Physicians are at the forefront of minimizing the preventive care gap

Eric E. Whitaker, MD, MPH
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There’s a major health disparity in our nation: Black and Brown communities often have limited access to affordable care. Patients from these under-resourced populations lack the preventive health screenings and early interventions that can reduce the risk of illness or disability. As a result, they tend to be diagnosed with chronic diseases more often, presenting advanced cases at earlier ages. Plus, the health care workforce continues to lack minority practitioners, perpetuating a crisis of mistrust in medical care.

Our challenge is to provide better care to more people early on, improve health and economic outcomes, and bring society closer to health equity. It’s no secret that the best way to address gaps in care is by seeing patients face-to-face, but it can be a challenge getting people to make and keep appointments. No-shows among culturally diverse patients are associated with a lack of understanding of scheduling systems and what patients perceive as disrespect for their beliefs. Success will require work from both patients and doctors.

Once patients are at an appointment, practitioners should allow time and engage patients in important lab tests, updated immunizations, and other preventive care measures as needed. Keep in mind that under-represented populations often lack preventive screening and results of a single measurement can be difficult to interpret. However, preventive care also must include education and cultural awareness practices. After all, physicians who model to be unbiased and transparent must put patients at the center of care and prepare them to participate fully in their care.

Education for both physician and patient

Informed consent is not as easy as collecting a signature. Patients are fickle and afraid. Though they may have pain or even serious health problems, many people refuse to see a doctor. If they do make an appointment after being persuaded by a loved one, many don’t keep it. Once patients enter the exam room, they still need convincing.

The resistance can come about because of cost, language, stoicism, condescension, fear of the prognosis, distrust, health knowledge, lifestyle preferences, or any combination of factors. Patients may have faced years or decades of not being treated properly because of how or where they live. But it’s vital that everyone who needs care sees a physician and takes the necessary preventive steps to ensure that other health issues don’t arise.

For instance, diabetes threatens to overwhelm health systems in many urban and rural underserved communities. Blacks and Hispanics with diabetes generally exhibit poorer glycemic control and outcomes relative to non-Hispanic white populations. The American Diabetes Association now recommends that screening for prediabetes should begin at age 35 for all populations.

Physicians can help patients lower their risk of developing diabetes or its complications if they intervene early enough. But too often, physicians fail to consider or patients resist preventive measures. Zing Health has seen success in uptake of continuous glucose monitoring among members with diabetes. But adopting the newer sensor technology and securing affordable coverage has required a process of education for physicians as well as members.

Practitioners can extend their efforts to book appointments by probing for the issues behind no-shows. Social service and transportation providers can help address underlying access or cost issues. To understand multiple risk factors, review of a patient’s medical history should consider social determinants of health such as unstable food or housing. Showing an interest in and understanding of a patient’s background can go a long way toward gaining buy-in.

A prescription for bedside manner

A practitioner’s race or ethnicity should not be a barrier to empathy. Asking open questions can encourage a more complete and trusting conversation. Developing multilingual and cultural competency within a practice will help gain trust and care-plan adherence. Practitioners should also consider physician bias—both real and perceived. Patients with financial difficulties or social limitations feel as if they are not getting the same care as others. Those from different ethnic backgrounds or races may not see themselves represented in a clinic and feel uncomfortable with their treatment or skeptical of its intentions.

Practices that employ people who speak different languages and have a diverse team are more welcoming. In Zing Health’s experience, a predominantly minority workforce encourages member engagement. If people can see people from their background making decisions, it’s a lot more likely that they will feel comfortable and be truthful about their health care.

Physicians need to recognize that everyone has biases. By being aware of their own, they can make more informed decisions, even if it means having their care plans reviewed. Most importantly, physicians should strive to understand the cultures from which their patients come. That means avoiding stereotyping of patients and respecting the magnitude of unconscious bias. Using race as a proxy or correction factor can result in withholding treatment to patients who would benefit from it.

Every case is unique. It’s this understanding that will allow physicians to be successful in closing the preventive care gap, creating a welcoming environment for all.

Eric E. Whitaker, MD, MPH, is executive chairman and founder of Zing Health, a community-based Medicare Advantage insurer that addresses the social determinants of health.