Inequality in the doctor’s office: How local physicians are working to expand diversity, care

Medical Watch

CHICAGO — Inequality in the doctor’s office. Structural barriers, bias and death gap are at the intersection of race and medicine, the challenges cut deep. But there is hope. Local physicians are working to expand diversity and access in communities left behind when it comes to their health where people are struggling to survive.

It takes three of her grandchildren to help Windora Cooper safely exit her Near West Side home and get to a taxi that takes her to dialysis or a doctor’s appointment at least three times a week.

At a recent appointment at the Rush University Medical Center, a nurse reviewed the over one dozen medications the 69-year-old takes daily.

“My mom is a trooper. she has gone through a lot,” Shalonda Cooper, her daughter, said. “She has high blood pressure, she has diabetes, she has gout and she’s a dialysis patient.”

And in 2015, Windora Cooper had a massive stroke that left her unable to speak or walk. Since 1979, Dr. David Ansell has been at the family’s side, not just caring for the Coopers but studying their health and learning from their experiences. The relationship changed the trajectory of his career. 

“It was almost as if everything I learned in med school wasn’t incorrect, but it was insufficient,” he said.

“He found that he could help our whole family with this information with our mom,” Shalonda Cooper said. “And that was his way into our neighborhood to see what we were dealing with.”

The farther Ansell travelled West of downtown, he noted a steady increase in structural barriers. Food and job insecurities fed poor access to care and ultimately contributed to diminished life expectancy.

“Life expectancy in the Loop, you could live to be 85 or 90,” Ansell said. “But you go seven stops down the Blue Line in Garfield Park and life expectancy plummets to under 69 years.”

The death gap he wrote about was echoed in a recent Sinai Chicago study. Researchers found the fatality rate for the Black population in Chicago is 65 percent higher than for the whites.

“It had to sink in. It took me many, many years until I understood that the degree of disease and illness I saw in my patients was not just due to their beliefs, behaviors and biology,” he said. “It was my observation and my study as an epidemiologist that it was something about neighborhood conditions themselves that was promoting poor health.”

However, he was taught to treat diseases, not economic deprivation.

“There is not one CVS store in the whole Black West Side of Chicago, not one,” he said. “So if you need to go to a CVS you have to leave the neighborhood. Coming to Chicago as a 26-year-old and working for all these years in these neighborhoods was ‘Ah-ha! What if we had it all wrong?’”

Like Ansell, Dr. Carl Lambert is trying to get it right. The family medicine physician has two brothers both on the autism spectrum.

“My earliest inspiration were my brothers,” he said. “I remember coming to Rush with my family to see the doctors and I would ask questions. And I found myself being very inquisitive and also very protective of my brothers.”

Lambert graduated from medical school in 2011. He was the only Black man in his class of 140 students.

“It was very shocking and a lot of times very isolating feeling,” he said. “We need to have more diversity in the physician workforce that we have.”

According to an Association of American Medical Colleges report, in 1978, there were 1,410 Black male applicants to medical school compared to 1,337 in 2014. In 36 years, 73 fewer Black medical school applicants. As for those enrolled, there were 542 in 1978 compared to 515 in 2014. No other minority group has experienced such declines.

For Lambert, the statistics reinforce his mission to care for underserved communities.

“The sort of care you provide in that sector adds years to patients’ lives,” he said.

When James Mendez was searching for a doctor, he sought the advice of his father, an associate dean at a Chicago-area medical school.

“He’s one of the people I asked, ‘Do you know any of your former students effectively you would trust with your son’s life?’” he said. “Now I said that in a joking matter, but it’s very serious in nature. There was not a long list, and in fact there were only two people. And that kind of shows the reality that we’re living in.”

The exchange led the 29-year-old to Lambert.

“Dr. Lambert knows the medical side of it, as many doctors, do,” Mendez said. “But he also knows some things that are more culturally cognitive, things I can come to him as a Black man and say and feel comfortable and understand that he knows where I’m coming from.”

While the doctor-patient relationship is critical, Lambert said so is addressing bias in medicine.

“There are certain biases toward, for example, Black people, that is fed by media and television and all sorts of different sources that influence how we as the public view Black people,” Lambert said. “And that may be seen negatively as say, unintelligent, not caring about their health or drug seeking or having a higher pain tolerance. And these things are simply not true, but we’re affected by those things, too. And those can consciously or unconsciously affect the type of care we provide.”

It’s the standard of care physicians like doctors Lambert and Ansell want for all patients. Shalonda Cooper and her family have insurance but have received charitable care at Rush in the past.  

“It’s all the way down to copays,” she said. “Am I going buy dinner or am I going to pay this copay? That’s how serious it is. You feel powerless.”

But their family has felt empowered by the access that has impacted three generations.

Niya Cooper, 23, is Shalonda Cooper’s daughter.

“Actually having people look at you as an individual and not just a patient or just a number it was really special here at Rush,” she said.

“Every tragedy, everything that happened in our family, Dr. Ansell was there. He was at funerals, he was at family reunions, he was at family get togethers, birthdays,” Shalonda Cooper said. “Oh he’s definitely a part of our family. A lot of people don’t have that to have your doctor in your family like that.”

Without his care, what would have become of the Coopers?

“Oh my God, who knows?” Shalonda Cooper said. “That’s something I think about all the time.”

Rush launched the West Side united program to bring economic development to areas in need — an effort to ultimately to boost access to good care. 

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