♪ ♪ ♪ ♪ >> Crossley: WELCOME TO "BASIC BLACK."

SOME OF YOU ARE JOINING US ON OUR BROADCAST AND OTHERS OF YOU ARE JOINING US ON OUR DIGITAL PLATFORMS.

I'M CALLIE CROSSLEY, HOST OF "UNDER THE RADAR," 89.7.

TONIGHT: THE OTHER "C"-- CARING FOR YOUR HEALTH DURING A PANDEMIC.

WE, LIKE YOU, ARE DEALING WITH THE EFFECTS OF THE CORONAVIRUS PANDEMIC AND ARE TAKING PRECAUTIONS.

WE ARE WORKING WITH LIMITED STAFF, AND OUR GUESTS ARE JOINING US REMOTELY.

FROM THE BEGINNING, COVID-19 REVEALED HEALTH DISPARITIES THAT ALREADY EXISTED IN COMMUNITIES OF COLOR, DISPARITIES THAT PUT THEM MOST AT RISK FOR INFECTION SPREAD.

DURING THE NEARLY TWO YEARS OF COMBATING COVID, LINGERING MISTRUST OF THE HEALTH CARE SYSTEM SLOWED VACCINATIONS AND FEARS ABOUT THE PANDEMIC LED PATIENTS OF COLOR TO DELAY OR AVOID MEDICAL CARE FOR DISEASES, LIKE CANCER.

DOCTORS ARE NOW ALARMED BY THE HIGH RATE OF ADVANCED DISEASE, ESPECIALLY AMONG AFRICAN-AMERICANS AND LATINOS.

WHAT IS THE LONG-TERM IMPACT OF THE DELAYED CARE?

JOINING US REMOTELY: DR. CHARLES ANDERSON, PRESIDENT AND CHIEF EXECUTIVE OFFICER, THE DIMOCK CENTER IN ROXBURY; DR. NAOMI KO, ASSISTANT PROFESSOR OF MEDICINE AT BOSTON UNIVERSITY SCHOOL OF MEDICINE AND A MEDICAL ONCOLOGIST AT BOSTON MEDICAL CENTER; DR. CECIL R. WEBSTER, JR., AN ADULT, ADOLESCENT AND CHILD PSYCHIATRIST AND PSYCHOTHERAPIST; AND MARK KENNEDY, SENIOR PROGRAM MANAGER IN THE CHRONIC DISEASE PREVENTION AND CONTROL DIVISION AT THE BOSTON PUBLIC HEALTH COMMISSION.

WELCOME TO YOU ALL.

SO, I WANT TO START THIS WAY: THIS IS SOMETHING YOU'VE HEARD ME SAY MANY TIMES AND YOU ALL PROBABLY KNOW IT.

IF AMERICA CATCHES A COLD, WE KNOW BLACK AMERICA'S GOING TO GET PNEUMONIA OR DEATH AS A RESULT.

THAT'S JUST AN OLD SAYING.

AND IT CERTAINLY SEEMS TO FIT RIGHT IN, IN THIS SCENARIO, WHEN WE TALK ABOUT DELAYED HEALTH CARE AGAINST A CONTEXT OF ALREADY EXISTING DISPARITIES.

BUT WHAT I WANTS PEOPLE TO UNDERSTAND IS WHAT WE MEAN ABOUT DELAY AND THE IMPACT AND I'M GOING TO START WITH YOU DR. ANDERSON.

TALK ABOUT A GOOD EXAMPLE OF WHAT IT LOOKS LIKE WHEN THE DELAY HAPPENS.

AND I KNOW YOU MENTIONED GLAUCOMA TO THE PRODUCER OF THE SHOW.

I WISH YOU WOULD TALK ABOUT THAT.

>> I THINK GLAUCOMA IS A GREAT EXAMPLE.

WHEN WE THINK ABOUT WHAT GLAUCOMA ASK, AT THE END OF THE DAY, YOU HAVE INCREASED PRESSURE IN THE EYE AND THAT INCREASED PRESSURE IN THE EYE IMPACTS THE OPTIC NERVE WHICH IS THE MAIN NERVE TO MAKE SURE YOU CAN SEE OUT OF THAT EYE.

INCREASED PRESSURE, NERVE GETS DAMAGED, ONCE IT'S DAMAGED THERE IS NOTHING YOU CAN DO.

