those who have a formal job have different health insurance (IMSS) than those who doesn't have a formal job (seguro popular). The quality of healthcare differs depending the institution, being on average better quality of healthcare in the IMSS compared to seguro popular.
· Language. Language barriers and education, as Fernandez et al concluded, is a factor that affects the health care disparities. Today I had an experience going for first time to a medical care outside of my country and speaking a different language. Even though I have been exposed to medical terms in English, I felt nervous, and it was difficult to clearly explain to the provider my symptoms. Fortunately, the provider was very patient, and the counseling was great. However, that made me think over about all those people without exposure to medical terms, and with lack of English proficiency, and I think that it could be almost impossible to have a good healthcare quality with this barriers for many reasons. First, because it is likely that the patient won't be able to explain the symptoms that he/she has to the provider. And second, because it would be almost impossible for the patient to understand the recommendations of the provider, and even more difficult if the provider talks with too many medical terms.