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Oby: From the campus of Harvard Medical School, this is ThinkResearch, a podcast devoted to the stories behind clinical research. I'm Oby, your host. ThinkResearch is brought to you by Harvard Catalyst, Harvard University's Clinical and Translational Science Center, and by NCATS, the National Center for Advancing Translational Sciences.

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What happens when the individuals most negatively impacted by a disease are not being screened? Racial disparities and prostate cancer screenings are persistent, as Black men are both under-screened for prostate cancer while having an increased incidence of prostate cancer and mortality in comparison to white men.

In a recent episode, "The NFL and Community-Engaged Research," we spoke with Dr. Alicia Whittington, assistant director of engagement and health equity research at the Football Players Health Study and a board member at the Augustus A. White III Institute for Health Care Equity. Today we are joined once again by Dr. Whittington and a second Augustus A White III board member, Dr. Jacques Carter, a physician at Beth Israel Deaconess Medical Center and previous medical director of the Prostate Cancer Screening and Education Program at Dana-Farber Cancer Institute.

Welcome to the show, Doctors Carter and Whittington. We're really excited to have you here and have this discussion. First, Dr. Carter, you are currently an attending physician at Beth Israel Deaconess Medical Center and an assistant professor of medicine at Harvard Medical School, while doing work in health equity. Could you walk us through your career path?

Jacques Carter: Sure, I'd love to. I grew up in Washington, DC, and always thought I was going to do something in medicine or public health when I was a young person in grade school and had a great interest in sciences. And I went to Howard University in Washington, where I was actually a psychology major because psychology majors were in vogue at that time.

And when I got out, instead of applying to medical school because I didn't think I was ready, I got a job working in public health in Washington. And I worked for the Department of Public Health as a sanitarium, which is a fancy name for a health inspector. I did mostly environmental health work-- air, water, food, sanitation. And because I had a degree and most of the other folks in that division did not, I was able to advance fairly quickly.

In DC, everybody is important. When anything comes from the Congress that's important, you have to act on it. And at the time, the city was controlled by the Congress. It still is, but then even more so because they had no home rule. There was no mayor in DC. You had a board of commissioners. So when a congressman or senator complained about anything in the city, the wheels started to turn, and things got done.

And I wrote many, many reports that never had my name on them that went to some senator on the Hill. As I started to do the work, I thought, maybe I'm not going to be a doctor. Maybe I'll be a public health specialist. That's what I really thought I was going to do. I was impressed with some of the people I wore with and the administration there in DC, and I thought maybe I'd get some graduate work in public health.

And it just so happens that I went to a meeting in Minneapolis having to do with waste control, since I was chief of that division. I had a chance to meet with a person who ran the department for the MPH program at University of Minnesota. He reviewed my record from discussion and thought that I did not have enough sciences. And so he said, if you want to get into this program, you got to go get more sciences, OK?

So I went back home, of course, and looked around for where I wanted to get these sciences and ended up getting courses at George Washington University. They had a program in environmental health. Initially, I just took a couple of courses-- one in malariology and another in tropical medicine. And then I just took the whole core program and got a second degree, actually, in environmental health.

And because of where that course was taught, it sort of changed the trajectory on what I was going to do in my life. Because if that had been taught in an engineering program, then maybe I would have stayed in environmental health. But because it was taught in the medical school from a paramedical standpoint-- not so much from engineering-- now I wanted to go to medical school.

And although I had applied to lots of schools of public health, including the one here on Huntington Avenue, one in New Haven, and of course Minnesota, and I got in-- I didn't get into New Haven, but I got into Harvard and Hopkins and Minnesota. And I actually put those things on hold because I'm going to medical school now. And I actually wrote all the directors of the school, saying that I would look at that again when I finished my four years.

And of course I finished my four years, and I'm thinking all the time now I'm going to be this outbreak kind of a doctor-- stomping out crazy outbreaks of Ebola and some weird things, some parts of Africa or Asia. And when I finished my four years of medicine, I again put off the schools of public health because I wanted to do a residency.

So by the time it came time for me to actually matriculate at a school of public health, my application was so old I had to go back and redo it. But I knew I was going to go to Harvard. Coming to Boston to train took me out of the Baltimore, DC area. Because I could have gone to Hopkins for my residency. And I think if I had done that, I never would have left my home area. I would have been somewhere in that sphere.

