Patient-Centered Health Care for African-Americans
March 21, 2023
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Whether it’s caused by a lack of generational wealth, less education, community, trust or oppression, African-Americans are at a disadvantage when it comes to their own health. Data proves it. What does it mean to take a patient-centered approach to clinical care for African-Americans? Primary care physician, Gregory Hall, MD, provides an eye-opening explanation of why disparities exist and what can be done to address them and reverse the trends.
Macie Jepson
One would hope, hope that every person in this country has access to equitable healthcare. But we know that that is not the case. We would expect that health outcomes are the same for everyone, but that too is not a reality.
Pete Kenworthy
Yeah, the numbers say it all, really. In the United States, African-Americans live to an average age of 74.8; white Americans, 78.8; Hispanics, 81.9; and Asians in America live to be 85.6 on average. So, why is that? And what can be done to improve health outcomes in our Black communities? Hi everyone, I’m Pete Kenworthy.
Macie Jepson
And I’m Macie Jepson. And this is The Science of Health. When it comes to the major killers in our country…we’re talking heart disease, cancer, diabetes…African-Americans have the highest incident rate and the worst outcomes. And you’ll notice I said African-Americans, not minorities. And why is that?
Pete Kenworthy
Joining us today is Dr. Greg Hall, primary care physician at University Hospitals in Cleveland, also the founder of the National Institute for African-American Health and an author. Thanks for being here.
Dr. Greg Hall
Thanks so much for having me.
Pete Kenworthy
So, I mentioned you’re an author because of your book, Patient-Centered Clinical Care for African-Americans. You’ve done extensive research on this topic. Not only do African-Americans have the shortest lifespan, they’re also the sickest. How did we get here?
Dr. Greg Hall
Well, it’s a long story. And thanks very much for bringing this topic to the front. It’s a long sordid story, right? It’s funny. It goes back to the time when the first slaves came to America, a mere 12 years after the first English settlers. And so, our history here goes back a long time. And the bias and the disadvantage and experimentation and all those things have sort of impacted our community, the Black community, in a negative way in terms of health. So, when you’re disadvantaged in terms of economics like poverty, increased poverty leads to poorer health outcomes. Decreased education leads to poorer health outcomes. And then just being disadvantaged socially in a number of settings leads to bad health outcomes.
Macie Jepson
You talked about slavery, and I think that that is an obvious, no doubt. But throughout the years it became redlining. It became segregation. Can we talk a little more about how that impacts health?
Dr. Greg Hall
Sure. Yeah. So, and people will say, why are we still talking about slavery? Why is that? It’s been gone since Lincoln died. So, but that history helps inform our current situation. That helps inform where we are today. And so, when slavery ended, they had the Jim Crow laws that there were laws in place that said separate but equal so the schools could be separate but equal, and the neighborhoods could be separate but equal. And all these things, the waiting rooms and so on. Healthcare could be separate but equal. But unfortunately that separate would never equal equal, right? And so, it wasn’t until the 1960s after I was born that they really said you can’t have separate but equal. So, those redlining that occurred through most of the 19th century was related to keeping people out of certain neighborhoods, having Black people in identified Black neighborhoods and white people.
There were laws that kept you from building a building and saying, you got to say who’s going to live in this building? You can’t just randomly build a building like you can now and say who it’s for. Back then, you had to identify, this is a house that we’re building for a white person and or this is a house we’re building for a Black person. And then the loans, how’s the bank loan going to go for that house or a business? If you’re opening a business in a Black neighborhood, you couldn’t get the loans to do that. You couldn’t empower that. So, all those redlining laws that were existing made Black neighborhoods. They made the suburbs. When they were establishing the suburbs, they were established for whites. They were not established for Blacks. So, in the inner city, slums were supposed to be for people that were poor, people that were people of color, Hispanic Latinos as well, African-Americans.
