Working to eliminate health disparities in cardiac care

AMA Wire
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The AMA Wire® “Members Move Medicine” series profiles a wide variety of doctors, offering a glimpse into the passions of women and men navigating new courses in American medicine.

On the move with: Keith C. Ferdinand, MD, professor of medicine at Tulane University School of Medicine, Tulane Heart and Vascular Institute in New Orleans. He focuses largely on cardiac risk factor evaluation and control, especially hypertension and hyperlipidemia, including communities of racial and ethnic minorities.

AMA member since: 1978.

How I move medicine: I move medicine by a combination of direct patient care and teaching the community how to identify risk factors and seek appropriate care. The one-on-one doctor-patient relationship is one of the highest forms of human interaction there is, and an opportunity to change people's lives in a positive manner. Identifying public health issues, which go beyond the patient visit, however, is equally as important. We must control the global burden of cardiovascular disease, along with achieving the laudatory goal of eliminating health disparities for our society.

What moving medicine means to me: On the individual level, we must treat our patients with respect, regardless of race, gender or social class. With electronic health records (EHRs), providers must take the time to show more concern for their patient's well-being than simply entering data into the EHR.

The busy clinician, with his or her back to the patient during the visit while entering data into the computer, becomes a barrier to patient understanding, adherence and follow-up. In the area of public health, while each individual patient is the primary concern, our society must address issues of health disparities and seek health equity across populations.

The work that means the most to me: The most important component of my work is helping people help themselves. It is difficult to navigate the complex, convoluted health care delivery system that we have here in the United States. My job as a physician is more than simply writing prescriptions or doing interventions.

It is perhaps more critical to educate patients on their diagnoses and risk factors, specifically for cardiovascular disease. Moreover, navigating between specialists and subspecialists can be confusing for patients. Assisting patients with understanding different specialties and how they may or may not assist patients and their care is a vital component in patient education. An informed patient can be a partner in his or her care and lead to better outcomes.

An experience from medical school that kept me going: I attended medical school at Howard University School of Medicine in Washington. At that time, especially in the African-American community, there was a strong interest in using various tools, in addition to medicine, such as law, social work and public education, to assist our community and improve their lives. Being exposed at Howard to giants in clinical medicine and research motivated me to be a positive force to help my community.

My source of inspiration: My primary source of inspiration is my late father, a World War II and Korean War veteran who believed there was no excuse for not doing what you are supposed to do, to complete any job or task at hand. He taught me the meaning of commitment, hard work, honesty and responsibility. Also, I must recognize my late mother, a public school teacher in the segregated South. She inspired me to not feel "second class" to anyone, despite the prevailing legal structure in New Orleans at the time.

My hope for the future of medicine: As we develop new drug therapies, including biologics and sophisticated interventions including new cardiac devices, we must avoid having a two-tiered system. It would be unacceptable for these new interventions to only be available to those who have private insurance, with a large bulk of society—such as those with government insurance, no insurance or minorities—having little access to necessary therapies and interventions.

The hardest moment in medicine and how I got past it: Approximately 25 years ago as a young physician, a teenage girl with congenital heart disease and pneumonia reached out to me from her bedside and asked me to not leave her since she felt uncomfortable and somewhat short of breath. Without warning, she experienced a sudden pulmonary arrest and, despite immediate CPR and intubation by the hospital staff, we were unable to revive her.

It taught me how fleeting life can be and how we must pay attention to the needs of high-risk patients every minute they are in our care. Despite feeling helpless, I eventually understood that we had done the best that we could offer, and that we physicians are only limited human beings with limited tools—we do not actually create life itself.

My favorite experience working with the medical team: I have always been appreciative of all components of my team, from students to medical assistants, nurses, pharmacists and physician assistants. Physicians alone can do little to help patients, and there is clear evidence that hypertension, hyperlipidemia and heart failure are best improved and controlled with team-based care.

The most challenging aspects of caring for patients: The most difficult patients are often those with limited health literacy and financial constraints. These are often the sickest patients with the most severe disease and multiple medications with complex indications. These patients are at risk for a potpourri of potential drug interactions and side effects. For these individuals, understanding their medications and indications and giving the appropriate care is of the utmost importance.

The most rewarding aspect of caring for patients: Seeing a complicated patient become stable with controlled blood pressure, lipids, diabetes, decrease in symptoms, and improvement in aerobic activity and capacity. Seeing the sickest individual get better allows me to remain committed to helping people care for themselves.

The skills every physician should have but won’t be tested for on the board exam: Empathy, feeling for our patients, and understanding the immense burden of having chronic illnesses, recognizing that all of us at some point—unless we have a sudden death or trauma—will become patients. Physicians must recognize the importance of helping people and never feel that we are somehow above or beyond the common man or woman.

One question students should ask themselves before pursuing medicine: Am I more interested in patients and my fellow human beings or do I see medicine simply as a job? While the financial compensation for being a physician is attractive, it is a long, arduous road from student to physician. Students who see medicine simply as a means of making money will quickly be disenchanted and will either leave medicine early or take inappropriate shortcuts in the care of their patients.

A quick insight I would give students who are considering medicine: Understand that there is power in medicine—not the power for our own self-aggrandizement, but rather the power to help patients and improve life itself.

Mantra to describe my life in medicine: Much of my inspiration comes from the book, The Healers, by African author Ayi Kwei Armah. The mantra that I carry in my heart and mind is that "there is power in healing, but not the power for self-aggrandizement." In Armah’s mystical novel, a young man pursues the highest ideals of serving others and what he could do to make his own community healthier while avoiding blind allegiance to the power structure.

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May 10, 2018
AMA member Karen Dionesotes, MPH, has always been interested in science. It is her deep concern for patients as people that drew her to medicine.