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?
Physicians contribute to health care disparities through unconscious (and conscious) biases that influence their clinical decision-making (including diagnosis, treatment, referral, and discharge planning) as well as communication with patients, family members, and other healthcare providers. I conduct research in the field of dermatology, in which the core textbooks are filled with images of rashes on white skin (with the exception of STDs which are shown on black skin, as Brooks mentions in the opinion piece). In consequence, trainees are not taught about the different appearances and morphologies of rashes on non-white skin, which may lead to significant disparities in diagnosis and treatment. Members of my research group are currently conducting a study to describe the prevalence of white and non-white images in the main dermatology textbook and the American Academy of Dermatology online training modules to raise awareness about this problem.
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?
In my area of research (pediatric dermatology), language barriers/literacy, insurance coverage for specialty care, prescription coverage, and geographic barriers are among some of the structural issues that influence health care disparities. Language barriers and literacy are particularly important because most of the treatments for pediatric skin diseases include time-consuming, complicated topical regimens. These are difficult for English-speaking parents to understanding, and are even more challenging to understand for families who have low English proficiency. In addition, the nature of pediatric dermatology clinics is that appointments are very short and fast paced, which unfortunately limits the use of interpreters. In addition, insurance coverage significantly limits patients’ ability to get referrals to specialty clinics such as pediatric dermatology clinics, and the clinics that do accept public insurance can have up to 3-6 months of wait times. Geographic barriers also limit the ability of patients to visit specialty clinics, especially if patients/families live in more rural areas and may have to take entire days off work just to bring their child to a clinic visit. Lastly, prescription coverage by insurances also limits which topical treatments patients can receive, and some of the newer, more expensive topical treatments are not covered or have a much larger, often unaffordable, co-payment.