By Brenda Gazzar
Code Wack Podcast, December 21, 2020
Featuring Dr. Susan Rogers, new president of Physicians for a National Health Program. Dr. Rogers is recently retired from Stroger Hospital of Cook County, Illinois, but continues as a volunteer attending hospitalist and internist there. She is an Assistant Professor of Medicine at Rush University, where she is an active member of the Committee of Admissions. She is a Fellow of the American College of Physicians and a member of the National Medical Association.
Why did a man in his 20s die from a totally treatable disease? How do social determinants affect patients’ ability to get to doctors appointments or buy prescribed medicines? Host Brenda Gazzar and Dr. Susan Rogers, new president of Physicians for a National Health Program, discuss how essential it is to acknowledge the role inequities play in health care and to stop blaming patients.
(10-second Talk back music)
Welcome to Code WACK!, your podcast on America’s broken healthcare system and how Medicare for All could help. I’m your host, Brenda Gazzar.
Dr. Susan Rogers is the new president of Physicians for a National Health Program. She spent much of her career at public hospitals in Chicago in order to treat African American patients, many of whom faced economic hardships and systemic racism. Her experiences solidified her view that Medicare for All is an important step in the battle for healthcare equity in America.
(5-second stinger music)
Some of Dr Susan Rogers’ most rewarding relationships have been with her patients at a primary care clinic at Cook County Hospital, a public hospital in Chicago. That hospital was later replaced by the John H. Stroger, Jr. (pronounced Stro-jer) Hospital of Cook County. One of her most memorable patients was a Tuskegee Airman, among the first African American military aviators in the U.S. Armed Forces.
(sound of airplane flying overhead)
Rogers: He kind of reminded me of my father… and he was a remarkable man and what he had gone through after, you know, the war. He had a difficult time because the GI Bill did not reward Black GIs at all. They could not get the mortgages. They could not get the training programs. He was a Tuskegee Airman, but none of those airmen were allowed to get into the commercial aviation system at the time so his struggle, after that. …Even after I left the clinic, he would still call me every Christmas.
(sound of telephone ring)
It was sad because I knew that one day he wasn’t going to call me because he was close to 90 at that point. And one day, I didn’t get the call and I called his wife and so she told me. That’s why I did that, I knew I was making a difference. I wasn’t just treating hypertension because the books said give this medicine. It was a very personal journey.
Dr. Rogers treated another patient whom she vividly remembers today because of what she learned from her story. The patient was a young woman who had diabetes and was overweight.
Rogers: She drank probably two or three liters of pop a day. That was of Coke.
(sound of soda pop fizzing)
So it was the caffeine, it was the sugar, it was all that. Of course, her diabetes was not controlled. And it was very frustrating, trying to take care of her, because she always came in with high blood sugars. And she would say, “I know I have to stop drinking all that pop and this and that but what else can I do?”
And I became just very frustrated and I didn’t know how to deal with that because I felt like I wasn’t the right doctor for her because I couldn’t figure this out. I couldn’t get her to change. And then it took me a while to understand that this was probably the only enjoyment in life she got — was from drinking this Coke. And when you think about it, that’s very sad that her life was such that this was, you know, how she survived. This is what helped her survive…Sometimes it’s drugs, it’s drug abuse and alcohol that help people survive. Sometimes, it’s something that looks so benign like a 2-liter bottle of Coke.
It became clear to Dr. Rogers that our healthcare system often doesn’t accommodate patients’ individual needs. She once heard from a chief resident about the case of a young man who had inflammatory bowel disease, which can be incapacitating but is treatable with intensive treatment and follow-up.
Rogers: He ended up not following up with appointments and not coming in for medications. And some of the medicines were IV, and all this, and he ended up dying before he was 25 from a totally, totally treatable disease. And he had access to that at county, but because of the life that he was living…What she found out, the chief resident as she looked into this because he had missed appointments, it turned out that his sister had died and he became the guardian of a 3-year-old. So this is a young man in his early 20s, who isn’t really working, who now has a 3-year-old, with a medical problem that requires intensive treatment that he wasn’t able to access because of this other part of his life.