And so, that all set up neighborhoods that had increased poverty and had poor education, poorer schools. They had disenfranchisement. They had businesses, if there were there, they were disadvantaged, and they had to charge higher prices. They had to deal with increased crime. And so, all these things were sort of stacked against communities of color. And those were in place by law. And so, one of the things we talked about is racism a public health issue? That’s the whole thing that goes all across the country. And so, but if laws put in place things that disadvantaged people, then you’d have to have laws that would go against that. And we’re a country of laws. We’re a nation of laws. So, we’re supposed to follow the law. So, you follow the law and then you become extra disadvantaged. And then there’s outcomes related to that. How do you get past that?
So, that’s why we’re still talking about it. We mentioned generational wealth. I grew up in the inner city of Cleveland. My father’s house, essentially worthless. After being there in Glenville, his house was nothing. Whereas if it was in the suburbs, it might have been a $100,000 or $200,000 thing that could have led, we could have helped pay for my son’s college or bought their first home if they got a job. And so, that advantage that people got when they inherited their grandparents’ stuff when they passed on, most African-Americans don’t have that. So, that’s just a little bit of a step up that a little less student loans. a little less owing on your house because you put a bigger down payment on the house and a little less this and that, and those things add up.
Pete Kenworthy
I mean, nobody’s arguing with what you just explained. But what wasn’t included there is how that impacts health. How do all of those things impact negatively the health of Black communities?
Dr. Greg Hall
Yeah. I get what you’re saying, Pete, and what’s funny is when you say no one’s arguing with that, there are people arguing with that. There are…
Pete Kenworthy
Fair enough.
Dr. Greg Hall
Not everyone, they’re not pleased, get over that, right? There are people that say that, but it should be no one arguing with it. But because that’s what happened. But there are, and so what happens with health, I think about it as people with a higher education have better health. So, people with a graduate degree or doctorate degree have better health than people with just a bachelor’s degree who have better health than people with just a high school diploma who have better health than people with a GED that have a better health than people who don’t have a GED. So, as you get more education, you get better health. And you can say, is smoking data related to that? People who smoke, it’s high with the low education and it’s low with higher education.
And those cardiovascular outcomes, the stroke, cancer, all those things are related. As you bring up an educated community, those things go down. And so, in the sense that if we’re not educating our kids then and we’re not giving them access, and that’s just related to that. It still doesn’t address bias and all the other disadvantage that we have out here, but it’s just a part of a component of that. So, as we can educate our community, we recognize what happened and say, this is what happened. That’s why we’re here. It was public policy that did this. It may have to be public policy to get us out of it. So, once we acknowledge that, then we can move forward. But if we’re, it is this big mess and African-Americans are feeling, the majority populations, they don’t care for us. They don’t like us. They don’t want us around. They don’t want us in our neighborhoods. They don’t want us in our schools. And I’ll just be a rogue, you know what I mean? And then in turn, you’re getting less education, you’re getting less degrees, you’re getting less opportunity, you’re making less money. And then, so it’s just a big mess. And so, as a community, as a United States community or American community, we have to somehow come together, recognize what happened, and then try to move forward.
Macie Jepson
Dr. Hall, I’m going to get this phrase wrong, but there is a phrase for the after effects of a lifetime of racism, because that also cuts lifespan for Black people. And furthermore, let’s talk about this stress that comes with living in that environment. I mean, studies show it literally decreases lifespan.
Dr. Greg Hall
That’s right. And so, what happens is the stress of being oppressed. And they’ve shown this when you oppress rats, right? You just antagonize them and you don’t feed them on the same schedule and you just irritate them. Those rats don’t live as long as rats that you feed on schedule and do that? So, a lifetime of stress can cause inflammation. And that inflammation has all sorts of things. Inflammation increased cortisol, and increased cortisol can cause you to gain weight. So, we have increased obesity. We have increased diabetes. We have all sorts of hormone issues that occur due to just chronic oppression. Wherever you go, you’re disadvantaged, you’re taken for granted. And that stress overall can cause poor outcomes. And that’s been proven as well. But I think that you can get lost in all the things that contribute to poor outcomes in African-Americans.
