Three years ago, one of my patients asked, “Doc, why can’t we talk on the computer?”

The question caught me off guard. In 17 years as a doctor for low-income Medicaid and uninsured people, it was the first time a patient expressed interest in swapping in-person visits with technology. He had moved 40 miles away from the clinic but didn’t want to change providers.

When I told him a FaceTime or Skype visit was not feasible, he then asked if we could talk on the phone or text because he wasn’t working, and this would allow him to spend less on gas. Although intrigued, my inability to meet his needs made me feel inadequate. I wondered how many other people like him wished the same but had never mentioned it.

After that visit, both in the office and on the street I found nearly unanimous agreement about people’s desire to communicate with health care providers using cell phones and the Internet. The few who preferred clinic-based visits, perhaps coincidentally, were either elderly or lived alone and felt socially isolated.

I shared this experience with a few health policy and opinion leaders. Could we transition to health IT solutions for follow up visits and perhaps even to keep people out of the ER? The consensus response was, “Do the poor have access to technology and the internet?”

These responses are not dissimilar from those I received in 2005 when I proposed conducting a computer-based research study for the CDC among prisoners. Seasoned researchers were skeptical and asked, “Are prisoners able to use computers?” “Aren’t you worried about literacy?” The computerized survey was welcomed by the participants and we encountered few, if any challenges with literacy. The skepticism, even now, represents a persistent knowledge gap between decision makers — funders, scientists, researchers, policymakers — and the community.

Research data show nearly 80 percent of persons from low income households use cell phones to text and this number increases annually. The data are also consistent with my experience. Nearly all of my patients have phones and in recent years we have used this strategy to locate and stay connected with many of them.

Whether on the bus, subway, grocery store line or walking down the street, it seems everyone is texting, staring at or talking into a device, even in our poorest neighborhoods. Yet, IT-based health care strategies are exploding everywhere except in low-income communities where, ironically, much of our highest cost health care is centralized. When will we make it a priority? I am convinced the community is ready — even if we aren’t.

This post was published on Huffington Post.

A few weeks ago I entered an elevator with my bike helmet. A gentleman noticed the helmet and commented, “That is great you ride a bike. I wish I could get my wife and daughters to exercise. I want them to learn to swim but they don’t want to mess up their hair.” I asked him what he thought the solution might be. He replied sarcastically, “I don’t know. Water that’s not wet?” He chuckled as he exited the elevator, but the conversation lingered, and I thought, “The beauty industry is fueling the obesity epidemic in black women.”

Black women have the highest rates of obesity in the U.S., and four of the five leading causes of death in black women are linked to obesity. Yet, for many of us, it seems our hair is more cherished than our health. The history and emotionally complex relationship between black women and hair has been highlighted in a controversial film that set social media ablaze with kudos and criticism alike. However, as a medical doctor who for over 20 years has witnessed the health impact of inactivity, our behavior is of great concern to me and continues to weigh heavily on my heart.

SOPHISTICATE BLACK HAIR MAGAZINE, 2011

A few years ago when we opened the Community Wellness Collective (CWC) in the most underserved, under-resourced residential area in Washington, D.C., we struggled to fill our exercise classes. We established the CWC because over the years, my patients with chronic health conditions told me they wanted to exercise but either had no where to go nearby, could not afford it or needed assistance to get started. Our wellness instructors, on a mission to serve and volunteer their time, would often traipse across the Anacostia River to an empty room. Consequently, I began to casually inquire about reasons for the lack of participation at CWC despite its location in a community with some of the nation’s most glaring health disparities. I learned a lot, but the most disconcerting reason was related to hair. I was told of associations between self-confidence and self-image and hairstyle and how class times needed to coincide with calendar appointments with the hairdresser. If a person had an appointment on Saturday morning, the best time for a class would be on a Friday night when she had no plans to go out that evening. A few women expressed their desire to exercise consistently but were conflicted by the financial burden associated with frequent beauty shop appointments. I was told, “It costs too much.“

Indeed, it costs too much. The long-term impact of prioritizing hair over health will likely bear substantially greater costs associated with preventable diseases, long-term physical disability and quality of life. At a time when obesity rates in the nation, and strikingly among black women, are stubbornly high, it breaks my heart to be reminded the extent to which beauty and hair obsession are so engrained in our psyche and linked to self-worth they continue to drive our choices about health and wellness behaviors. We have the tools and information to combat obesity and other preventable diseases. But amidst the ubiquity, power and influence of the beauty industry, I wonder if we stand a chance. Do we? Let me hear from you.

This post was originally posted on Huffington Post.

While scrolling news headlines, a ticker for a recent Washington Post blog by Philips: ‘The Changing face of healthcare’, caught my attention. As expected the article included discussions about our national shifts toward value-based health care and why doctors and our health care system must transition toward becoming more responsive and data-driven. As with many articles on this topic, it was devoid of the patient perspective — health care consumers. The direct patient perspective is chronically absent from deliberations about our health care system transformation and I believe this continued omission will ultimately thwart efforts to improve quality and reduce costs. Patient engagement is central to any strategy to transform our health care system. Why then don’t we consistently seek and incorporate direct patient ― particularly high-cost users’ ―  input about realistic approaches to health care innovation and transformation? What we would we learn if we did? I decided to chat about this with a few health care consumers.

During a health education session with low-income residents in Washington, DC, I posed a question to a room filled with middle-aged men and women, most of whom we would deem high-cost, high need users: ‘What would it take to convince you to stop using the emergency room and build a relationship with a primary care doctor?’. I learned three things. First, each of them had at least one negative interaction with the health care system which discouraged them from further engagement. They described dismissive doctors who make them feel as if they are on an assembly line and condescending and impatient health care staff who don’t actively listen to their concerns. Their comments applied to both inpatient and outpatient care. One person said, “Every person I know who went into the hospital sick, ended up dead. That’s why people don’t go”. These interactions and perceptions have eroded their confidence in our health care system as a place of compassion and healing. Consequently, for most of them, absent a dire situation, doctors and the health care system should be avoided.

Second, while they seemed aware of the relationship between preventive behaviors and good health, there was little personal acceptance of this connection when it came to theiractions and preventing disease. For example, they shared stories of people they knew who delayed care for diabetes resulting in leg amputation yet none of them had recently been screened for diabetes nor had they consistently gone for annual physical or dental exams.

Finally, they told me in quite colorful language about their deep and penetrating distrust of the medical establishment. The discussion focused primarily on the relationship between doctors and the pharmaceutical industry. One person said, “It [doesn’t] matter why you go to see the doctor, you’re [going to] walk out with a handful of pills and the medicine makes you even sicker than you were before.” Another said, “the only reason doctors want to see patients is to get rich prescribing drugs people don’t need.” I was a bit astounded by the uniformity of their opinion that doctors are more concerned about pleasing and being compensated by the pharmaceutical industry than caring for them. Health care-related conspiracy theories and distrust are more pervasive than we acknowledge and are impacting patients’ willingness to engage in our health care system.

I have participated in countless public health and health policy conversations. The focus of these health care strategy and program implementation discussions have never been focused primarily on the types of issues raised by these consumers. Whether clinicians, policymakers, innovators, researchers or financial overseers, patients are our raison d’etre and their buy-in is imperative. Therefore, continued omission of their voices will thwart our progress. Addressing their feedback is daunting but we should not dismiss their concerns and suggestions because the solutions seem impractical. Until we strengthen our collaboration with health care consumers, directly acknowledge and consistently incorporate their perspectives into our strategies from conception to implementation, the transformation we seek will continue to elude us for decades on end.

This post was originally posted on The Huffington Post