TO MAKE SURE THAT NO ONE IS EXPERIENCING THAT DAMAGE YOU NEED TO BE MONITORING THE PRESSURE IN THE EYE.

SOMETHING AS SIMPLE AS DELAYING THAT FOR USE SEVERAL MONTHS, ESPECIALLY IF YOU NOW ALSO RUN OUTS OF YOUR MEDICATIONS, CAN LEAD SOMEONE TO BE IN A POSITION WHERE THEY'VE PERMANENTLY LOST VISION IN THAT EYE.

AND THAT'S JUST I THINK A REALLY CONCRETE EXAMPLE.

AND WE'RE TALKING, YOU GOT TO REMEMBER, SIX MONTHS INTO THIS PANDEMIC, 60% OF PEOPLE WERE DELAYING AND DEFERRING CARE.

SIX MONTHS AFTER THAT MANAGEMENT CAN DETERMINE WHETHER CAN YOU SEE OR NOT.

>> Crossley: DR. NAOMI KO, GIVE ME AN EXAMPLE OF WHAT IT LOOKS LIKE, THE IMPACT OF IT WHEN YOU DELAY CARE.

>> I REALLY LIKE THE GLAUCOMA EXAMPLE, WHICH WORKS FOR BREAST CANCER AS WELL, WHICH IS MY SPECIALTY.

WHAT WE DON'T LIVE IN IS A MODEL OF PREVENTION, WE LIVE IN A EPISODIC CARE MODEL.

LIVING IN THAT NETWORK IS NOT WHERE IF VALUE AND COST IS THAT WE SEE HERE.

WHEN BREAST CANCER, IF YOU ARE ABLE TO GET SCREENING MAMMOGRAM SAY OR IF YOU HAVE ACCESS TO A PRIMARY CARE DOCTOR, THEN IF YOU HAVE A QUESTION OR A SYMPTOM OR SOMETHING COMES UP, THEN SOMEONE WILL SEE YOU, AND YOU CAN GET THAT TAKEN CARE OF EARLIER.

HOWEVER, IF YOU DON'T -- IF YOU'RE NOT PLUGGED INTO THE SYSTEM AT ALL, AND SOMETHING COMES UP AND YOUR LIFE IS ALREADY CHALLENGING, IT CAN BE REALLY DIFFICULT TO GET CARE THAT YOU NEED.

AND SO PEOPLE WILL PUT IT OFF, OR THEY DON'T HAVE TIME AND THAT DELAY IN CANCER CARE IS DEADLY.

AND SO IF YOU DON'T GET A CANCER DIAGNOSED EARLIER, THEN THAT DELAY REALLY PUTS YOU AT MAJOR RISK.

>> Crossley: MARK KENNEDY, YOU HAVE SEEN A LOT WITH BLACK MEN WHO SMOKE.

BUTTING OFF CARE THAT -- PUTTING OFF CARE THAT REALLY MIGHT MITIGATE A SITUATION AROUND DIABETES.

>> YES, I HAVE.

AND I'VE HAD A LOT OF DISCUSSIONS RECENTLY ABOUT PERIPHERAL ARTERY DISEASE.

AND IF YOU THINK ABOUT WHAT THAT IS, AND WHO'S MOST IMPACTED BY THAT, IT'S PEOPLE WITH DIABETES, THAT SMOKE, AND WHEN YOU LOOK AT THAT FROM A GENERAL PERSPECTIVE, A LOT MORE MEN ARE IMPACTED THAN WOMEN.

AT THE END OF THE DAY, WHEN YOU LOOK AT CARE FOR DIABETES, WE KNOW OF COURSE THERE IS DIABETES SELF-MANAGEMENT SO WE'RE LUCKY IN THIS PARTICULAR CONTEXT THAT SOME OF THAT IS ACTUALLY TAKING PLACE AT HOME.

BUT WE ARE CERTAINLY SEEING A LOT OF TOE AND FOOT AMPUTATIONS, THAT ARE ARISING AS A RESULT OF THE TOPIC THAT WE'RE TALKING ABOUT HERE.

AND I THINK THAT THIS IS ONE OF SEVERAL CONDITIONS AND SITUATIONS WHERE THE DELAY IN CARE OR THE HESITANCY FOR PEOPLE TO GO BACK TO GET CARE IS CAUSING SOME VERY SIGNIFICANT ISSUES.