To me, that was so incredibly sad and nobody knew about it because everybody just (thought) “well, he just misses appointments. He doesn’t care. He doesn’t take his medicine because he doesn’t care.” And I’ve always said patients do care. It just might not be a priority because of what’s happening in their life and other things and if you don’t ask about that, you’ll never know.
But that was a tragic story that never, ever should have happened…Everything that could go wrong went wrong. You know, there’s millions of stories like that and yet he was blamed for not making appointments and for not taking his medicine. I saw those stories and that’s what kept me there.
While clerkship director for medical students on rotation, she worked to educate students about how the conditions of patients’ environments affected their medical outcomes.
Rogers: Many white students have no idea. You know, their frame of reference is totally different. Why aren’t they taking their medicine? Well, you know, I’ve yet to find a patient who chose to be short of breath rather than take their medicine. So there’s reasons why people don’t… so teaching them about the social determinants of health, and for them to see firsthand how this impacts health outcomes. People aren’t able to pay the copay for their medicine, they’re not able to get to the pharmacy to get their medicine for whatever reason, there are a variety of reasons, diabetics can’t eat right because there’s no grocery store in their neighborhood. You know. What is labeled fast food swamps, that’s what’s there. It’s a grocery desert but a fast-food swamp.
And so, to see these impacts firsthand, you see the inequities that are there. And again, it goes back to life. Many people have no choices in their lives.
Another issue is that pain is often undertreated in Black patients. They’re not given prescriptions for opioids to control their pain at the same rate as white patients. As a result, Black patients weren’t affected by the Opioid crisis like white patients — and many pharmacies in Black neighborhoods didn’t stock morphine or other painkillers.
Rogers: So if you ran out, you may not be able to get it that day, and cancer pain is incapacitating. So there are a lot of those other issues that people in other neighborhoods don’t even think about.
Helping such patients is largely why Dr. Rogers is involved today in the fight for single payer healthcare in America. In fact, when she started her training at Cook County in 1979, the hospital functioned almost like a single-payer, Medicare for All system, she said.
Rogers: We never asked about money. I don’t even know if you came in with a million dollars in your pocket for you to be able to pay for anything, because there wasn’t a cashier. We were funded by the county but when you saw somebody, you decided what they needed, what medicine they needed. The medicine was free. There weren’t even copays when I started there. If you needed your gallbladder out, you got your gallbladder out. It wasn’t a question of whether your insurance would cover it.
There were some downsides to it because It was underfunded and we were overwhelmed with volume but we had phenomenal physicians there and being in the department of medicine, there were a lot of like-minded physicians, who were there for similar reasons. They wanted to take care of this patient population. That’s where I first heard about single payer and the PNHP.
But with time, the county hospital’s financing changed, complicating patient access and care. Dr. Rogers retired from Stroger Hospital of Cook County in 2014 but continues as a volunteer attending hospitalist and internist there.
Rogers: We have now started with Medicaid and managed Medicaid, which has networks, and there are barriers to getting care because of those networks….Before, if a doctor took Medicaid you could go, but now you have to have a doctor that not just takes Medicaid, but also is in your network. And then there’s a lot of specialists who will not see Medicaid because the reimbursement is so low. So a lot of the patients that we see now are not able to get some of the care that they needed.
Dr. Rogers believes that Medicare for All would improve healthcare access for all. But she notes it will take more than that to tackle socio-economic inequities.
Rogers: It’s not a panacea. It’s not going to solve the problem but at least it can help address the problem of access. But the stewards of the system have to make sure that the structure does not succumb to the mechanisms that contribute to continuing structural racism.
So right now we have a system (whereby) no one wants to treat poor people because you don’t make any money, and that’s the whole point of health insurance to make money. And it’s not just health insurance. You’ve got these hospital corporations. Here in Chicago, there’s a hospital, Mercy Hospital, on the south side that is part of a huge hospital group that is sitting on billions of dollars in endowment. But this hospital’s going to close because their payer mix is mostly Medicare and Medicaid. It’s not a lot of private insurance, so they’re not bringing in enough money. And so that’s going to leave this area as a hospital desert. Where are people going to go? There’s no obstetrical or prenatal care in this area if that hospital closes. Going 15 miles for a routine visit may not be a problem but if you’re in labor, that’s a big problem.
That is a big problem. Thank you Dr. Susan Rogers, president of Physicians for a National Health Program.
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