What are the potential Sources of Racial and Ethnic Disparities in Care in the clinical encounter?
Is it HEALTHCARE PROVIDER PREJUDICE OR BIAS?
come up with a in hospital clinical experience related to the questions above
Potential Sources of Racial and Ethnic Disparities in Clinical Encounters
There are several potential sources of racial and ethnic disparities that can arise in clinical encounters. Some of the key factors include:
Healthcare Provider Prejudice or Bias
One source of disparities is implicit or explicit bias, prejudice, or stereotyping on the part of healthcare providers (Hall et al., 2015). Providers may hold unconscious biases that lead them to spend less time, ask fewer questions, or prescribe different treatment to racial/ethnic minority patients compared to white patients. Providers’ personal attitudes and beliefs about different groups can negatively influence clinical decision-making and the quality of care provided.
Language barriers between providers and patients who do not speak the same primary language is another source of disparities (Jacobs, Chen, Karliner, Agger-Gupta, & Mutha, 2006). Patients who do not fluently speak the language used by their provider may have difficulty understanding diagnoses, treatment plans, or medical instructions. This can lead to worse health outcomes if patients do not fully comprehend their care. Even among patients and providers who speak the same language, cultural differences in communication styles can sometimes cause misunderstandings.
Differences in Patient Preferences
Racial and ethnic minority patients may sometimes receive different treatment than white patients not due to provider bias, but because of cultural differences in patient treatment preferences or health beliefs (Cooper et al., 2003). For example, some minority groups may be more or less likely to prefer certain medical procedures or treatments compared to the general population. When providers are unaware of these cultural differences, it can negatively influence the care provided if it does not align with a patient’s values or preferences.
Underlying social and economic inequalities between racial/ethnic groups are also a fundamental cause of healthcare disparities (Williams & Collins, 1995). Minority groups face higher rates of poverty and lack of health insurance that directly impact access to quality medical care. They may also experience more occupational or environmental hazards that take a toll on health. Even when insurance status and income are comparable, residual socioeconomic disparities persist in influencing health and access to care.
In summary, racial and ethnic disparities in healthcare can stem from a variety of factors at the provider, patient, and systemic levels. Addressing biases in clinical decision-making, improving communication across cultures, increasing awareness of cultural health beliefs, and reducing socioeconomic inequalities may all help to diminish disparities in care experiences and outcomes between minority and white patients.
In-Hospital Clinical Experience Related to Potential Sources of Disparities
During my clinical rotation in an emergency department, I observed an interaction between a provider and a Spanish-speaking Latino patient that seemed to stem from communication barriers. The patient spoke limited English and the provider did not speak Spanish. They were trying to communicate through a phone-based interpreter service, but there were long delays, technical difficulties, and it seemed like important aspects of the history and exam were getting lost in translation. As a result, the provider seemed frustrated and impatient with the patient. This likely compromised the quality of care received by the patient due simply to the language barrier, independent of any bias by the provider. The experience highlights the importance of having multilingual staff or in-person interpreters to avoid such communication-based disparities from occurring.
Jacobs, E. A., Chen, A. H., Karliner, L. S., Agger-Gupta, N., & Mutha, S. (2006). The need for more research on language barriers in health care: a proposed research agenda. The Milbank quarterly, 84(1), 111–133. https://doi.org/10.1111/j.1468-0009.2006.00440.x
Hall, W. J., Chapman, M. V., Lee, K. M., Merino, Y. M., Thomas, T. W., Payne, B. K., Eng, E., Day, S. H., & Coyne, C. (2015). Implicit Racial/Ethnic Bias Among Health Care Professionals and Its Influence on Health Care Outcomes: A Systematic Review. American journal of public health, 105(12), e60–e76. https://doi.org/10.2105/AJPH.2015.302903
Cooper, L. A., Beach, M. C., Johnson, R. L., & Inui, T. S. (2006). Delving below the surface. Understanding how race and ethnicity influence relationships in health care. Journal of general internal medicine, 21(Suppl 1), S21–S27. https://doi.org/10.1111/j.1525-1497.2006.00305.x
Williams, D. R., & Collins, C. (1995). US socioeconomic and racial differences in health: patterns and explanations. Annual review of sociology, 21, 349–386. https://doi.org/10.1146/annurev.so.21.080195.002025