So it brought me here and got me involved in public health activities. I started doing work in health equity. I went to a tea put on by the dean of students at the Harvard School of Public Health. And she was going around saying, what are you doing in public health? So she got to me and she said, so what are you doing now? I said, well, I'm working at Beth Israel Deaconess. She said, no, what are you doing in public health?

And I scratched my head, and I thought that I wasn't doing some of the stuff that I planned to do in public health. I was a clinician. I was taking care of patients and teaching medical residents and medical students. But I wasn't really doing some of the things that I thought I should have been doing in public health. So I said, well, let me get going.

So I applied for a position on the board of health in Brookline. I lived in Brookline, and I took care of a lot of Brookline employees in my office down in Brookline village. So some folks spoke up for me, and I actually got one of these five spots on the board of health. And they're plum spots because everybody-- the town is loaded with medical people-- nurses, doctors, public health, social. Everybody wants to do this.

So I get on this board, and I'm the newbie. But I'm the only MD on the board at the time, and the person who was in charge was leaving, and they were hiring a new director. And it just so happens that Brookline wants to stop smoking in public accommodations. No smoking in town. First town to do it in the state. They were going to bring it in over time. It's going to be gradually in over five years to cut down on the pinch and the pain.

So I got asked by the then-chair, who said she was going to be out of town. I had no idea what I was walking into. So I walk into the meeting in the high school, and the place is packed in there and there are signs-- save my job, you want to put me out of business, and all this kind of stuff. And these are all the bar owners in town on it that all the business is going to go to the nearby-- they're going to go to Brighton and Newton. Our bars are going to close. The restaurants are going to close. So people need to smoke when they're eating and drinking.

And it was sort of intimidating, in the sense that you had these people booing. A lady got up and she said, well, you know my daughter who-- she's eight, and she has asthma, and she can't be around smoke. Boo. I mean, it was you had to see it. I mean, this is a hostile environment. But in any event, I got up and I made my point, stated my case.

There was one bartender who said that he was going to be put out of a job. So when I got up, I said, you know, I care about the folks in the town. I care about you, too, as a bartender, and I think that I want to protect your lungs from sidestream smoke, and on and on and on. And so the role of health department is to do that kind of protection.

And when I left and they made the vote-- they actually made everything come in in the three months and no graduation. It was like, it's going to be done in the whole town. And they did it. It was tough for some of the owners because people had to come outside to smoke, but they couldn't smoke inside. We offered an option of having if you had a separate room with separate ventilation that only the smokers could be exposed to the smoke, and only one restaurant in town did that, and they never used it.

They had-- it's going to be a "cigar bar," they called it, because it was a bar. But they never used it for smoking because they were concerned about building it and then having to have the rules changed a year later, and you just spent all this money for a separate system, and then all of a sudden the government changes the rules. So only one place did the building and never used it.

So that was sort of my first real foray into public health as a manager, an administrator, somebody who's leading the organization. And so a year later when the lady left who I substituted for that time, she actually nominated me to be the new chair. And in my third year on the board I became chair, and I had four more three-year terms as chair. So I did 13 years as chair of board of health in Brookline.

And every year you vote for a chair, and somebody would always say, well, we vote for Carter again. And I finally told the commission, I said, look, I'm not going to do it next time because I'm sure there's somebody on here who wants to do it, but they didn't want to say so. Because once you get nominated, I mean, it's a small little group. All of us are together. So if you say something about me, I'm going to know it.

So I finally stepped off after that time. I'd been there long enough. I'd done more work in public health in the town of Brookline, dealing with all kinds of issues in a small town with a lot of people who like to fuss about stuff and complain. And so many, many things came to the board of health, and unlike a bigger city where your complaints-- nobody pays attention sometimes-- in a small town, somebody is going to pay attention because that person is at the door of the health commissioner, knocking on the door-- or calling with the personal telephone number saying, you've got to do something about this.

But that was how things went, and I actually enjoyed that. I was always at meetings, and we had a public health leadership award which would give out to some prominent person in town every year. And of course, I pushed it off of myself as being the person who shouldn't get it because I'm the chair of the board. So when I get off, of course, I can't stop these guys from giving me this award.

But the funny thing about the award is that I go to the library where they're having my little party, and I'm getting this award. And then one of the members of the board of selectmen-- who had been around for years-- and she walks up. She said, you know, I didn't know you didn't work for the town. Because I was at all the meetings-- every night, every day, I was at all these meetings there. I don't know how I kept a job. But she said, I thought you worked for us. I didn't know that you were a volunteer.

