12. Reducing Disparities & Preventive Medicine’s Impact on COVID-19 (Part 2 of 2)

Episode 12:  Reducing Disparities & Preventive Medicine’s Impact on COVID-19 (part 2 of 2)

Carl Earl Lambert, Jr., MD, FAAFP, Christina Wells, MD, MPH, FAAFP, and Marian Sassetti, MD, FAAFP host this 2-part podcast series addressing disparities in healthcare and the importance of preventative medicine in reducing them.  The pandemic has brought the curtain down and clearly exposed major disparities we are still facing.  They invite you to join them as they address these issues with honesty, care, and compassion.

Carl Earl Lambert, Jr., MD, FAAFP:

Thank you so much for listening to our I-VAC podcast about reducing disparities during COVID-19, as well as the impact primary care providers have on COVID-19. We are shifting to the second part of our discussion that really focuses more on the primary care providers impact on COVID-19. So what do you think a primary care doctor’s role is in helping to address and prevent disparities? Or is there a role? Do I have it all wrong? Am I confused? So what are your thoughts on that?

Christina Wells, MD, MPH, FAAFP:

Well, I was doing a talk for medical students a few months ago. And one of the things that I mentioned was the impact and the importance of preventative care. And thinking about the role of physicians or pediatricians, family docs, like you mentioned earlier, who are engaged in primary care and how they are at the forefront of seeing patients, interacting with patients, having those ongoing relationships. And because they are at the forefront, they are like the gatekeeper, they’re that first point of contact. They’re going to hold a pivotal role in being able to have an impact on preventing COVID in terms of preventing worse outcomes` from COVID.

Marian R. Sassetti, MD, FAAFP:

So my personal belief, this is Marian, is that I think as healers, and that’s the way I like to think, we’re not technicians. People don’t come to us for an incision and drainage practice. They’re advocates. They come and they expose their most sacred part of their lives, their histories, their families, their sorrows, and they trust us. I think that if we begin to understand that we’re a part of this very, very long and noble line, again, I get to be old in my old age and be philosophic, I think we forget where we came from. We came from healers, we’re the spiritual people in the community. And not only do we have this opportunity, I personally think there is a responsibility to advocate for what happens in our patient’s lives outside of our practices.

And to understand it, and to, again, the word solidarity to say to ourselves, “What part of this patient’s life can I impact when they’re outside of my office?” And I’m not saying to change it all, but what part of their experience do I have some power, I have some control, I have some resources, I have something that society has accorded me that I can use at the front end to help these patients and my patients not suffer the way they’re suffering. So I’m a big proponent that as healers, we have this big societal responsibility. Great numbers of gifts and joys come with our practice, but also a sense of responsibility of where did the suffering come from and what part can I play in alleviating it?

Carl Earl Lambert, Jr., MD, FAAFP:

Yeah. You know what, as you all were talking, I don’t know why I was thinking about Guardians of the Galaxy.

Christina Wells, MD, MPH, FAAFP:

Nice.

Carl Earl Lambert, Jr., MD, FAAFP:

I feel as PCPs, we are kind of the guardians, as I think Dr. Wells said, we’re the gatekeepers, we’re the first point of contact. When patients have a question about anything, about vaccines, “Am I a person under investigation?” I was getting loads of that at the beginning of the pandemic. They came to us like, “Dr. Lambert, is this a thing? Is this something I should be concerned about?” They trust us like, “Hey, Dr. Lambert, what’s the literature show? Did you get the vaccine? Would you recommend?” They wanted to know everything.

And again, a lot of that hinges on our expertise, but then also our personal touch and relationship. And going back to the very top of this discussion when we shared the statistics, we know that as PCPs, we are the ones that are mainly managing and assisting patients to gain control over chronic diseases that might be running amongst. So certainly, this is in our wheelhouse. And I agree totally with Dr. Sassetti as far as we’re advocates too. Right? Since we’re the first point of contact, we’re the first people usually to hear if there’s issues or if there’s barriers for patients to get what it is that they need. And we are in a position of influence. And I think that’s an opportunity to use the power that we have for good.