And if you’re looking for one clear answer, you’re not going to get one. But I just think that you have to address education. So that’s improving the schools. People said, well, how do we try to help health disparities? I think we’re going to have to do it with the children, educate our children better in the schools so that they can grow up more educated because we know more educated people have better health. More educated communities have less crime. They make more money. And so, all that data, if you just say, well, how would we make life better 30 years from now? We would start with the schools and try to bring up a smarter, more educated community. And that means not having them live in a disadvantaged community, which we still are disadvantaging our schools. We’re disadvantaging schools in Black communities versus schools in white communities, even within the same school system.
And so, how do we that in an equitable way? Because we’re paying on the back end. If people say, what do you expect of your government? You expect them to be a good guardian of your funds, of your tax dollars. You’re paying that. You expect them to spend that money in a way that makes you feel like they’re doing right by you as a taxpayer. So, in Ohio, if you look at the Ohio budget, a third of it goes to Medicaid. A big chunk of it goes to jails. So, you have a big…that’s a whole other conversation about the percentage of African-Americans in jail. So, you’re spending a lot of money on education and jail, on healthcare and jails. And unfortunately, of that 30% of the Ohio budget that goes to that, a third of that goes to African-American health. Yet we’re 13% of the population in Ohio. So, we’re disproportionately spending on healthcare on the back end when with advanced cancer, advanced cardiovascular disease after a stroke, we’re spending a ton of money on healthcare on that when African-Americans, when we should really be smarter putting that money at the front end and prevention, putting that money in education so that we don’t pay that on the back end, because we’re all paying for health disparities because we all pay taxes and we’re all disproportionately paying for it.
And we’re spending money on a dysfunctional sort of system because everyone agrees that preventing disease is better than treating advanced disease. And it’s also very much cheaper.
Macie Jepson
But we’ve got to get the patients through the door. And the lack of trust is an issue as well. And trust is the cornerstone of good medicine.
Dr. Greg Hall
It is. It is. And that’s why when people say why doesn’t the Black community just pull themselves up by their bootstraps? Why don’t they go to the doctor? Why don’t they stop smoking? Why don’t they eat a better diet? Why don’t they exercise more? That would lead to better health. Everyone sort of a agrees with that. But you’re in an environment, African-Americans are in an environment where you can’t walk around the block many times because of crime. You can’t, you’re living near, you can’t buy fresh fruits and vegetables because of food deserts in the city. And if you get fruits and vegetables, they’re not ideal. And they’re not at a cost that you can get them. And so, all those things, not being able to start a business in a poor community because investment in that is going to cost you more for insurance. It’s going to cost you more for employees. It’s going to cost you more to keep your parking lot safe. All of those things disadvantage those communities. So, it’s sort of how do you do it?
So, it’s like you think of health as one thing, doctors and hospitals. But if we move away from that and think of health as a community, health as how do we be proactive about educating people about smoking and exercising? There’s schools that don’t have athletic programs. So, exercise is key. And so, if the schools don’t value gym, just exercising, then the students aren’t. And if you look at the meals that are served at schools, no one would eat that at home. And so, we’re not feeding, we’re not showing the kids about fruits, vegetables. We’re not serving them food that they can be nourished by. And so, it’s all just sort of a big society problem. When people say it’s not their problem, you’re not paying money in the most efficient way to make the nation as healthy as it could be.
Pete Kenworthy
Let’s stick with this trust for a second. There’s that general broken trust in medicine by Black Americans. And let’s do a little bit of the history. In the 1930s the US Public Health Service and the Tuskegee Institute launched the study in which researchers let syphilis progress in Black men without treating them for the disease. That’s well known and often quoted. What other examples are there though? And the other part of that is are Black people invited to the table for things like research? Where’s the cutoff here?
Dr. Greg Hall
Yeah, and I get it. So, trust is the key to a lot of the issues that we have in terms of African Americas not going to the doctor, not feeling comfortable in front of the doctor. And some of that is just generational, sort of earned mistrust. Going back to the slavery days, when the father of gynecological surgery, J. Marion Sims, did, he experimented, perfected surgical techniques on unanesthetized slave girls over and over. And he was a scientist. He was a researcher. He documented who he did the surgery on, what the surgery was, what the outcome was. And so, there’s no debate on whether he did that. And it was certainly not against the law to do surgical experiments on slaves. But what does their family think about doctors and generationally? So again, the Tuskegee syphilis study, not being told about what the study was, not really being told they had syphilis. Everyone knew but them and their wives. And then sharing that information with all the medical providers in the community so that they didn’t accidentally go somewhere and get treated for syphilis after the treatment was out there.
