Transcript

Taking Health Care to the Streets | Dr. Cheryl Whitaker | TEDxNashvilleSalon

hello Nashville thank you so much for having me jamming a little Dolly Parton here one of my favorite singers so if they let me sing I might sing nine to five if I had a song but oh I need a clicker thank you thank you guys so much so I grew up actually my first time here in Nashville I grew up about six hours away in a small town called Washington Georgia and where I grew up no one that I knew ever went to the doctor for anything unless they were seriously ill or if they went it was definitely to the emergency room as a matter of fact I remember growing up my mom and family would say old that hospital they kill people over there and I thought okay has it become a doctor I look back people's people's diseases have progressed so far there was not much that the hospital or doctors were able to do but I also knew we had insurance I was able to go through my entire college career with but without ever having a pap smear or learning about self breast exams so we never access preventive care when I was growing up and I really didn't know much about it at age 20 I had my first visit to the dentist I had a cavity I was in a lot of pain and the dentist gave me a choice he said look you can have an extraction we're gonna have a root canal and I was twenty years old he's playing the root canal I'm like I don't think I want that that sounds painful I'll take the extraction I thought I was making a rational decision but because growing up I didn't know a lot about it I made a choice that actually impacted me many years down the line and in my 30s I was able to take advantage of new technology and correct it as I look back I would hear my mom say so-and-so died this person died and at the time these people were in their 40s and 50s and I couldn't put all together at the time but I knew that many of them did have health insurance coverage but they were still dying early and they were dying from preventable conditions like diabetes high blood pressure high cholesterol and sort of wandering there we know what's going on it but definitely inspired me to continue in my career heading towards medicine and the practice of as a young medical resident out in California as learning internal medicine I began to see patient after patient again who would present with advanced cases of conditions that were related to very treatable and manageable conditions like diabetes high blood pressure cholesterol hepatitis etc and began to wonder well why is that why is it that people have access to care but we're still seeing progression of disease that's extraordinary remarkable and it will impact their ongoing sort of morbidity disease burden and their ability to live a healthy and happy and highly functioning life it was it was clear that at that time primary care and prevention which is what I was studying and learning to be was failing many of our patients many of my patients so insurance was important but it wasn't the only issue when I landed in Chicago and began the practice of medicine on the south side I realized that wow I'm seeing over half the people I'm seeing are actually covered what's what's going on here what is it that we're missing as we think about the treatment of conditions that I was seeing over and over what people weren't managing them well and it really disturbed me so much that I said gosh I've got to do something about this I realized as I looked at the communities that many of my patients were from that they faced a lot of obstacles and challenges getting to the care that they needed it wasn't as simple as having insurance in fact seem to be a lot more complicating factors as a scientist I realized as I looked at the data that well this transcends race or ethnicity what's the factor there is there something predisposing my patients to not following up and not in the care that they need what was getting the way of access even when they had health care insurance what we figured out is that actually if you look at all the data it's really low income that has the biggest impact on health outcomes in our country where you live matters too and as we look at the data there's a lot of data that shows you that where people live influences and has a great impact on their health care outcomes low income and low resource communities often have low resource areas around them meaning there's not much that they can access that's beneficial for them sometimes health plans or providers may have to intervene to overcome barriers that people are facing and obstacles that they're facing transportation is one that we know is important you got to get there sometimes for families with child bear a child bearing age child care is important while mental health we really need to think about it we know that it's there and many times we don't pick it up because we're not looking for it it may get in the way of how people access health care even recognize that they have a mental health condition or and they have a chronic condition that would do well if it's better treated sometimes people just don't want to go to the doctor by themselves they may need support some people are afraid of doctors that's not unusual I know I took my husband home I he's also a physician we were in our late 20s and my mother said to me she goes she was just staring us she goes you all don't act like doctors I said mom I'm your daughter she so is as if a doctor might be an alien right so we have to realize that there are things like white coat syndrome or just myths and fears related to seeing a doctor and then follow-up sometimes you get there but then the doctor asks you to come back multiple times that might get in the way if you're dealing with a low income and low resource situation now the social and economic factors if you're in a low resourced environment can be paralyzing what we know is from us from a study get done at Princeton and Harvard is that the the cumulative cognate load of excessive stress can take you down 13 IQ points the ability to deal with strapped with a with a doctor's appointment or anything but an emergency our patients just won't have that other things are important well when I began to really listen to my patients and understand what I want to understand well tell me more you you you don't want to take the medicine I'm prescribing for your high blood pressure will you take anything and they say doc I take oil I take vinegar and garlic every day okay vinegar and garlic how about I add a little bit of this little water pill here hydrochlorothiazide low side effects you continue to take that and let's see if together they might work and you