Philly cardiologist: When doctors focus on listening, low-income patients benefit
Physicians, nurses and other health practitioners can make a big difference by learning more about the lives - and challenges - of the patients they treat before prescribing medication.
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For the last year and a half, I have spent each Thursday working and teaching in a cardiology clinic at Temple University in North Philadelphia. It has been an eye-opening experience.
As a cardiologist who is focused on prevention, I have seen the remarkable health benefits that can occur from making lifestyle changes such as eating more vegetables and adding exercise into your daily routine. Diabetes, weight, and high cholesterol are helped by such changes.
However, there is one health condition that almost always requires medication: having high blood pressure. Hypertension is often genetically determined and medication can be critically important in managing the condition.
While working in North Philadelphia, I've noticed that too many people do not take their blood pressure medications regularly, miss important doctor's appointments, and are overweight and sedentary. The unique challenges facing this population can lead to medication non-compliance and an inability to change one's lifestyle. To improve this problem, I looked for insight from two recent studies.
The first study looked at medical practices in New York City, where many low-income individuals with high blood pressure were not taking their medications. Here is what the researchers found:
People did not take their medications when doctors spent more time talking about the medication rather than building a relationship with their patients.
In African Americans, there was an eight-fold increase in not taking medications when no one addressed sociodemographic circumstances. When difficulties with issues such as money and transportation were discussed, more patients took their medicines.
The risk of non-compliance was increased 1.5 times when a patient felt the doctor was a poor communicator.
In the second study, researchers measured inflammation and early signs of vascular disease in people living in food deserts. A food desert is a low-income location with poor access to healthy food. An estimated 23.5 million people live in such deserts across the United States. The researchers examined food deserts in the Atlanta region. Here is what they found:
Areas with poor food quality, low access to healthy foods, or more fast-food restaurants were associated with obesity and with diabetes risk.
The relationships between living in a food desert and cardiac risk, as measured by inflammation, was driven more by income rather than by access to healthy foods.
The study demonstrated that areas of food deserts, low income, and low-access had a higher proportion of African American residents. These neighborhoods have been reported to have more fast-food restaurants, fewer supermarkets, fewer healthy options, lower levels of social cohesion, and worse walking environments. African Americans formed a higher proportion of those with low income, a key driver of increased cardiac risk.
People living in food deserts had a decreased fruit and vegetable intake, and a higher prevalence of hypertension, smoking, higher body mass index, diabetes, and 10-year risk for developing heart disease.
These two studies clearly demonstrate that patients living in a low socioeconomic area do not take their blood pressure medications and that patients are overweight because they live in food deserts. But the more important message that I took away from the studies is that physicians, nurses and other health practitioners can make a big difference by learning more about the lives — and challenges — of the patients that they treat before prescribing medication.
Listening carefully and with empathy is crucial. For example, listening to a patient's challenges may lead to discussion about the many inexpensive generic blood pressure medications that are available. Learning more about a pateint's community and helping them find ways to become more involved may help with chronic conditions, such as high blood pressure or cholesterol and diabetes. For example, urban community gardens may be especially beneficial for lower-income residents, providing a space to grow fresh produce and experience relaxation and physical activity.
These lessons are not unique to an urban population, and there are no easy answers. The messages from these two studies support the need for a collaborative partnership between health care practitioners and their patients; this relationship needs to be much more than just a prescriber of medications to someone with a chronic medical condition.
David Becker, M.D., is a runner and a board-certified cardiologist with Chestnut Hill Temple Cardiology in Flourtown, Pa. He has been in practice for more than 25 years.