>> Crossley: NOW, DR. CECIL WEBSTER YOU AND I HAVE TALKED DURING THE COVID PERIOD ABOUT THE INCREASE IN MENTAL HEALTH CONCERNS.

BUT ONE OF THE POINTS YOU WANT TO MAKE CLEAR IS THERE IS A FALSE DIVISION BETWEEN MENTAL AND PHYSICAL ILLNESS.

AND HOW DOES THAT PLAY OUT WHEN WE TALK ABOUT DELAYED CARE?

>> WELL, THAT'S A GREAT QUESTION, CALLIE.

WE MAKE THESE DIVISIONS BETWEEN PHYSICAL AND MENTAL HEALTH FOR A LOT OF REASONS, MOSTLY SO WE CAN GET A BETTER UNDERSTANDING OF DISEASE.

LIKE WHAT IS IRRITABLITY, WHAT IS NOT FEELING SO MOTIVATED TO TAKE YOUR KIDS TO SCHOOL, WHAT IS MEANT BY YOU'RE NOT ABLE TO FOCUS AT WORK.

BUT REALLY WE HAVE ONE BRAIN, ONE BODY AND THE DIVISIONS BETWEEN FM AND MENTAL HEALTH ARE VERY USEFUL BUT VERY INTERCONNECTED.

IF YOU ARE STRESSED OUT WATCHING POLICE VIOLENCE ON TELEVISION, WE KNOW THAT CAN HAVE IMPACT ON BLACK AMERICANS, BASED ON DAVID WILLIAMS AND HIS WORK AT HARVARD CHAN SCHOOL.

THEY ARE TIED TO PHYSICAL AND MENTAL HEALTH.

>> Crossley: THIS STUDY "WASHINGTON POST" AND THE UNIVERSITY CREDIT HANDGUN CENTER, ONE OF DEN AMERICANS, DELAYING HEALTH CARED, THE HIGHEST RISK GROUPS WERE MEARCHTION AND LATINOS, WE SAID IN THE BEGINNING.

AFRICAN AMERICANS AND LATINOS CARE ABOUT THEIR HEALTH TOO.

LET'S TALK ABOUT THE DELAY.

PARTICULARLY SINCE YOU HAVE GIVEN EXAMPLES OF WHAT HAPPENS AS A RESULT OF THE DELAY.

I'M BACK TO YOU DR. ANDERSON, WHY HAVE SO MANY AFRICAN AMERICANS AND LATINOS ESPECIALLY DELAYED CARE?

>> IT JUST REMINDS US OF THE FRAGILE BACKDROP OF HEALTH AND WELLNESS.

WHEN YOU HAVE OTHER COMPETING PRIORITIES THAT YOU'RE JUG YOU LING, AND YOUR ATTENTION AND ENERGY REQUIRED TO DEAL WITH SOME OF THOSE OTHER COMPETING PRIORITIES, BECOMES GREATER LIKE MAKING SURE THAT YOU GOT FOOD ON THE TABLE, STABLE HOUSING, WHEN YOU ARE IN AND OUT OF THE HOSPITAL VISITING FAMILY MEMBERS OR DEALING WITH FAMILY MEMBERS DEALING WITH THIS AWFUL DISEASE, WE GOT TO REMEMBER THERE IS THIS WHOLE POPULATION THAT AS YOU SAY, THE REASON WHY ONE PART OF THE POPULATION IS LIKELY TO GET PNEUMONIA WHEN EVERYONE ELSE HAS A COLD, IS BECAUSE OF NOT HAVING REALLY THAT INALIENABLE RIGHT TO HAVE THE SAME SORT OF RESILIENCY AND I THINK THAT'S A HUGE COMPONENT OF THIS.

>> Crossley: DR. KO, YOU TALKED VERY SPECIFICALLY ABOUT THE BLACK WOMEN WHO END UP IN YOUR CARE AT AFTERNOON ADVANCED STAGE OF CANCER, BREAST CANCER SPECIFICALLY, WHO SAY, I'VE GOT TO TAKE CARE OF MY PARENTS, ALL THESE OTHER THINGS.

WHAT SOME RESEARCH SCIENTISTS LIKE YOUR SELF ARE CALLING SOCIAL DETERMINANTS OF HEALTH ARE WEIGHING IN ON THEIR OWN DECISIONS ON HEALTH CARE.

