Please read required readings and write your responses and upload to the CLE by 1 pm on the day of class February 6th.
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?
For one, I think many healthcare providers see disparities as biological processes (ie "Latinos are predisposed to worse diabetes"), which often negates the social factors that contribute to disease. Even during medical school we are taught that many disease are biologically different in different races. We can see this by many physicians wanting to place "race" in the one-liner. Although here at UCSF many counsel against this idea, I know some attending physicians like "race" to be mentioned in every one-liner (except for when the patient is white of course...). I think this allows too many people to anchor on diagnoses that are strictly "racial" and not broaden our differentials.
One area of interest to me is STI disparities. Certainly, there are higher rates of HIV transmission as well as GC/CT transmission in people of color. What is interesting to me is that I believe providers often contribute to these disparities. Many counsel patients on behavioral factors such as condom usage when in fact they should be offering PrEP. The "irresponsive" condomless sex is much easier forgiven among white patients compared to patients of color. I really don't have any empiric data to support this but I have found this to be my experience anecdotally.
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?
Structural issues around the disparities of interest include lack of comprehensive insurance, physical structures and locations of clinics, language barriers, and explicit/implicit bias within healthcare providers. Although insurance coverage is expanding (or at least it was), this remains to be an issue for patients who meet criteria for PrEP initiation. Clinics are currently still in solid structures, which require patients to take time off of work to go to. This disproportionately affects patients who are more dependent on their income. Language barriers are a huge issue in sexual health. Many providers who are seemingly fluent in a second language still struggle to find the correct words when talking about sex and sexual health. Additionally, it is difficult for patients to discuss these intimate issues with a translator in the room because it's awkward. Lastly, there is a large amount of explicit/implicit bias within our healthcare providers who are overwhelmingly straight, in monogamous relationships, or have ideals of what a traditional relationship looks like.