All of the inelegant social aspects of high school also exist in healthcare: stigmas, stereotyping, bullying. When applied to entire subpopulations, they can result in inadequate care and disparities in care that are difficult to fix. In this sense, health care disparities are not simply explainable by access to care or health insurance.
There are larger, more pervasive variables that cannot be readily controlled by government planners. Issues such as geographic location (distance from a bus stop) or handicap access may form an invisible barrier to certain groups of people. Providing top-quality health care in a community that does not believe in modern medicine can be challenging. Opening a practice in a neighborhood with a particular ethnicity without people at the telephone who speak the language is doomed to failure. Inclusiveness in medicine is a many-faceted challenge.
According to a recent report, health care clinician bias, stereotyping, and clinical uncertainty is all factors that likely contribute to health care disparities.1 Some clinicians hold implicit biases as well as attitudes and beliefs about specific racial or ethnic groups that can negatively affect the delivery of health care. Studies about showing that clinicians treat and diagnose disorders in patients from minority groups differently and are less likely to include those patients in treatment decision-making.
This leads to a breakdown in the trust and communication relationship between clinician and patient, further distancing these patients from healthcare. Bias can affect clinical decisions directly and also can affect treatment through its effects on interpersonal communication.
Patient experiences with stigma are associated with less engagement with the healthcare team as well as poor clinical outcomes.2 However, how that stigmatization affects the actual relationship between patient and doctor is less clear. The impact is clear: patients who are somehow different from mainstream medicine (black, poor, LGBTQ, obese, too tall, too short, blind, or illiterate) are less likely to receive the same quantity and quality of care as their white counterparts.
A growing body of research suggests that experiences of stigma are associated with poor engagement in clinical care and adverse clinical outcomes. However, the effects of stigma and discrimination in health care settings on patient-clinician interactions are not well understood. A potentially fruitful avenue of research is to better understand the social and structural barriers that drive disparities within the health care system so that engagement in prevention, care, and treatment of illnesses in all individuals can be facilitated.
Architects of health care systems have their work cut out for them. Even the best hardware (buildings, handicap access, mass transit availability) can be undone by faulty software (people, attitudes, discrimination, even restrictive office hours). The battle against health care disparities will likely never end and cannot be won in court. It requires the diligence and awareness of a dedicated healthcare team.
1Wasserman J, Palmer RC, Gomez MM, Berzon R, Ibrahim SA, Ayanian JZ. Advancing health services research to eliminate health care disparities. American journal of public health. 2019 Jan;109(S1):S64-9.
2Nelson A. Unequal treatment: confronting racial and ethnic disparities in health care. Journal of the National Medical Association. 2002 Aug;94(8):666.