And it went for 40 years. And so again, what do those families know about that? I took care of a patient early in my career who was from that study. So, his family didn’t like doctors, weren’t too particular about me because of that history. And so, even in the 70s, the first heart transplant in a Virginia hospital was done on a man that fell off of a three foot wall, yardstick high, hit his head, lost consciousness, went to the hospital and they transplanted his heart within 24 hours to another person. That was the first heart transplant. They were waiting on a heart, and he provided it. So, what does his family think about doctors and hospitals? What does his neighborhood think about doctors and hospitals? What do his coworkers think about doctors and hospitals? And so, all those things, when those atrocities happen, that’s why African-Americans don’t want to donate their organs when they’re in the hospital, cause they think you’re speeding that up. And I remember thinking, well, where would you get that crazy idea? Cause I didn’t know about that history. They know about it, but everyone doesn’t know about it. And so, this trust, it’s really, if you knew all atrocities that have been done from the medical establishment to African-Americans, you wouldn’t trust it either. You’d wonder about the people who do sort of blindly trust. And so, we have to, now, as a medical community, try to repair, regain the trust that we can get on, particularly, for African-Americans. We have to first acknowledge it, which when I lecture about this, I tell providers, you know, have to put it out there.
I understand why you don’t trust doctors or why you don’t like doctors. I get it. I know that history. And then that’s this point where we can move forward and try to earn trust from a person. But if you say, I understand why you don’t trust me. And here, can we go forward? Versus I don’t know what you’re talking about. You’re crazy. That never happened, or that was 50 years ago. Get out of here, get past it, get over it. That’s not a way to move forward and have a trusting relationship. So, that’s when I then prescribe amlodipine for your high blood pressure, that’s why you don’t get it. I don’t know if this guy really is in my corner or girl or this professional was trying to make me better or whether they’re experimenting or what they’re doing. So, that that’s been a big, big barrier just even if you’re in front of a doctor, having them take the medicine or get the CT scan or get the colonoscopy, because there’s just so much baggage related to all that history that we need to be aware of.
Pete Kenworthy
And obviously, if you don’t trust doctors, clinicians, you’re not going to go see them and you’re going to have worse health outcomes, right? I mean, clear.
Dr. Greg Hall
Absolutely makes sense. Absolutely. Yeah.
Pete Kenworthy
But there’s no easy way to fix that per se. And it’s not an issue of I don’t trust white doctors. You mentioned that that guy’s family wasn’t too sure about you just because you’re a doctor, right?
Dr. Greg Hall
Absolutely. I’m the doctor and they don’t trust me, cause I have to earn their trust as well.
Pete Kenworthy
So, what is, if you have generational distrust, is it going to take generations to get it all back, because that’s not going anywhere. That’s still fed in the homes and communities…
Macie Jepson
Like turning the Titanic, I would think.
Dr. Greg Hall
Yeah, well, it’s a big problem. But when you know turn the Titanic, you’ve got the whole Titanic on the same page. And so, if you’re turning a thousand little rowboats, that’s much harder. Some people think they know the right way. And so, it’s really even worse than turning the Titanic, because we aren’t on the same page, because everyone doesn’t know the history. Everyone doesn’t acknowledge the history. Now we’re at a point where facts aren’t facts and truth isn’t truth. So, it is like there’s no right, there’s no wrong. So, it makes it more hard to get us on the right course, because we can’t seem to agree really on anything. And there’s disfunction on both sides. This is not whites oppressing Blacks. The Blacks are oppressing themselves in many ways by just not even trusting Black doctors when they see them or not even trusting obvious things they’re seeing or not seeing that their mother and father died prematurely because they smoked. And here I am with a cigarette in my mouth.
