Is there a model out there that can narrow the care gap?

Years ago, as a young cardiologist in inner-city Brooklyn, I remember an elderly Spanish-speaking patient named Maria who faced the painful task of deciding whether to use her government subsidy to buy groceries or to fill the medications I had prescribed to treat her heart failure.

I wasn’t unfamiliar with this kind of poverty. I had been born into a Jewish family in Tehran, and soon after, we fled Iran to escape the Islamic Revolution. We eventually moved to the Dominican Republic, where my father enrolled in medical school. Poverty and disease were pervasive on the streets of Santo Domingo and images of malnourished children begging for food or money are still etched in my mind.

Little did I know at the time that this early exposure would later mold the way I thought about and practiced medicine. Upon completing my cardiology training, I immersed myself in an inner-city medical practice that primarily served a low-income elderly population of Spanish-speaking patients. Believing that everyone deserves the right to medical care, I wanted to start where the impact would be most felt.

Stories like Maria’s were commonplace. As a clinician, I remember feeling frustrated that I didn’t have the time to address her myriad concerns. With the changing landscape of health care, and reimbursement cutbacks that force physicians to essentially see patients in ten-minute blocks, there was no time. No time to focus on preventive health. No time to educate. No time to help Maria with her food-medication quandary. And certainly no time to really get to know her. I was quickly becoming a prescription dispensary, giving hugs and pushing drugs. Frustrated by the kind of care I was providing, and well aware of my desire to impact health and wellness in a more holistic way, I left.

Well, if time was the secret ingredient I needed, the solution, I thought, must be in seeing fewer patients. In keeping with this, I spearheaded a concierge medical practice, written about in the New York Times, that aimed to deliver high-touch and personalized medical care to the very affluent. It was a demographic I knew well. Indeed, when we moved from the Dominican Republic my family settled in the wealthy suburban enclave of Great Neck, New York. Yet I soon came to appreciate that as much as that experience helped me understand my patients, so did my time in inner-city practice. Taking care of patients who fell on the more affluent end of the spectrum, I noticed more similarities to than dissimilarities.

We all share a common thread and regardless of our financial standing — or any other differentiator for that matter — our life struggles and health goals are similar. I have learned that we are united in our goal of leading a healthy, happy, and balanced life. However, in order to make this goal a reality we need a medical model that enlists a holistic and integrative approach to wellness and health care that is accessible to all.

This raises the question: How do we achieve this model?

I don’t yet know the precise details to realizing this model, but what I do know is that that it is achievable and necessary. With the advent of new technologies, telemedicine, iPhone apps, and a world that is immersed in and thrives on social media all that is needed is a well-intentioned initiative. I know that empowered patients and physicians together will find a path to closing the gap, making optimal heath and wellness accessible to all. Despite the seismic changes in health care in the United States and the myriad questions that remain unanswered, this vision — one that serves the greater good — makes me  proud and excited to be practicing medicine in this era.

Daniel Yadegar is a cardiologist. This article originally appeared in The Doctor Blog.

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