know what I actually want a lot of battles just meeting people where they are but that's real people have their own remedies and in many communities they may approach it healthcare way different than the doctor might approach it and we're gonna have to take some of those things into consideration in much of my medical practice my patients would accuse me of experimenting on them often you might start a medicine your doctor might start a medication on you let's say you're taking something for cholesterol might start you with the low dose and then progressively increase the dose over time well my patients would say doc why are you doing that like don't you aren't you really smart and then you go to all these schools or should you know which one works and how much I say well no we have to sort of test your tolerance every individual responds differently well we often found that when I said I had a medical practice my patients thought that meant I was practicing on them so these are things that you got to think about as you as you deal in different communities you want to understand what are the mints the cultural mores that influence how they think about medicine what are those things and we have to really think about acknowledging those now it's not just South Side of Chicago where this occurs when I went home as a young doctor and I begin to talk to my own family I found that a lot of what I was seeing in Chicago I saw it in Washington Georgia so it turns out that these myths are largely there they're around and what's important for the medical community is that we address those when we are trying to meet patients where they are to get them on track now I'm solution-oriented give me a problem I want to find it so I found I'd sort of studied all these problems over 15 years and I said you know what I'm gonna start a company we're gonna solve this I'm gonna do it so first we start with individual issues we want to understand what is get in the way of a person accessing care we talked about all the different obstacles that might impact a person's approach to healthcare then we have to think systemically what are the system barriers that are in a community we talked about barriers and access in low resource communities we have to understand those we also have to understand the disease burden in those communities because we want to be well equipped when we go in to help and intervene and meet people where they are that we know what they're dealing with the science of that is called population health you understand the broader community and then you can really hone in on the individual and be effective so you armed your staff with great tools they're able to go out and really make a difference disease and burden is important understanding where you are what's going on in that community there's a community in Chicago called Humboldt Park it has the highest incidence of diabetes in the city well before you go into that community you really need to understand how do people think about diabetes in that community because when you go in you're going to want to be armed with that information so that you're your starting point makes sense for where you are mental health we talked a little bit about it before really important it is if for most a chronic condition so it bears a nice the same respect as diabetes and high blood pressure and high cholesterol emia because it's going to require ongoing contact with the healthcare community to support that person to get what they need and also it can ask other conditions and make people less likely also to seek here for conditions that could easily be treated and managed so we take all this information and we can move forward much more effectively managing that dollar that we're spending on health care and getting better outcomes I much rather spend the money upstream on prevention and treatment of these conditions then downstream losing a foot going on dialysis I'm suffering from let low exercise tolerance etc when your heart starts to give out now at the company we started we went really local we believe healthcare is local right that's what we've been talking about communities what do you see in communities how do you best understand him so we locate employees locally we hire from local we train local healthcare is local so we're going to build capacity in those communities by hiring people from them to participate in improving the health of their own communities for its creative partnerships where do members and patients go we want to be everywhere they are that's churches schools other not-for-profits that are in the community doing great things technology is important our folks are enabled with technology that allows them to in the field they're in a certain community they can pull up a zip code and say aha this community has this percent of diabetes this percent of hypertension we also know about the place they're in we can look and see ha this community has six churches 35 liquor stores three playgrounds right we know what people are dealing with is you don't want to tell people to go exercise if there's really nowhere for them to go right so you want to know your community our folks are digitally and technically enabled to be able to do that so while health insurance is important and I agree it is a great starting point our folks may not be completely enabled and equipped to take advantage of what that access offers so we hope we want to help them out we want to begin to coach them on yes these doctors are in network this is where you can go and begin to engage there he wasn't one to go with you we'll send someone with you so that you can get the care you need it's much better to invest upstream then to have to go downstream and spend money on a foot that's not working on a heart transplant etc many things if we deal with them upstream we then have a health care a health care system that is much more efficient effective and hopefully cheaper for all of us obstacles we have to deal with them and think about them so while being think the forward progressive next-generation payer and provider who providers who are rendering these insurance products that we're aware of these obstacles and we're ready to coach in place our members and then we can take it global I think that the science of community is something that we can take all over the country we learn about communities we can go all over the world implementing improving and hopefully saving lives if we'd had a system like this when I was coming up I think I might still have that molar and the people I thought that my parents you know who knew who are dying early might still be alive thank you [Applause] you