The other thing that came to mind was really we’re influencers. Social media is such a big thing. We’re influencers and role models. So I know we all interact with students. So they’ll be the ones taking care of us. They’ll be the ones that’ll be at the helm should there be, God forbid, another pandemic that comes. So they need to be aware of all these things that we’re discussing. So I think that’s something else that we should consider in terms of why our role is so important. That’s just my two cents. Our role is just ripe with opportunities to have a positive influence on decreasing deaths and keeping patients informed about what’s the latest and greatest with COVID, whether that’s vaccines, if that’s new treatments that are available for patients who may have mild or moderate symptoms and so on. Okay.

Well, I think the next thing I wanted to touch on was really communication is key. And I think Dr. Wells, you said this, that vaccine is only a part of it. I think a big discussion point that we have with our patients is how is your whole quality of life? And I think that’s true. When I’m with a patient, my intention is not just get the vaccine and I’ll see you in six months. It’s more of a, “How are you living? What’s happening? Are you stressed out? Are you eating your vegetables?” Right? Sometimes you feel like a little bit of a parent. So I wanted to ask you first, Dr. Wells, what do you think the importance of quality of life is in terms of our role as primary care doctors in this fight against COVID-19?

Christina Wells, MD, MPH, FAAFP:

Yeah. Well, I think it goes back to what we may have mentioned earlier about that part of the reason people were more inclined to have worse outcomes with COVID was because they had poor management of chronic disease. And if we don’t focus on how to help people have better management of chronic disease, then we’re still going to have trouble when there’s some sort of pandemic and people’s immune system now becomes attacked by something that’s going to take them out because they’re already weakened by a chronic disease.

And so thinking about how do we impact people in helping them to understand how to manage chronic disease. And for me, I’m really big on lifestyle. And so helping people to understand how what they do every day is going to impact how well they’re going to have quality of life. And so that quality of life goes beyond the medication they’re taking, goes beyond a vaccine they’re taking, and it goes on to how are they managing stress? How are they sleeping at night? Like you said, Dr. Lambert, are they eating their vegetables? Are they exercising? Are they getting fresh air? All of these things are going to be important.

And that is why we as primary care physicians are in an optimal place to be able to address this and impact it because we are the ones at the forefront of dealing with these chronic issues that impact quality of life.

Carl Earl Lambert, Jr., MD, FAAFP:

Absolutely. Dr. Sassetti, any other comments from you on this?

Marian R. Sassetti, MD, FAAFP:

Just another line that I’ve used over and over is to invite patients to see their best healthiest selves and to start there, because again, I can make assumptions about what their best self looks like. If you control your diabetes, you won’t go blind, you won’t go on dialysis. And their best self is providing for their family or their best self is making it to their child’s graduation or something like that. So I like the idea of the chronicity of their goals and their views and helping them understand why vegetables, fresh air, all that, how does that help you be your best self?

So again, it’s a curiosity. I can’t tell you how helpful that has been in my practice as I begin to engage in these curiosity conversations. It’s kind of a help me help you, that line from that movie. So how do I best understand what your vision of your health and wellbeing is? Sometimes, that’s just living in a better neighborhood where their kid can ride a bike. Okay. That’s a real vision, getting your kid out and healthy. And how can we help that? You don’t want to talk about your diabetes today. I get that. So those kind of conversations have helped me see how I can be helpful in the patient’s life outside of my office.

Carl Earl Lambert, Jr., MD, FAAFP:

Yeah. Brilliant. I do want to touch on this piece too. When we’re in the examination room, when we’re with our patients one on one or with the family, there may be a variety of communication techniques or just things that come up. And I have the opportunity to be a part of a conference, the Patient Advocacy Foundation, and their theme was health literacy. So I think certainly, that comes up too. Again, I’m going to point this to both of you because sometimes, to be honest, health literacy may just be printing out an after visit summary, giving this to the patient and say, “Hey, read this when you get a chance and I’ll see you in six months.” Right. That’s not great. That’s not great. That’s not the best example of that.

But do you think health literacy plays a part in terms of not just within COVID-19 related topics, but really in terms of just wellness and management of chronic conditions and risk factors that we know can harm a patient too. What are your thoughts on health literacy? What are the dos and don’t, if you will, in terms of engaging best with this?