And so, we have to try to say, as some are really with establishing the nonprofit, I was like, this is the National institute for African-American Health. It’s in the name which we need to be a trusted source of information for African-Americans across the country so that they can, because they don’t trust establishments, they don’t trust universities, they don’t trust the government. The CDC is not widely trusted. NIH. It’s like, wow. So, if you can’t point to those sites, those institutions as a point of trust, where do you turn? And people are just turning to crazy conspiracy theories on the internet. And we could go off another hour on conspiracy theories. So, by saying, here’s an organization that’s really dedicated to you, to your unique problems, your unique history, unique from Hispanic Latinos, unique from Asian-Americans, and we know your problem is unique from that. It’s not a minority problem. Minorities have a whole slew of different problems particular to the minority group. And so, my big thing was to say, let’s tease out African-Americans who have an entirely unique experience and address that with a laser focus versus just saying there’s whites and there’s people of color.
Macie Jepson
Which brings us to a question that we really wanted to ask of you, and that is the value of treating Black people as Black people as opposed to in general, because which works for white people may not work for Blacks. Could you explain that?
Dr. Greg Hall
Well, I tell providers, if you say I don’t have a racist bone in my body or I don’t have any biases and I treat all my patients the same, that’s the person to avoid. If you treat everybody the same, you are the person that’s really causing all the problems. Quiet as it’s kept, right? So, you need to recognize that if you have an African-American patient in front of you, they’re more apt to distrust you as a provider, distrust your institution. They’re more apt to not take the medicine you give them, to not get the MRI you order. That’s just a fact. And so, you have to spend more time gaining their trust. You have to do more small talk. You need to spend more time listening to them and what they are saying. And it may take more time and more energy and you may not want to do it, but that’s how you provide the best care for them.
And so, I say equitable approach. You don’t counsel non-smokers on stopping smoking. That’s a waste of time. So, if you said, I treat everyone the same, then everyone gets stop smoking whether you smoke or not. Everyone will get this, that and the other. Just like if a rape victim comes in, the exam related to a rape victim is different than the exam related to a mother of six who needs to pick their kids up from school. That approach is different. Everyone accepts that approach as being different. So, you’re just giving patient-centered care, which is really how my book was able to get published. It’s not let’s just do, let’s just think about the patient and then once we’re thinking about the patient and what their particular needs are and then try to provide that need, you lean into that, then people have shown just incredibly increased success.
Pete Kenworthy
Again, we mentioned it at the beginning, your book is titled Patient-Centered Clinical Care for African-Americans, and you’ve seen that approach giving clinical care to African-Americans for them. You’ve seen that reverse trend. You’ve seen statistically how it changes. Can you touch on some of that?
Dr. Greg Hall
Yeah. There’s a number of things. Recent data is showing that if a Black person has a Black doctor, their health outcomes are better. Infant mortality goes down for Black women when they have a Black woman gynecologist or obstetrician. And so, those rates go down just because they’re able to get trust faster. I mean, they may not like doctors, but I can gain the trust faster than someone who’s not like them or doesn’t come from the same neighborhood. And so, that has done it. There are certain medications for my book. It was really clinical care. There’s medications for hypertension that work better in African-Americans than in other communities. And we’ve known that. For Asian Americans, there’s different doses that you give for statins or for other medications. And so, we already have applied that for years. There’s different interpretations of labs for African-American specific.
And so, I wrote the book really for providers of African-Americans. If you have a big African-American population, then I’m pulling together all the information you need to be take best care of them. If I move to Amish country here in Ohio, I need to read about what diseases are more prevalent in the Amish. What do they see? What are their barriers? And I’ve read about that. Just as an example, there’s more higher heart disease, lower cancer because more beef and potatoes and whatnot. And so, just taking a patient-centered approach to taking care of a community, it’s just a natural thing. But you can’t broadly paint. I have some incredibly compliant, adherent, great African-American patients that do exactly what I say, and I don’t have to build their trust. And it’s wonderful. And I have other patients that come in, and I’m still trying to build trust. I still haven’t succeeded with them. So, there’s a whole bell curve of people that come in to receive care, but if the preponderance of them have X, Y, or Z, then that’s what you need to focus on. The preponderance, 45%…some data shows of African-Americans don’t trust doctors or hospitals. So, that’s half. So, if you’re not addressing that, if you’re acknowledging that early on in your encounter as a provider, you’re really missing the boat.
