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Minority status and vulnerable early life experiences prompt physicians' engagement in reducing care disparities

Many of the physicians most engaged in reducing health care disparities are either minorities themselves, had childhood experiences with minority neighbors, or experienced early discrimination or vulnerability, concludes a new study. The researchers conducted in-depth interviews with a group of 14 physicians with high engagement scores from an earlier survey of 836 primary care doctors on physician engagement in addressing racial/ethnic health care disparities. The interviews focused on how these physicians became interested in alleviating health care disparities and what strategies they used to improve care for their minority patients.

Half of the physicians identified themselves as minorities. The remainder related extensive personal experiences with minorities, especially in their childhood. For example, one white doctor grew up in the Virgin Islands where he was in the minority and where he felt at-home with his nearly universal black neighbors. Not all those identifying as a minority were so by race or ethnicity; some felt that way by occupation, religion, and even non-mainstream medical training. Still others mentioned time spent in a developing country in their youth or their own periods of vulnerability, such as times without health insurance.

Many physicians expressed frustrations with some key barriers to equitable care, such as language barriers, resource limitations, lack of patient education, and low patient empowerment. Strategies they suggested for reducing care disparities ranged from being interested in the patient (active listening, taking time with the patient, maintaining eye contact), speaking to the patient as an equal, and understanding their background and needs (social and environmental circumstances). The study was supported in part by the Agency for Healthcare Research and Quality (HS15699).

More details are in "A qualitative study of physicians' engagement in reducing healthcare disparities," by Susanne K. Vanderbilt, B.S., Matthew K. Wynia, M.D., M.P.H., Margaret Gadon, M.D., M.P.H., and G. Caleb Alexander, M.D., M.S., in the December 2007 Journal of the National Medical Association 99(12), pp. 1315-1322.

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