Christina Wells, MD, MPH, FAAFP:

Yeah, I think this is really, really important. Every summer I have a IAFP extern. And so I have a student come and work with me in the clinic. And one of the projects I had the student work on was to call diabetic patients and assess things like understanding of their chronic disease, understanding of their medications. And you’re right. We give a patient an after visit summary. And then what happens? A patient goes home, they put it on the table, they don’t take the medicine because they don’t understand why they’re taking it. They don’t know what to eat for diabetes. And that’s what we found. Most people just really had poor health literacy, understanding what their disease is and how it impacts them. Just because you feel good doesn’t mean that there’s not something going on.

And so we really have to have a greater push to improve health literacy amongst our patients. I think if we improve that, we’ll see greater impacts and better outcomes in terms of management of chronic disease, prevention of chronic disease. And that will also help us as we go through COVID and if we come to another pandemic. And so that health literacy piece is something that we really, really skip over, but that needs to be more emphasized.

Carl Earl Lambert, Jr., MD, FAAFP:

I love that. I have to give a shout out to the IAFP externship. I did that my first year of medical school and here we are. So I just have to give a shout out for that. I love that you’re doing that. And Dr. Sassetti, you are like the master of lines. So do you have a line relevant to that?

Marian R. Sassetti, MD, FAAFP:

I do. But first, I want to honor my immigrant Italian grandparents. And I remember growing up with stories about how my grandmother, who just never learned the language, would be told to do things. And people thought she was stupid. I hate saying that, but she pretended she understood the language because she lived in America and that’s what she did. And I encourage all of us sometimes to remember those days in medical school, when you pretended on rounds, you knew what everybody else was talking about, because you just didn’t want to show your ignorance. Because we shame people who don’t understand what we think they should understand.

So I’ve learned to really… My line, Dr. Lambert, is sometimes I talk too fast and sometimes I don’t even make good sense. So what did I say that didn’t seem to make sense to you? Or sometimes I missed the boat. What did I say that didn’t make sense around whatever it is? So I make myself the problem and not them. Or some of the information we have, I’ve read it. And to tell you the truth, I don’t think it really describes X, Y or Z as well as it could. What are your questions around this? Or doesn’t this piece of information tell you? So then I hopefully help them get rid of any shame.

I actually say, “You know, this piece of paper’s not good. What’s your views on what it’s not clarifying for you? What would be your thoughts about it?” So I engage them. And we don’t always talk the way we need to talk. We don’t always explain things the way we need to explain it. And giving people space and not shaming them. And I don’t think there’s any doctor alive who thinks we shame our patients, but we do by accident. So I think that’s a really important piece of literacy, is to acknowledge that the language we use might not be anything that they’re familiar with or that they could take home, and being open to hearing what makes sense to them and what mistakes I could have made in transmitting that information.

And boy, have I gotten it back? Yeah. Here’s what you said wrong, or here’s what I didn’t understand, or this piece of paper doesn’t help me. It said to call in 24 hours or that kind of thing.

Christina Wells, MD, MPH, FAAFP:

I just wanted to piggyback on that a little bit. I think it’s so important for us as primary care providers to be able to be honest with our patients that we don’t know everything. And especially as medical information is always forever changing, as we saw with COVID, when we can help our patients to understand that we’re human beings just like them, that we make mistakes, that we’re learning and growing in the process, then I think that also helps to build that trust, and that will help us to have even greater impact when we can say, “Look, I don’t know, but I’ll find out or I’ll get back to you or this is what we thought yesterday, but that information has changed, and that’s why it may seem like I’m selling you something different today.” So that honesty piece, that humility piece, I think will go a long way as we’re building relationships as primary care providers.

Carl Earl Lambert, Jr., MD, FAAFP:

I love that. And isn’t that what we teach our students? So if we ask them a question they don’t know, we tell them, “Don’t just stop it I don’t know, look it up and get back to me.” So there’s just so many pearls here that I’m hearing. Empowering, educating, giving the power back, talking to patients and honoring their dignity, decentering ourselves even. Right? So these are all excellent things. I think one other thing that came to mind for me was not only are we leaders in the examination room, but we’re leaders in the community too. When you talk about prevention, or even back to our prior discussion about COVID-19 and vaccination efforts and such, I think one power that we have as PCPs is that, oftentimes, we may gain trust, we may be a trusted member in the community itself, we may have opportunities to partner with community influencers or stakeholders to get positive messages out.

