“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
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.
References
Armstrong, K., et al. (2007). Racial/ethnic differences in physician distrust in the United States. American Journal of Public Health.
Freeman ,H.P., et al. (2011). The history and principles of patient navigation. Cancer.
Traylor, A.H., et al. (2010). The predictors of patient-physician race and ethnic concordance: a medical facility fixed-effects approach. Health Services Research.
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