But the town was full of volunteers. Got all these volunteer boards. Some people take it seriously. Some people are very tough with their roles. Other people try to be nicer to the residents. But there are a lot of boards in town, and that public health board was the plum board. I was certainly happy to have taken that. In fact, for the longest time I was the only person of color in any kind of leadership role in the town, even though it was a volunteer leadership role.

But that was sort of how I got going again in public health after spending time working on some clinical research and other things that was not directly related to public health. And it brings you face-to-face with health equity issues.

Oby: Thank you for walking us through your career and the volunteer work you did and so many different aspects of your career path. But what inspired you to work in health equity?

Jacques Carter: I'll tell you, it's another one of these things that falls into your lap. I have a good friend who works at Dana-Farber Cancer Institute. So I got asked one day to participate in this Massachusetts Prostate Cancer Symposium, which they have every year in May. And this, I think, was the second one they'd had. And I got to ask to run a workshop on prostate cancer and African-Americans.

I take care of African-American patients-- a lot of men. So I figured, this is a breeze. I'm going to go to this workshop, where I fully expected there'd be 10 people listening to me talk. And I rolled into this room, and it was packed. And they had a camera sitting in the middle of the crowd, and so two of us are sort of moderating this program. It was the minister from Roxbury or Dorchester, who the prostate cancer survivor, and me.

And I'm looking at the front row and there's Bill Owens, one of the senators from Roxbury-- one of them-- had been a senator for a long, long time, and Charlie Austin, who was a news anchor on WBZ. All these survivors-- seeing all these folks and the room being packed like it was with a lot of health professionals-- it made me know that there was something different going on here. And prostate cancer, which has the worst disparities of any cancer among any group-- prostate cancer in Black men, compared to white men, actually has two and a half times the mortality.

So that just to me just made a lot of sense that I'd be doing some work in that sphere. And the big piece is that because I did that talk and that symposium number two back in, I don't know, 20-plus years ago, I got asked to do it again the following May. And I said fine, I'll do it again. But this time they said they want you to deal with prostate cancer in minorities.

Now, that's a little different, because folks have different risk factors and different morbidity rates and all. So that was a little tougher, but it made me start to look at different folks and how different kinds of cancers impact different groups differently, how you have to make sure that when you're dealing with Black folks that you've got to separate out the Haitians from the Jamaicans, and they could all have different cultural pieces that impact how they deal with health issues.

You look at mortality-- infant mortality among the groups-- you can have this sort of monolithic Black group, but then you get into that-- different groups have different kinds of mortality. So you have to be careful how you look at folks of color. But anyway, I started doing that. And because-- one little other story-- because I was doing the symposiums, one of my friends who worked at Dana, they wanted somebody to work doing some prostate cancer screening in the community.

Because Dana had recognized these huge gaps in mortality between Black men and white men-- 50% more incidents, but two and a half times the mortality with prostate cancer and Black men. And they were getting it at an earlier age. So you got younger patients getting prostate cancer, and they're dying a more aggressive disease. And they recognize that.

I have to give kudos to Dana because they didn't have to do that. They are a treating institution. It's not to them to go out and find the cases. But somebody in community benefit at that institution recognized that there was a huge disparity, and they were willing to put some money into it, put some effort into it. And there was some money coming from Gillette, the razor blade company, and Gillette decided to sponsor this van.

So I, as the medical director, and one of my good buddies-- my good buddies now-- we were just working together in the beginning, but he was the educator and navigator. And we had a whole team-- somebody driving this big 40-foot RV called the Blum Family Van, and we had me working in the back. We had people drawing blood.

So we actually went out and we worked with community organizations. So a church would call us and say, we want to have a prostate program. Then we've set up the time, we've pulled the van up in front of the church, and everything was self-contained. And they would get the people to come on the van and we screen. And we did that for 10 years-- I did it for 10 years.

And through that time we educated and screened about 5,000, 6,000 men. All over Boston, down on the Cape-- we even went down to Newport with the YMCA down there. But we educated and screened a lot of people and the hope, in the process, saved some lives. But that particular focus on disparities led me to work with a group called PHEN, P-H-E-N, which stands for Prostate Health Education Network.

And a guy named Tom Farrington started that. He had prostate cancer and he wrote a book called Battling the Enemy Within. And he started PHEN with the support from Dana-Farber. So Dana allowed them to have the meetings in the boardroom once a month-- a support group meeting for men-- and this was geared to African-American men, but anybody could come. It was all mixed, but it was geared to those guys because that was the disparity.

