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 care disparities by perpetuating societal stereotypes, making assumptions about patients based on their race/gender/sexuality, and by passing on these behaviors to trainees in the educational setting. An interesting point brought up by the Van Ryn articles is that providers’ attitudes and actions will influence patients’ views of themselves and their relationship with the world, including their “fundamental value, self-reliance, competence, and deservingness”. In the field of lymphoma treatment, it would be interesting to investigate how providers’ biases influence patient recruitment to clinical trials based on race/ethnicity.
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?
1. Language barriers. While there are increasingly more resources available for interpretation in common languages in San Francisco (Spanish, Cantonese, Mandarin), in many parts of the country these services are sparse or inaccessible. Even in well-resourced hospitals I have seen providers carry out conversations in English while the patient responds in Spanish instead of waiting for a Spanish interpreter. In cancer care, communication is vital especially with intense and complicated treatment plans. Additionally providers need to have a comprehensive understanding of the patients’ values and desires for treatment and quality of life, which requires a high level of trust and nuance in conversation.
2. Transportation. Coordinating appointments can be very challenging for patients, especially in outpatient care at an institution with multiple campuses like UCSF. Cancer treatment requires complex treatment plans that may involve many specialists as well as facilities such as imaging centers, infusion centers, outpatient labs, and physical therapy. Thus patients without reliable transportation will have inferior care.
3. Internet access. As the electronic medical record becomes more and more integrated into providers’ routines, a patient without Internet access will have increasing trouble making appointments and contacting providers. For example, now most communication between patients and providers occurs on MyChart. This is especially relevant in cancer care because patients will have many appointments and questions about their treatment plan. Also access to the Internet allows patients to have the information to advocate for themselves when interfacing with the health system and their providers.
4. Geographic barriers. Often patients travel far distances to access lymphoma specialists at UCSF. However, if they fall ill acutely they may live too far away to come to UCSF or UCSF-affiliated hospitals. While theoretically any hospital should be able to provide patients will excellent care, patients who go to an outside hospital run into issues if providers cannot see their full medical history and access specialists’ recommendations due to incompatibility between EMRs. Thus patients with complex medical histories may receive inferior care due to geographic barriers.