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?
Based on the readings from the week, pre-existing beliefs regarding the relationship between perceived race/culture and patient adherence to medications or intervention protocols clearly underlies the bias and stereotyping of patients which therefore reinforce these mechanisms and disparities. The consequences from this cyclical dilemma are further compounded by physicians who do not take the appropriate measures to ensure that patients are fully informed and understand their options and available resources, either due to language barriers (or the failure to recruit an appropriate translator) or general sentiment that these patients won’t incorporate or integrate the provided information into their recovery methods.
Given that I conduct research in the field of complementary and alternative medicine (CAM), this phenomenon is particularly a topic of concern given that generally speaking, these types of interventions are not covered by health insurance and generally require significant out of pocket costs to the patients (with a few exceptions and health care organizations). Consequently, the patients who typically have access to CAM have the available resources necessary, therefore it would be my guess that individual physicians are less likely to even suggest the option or possibility for CAM interventions, further reinforcing the fact that CAM is only implemented and available to a limited number of patients. Unfortunately, CAM practices (yoga, meditation) are often techniques that can be practices at home or by oneself, therefore potentially benefiting those with limited resources the most. It would be interesting to conduct a study that evaluated patient statistics regarding who is and is not provided information regarding CAM options. This type of study would highlight the possible disparities that exist pertaining to access of information provided by individual physicians.
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?
Language barriers may be one of the most heavily influencing structural factors contributing to health disparities, as well as in the access to CAM treatments given that there are already a limited number of individuals trained in administering these types of programs (i.e. mindfulness based cognitive therapy). Thus, patients who do not speak English have heavily impeded resources and options when it comes to these types of interventions. A second structural issue would be the fact that CAM practices are not covered by most health insurance plans and therefore patients will often have to pay out of pocket. Geography most likely plays a significant role in access to these programs, given that they are limited in their scope. Patients most likely would need to travels longer distances then usual in order to access these programs and therefore may be discourage consequently. Education may also play a significantly role in the curiosity and openness of patients to CAM practices. Given that mediation, mindfulness, and yoga have roots in Buddhist practices, previous research has shown that some patients are less receptive to these practices as they are perceived as being in contradiction to their personal or religious beliefs, and cannot see their practical approaches and re-contextualized methods.