Macie Jepson
It sure would help if we had more than 5.7% of our physicians being Black.
Dr. Greg Hall
Yeah, absolutely. It would help instantly. That would be a big difference. And there’s all sorts of barriers. And we could talk another hour about that, the barriers to getting into college and the barriers to getting into medical school and getting out of medical school. And I tell you, you think getting into medical school is hard. Try getting in then getting out. And there are disproportionate African-Americans who can’t get in; disproportionate African-Americans don’t graduate. So, now you’ve got an African-American medical student who’s done two years of medical school who’s $200,000 in debt but can’t graduate, can’t pass the test that’s halfway through. The medical school has built in attrition; 20% of their students aren’t going to pass. And a disproportionate high number, that 20% is African-Americans. And they’ve already been weeded by the MCAT. They’ve already been weeded by the college. And so, it’s just not needed. So, as an institution, medical schools need to be deliberate about graduating their students. You know what I mean? You admit them. That’s a commitment. You should be committed to graduating, because you’ve done an incredible weeding process. And we’re, even after African-Americans graduate and go into residency, the highest dismissal rate from residencies are all in African-Americans. And so again, imagine you still got, now you graduate, you’ve got $400,000 in student loans, you go to a residency program and because of bias and distrust, now you’re dismissed from that and now you can’t practice anywhere.
And so, all those disproportionate, disadvantaged, we see that go through college, through medical school, through residency, and then now you arrive at a hospital and your chairman doesn’t like you because you’re the only African-American. I mean, it’s really a mess.
Macie Jepson
And here you are a highly successful physician, and I’m sure you have your own personal stories?
Dr. Greg Hall
Oh my God, it’s a ton of them. And they’re never ending. That never ends. I was at the facility two weeks ago and I wasn’t in a lab coat, but I had a stethoscope dangling around my neck. I had a tie on, which I hate wearing ties, but I happened to have a tie on. And a man came in with the boxes and says, are you with maintenance? And I said, no. And then the nurse was like, you should have told him you were a medical director and you’re the corporate medical director. And I said, no. I can be with, I wasn’t really trying to do that. You know what I mean? But that takes a little chip out of your, for all the things you’ve done, even with a tie and a stethoscope around my neck, I can instantly be with maintenance.
Pete Kenworthy
You’ve talked about lots of, I guess, problems for lack of a better way to put it. And you did talk a little bit about some of the solutions in terms of government funding at the wrong end. You talked about how the government funds during Medicare which is once the problems are already well down the road, whereas if you spent on prevention, a lot of these problems might be prevented. It’s prevention. What are other solutions? And I know you can’t sum this up in a minute or two, but what are the solutions? We’ve talked a lot about problems, but it would be great to have some answers. And I realize some of these things could take decades, but maybe there are some simpler things or some things we can do that change these. What are the numbers we quoted at the beginning here that African-Americans live to be 75. White Americans are basically 79. Hispanics, 82. Asians 85. That’s a big gap.
Dr. Greg Hall
It is a big gap. And it doesn’t explain everything, but there are ways that we can, if we recognize some of the differences that happen. So, the classic disparity is that breast cancer occurs more in white women, but the mortality related to breast cancer is way higher in African-American women. So, you have this, why is something that occurs more in one population is killing more in the other population? That’s really because of not the absence of targeted research on the types of cancers that occur in African-American women. So, all have to do is just direct your attention to it. And so, right here in Cleveland, we brought our infant mortality rate down significantly because we took a targeted approach to what was happening in Black women, and what were their issues in terms of infant mortality. And if you can prevent that, you could just save all kinds of money. A premature baby can cost hundreds of thousands of dollars at the beginning of their life, plus the chronic care issues that they continue to have. And so, we took a targeted approach to infant mortality in Black women, not minorities, but Black women, and was able to bring it down and save all that money.
Pete Kenworthy
What did you do? You talk about a targeted approach. I’d like to hear more about what was done. And can an approach like that work with other things other than infant mortality?