So I think I would ask you all, have you had experiences with that either during the pandemic or even prior to that? Have you had opportunities to even partner with, I don’t know, churches, synagogues, religious organizations, community health centers? I’m just curious, what have your experiences been with that? And do you think that there’s some truth to what I’m saying?

stina Wells, MD, MPH, FAAFP:

So in thinking about working with community stakeholders, I think it’s really important because if you’re trying to impact a patient, you have to understand what is going on in their life outside of the clinic and what is impacting them on a day to day basis. And so part of that is going to the community where they live, their social and their family connections. I was mentioning earlier that I’ve partnered with churches in the past to do community outreach, also partner with local barber shops, where people go and congregate. People are not only coming in for their grooming, but it’s also a social setting for them. And in those types of settings, you learn a lot about people.

And so going into these types of environments, I’ve been able to partner with students from different medical student organizations where we go in and really do health screenings and trying to understand where people are coming from, what they are dealing with. And so I think partnering with people who are interacting with people on a daily or ongoing basis is really important because they can hit it aspects where we can’t when we only see a patient every three months in the clinic. We may not be understanding things that are going on in their environment, things that are going on in their neighborhood, things that are going on in their families that may be impacting their ability to manage their chronic diseases or to manage information or misinformation they’re hearing about COVID. So those partnerships are important.

rl Earl Lambert, Jr., MD, FAAFP:

How about you, Dr. Sassetti?

Marian R. Sassetti, MD, FAAFP:

Yes. I’ve been very fortunate. Again, it’s the age thing. I’m old in the community and established. So interestingly, I keep often being the doctor invited. And I will tell you, I don’t need to do that anymore. Those of you listening, I really encourage you, if you get an invitation, please take it. I think one of the things we all suffer from is the imposter syndrome, and I’m not good enough, or I’m not a speaker, or that Marian’s good at speaking. And I didn’t know I was good at speaking until I spoke. So I would really encourage people who get invited. That means what you have is desirable. And again, it’s your experience. You don’t have to be an expert in public speaking. Show up, understand what the questions are. You’ll be surprised at the kind of questions you get from the community.

So I have an ethos of I don’t say no, but I’ve been trying to ask my colleagues to say yes a few times. And I really think that we need to help each other do that, to see that role. I know it sounds like I’m asking people to take on a lot, but really it is, again, that sense of our tribe. We are spiritual leaders in the tribe. And if people want us to show up, I really would encourage us to show up and get rid of that imposter syndrome.

We are the front lines, like Dr. Wells was talking about. We have a lot of knowledge that we don’t give ourselves credit for, and a lot of experience that our community is hungry for. Sometimes, just showing up at children’s schools helps the parents say, “The community docs says we got to do it this way.” There’s been some benefits in the area that have asked my opinion and I get to say, “This is what the CDC says. This is…” You don’t have to be an expert. I didn’t invent the rules for the benefits. I just quoted the CDC. And I think that’s a really empowering things, both ways, for us to be participated.

Carl Earl Lambert, Jr., MD, FAAFP:

Absolutely. And also makes me think about the broader sense of community now. And even the power of technology and that we can even tap into that. I know I had shared prior that I am a bit of a reluctant communicator, which is, it’s funny that I’m doing a podcast. And also have been able to be a part of a media ambassadorship through the American Academy of Family Physicians, where we do just that. We talk to radio, TV, just different spokes people that can get the message out.

And again, I think that’s a way to advocate and to educate as well. So I think I agree with you. I think we do need to take advantage of whatever opportunities come our way, because we have important things to say, and we can use that as leverage to influence our communities, local and nationally, even if that’s the case too.

Christina Wells, MD, MPH, FAAFP:

Before we go on, I just want to add to that. I think it’s important for us to see ourselves as advocates. And in the respect that if I’m an advocate in one area, for me, maybe it’s healthy eating, and then Dr. Lambert is an advocate in another area and Dr. Sassetti is an advocate in another area, then when we combine those efforts, we will have a much greater impact to think about how we can, as a whole, as primary care providers as a whole, be able to have a greater impact on communities and see changes in communities that will help us to be more successful in combating disease and in helping people to have improved qualities of life and have healthier outcomes. Because it’s going to have to take us doing and thinking about things that go beyond the walls of our clinics and our hospitals.