PLEASE EXPLAIN.

>> OF COURSE.

I HAVE SEEN SO MANY WOMEN WHO HAVE TOLD ME, I CAN'T BELIEVE THIS IS CANCER.

I CAN'T BELIEVE IT.

I JUST -- I DIDN'T REALIZE THAT!

LIKE OH MY GOD, AND THEY FEEL SO TERRIBLE ABOUT IT.

AND WHAT I THINK WE UNRAVEL IN OUR ENCOUNTERS IS THAT THEY'RE BUSY.

THESE WOMEN ARE TAKING CARE OF KIDS.

THEY'RE TAKING CARE OF PARENTS.

THEY ARE DOING WAGE JOBS AT TIMES, WHERE THEIR WORK IN, YOU KNOW, HOURS, MONDAY THROUGH FRIDAY, THEY DON'T HAVE TIME OFF.

THEY CAN'T TAKE THAT TIME OFF.

SO THEN WHEN SOMETHING LIKE THEY FEEL SOMETHING OR THERE'S A MASS THAT'S GROWING, THEY'RE LIKE AH, NO, THEY'RE IN DENIAL, BECAUSE IT'S SO MUCH EASIER TO SAY, IT'S NOTHING, I'M NOT GOING TO WORRY ABOUT IT, OR JUST THAT FEAR AND DENIAL IS JUST SO GREAT IN THEIR MINDS.

THEY FINALLY TAKE THAT EXTRA TIME, THIN THEY HAVE TO FIND A PRIMARY CARE DOCTOR OR GET THEMSELVES INSURANCE OR IF THEY DON'T SPEAK ENGLISH, IT'S REALLY HARD TO NAVIGATE THAT SYSTEM.

AND IT ENDS UP GETTING TO THE POINT WHERE UNFORTUNATELY, MANY OF OUR DIAGNOSIS HAVE COME THROUGH THE EMERGENCY ROOM, LITERALLY THE EMERGENCY ROOM.

THEY SHOW UP THERE AND IT'S JUST LIKE THE DOCTORS THERE KNOW WHAT TO DO AT THE EMC, THEY GIVE THEM APPOINTMENTS THE VERY NEXT DAY IN OUR BREAST CENTER AND SAY YOU HAVE TO SHOW UP TOMORROW.

SOMETIMES, IF THERE'S AVAILABILITY, WE WILL SEE THEM THE SAME DAY.

BUT IT'S A REALLY BIG TRAGEDY.

AND HOW WE FIX THAT IS WAY BEYOND OFTEN WHAT WE CAN DO IN JUST THE HOSPITALS ALONE.

THIS IS A SOCIETAL PROBLEM.

AND IF DELAYS FOR THESE WOMEN, THEY OCCURRED BEFORE COVID, YOU KNOW, BUT NOW WITH THE PANDEMIC, I MEAN, NOW IT'S INCUMBENT UPON US TO REALLY MAKE A DIFFERENCE AND REALLY MAKE A CHANGE.

>> Crossley: AND MARK, I WANT TO PICK UP FROM WHAT DR. KO JUST SAID.

SOME OF THIS FEAR EXISTED BEFORE COVID BUT A LOT OF IT HAS BEEN EXACERBATED AS I SAID AS THESE HEALTH DISPARITIES BECAME REVEALED DURING THERE PERIOD OF TIME AND THE FEAR HAS GROWN ACTUALLY.

YOU ARE TALKING ABOUT PEOPLE WHO ARE AT HOME SUFFERING RATHER THAN DEAL WITH A SYSTEM THAT HAS NOT INTERACTED WELL WITH THEM IN THE PAST.

>> YOU'RE ABSOLUTELY RIGHT.

AND YOU KNOW THE ISSUES OF CULTURAL INCONCORDANTCY AND LANGUAGE INCONCORDANTCY IF YOU WILL HAS EXISTED LONG BEFORE THE PANDEMIC.

SO PEOPLE WHO WEREN'T HAVING GOOD SUBSTANTIVE RELATIONSHIPS AND EXPERIENCES WITH THEIR DOCTOR PRE-COVID AREN'T GOING TO RUSH TO THE DOCTOR DURING COVID OR AFTER COVID, SO WE KNOW THAT'S EXTERNAL CASE.

