It’s ridiculous to think we can separate socioeconomic issues from health issues. People don’t even walk in the door if they don’t think they can afford the care. —Stacey Ishman, MD
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November 2020
Dr. Johnson also said bias can cut both ways in terms of assuming families with private insurance will process complex information more easily or will better understand the need for follow-up care. “There are strategies around standardizing care and using more evidence-based, standardized protocols in terms of reducing that variation we see,” Dr. Boss said. “There probably is a lack of community-based participatory research, at least in pediatric otolaryngology. We have to really get out and say, ‘What do you need, and how can we connect with your community?’”
Prior Knowledge of Socioeconomic Status
Experts differed in their approaches to understanding patients’ socioeconomic status. All agreed patient care shouldn’t be based on insurance type or ability to pay. Dr. Ramadan pointed to a 2018 study that concluded that otolaryngologists do not “exhibit any disparate healthcare access bias in providing MT to children with otitis media” (Laryngoscope. 2018;128:2898-2901). Dr. Boss concurred but also pointed out that physicians have “preconceived notions about what parents will choose for their children, or they would proceed with care based on routine or history of treating different populations.”
Dr. Johnson, however, sees it differently. As a surgeon placing tracheostomies in children, he said he must have prior knowledge of a patient’s home life. He doesn’t see a parent’s ability to manage the recommended post-operative care as prejudiced or biased.
“A child with a trach needs 24-hour care,” he said. “If [the family] can’t support a kid with a tracheostomy, we have to make some changes. If you have a kid on a ventilator and they live in a third-floor apartment with no elevator, how are they going to carry the vent up and down the steps? What if they don’t have reliable access to electricity or a telephone? You can’t have that situation. You have to be able to call 911 in the event of a problem.”
The key, Dr. Ishman said, is to always include patients in decision-making. “If you can do that, it helps you get beyond some of the bias of how you approach patients. It’s ridiculous to think we can separate socioeconomic issues from health issues. People don’t even walk in the door if they don’t think they can afford the care. I’m less worried about the people who walk in my office and don’t come back than those who don’t ever walk into the office.”