By Dr. Daria Brooks Terrell
As a surgeon practicing on the South Side, I often have to consider social factors that have little to do with diseases that can lead to surgical complications. When patients leave the hospital, do they have a safe home situation to go back to? Can they afford their medication? Do they need help with their care?
Patients deserve sensitive treatment options, but especially as they age their physical and mental condition may hinge on social conditions. When medical providers talk about health equity, we are trying to give everyone the opportunity to have the best possible care with the best possible outcome.
For some patients, it’s a bigger challenge.
They may have to devote a sizable portion of their earnings to health care. To live within their means, some try to get by without seeing the doctor, even when they sense something is wrong.
The Affordable Care Act has put care within reach.
Even so, in some Chicago neighborhoods with few primary care physicians, it may take months to obtain a doctor’s appointment and once scheduled, patients may have to travel great distances to find providers in their network. These access challenges can create hurdles that have real costs. Doctors may discover disease in more advanced stages, which makes surgical care more complicated or complex.
Chicago’s public health workers and medical providers try to get people access to preventive care before one thing leads to another.
With better access, particularly to primary care, people can get timely attention to specific medical conditions as they age. Eyes, ears, muscles and joints can all affect balance. Heart disease or medicines might make people dizzy. A diet short of Vitamin D and calcium could be bad for bones.
There are many reasons why one person might get up from a fall with bruises and another suffers a fracture, but we know that economic and social barriers to good health add to the risk that one false step will mean a trip to the hospital.
Initiatives Advance Health Equity
Chicago has been working to address health inequities, with plans to reopen the Roseland mental health clinic and expand the nursing program at Kennedy-King College.
Illinois supports community-led collaborative programs to bring the South and West Sides more treatment options for youth trauma, pregnancy and aging.
The Center for Better Aging at St. Bernard Hospital is a very cohesive and comprehensive program with the opportunity to improve the longevity of people age 50 and up. The center brings together primary care and specialty care with the needed resources to address these social determinants that we know have an impact on getting timely care.
Involving specialists is important because over the years, older adults face more obstacles, and often that means more doctors. Someone may come to one office for primary care and another to see a heart specialist. Then one doctor says, “You’re not breathing well. I would like you to go to another place and see a lung specialist.”
New doctors may get involved because this one or that other one didn’t take their insurance.
With this fragmented specialty care, providers may not get the full picture of conditions. Has the doctor in location A talked to the doctor in location C? Do they know the list of medications is getting longer?
The genius of the Center for Better Aging is to bring specialists together to consider the whole person and prevent catastrophic results. Let’s look at hearing and vision now to prevent someone from falling and breaking their hip. Or else, as an orthopedic surgeon, I have to come in and fix that hip.
When I think about the complications of health equity, I take to heart the mission of St. Bernard Hospital to care for people with respect and dignity.
When it comes to older patients, if there isn’t honest communication between providers and patients—if there isn’t substantial relationship building where the patient can trust their provider—doctors are less likely to get the information they need to truly help patients.
As a practitioner, if I don’t respect what this person is telling me, then I’m not getting the big picture. The patient who feels discounted is less likely to engage in meaningful conversation. If they have high blood pressure, they should feel comfortable asking questions about their prescriptions. If I don’t know they’ve quit taking their medication and their blood pressure is still high, we are in a vicious circle. A respectful, culturally appropriate environment starts to address healthcare disparities.
Social Disparities Tip the Balance
But well-being also takes a healthy environment.
Obesity is a big complication for many of our orthopedic patients. They have a much higher risk of arthritis of the hip and knee, and may face lifetime disability from back pain, arthritis and pressure on the spinal column.
Some need to lose weight before they can be a candidate for knee replacement surgery. When I tell patients to lose weight, I also talk about the impact of obesity on developing high blood pressure, diabetes, joint problems and even mental health issues. Still, not all the complications are medical. I could tell patients to eat better, but first I have to know about their access to fresh foods and ability to prepare them.
Or I can say, try to engage in some form of exercise. If my patients lived somewhere else, they would have access to a fitness club. Instead, they’re looking at park district classes that are all filled up.
One patient told me, “Well, doc, I don’t feel comfortable walking in my community. My neighborhood is not safe.”
About four or five years later, she unfortunately was the victim of a drive-by shooting. The incident left her with partial paralysis of an arm and other issues.
Health equity rolls up all the ways to support people in an active life.
There are many more gaps to fill, from transportation for medical visits to communication breakdowns to all the other ways the system works against patients.
Our communities can support older adults on their health journey–family members can ask questions in office visits or help them use mobile apps to track their health. But without access to a primary care provider and the specialists they need, their loved ones can’t truly be healthy.
The South Side needs to build a healthcare workforce that understands the conditions of age.
Their empathy and expertise will help engage patients, families and caregivers in assuring smooth transitions of care and working to achieve more equitable health outcomes.
Dr. Daria Brooks Terrell is an orthopedic surgeon and chair of the department of surgery and Medical Director of Clinical Programming and Health Outcomes at St. Bernard Hospital in Chicago. Terrell cares for patients with degenerative, overuse and traumatic conditions of the bones and joints. She has been a champion of her hospital’s efforts to address patient safety and is organizing programs to use health apps as an aid in treating heart failure and hypertension.
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