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?
This is an interesting question and one that probably affects every patient in one way or another. A statement from previous homework posted to the forum that was very eye opening to me is that clinicians tend to be very good at identifying poor health literacy and the health disparities that result from this, but it is much less frequent that we do much about it. Time spent with families during a clinic appointments or family meeting is limited and many focus on the issue at hand instead of delving deeper to the underlying circumstances. Doing so would allow better education and at least a chance to improve the health literacy of the individual or family. I don’t think is done intentionally, and is most likely due to systems issues (shorter time with each patient = more patients per day = more patients “treated” and more money to the big man). But today’s clinicians are tomorrow’s teachers and if such disparities aren’t identified and addressed, we don’t teach others to do that either.
I work in pediatrics and I find this to be a constant struggle. There is so much guidance and support to give but we often only scratch the surface and don’t get a chance to identify the specific needs of each family. It would be interesting to compare patient satisfaction, follow up frequency and care compliance between two clinics with similar patient populations, but one has no time constraints and the other with typical clinic visit time constraints.
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?
My area of interest is pediatric critical care. These are the first 4 structural issues that come to mind for me:
- Language barriers: it’s very easy to pop into the room of a patient whose family speaks English to give them frequent updates and care. This is less so with families who do not speak English. The process of getting an interpreter to the bedside makes it more challenging to give frequent updates. As such , these individuals receive less communication and patient-doctor relationships are less likely to form.
- Community resources: Many children I care for are technology dependent and sometimes require 24 hour care. Availability of these services is limited in many areas (particularly rural areas) and therefore, the quality of care and quality of life of these patients and their families are affected by regional differences in resource allocation.
- Insurance coverage of medications and devices
- Parental financial situation and employment status: families of low income often have jobs with limited benefits. There is often fear of losing the job if they miss work. Therefore, these families are often less frequently available to be at bedside of their sick children, and less available for appropriate communication and education.