And I started because I was working with the Blum Family Van as this Prostate Cancer Screening and Education program at Dana. I felt somewhat obligated to show up to the support group meeting. And like anything else, you go three or four times, all of a sudden you're part of the meeting. So it got to the point where at every meeting I was asked to and counseled the newly-diagnosed men.

And we take them into a separate space-- sometimes one, two, sometimes four, five. And we would show them a video from the NIH about fighting prostate cancer and answer all their questions. And that became part of the routine for years. We did that.

And again, that was in men's health prostate cancer, which I did a lot of. I did a lot of other work in other cancers too, with women and breast cancer and other things, but that was a focus that I still have today. I still do the Mass symposium every year. I did it last month.

Oby: So Dr. Carter, you used to be the medical director of the Prostate Cancer Screening and Education Program at Dana-Farber Cancer Institute, which you were just talking about. Can you talk a little bit more about the work-- how that work ties into health equity? You started to talk about it, obviously, with the group you were in, but if you have anything else you'd like to share with us.

Jacques Carter: I'm a believer in the fact that if you put it out there in the right way, people get educated. But one thing about the PHEN program is that we went to Washington every September, prostate counseling. Every September we had a big program in DC, on the Hill, sponsored by the Black Caucus. And they put us up and we had a room in the capital and we'd have people come in and talk.

And at one point, when a pretty big study was done-- it was called a PLCO study. It was dealing with prostate cancer, ovarian cancer, and a couple other things. And they looked at prostate cancer therapies and treatments over the years, and they ended up sort of saying that it made no difference whether you got screened or not, in terms of mortality. And that study came out and said therefore, men shouldn't be screened.

This is from the US Preventive Services Task Force, which is to folks who do primary care medicine, it's like the Bible. They sort of tell you check somebody's eyes, don't check eyes. Change your diet, don't change the diet. Treat the cholesterol, don't treat it. And they came out and said, no screening. So guys heard that. They heard the fact that the government says, no screening. Doesn't make any difference.

And that was a big mistake, because what it led to was the fact that men-- especially Black men-- don't want to be screened anyway. They want to stay as far away from the doctors as they can. And so now you're giving them an excuse, saying, hey, it's legitimate. No need to screen. No need to have a digital rectal examination. Not doing that to me, doc. I don't need that anymore.

And then we saw-- as that came down-- we saw that we started to have men presenting again with more advanced prostate cancer. We had sort of dropped the numbers by getting guys screened and picking up early cancers. Now, the big argument with screening everybody on population-based screening is that you pick up a lot of guys who have sort of insignificant prostate cancer. They got prostate cancer, but if you didn't tell them they had it, they wouldn't know it, and they'd die of a stroke or heart attack or something at 85 and never knew they had it.

So we sort of picking them up early and then these guys now want to be treated. Even sometimes when you say, hey, you don't have to be treated, they want to be treated, and they have all the complications associated with the treatment, for a lot of guys. Surgery, there's some incontinence, and a whole bunch of things, impotence and on.

And so stopping the population-based screening made a lot of sense. At least you want to have people who have serious disease and not sort of this low-level disease that's never going to bother them. So it's like throwing out the baby with the bathwater. In this case, all those Black guys got tossed. They were in the basin and they got tossed out, because they were in with white guys who had minor disease.

And we started seeing more and more of that. And we started to petition the task force. And I actually moderated a session on the Hill with the then-chairman of the US Preventive Services Task Force, who at the time was a woman from the UCSF, and a woman from Dana and a woman from a cancer institute out in Washington. There was three women on the panel and me, and we stated the case at that point that there should be some exceptions for men at high risk. And that included all African-Americans, or men of African descent, and any man who has a family history of prostate cancer.

So if you had a white guy whose brother had prostate cancer, he's at high risk, plain and simple, the truth. And they finally put out a proposal-- this was done a couple of years ago-- that men at high risk should have a discussion and they changed the grade from a D-- that is, there's no benefit at all-- to a C, that there's positive benefit for screening these high-risk guys.

And that is pure equity issues. Those are issues that deal straight up and down with you've got a group who's at high risk. If you don't screen them properly, they get lost and they end up with bad disease, and the numbers look even worse. So that's the political piece of this thing. It's always little pieces, you know, that you get into in public health. You've got the political piece, administrative piece, you've got science. You've got the ethical dilemmas and the whole thing, and that's what we have to deal with.

