Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

An internal dialogue on closing the gaps

Kamala Tamirisa, MD and Annabelle Santos Volgman, MD
Policy
September 25, 2020
Share
Tweet
Share

Black people are dying at disproportionate rates from the pandemic.  For decades, racial disparities in health care have resulted in poor outcomes even before COVID-19.

Individual risk factors for poor health are more pronounced in Black people and racial minorities. However, these individual risk factors may not account for all outcomes. There are also additional factors at the community level. Health care outcomes in Black children may be limited by socioeconomic status to segregated housing and schools with economic disadvantages since childhood. The racial disparity is evident in the affordability of health care as well as differences in insurance coverage. Racial minorities receive an unequal quality of care even after insurance status, risk factors, and affordability are controlled. Stereotyping, biases, and uncertainty from health care professionals contribute to this unequal treatment – for example, Blacks are less likely to receive stroke prevention treatment, cardiac transplantation, and counseling for life-saving defibrillator therapy.

Narrowing these gaps will need the engagement of clinicians on an individual level and system as a whole. Health care professionals and support systems are as much a part of the solution as a part of the problem. On the one hand, we strive for exceptional quality of health care for all. On the other hand, there are many factors that undermine our efforts, from our own implicit biases at an individual level, to lack of targeted initiatives at a system level.

Undo implicit biases

The health care professional’s implicit biases add another layer to these underlying individual and community disparities. Implicit biases are pervasive amongst all, including physicians, administrators, allied professionals, and nurses. These biases could be due to perceived differences in a person’s outfit, language, dialect, body habitus, name, or skin color. These assumptions may be innate or learned. Health care professionals are humans, and as humans, we need to admit that we are prone to often-unrecognized biases that result in exhibiting stereotypical behaviors that may actually worsen the problem that we want to tackle.

Taking self-assessment tests and soliciting feedback are initial key steps toward change.

Research and dialogue from bedside to the boardroom is the key to pointing out this elephant into the room. Social determinants of diseases are a hot topic for discussion, both at the international level with WHO, to regional levels with governors and other leaders. However, change does not happen with publishing data and collecting statistics alone. Programs similar to the diversity and inclusion classrooms should be an integral part of the curriculum for medical and other health care students and during bedside training. A persistent, purposeful, and repetitive intervention to undo biases on individual and organizational levels might take us one step forward.

Dissect “non-compliance” more often

Sometimes we label patients who do not follow our advice as “non-compliant,” but maybe we need to pause more often to wonder why. Dissecting the root cause of non-compliance may be the key – it is often synonymous with the lack of a multitude of factors such as affordability of medications, smartphones for telehealth, transportation, healthy diet, and literacy gaps leading to poor insight into health issues. These patients may be living in safe houses or shelters. They may be poverty-stricken. Or they may just be uncomfortable letting others know their plight. Some of these might perceive language and cultural barriers when seeking medical care. As health care professionals, we can make an effort to help our patients overcome these obstacles. Asking questions with the intention of understanding their situation and clinical presentation might take us one step towards our goal of health care equity.

Organizational targeted initiatives

As health care professionals, we do not work in silos independent of our support systems. Our introspection and education alone will not suffice in bringing forth the necessary change. At an institutional level, we need to set aside funds for transportation, access to telemedicine, free medications, integrated clinics, and community-based care for patients who have socioeconomic restraints. Although some organizations are helping with these efforts, it needs to be universal.  We should focus on prevention of disease rather than treatment alone. These funds can provide free or affordable exercise programs, weight loss facilities, dieticians, and mental health resources. These will mitigate the barriers to the conscious efforts to undo implicit biases.

Physicians or other health care professionals may not have the energy or time to see themselves as the problem in racial disparities. If we are to make a difference, addressing this issue will need all hands-on deck – physicians, nurses, allied professionals, policymakers, organizations, and administrators. As clinicians, we can change the way we practice by ensuring that we treat patients without biases and advocating for our patients at the levels of our medical organizations, state, and national legislatures.

Kamala Tamirisa and Annabelle Santos Volgman are cardiologists.

Image credit: Shutterstock.com

ADVERTISEMENT

Prev

Why this physician became a personal trainer

September 25, 2020 Kevin 0
…
Next

Done is better than perfect. The enemy of good is better.

September 25, 2020 Kevin 0
…

Tagged as: Public Health & Policy

Post navigation

< Previous Post
Why this physician became a personal trainer
Next Post >
Done is better than perfect. The enemy of good is better.

ADVERTISEMENT

Related Posts

  • Why the health care industry must prioritize health equity

    George T. Mathew, MD, MBA
  • Why this physician teaches health policy in medical school

    Kenneth Lin, MD
  • Health care workers need policy changes, not just applause

    Yuemei (Amy) Zhang, MD
  • Health care is not a service commodity

    Peter Spence, MD, MBA
  • The path to gender-affirming care is closing: We need to open it

    Anonymous
  • Democracy and the health of a nation 

    Audrey Shafer, MD

More in Policy

  • Bundled payments in Medicare: Will fixed pricing reshape surgery costs?

    AMA Committee on Economics and Quality in Medicine, Medical Student Section
  • Who gets to be well in America: Immigrant health is on the line

    Joshua Vasquez, MD
  • Online eye exams spark legal battle over health care access

    Joshua Windham, JD and Daryl James
  • The One Big Beautiful Bill and the fragile heart of rural health care

    Holland Haynie, MD
  • Why health care leaders fail at execution—and how to fix it

    Dave Cummings, RN
  • Healing the doctor-patient relationship by attacking administrative inefficiencies

    Allen Fredrickson
  • Most Popular

  • Past Week

    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Harassment and overreach are driving physicians to quit

      Olumuyiwa Bamgbade, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
    • Addressing menstrual health inequities in adolescents

      Callia Georgoulis | Conditions
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
  • Recent Posts

    • The shocking risk every smart student faces when applying to medical school

      Curtis G. Graham, MD | Physician
    • Clinical ghosts and why they haunt our exam rooms

      Kara Wada, MD | Conditions
    • High blood pressure’s hidden impact on kidney health in older adults

      Edmond Kubi Appiah, MPH | Conditions
    • Deep transcranial magnetic stimulation for depression [PODCAST]

      The Podcast by KevinMD | Podcast
    • How declining MMR vaccination rates put future generations at risk

      Ambika Sharma, Onyi Oligbo, and Katrina Green, MD | Conditions
    • The physician who turned burnout into a mission for change

      Jessie Mahoney, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Harassment and overreach are driving physicians to quit

      Olumuyiwa Bamgbade, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
    • Addressing menstrual health inequities in adolescents

      Callia Georgoulis | Conditions
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
  • Recent Posts

    • The shocking risk every smart student faces when applying to medical school

      Curtis G. Graham, MD | Physician
    • Clinical ghosts and why they haunt our exam rooms

      Kara Wada, MD | Conditions
    • High blood pressure’s hidden impact on kidney health in older adults

      Edmond Kubi Appiah, MPH | Conditions
    • Deep transcranial magnetic stimulation for depression [PODCAST]

      The Podcast by KevinMD | Podcast
    • How declining MMR vaccination rates put future generations at risk

      Ambika Sharma, Onyi Oligbo, and Katrina Green, MD | Conditions
    • The physician who turned burnout into a mission for change

      Jessie Mahoney, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...