Dr. Greg Hall
Absolutely. Well, doulas. Having a sort of an aide or a person go with you to your appointments and help listen and help follow up. So, there are people that said, you know, need to stop smoking. And so, some people stop smoking when they were pregnant. Other people don’t. And so, if you have someone, the doctor says and then walks out, and I don’t like him or her anyway, you’re just going to do whatever. I don’t see why smoking would hurt my baby. But if you have someone who’s coming over, has been to your house, who’s in your environment and saying, you know, really need to do this. You really can’t do that. You really need to do that. What other stressors do you have? They address the stressors in their spouses. They address the poverty food issues. And so, they just did a wraparound approach to what were the needs of the person? What do you need? You transportation to the doctor, we’re going to provide that. You need to breastfeed. Let’s talk about why you don’t want to do that, and let’s talk about what’s best for the baby.
Macie Jepson
Doctor, as we wrap up, and it’s going to be the hard, I know, but you’re such a great communicator, I trust you. What would be your biggest piece of advice… I’m thinking about our audience here…your biggest piece of advice for a Black person listening today? And what would be your biggest piece of advice for a physician or a caregiver and how they can turn the needle because it’s going to take both?
Dr. Greg Hall
Absolutely. Absolutely. I think that African-American patients should know that because they assign all the doctors with an NPI number. We have an NPI number. So, we’re being graded as providers on our outcomes from surgery, how good we are at getting you to take your medicine, how good we are at getting you to get screened, how long you live. So, all that data through an NPI number, which started maybe 10, 15 years ago, is being tracked. And so, if you’re an African-American patient, you should know that your provider is being evaluated on their success of taking care of you and that, so their motivation is not so much moved by their biases or what they watch on TV, but in order for them to get paid the maximum amount, they need their patients, individually and collectively, to have better outcomes. And so, that’s out there.
And really I educate providers to let them know that’s what your NPI number’s doing. They’re tracking your outcomes. Or if you order a mammogram and they don’t get it, they know that. And so, you’re no good at it and you may fall off of insurance plans because your outcomes with your community are not as good. And so, that’s being tracked. So, that’s sort of a protection to the patient that wasn’t in place in the past. And so, that’s, know that providers are rewarded for taking good care of you, and they’re punished for not taking good care of you individually. And so, people don’t really, we don’t know that. And then so you can trust what they do more because of how the system is set up, not just hoping to trust them on an individual basis. Every provider you see, I got to build trust to see if I trust that person.
That’s a lot of time and energy for the patients. That’s why patients would say, if I have surgery, can’t you do it, Dr. Hall? You don’t want me doing surgery. But they trust me. They don’t want to have to try to build trust for a whole other person. Well, you don’t have to because these things are in place, already in place. And so, they really should. A surgeon is not going to do surgery on you unless they’re fairly certain you’re going to live through it and you’re going to prosper after it because it’ll make their numbers look bad.
Macie Jepson
And do we give advice for physicians?
Dr. Greg Hall
Well, the advice for physicians is you have to take some time to learn about the community you serve. And so, when I speak at hospitals and grand rounds in hospitals, and I say, raise your hand if you read anything about the research related to African-American health, I raise my hand. No one raises their hand. And here’s a hospital. I’m speaking in a hospital, 85% African-American, right? So that’s a problem if you’re not, and then again, and it’s irritating to some people, but if there was a hospital in an 80% Asian-American community, the director of nurses would be Asian-American. The chairman of medicine would be Asian-American. Probably the vice president or the CEO would be Asian-American. But if you go to an African-American community and look at the same hospital, the director of nurses is not African-American. The chairman of medicine is not African-American, so they’re not at the table. And so, they’re not able to say, kind of push some of the things that I’m saying. Let’s empower, African-Americans know these things, but we’re not in a room when those decisions are made. So, having a diverse opinion, having an opinion of someone who’s looks like that community leading the charge, that makes differences as well.
Pete Kenworthy
Dr. Greg Hall, founder of the National Institute for African-American Health, also a primary care physician here at University Hospitals in Cleveland, thank you so much for your insight today.
Dr. Greg Hall
Yeah, thanks for having me.