And this stuff goes way back. I mean, I've done lectures on disparities and how things started back in slavery time, even before that-- you can way back. There was a couple friends of mine-- name was Michael Bird-- Wilbur Michael Bird. He went by W. Michael Bird-- and his wife, Linda Clayton. They were both Black gynecologists, and they came to the Harvard to do MPH, and they had fellowships at Harvard School of Public Health.

And they did these two books called the American Health Dilemma, dealing primarily with disparities in health. Both books got nominated for Pulitzer prizes, but it all dealt with disparities. The American health dilemma is the disparities in health care and how we can straight that up and make folks have similar lifespans. And not have this huge difference-- in one zip code, you're a woman, you live to be 89, and another one, you live to be 69.

So there's a lot of work being done in this area, but there's already been much, much done-- excellent work that's been done-- to help deal with disparities in health.

Oby: Thank you so much. So for both Doctors Carter and Whittington, you are both on the board at the Augustus A. White III Institute. Could you briefly describe the goals of the Institute and how you got started there?

Jacques Carter: The Institute-- the brainchild of attorney Macey Russell-- who's done some disparities work for a long, long time in the legal profession-- and Kirk Taylor, who's a neurologist, and myself. And we had talked about it for a bit, but Macey was the impetus behind getting it off the ground. We shopped it around to medical institutions to get somebody to be interested in it. Macey was on the board here at BI Deaconess, spoke to the leadership, and they sort of were supportive, but nobody ever got it off the ground.

And Macey pulled together a group, including Alicia and others, to be the board for this Institute. And then the whole idea was to serve as a platform for being able to look at all the stakeholders that have to do with health equity in this country. That is the Red Cross and the March of Dimes and all those folks, but also institutions. All stakeholders in this and the public-- bring them all together and try to find a way to level the playing field, if you will, to deal with equity and not equality and how to make that the real deal.

And it was named after Gus White because Gus had done some work in that area over the years and done some writing in that area. And Alicia can talk about Dr. White-- that's her mentor. But I think that because Gus had done that we thought it was a good idea to name the Institute after him and talk about some of the things that he talked about in his books over the years. And we're still trying to bring that all together, trying to bring together the various stakeholders.

If you are X organization and you're dealing with maternal and child mortality issues and disparities in that area, we want that information on our website so we can send it out to people who we deal with. And that actually helps the other organizations. And we want them to be stakeholders in what we do because we are not competitors.

We're trying to help improve disparities in this country. And if we have to swallow our pride and have somebody bigger than us doing something, then do it. Because that's going to help the people that we are focused on here.

Oby: Can I go back just one moment? You mentioned equality and equity and really reaching equity. Can I ask you or Dr. Whittington to speak to that a little bit for those who may not know the difference?

Jacques Carter: Dr. Whittington?

Alicia Whittington: Sure. So thanks so much for having us on today and for having me back. So the difference between equity and equality-- is fairness under all circumstances, and equality is equal. But when you think about all of the different challenges that arise just being a human, and as Dr. Carter said, in different zip codes, there's lots of different things going on. So for example, there may or may not be a clinic, or some sort of resource, in a particular area versus another one. And so things like transportation-- they have an impact on access.

Jacques Carter: Part of it is that to have equal outcomes sometimes requires that I give you a little bit more than I give her. Now that's equity. I can say, OK, everybody gets $100 bonus. OK, and you get $100 bump. But maybe you in your circumstances need $200. Equality-- everybody gets 100 bucks, but it's not equity, trying to bring you up to where somebody else is.

Alicia Whittington: Well, as Dr. Carter mentioned before, some of the historical pieces-- so when you look at that and you see how different cross-sections throughout society were excluded, marginalized, and it was intentional. And then even when trying to, let's say, become a physician-- I'm sure Dr. Carter could speak even more on this-- the number of individuals in the room making decisions coming up with best practices, standards of care-- it makes a difference when you have diversity at the table-- diversity of thought, diversity of everything.

I think I was a social justice warrior before I even turned 10. Because when my mom would take us to the doctor I would notice things that I thought weren't fair. And so I would start asking questions, and when you ask questions, you just start to get answers that don't make sense to you. And so I always said, well, I want to change these things.

I was also that person that, when I noticed something, I would petition before my parents why we should switch provider. And it's brought me here and it's keeping me here.

Oby: Dr. Whittington, did you want to speak to the Institute a bit as well?

Alicia Whittington: Dr. Carter, when you mentioned being the newbie on the Board of Health-- I felt like the newbie when Dr. White asked me to serve on this board. And so just being around them every single meeting-- and it takes a lot of work to put something like this together-- but every single meeting was so amazing to me because I learned something.

