Interviews were conducted with community leaders and healthcare professionals in Atlanta, Georgia regarding healthcare disparities surrounding COVID-19.
- Breanna Lathrop
- Chief Operating Officer at Good Samaritan Health Center
- Family nurse practitioner
- Dr. Sreeni Gangasani
- Cardiologist in Gwinnett county
- Runs a free clinic in Global Mall, Norcross through Indian Physician Association
- Clients are local and under/uninsured or from foreign countries
- Jasmine Cofield
- PA-graduate from University of Detroit Mercy
- The Cohort Diversity Chair
- Founder of Physician Assistants of Color
Q1: What have you primarily noticed in terms of inequalities in your profession and what do you think is important for future healthcare professionals to know?
Dr. Gangasani: I work in both the hospital and the office. In the office, most of the people when they do not have insurance, they try not to come to the hospital and just come to the office. Even then, they try to avoid doing a lot of testing. Many patients who come to the hospital already a lot later compared to someone with insurance to really not put more workload or financial burden on their families so they take a lot longer before they present to the hospital…we need to educate the people in Georgia that there are free clinics and opportunities that are really beneficial to take care of their problems early on instead of a lot later.
Jasmine: A lot of times, the patients are not met where they are. For example, they come in with high BP…before they start you on medication, they want to see if there are any behavioral changes. Sometimes when a patient comes back, they are accused of not doing what they were supposed to do but the providers did not take the time to learn if they have a nearby market with healthy food or take the time to educate the person on foods to avoid to lower BP, do they even have nearby park or place to implement the behavioral changes the providers recommended…when you don’t ask them these questions, you make it seem like it is their fault.
Breanna: Most of my patients do not have healthcare insurance so I expected many of them to have unmet healthcare needs. I was surprised by how many were hurt by the healthcare system. I have patients who, due to language barriers, were not explained a surgery and I have done pelvic exams on women who I was the first one to explain to them why they no longer have their menstrual cycle is because the surgery removed their uterus. Having that kind of trauma where you have not been informed or been made felt ashamed is not something you recover from and carry with you when you meet new healthcare providers. We need to fix how we treat people.
Q2: How do language barriers impact access and quality of healthcare?
Jasmine: I have seen it hinder patient and physician interaction. One population I was completely oblivious about was the Hard of Hearing community. When you add on a patient who is deaf and does not have the medical aptitude to understand their disease process and care, I was amazed at how much they face in terms of disparities and healthcare quality as well. Using the hospital resources, every hospital should offer something where the patient provider can communicate. Since you can no longer use a family member, I’m sure there are some settings where resources are unavailable and you have no other choice. For efficient patient-physician interaction, you should use what your hospital provides.
Q3: How does medical school teaching negatively impact racial and sex bias and inequality in healthcare field?
Dr. Gangasani: Medical school and residency is very much focused on textbook knowledge. Once you come into the practice, you learn a lot about the social disparities. We hide from it during medical school, residency, and fellowship…our attending physician handles it so we are not so much exposed to it. It also depends on which hospital you were trained at…not many homeless people while my friends who trained at another hospital dealt with entirely different populations than what I was dealing with.
Jasmine: One thing about medical school and PA school teaching…1) starting off with a homogenous class and faculty. When you come from a homogenous cohort, people similarly share the same experiences and you don’t have a diverse studying experience. One thing I didn’t like during teaching is the lack of representation. For example, in dermatology, there were not very many clinical cases on black skin so how can these future medical providers be able to identify something on black skin. Like Lupus which primarily affects African American women but when you look up photos on Google, you do not see images of African American women.
Q4: In what ways does the heavily administrative nature of our healthcare system inhibit healthcare providers from reaching underserved and marginalized groups, and how can healthcare providers overcome those challenges?
Jasmine: From my rotation, from what I saw, what most people do not know is that healthcare is largely, largely run by health insurance. My first rotation in a hospital, I quickly saw how dispositioned, meaning how a patient was discharged and what happens to them after they leave the hospital is largely determined whether their health insurance covered it. Another thing I saw was that providers needed to do prior authorization to do the things they felt their patients need. I have seen a patient who had a disease with only one FDA-approved treatment option which was not covered by their insurance and we had to treat them symptomatically. So those are the things I saw hindering a patient from obtaining great quality health care. I always say health insurance is the overseeing bad army and we are the soldiers on the front line who catches everything for it because the patient does not know how everything goes.
Dr. Gangasani: From the insurance people, their bottom line is that they want to make money for their investors and stockholders. It is a real frustrating problem where every day, I have 2 or 3 people where I am fighting with the insurance company, talking to their doctors, and telling them it is necessary. Sometimes I have to send people to the hospital and the whole process is going to pay a lot more to send someone to the hospital or ER to get their tests done which adds to their bill but at the same time, I don’t want the patient to die or have issues at home. It is more important for the politicians than healthcare providers to hopefully come up with a solution especially for people in their 50s and 60s when they lose their health insurance with pre-existing conditions, lose their jobs, and cannot find another health insurance to see have a MediCare plan where they can have private person buy into the insurance. It is a more reasonable option instead of paying money to private insurance companies when they are young but when they really need it is when they are in their 50s and 65 but before they have MediCare and don’t have the insurance coverage. Hopefully, these will get the private insurance companies to learn to listen to the physicians and let healthcare providers do their jobs instead of cutting the benefits so insurance companies can make the money.
Breanna: This is a perfect example of why policy matters…I think stories are powerful. People learn from stories, not data. All the data we have in the world, what changes people’s minds at the end of the day, particularly people who are not in healthcare, is hearing those experiences. Rather than saying I can’t change that process, say I can show up tonight and find ways to bring these issues front-and-center so we can have this community knowledge and include our patients, their stories, and their frustration from continuing to accept the way our healthcare system is and how we can envision something different.
Published: April, 2021