Marian R. Sassetti, MD, FAAFP:

Beautiful.

Carl Earl Lambert, Jr., MD, FAAFP:

Absolutely. So I mean, to our listeners, I’m really hoping that you’re hearing a call to action. You’ve been informed. Hopefully you’ve been inspired by our narratives as well, but hopefully you’re also hearing some ideas of what you can possibly do, where you are with the sphere of influence that you have as well. As we are landing our pretty robust discussion, I want to ask Dr. Sassetti and Wells, are there any final points or comments or even takeaways that you want our listeners to have before we end our conversation today?

Marian R. Sassetti, MD, FAAFP:

Well, I’m aware of how much is demanded of us and how exhausting and trying these two years have been. And if you listened closely to this podcast, we’re asking more, right? I’m going to first encourage all of us to rest up. Please take that time. We preach that. We teach that. If we are going to do this well, we have to honor that we’re exhausted. And then whatever it takes to rest up, please do. I think I told the story on another podcast where I just would take vacation days from COVID, where I just wouldn’t read a single thing, I wouldn’t think about it at nighttime. And I leaned on my colleagues. It was fun. We all took COVID vacation days from the literature. What did I miss? What’s new? That kind of thing.

And then honor whatever you’re feeling right now, as far as that exhaustion. And it is real. But it doesn’t mean we can’t do this. So I’d say, first, be compassionate to yourselves, be loving to yourselves, rest up, and then hear that deeper call. Remember that day we took those oaths, and this is what we were born for. I truly believe that. I really believe this is our moment in time as primary care docs. So I don’t want those two pieces. I don’t think they’re mutually exclusive. I think that we can rest up, we can rejuvenate and then we can say to ourselves, “What part can I play in this historical pandemic? Because it will end and what will I have contributed is an important thing for all of us.”

Carl Earl Lambert, Jr., MD, FAAFP:

Absolutely. We are certainly in a galvanizing time. So we need to remember that. Dr. Wells?

Christina Wells, MD, MPH, FAAFP:

Dr. Sassetti brought up some excellent points. And I think part of the way we can reduce that compassion fatigue is by coming together and realizing that I as an individual don’t have all the answers, but if I put my power with your power and with Dr. Lambert’s power, then that can make us more successful in being able to be those advocates. And then, as we then partner with our communities and our stakeholders and our communities, that again, will help us to not feel like we are in it alone. And so I think that we have to, again, think about how we do medicine and do medicine differently. That medicine is not in a silo, and that it has to be a collaboration with other providers, with other community stakeholders, and most importantly with patients, their families and their friends, because if we don’t really look, again, outside to see what is impacting our patients as a whole, we won’t be able to really, really turn the tide of how we address medicine in the United States.

And we, as primary care providers, we have the optimal role. We should be at the forefront. We are the ones that will essentially take the lead on this, and it’ll be important and pivotal that we lead and guide because we know patients from a more chronic, a more long term, a more intimate relationship, and that’s going to help us to be able to really have the greatest impact.

Marian R. Sassetti, MD, FAAFP:

Perfect.

Carl Earl Lambert, Jr., MD, FAAFP:

Beautifully said. Beautifully said. So I have a nine month old son. He is in the room down the hall. He’s been home with me for about a week. And I think about what have we learned so far from this pandemic and what sort of world are we leaving for our kids, our future loved ones, our mentees, or soon going to be providers one day? What are we going to do? And I’m sure my son’s going to have questions, his older about like, “Hey, what did you do during that time, dad. Did you show up?” Right? And I’m hoping that I can say, “Yeah, I showed up and here’s how.” Right?

But to our listeners, this is an all hands on deck situation. I love the theme of power, right? We are combining our power to really create a better future for all of us. We all win when we do that. So again, to our listeners, I certainly hope that you’ve been inspired in some form or fashion in terms of how you practice, how you relate to patients, or even your local communities.

And again, spheres of influence is how you will help to write the wrongs, turn the dial towards justice and away from worse and disparities and so on. So again, it’s been my pleasure. I’m just so happy to be with such seasoned and master communicators here. So I’m just fortunate. I thank you both, Dr. Sassetti and Wells, and to our listeners. I wish you well. Thanks so much for listening.