“There [are] a lot of positive changes that have happened.”
“Racial and ethnic minorities do have worse outcomes in acute and chronic conditions,” says Sanjai Sinha, MD, internist at Weill Cornell Medicine. “So what can I do? What can medical schools do? What can institutions do to make us a little bit more aware of what our patients want?”
Looking at what healthcare providers and facilities can do to reduce health disparities is crucial since structural barriers play such a big role. Most people want to take care of their health, even if they’re not attending appointments. If doctors can help chop away at some of those barriers, participation in health care will likely increase. Learn more about obstacles that cause disparities in health care here.
“Doctors That Look Like You”
Historically, Hispanic and African Americans typically report less trust in physicians and the healthcare system than white Americans do, according to a study by researchers at the University of Pennsylvania. This is also true of adults with lower income and no health insurance. Distrust in your physician can affect whether you seek out preventative care, attend follow-up appointments, or adhere to doctors’ recommendations.
However, many factors can increase or decrease trust levels. Studies have shown, for example, that racial and ethnic minorities are more likely to trust a doctor from the same race or ethnicity. In fact, a 2010 study of over 109,000 patients found that when patients could choose their own physician, they were more likely to select someone of their own race or ethnicity—especially when the patient spoke a language other than English.
“There's a lot of energy and resources put into diversifying our medical student population, our residency population, and our faculty,” says Dr. Sinha. A racially diverse medical community helps not only by giving patients “doctors who look like them,” but it may also improve the education of all medical students by exposing them to different viewpoints.
Patient navigation is a medical intervention to deliver timely diagnoses and treatments to vulnerable populations by breaking down structural barriers in health care. It was originally designed by the American Cancer Society when it was noticed that improvements in cancer care were lowering mortality rates—except among low-income and uninsured Americans.
Patient navigation models provide interventions across the healthcare continuum, including:
Outreach for prevention and early diagnoses, such as calling to inform someone that they are due for a mammogram or colon cancer screening
Providing free screening clinics to improve chances of early diagnosis
Providing transportation options for treatments, such as for dialysis, which may be done multiple times a week
Offering nonconventional appointment times, such as evenings and weekends
“Experiments like these are happening all over the country, where we have to be accountable for our patients,” says Dr. Sinha. He calls this trend a “more team-based approach” to helping all patients, rather than just each individual provider helping their own patients.
Building trust takes time, but patient navigation can bring fast results by helping to improve screening rates, catch diseases early, and reduce hospitalization rates. “There’s a lot of positive changes that have happened, even from when I started [as] a young attending physician in New York in 2001,” says Dr. Sinha.
Dr. Sinha specializes in internal medicine at Weill Cornell Medicine in New York.
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(soft piano music)
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We do have a big problem.
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You and other clinicians and healthcare systems
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are trying to address it.
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Where are we headed in the future
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to try and bridge the gap between healthcare disparities
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that exists today?
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(soft piano music)
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Racial and ethnic minorities do have worse outcomes
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in acute and chronic conditions, so what can I do?
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What can medical schools do?
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What can institutions do to make us a little bit more aware
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of what our patients want?
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Because at the end of the day, you can prescribe any medicine
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in the world or any treatment in the world.
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If the patient doesn't take it, it's a failure.
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There have been studies that have looked at the trust level
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between populations in poor neighborhoods and doctors
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that look like them, and will they trust them more to do
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a lot of these preventative tests,
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versus a doctor who doesn't look like them.
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There's a lot of energy and resources put into
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diversifying our medical student population,
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our residency population, and our faculty.
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We're trying to proactively look at all of our patients,
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and look at those that live in the poorest zip codes.
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They tend to be black and Hispanic in New York City,
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and reach out to them ahead of time to say,
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"Hey, you know, we've got information that you haven't
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had a mammogram yet."
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It's called patient navigation,
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and experiments like these are happening all over the country,
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where we have to be accountable for our patients.
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So if we reach out to them,
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we may have to call them multiple times,
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can we arrange transportation, and then we may have to offer them
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a mammogram on the weekend, or at night.
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A lot of these things are coming into place,
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and when we show the powers that be that,
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"Hey, we're actually improving screening rates for breast cancer,"
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or "Hey, their diabetes control or their high blood pressure control
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is going down," or most importantly,
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"Look, they're not getting hospitalized as much."
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"They're not going to the emergency room as much."
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So there's a lot of positive changes that have happened,
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even from when I started,
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when I started as a young attending physician in New York in 2001.
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A lot more team-based approach to taking care of patients,
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and a lot less, just, me individually.
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Armstrong K, Ravenell KL, McMurphy S, Putt M. Racial/ethnic differences in physician distrust in the United States. Am J Public Health. 2007 July;97(7):1283-9.
Freeman HP, Rodriguez RL. The history and principles of patient navigation. Cancer. 2011 Aug;117(15 0):3539-42.
Traylor AH, Schmittdiel JA, Uratsu CS, Mangione CM, Subramanian U. The predictors of patient-physician race and ethnic concordance: a medical facility fixed-effects approach. Health Serv Res. 2010 Jun;45(3):792-805.