And even though the individuals he mentioned were all Black, but we have diverse perspectives on things. I won't say that I'm in a different generation than, Dr. Carter, but I might be.

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And so it's just there's different issues that are brought to the forefront. And I appreciate his perspective all the time. In fact, he is one of my mentors as well. Now, he doesn't know it, but I also ask him lots of questions. So thanks, Doc.

Jacques Carter: Anytime.

Oby: So the Institute conducted a webinar entitled "The Healing Power of Music" last year, led by Dr. Lisa Wong, a pediatrician and musician who is a strong advocate for using music in medicine. Can you talk about how music can be used for healing?

Alicia Whittington: If I could just first start by sharing how this webinar came to be.

Oby: Please do.

Alicia Whittington: So our wonderful group of board members met several times, and we were coming up with programming. How do we bring people together from all professions and just different interests and talk about health and things that are important? So a few years ago, when Harvard Medical School used to have the Talks@12, Doctor Wong gave this brilliant presentation on how music affects the brain.

The lecture was just absolutely incredible, and I really identified with it because I'm also a violinist. She talked about growing up and studying music. I'm like, oh my gosh, I have some of the same experiences. But then seeing her as a pediatrician who's still a musician-- it's just amazing.

And so it just came up in conversation and we said, you know, what about the connection between music and healing? And then it went from there, and then we started adding other experts. We had Dr. Gebhardt.

Jacques Carter: Dr. Gebhardt, yeah.

Alicia Whittington: Dr. Kirk Taylor was the moderator and then a couple of other individuals. Such a fruitful discussion. And part one, we had so many registrants. It had to have been close to 250 or so. And the conversation was so incredible and everyone just seemed like they wanted more. And then we scheduled a part two that was also incredible. And to hear the different perspectives was just wonderful.

Jacques Carter: I agree. It was a great program. And I think anytime you can give folks something that is calming, something that is soothing, something that makes them think a bit, and done in a way with doctors, there are all-- I mean, except for the two musicians, I mean, everybody else was-- Kirk's a doctor-- a neurologist, actually.

There was also a pianist. And so we had all these musicians on, along with a couple of professionals-- a guy who works a church down in Texas, done a lot of spiritual stuff, and a conductor and musician in Chicago. It was just a beautiful program, and it's available on our website, aawinstitute.org-- it's right there.

Oby: How can a health care center or an individual facing health inequity access the resources the Institute provides?

Jacques Carter: Well, we have a website, and the website will refer people to other people. Say if you're dealing with something with maternal and child health, well, our partner in this and a stakeholder is the March of Dimes. We had a huge benefit program in November for the March of Dimes called Black Tie for Babies. It was a black tie event. We raised a half million dollars for the program, and out of that money will be funding for a NICU at Boston Medical Center and some other things.

And we're doing that with as many organizations as we can. Dr. White spoke about the groups that would get disparate health care and he-- and if you're in one of those 13 groups, even if it's unconscious, you're going to get that. If you walk into the emergency room or a walk-in clinic or an office, if you're Black, you're going to get disparate health care.

If you are Latino, you're going to get disparate health care. If you're a woman, you're going to get disparate health care. If you're fat, you're going to get disparate care. If you're gay or lesbian, you're going to get disparate health care. So those are built-in attitudes that we have to change.

And one way to do that, I think, is to try to prepare people for the encounter in the emergency department. That sounds crazy, but you want to prepare them. So you got to give them a cheat sheet. You're going in with abdominal pain, these are some questions you might want to ask your doctor.

What typically happens is a person goes in, they get examined, the doctor says something, and they come out, and you say, what did the doctor say? Well, he said, take these pills. Oh, what are the pills for? I don't know. He just said take these pills.

So you'd like to sort of have people be informed when they come out of that encounter. Even though they are sort of sick and not feeling well, but you want them to go in to have good questions so they can ask and be able to talk about the encounter when they come out, and more than just, I got these pills, and I'm supposed to see my doctor in two weeks.

So for those groups that I mentioned-- those 13 groups-- we're putting together little blurbs. If you're gay or lesbian, we got a little blurb. These are the health care issues that are important to ask your doctor about. And we're working on that right now.

Oby: Amazing. Thank you both so very much. It has been such a pleasure to have this conversation with both of you.

Alicia Whittington: Thank you for having me.

Jacques Carter: Thank you.

Alicia Whittington: Thank you for having us.

[music playing]

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