How One Doctor is Driving Racial Justice in Healthcare
In healthcare – and indeed, society, as a whole – the year 2020 has brought us to a precipice, where we can acknowledge a set of real disparities and take steps to reform key institutions or continue to ignore them, at our own peril.
The fundamental shifts that must occur to make the healthcare system more just and equitable have been on the mind of Dr. Jedan Phillips, Clinical Associate Professor, Department of Family, Population and Preventive Medicine, at Stony Brook Medical Center in Stony Brook, New York. We spoke with him on two separate occasions: in late May, as the coronavirus pandemic seemed to be peaking but not before revealing wide-scale issues that put people of color at greatest risk; and then again in June, after the death of George Floyd and two weeks of powerful protests and demonstrations it ignited. As a Black man, he is deeply invested in how the near future unfolds; and, as a healer and an educator, he has a keen interest in capitalizing on this moment as a catalyst for change.
As our nation recovers from the pandemic and struggles with how to undo 400 years of systemic racism, Dr. Phillips knows we have a long road ahead. He shared with us what he’s doing as a doctor on the front lines, and as an educator who is shaping the next generation of healthcare professionals.
A Small Step in Closing Gaps in Care
Increasing access to care has always been a central tenant in the push for health equity, and now it’s more crucial than ever. Covid-19 has made it much more difficult to manage the chronic conditions that disproportionately affect communities of color, and complications from diabetes, high blood pressure, and more are on the rise because so many people have avoided doctor visits. Dr. Phillips understands that many of these patients will eventually turn up in the emergency room – or check out of the healthcare system entirely until it’s too late.
Though it isn’t the perfect solution, telemedicine visits have been a boon for not only Dr. Phillips and his patients, but Stony Brook as a whole. Telemedicine visits have helped Dr. Phillips stay connected with patients who might slip through the cracks or disengage with treatment, and they have also helped the health system preserve resources that might have been needed for a Covid-19 influx. Dr. Phillips is such a believer in telemedicine’s ability to close gaps, that he is currently pursuing a grant that, if awarded, he will use to purchase smartphones for up to 200 of his patients. “Most of these patients don’t have computers, but they do have smartphones,” Dr. Phillips said.
Because telemedicine visits have made such a difference, Dr. Phillips thinks they will become a regular and increasingly efficacious part of how medicine is practiced. “Trying to stay on top of chronic care and do it with telehealth or telemedicine changes the focus, so we can now take a proactive approach as opposed to a reactive approach,” he said.
Reevaluating How We Communicate and What We Say
Telehealth is not without its shortcomings – Dr. Phillips is concerned that, for many physicians, there is a learning curve that will test their ability to communicate in a way that is effective, compassionate, and patient-centric. “We have to get practitioners used to using language that will reach their patients but also, make sure they have the patience and understand that not everybody has a laptop, not everyone has a room in their house where they can go be by themselves and do a Zoom meeting,” he said. He thinks doctors need to get better at asking the right questions, listening with an open mind, and then, dig deeper to ask questions which may reveal nuanced yet unexpected answers.
Dr. Phillips isn’t afraid to leverage his own experiences as a way to open the door to effective communication and gain his patients’ trust. In one instance, he revealed his son’s death from cancer to facilitate an honest talk about anxiety and depression. Another time, he had to offer some real talk to get a patient to realize the severity of his health condition. “I had a guy come in, and he was dealing with the stress of being a man of color in society, worries about money, stresses at home…now, imagine, with all of those things, if you also had out-of-control high blood pressure,” Dr. Phillips recalls. He ultimately put it in perspective for the patient: “’If you get hospitalized, bro, you’re not going to be working.’” And it worked.
Choosing the right words is just as important in the classroom as it is in the exam room. Even though the next generation of physicians is the most diverse in history, race is still an incredibly sensitive topic – despite the fact that it is one of the major drivers of health outcomes. What has been effective for him is reframing the discussion. “The term ‘social determinant’ makes it a little easier because using a word like ‘racism’ makes some white folks uncomfortable, and sometimes when people feel uncomfortable, they can use that discomfort as an excuse not to become more enlightened. I had to come up with less threatening terminology so that I could invite them into the conversation.”
Creating Positive Change, From the Inside Out
One of the things that Dr. Phillips is most encouraged by is how his students have embraced the moment, signifying that they understand what’s at stake. “There’s so much more awareness [of health and social inequities]. If they know something, they’ll tell you, and if they don’t know, they are asking for scenarios or situations to better prepare themselves.” And, as Dr. Phillips sees it, knowledge and preparation are important, but will only take his students so far in the fight for a more just healthcare system. “I tell them, ‘Compassion is like any other muscle, it won’t be ready for you unless you are already using it.’”
Dr. Phillips also believes that even those in the current medical establishment can still make a difference – but they’ve got to be willing to listen. “The world is at a place where we’ve got to learn, we’ve got to pivot,” he said. And that means getting comfortable being uncomfortable and learning to question inherent biases. “You can no longer be the silent partner. You’ve got to understand the role that the medical professional has played in the racial history of America, and educate yourself on the impacts of your bias.” Further, Dr. Phillips emphasizes that it has to be a broader conversation than just healthcare. “Know who Emmitt Till is. Know why it’s more than just George Floyd. If you sit back and don’t say anything about police mistreatment of people of color – because it doesn’t happen to you…if you see something, you have to speak out and confront those things.”
As unsettling and unfamiliar as this time in history may appear, Dr. Phillips is optimistic about the nation’s ability to turn the corner and come out the better for it. “I think that the pandemic has been a public health nightmare and blessing for a variety of reasons: the disparities, the morbidities and mortalities affecting lower-tier and people of color in our society are being highlighted by this pandemic. Everybody is now becoming aware that we need realistic, efficient access to medical care.”
He says it’s an unfortunate truth that, “…all of this had to happen before people said, ‘This is serious.’ We have to come together and recognize that it’s a good thing to care. We’ve got to pivot on that, and then if something else [such as another pandemic] comes, we’re better able to handle whatever the next issue might be.”