THE OTHER PINT THOSE THAT I WANT TO BRING UP IS THE FACT THAT THERE IS AT LEAST SOME LEVEL IF NOT A DIFFERENT DISCAN CONNECT THAN I EVER IMAGINED BETWEEN AN ASSOCIATION WITH SYMPTOMS OR SOME TANGIBLE MESKS MANIFESTATION THAT THERE IS SOMETHING WRONG, VERSUS THE FACT THAT I DON'T FEEL ANYTHING, SO I DON'T REALLY THINK I NEED TO GO TO THE DOCTOR.

YOU EXACERBATE THE NEED TO WORK UNDER THE CONDITIONS OF COVID BECAUSE SO MANY PEOPLE ARE LOSING JOBS AND PEOPLE ARE FEELING MORE PRESSURE TO TAKE CARE OF THEIR FAMILY.

SO AT THAT POINT, IF YOU DON'T FEEL LIKE THERE'S SOMETHING WRONG, YOU'RE DOUBLING DOWN ON TAKING CARE OF YOURSELF AND YOUR FAMILY, YOU HAVE THAT -- YOU HAVE THAT ISSUE, IN ADDITION, WHEN YOU TALK ABOUT PEOPLE NOT SEEKING CARE.

WE KNOW THAT SOME OF THE THINGS THAT IMPACT PEOPLE OF COLOR MOST, DIABETES, A LOT OF HYPERTENSION, A LOT OF CANCERS ARE NOT SYMPTOMATIC UNTIL IT'S LATE IN THE GAME, OKAY, WHEN MEN TALK ABOUT CONDITIONS THAT IMPACT THEM WITH THEIR FRIENDS AND I KNOW I'M GUILTY OF THIS, WHEN I TALK ABOUT SOMETHING, I GENERALLY USE LANGUAGE LIKE, THAT WAS BAD ENOUGH FOR ME NOT TO BE ABLE TO GO TO WORK.

I TALK ABOUT THOSE THINGS IN THE CONTEXT OF MY ABILITY TO WORK.

AND IF I DON'T THINK THAT MY ABILITY TO WORK IS COMPROMISED I'M GOING TO CONTINUE TO GO TO WORK AND I'M GOING TO CONTINUE TO NOT SEEK THE PREVENTIVE CARE THAT DR. KO WAS TALKING ABOUT.

BECAUSE I DON'T KNOW THAT I NEED IT.

AND AT THE END OF THE DAY, WE HAVE LATE-STAGE DIAGNOSIS OF A LOT OF THINGS THAT COULDN'T HAVE BEEN PREVENTED WITH A MORE PREVENTIVE MENTALITY AS OPPOSED TO MORE OF A REACTIVE MENTALITY.

>> Crossley: AND DR. WEBSTER, I WANTED TO HAVE A PIECE OF THIS AS WELL, A LOT OF HISTORIC BAD TREATMENT BUT AS YOU POINT OUT THE SYSTEM IS SET UP TO PAY FOR INTERVENTIONS THAT ARE -- SEEMED MEDICALLY NECESSARY.

SO IF SOMEBODY CAN TELL THAT YOU HAVE A BLOCKAGE, FOR EXAMPLE, A HEART BLOCKAGE, OKAY, WE'RE GOING TO PAY FOR THAT AND MAYBE YOU CAN BE PERSUADED TO LEAVE YOUR JOB AND GO IN AND CHECK IT OUT.

BUT IF YOUR MENTAL HEALTH IS WORSE THAN IT WAS TEN YEARS AGO WHEN YOU FIRST GOT DEPRESSION, NOBODY SEES THAT UNTIL WE ARE WAY PAST A POINT OF GOOD INTERVENTION FOR YOU.

WHAT MAKES IT HARDER FOR YOUR JOB.

SO TALK ABOUT THAT A LITTLE BIT.

>> YES, WELL, FIRST I WANTED TO ACKNOWLEDGE THAT THERE ARE SOME -- THERE ARE GREAT SYSTEMIC INEQUITIES AND RESOURCES.

OBVIOUSLY MANY PEOPLE ARE FACED WITH ECONOMIC CONSTRAINTS.

THEY NEED TO WORK.

THEY NEED TO SUPPORT THEIR FAMILIES.

AND OF COURSE THE THINGS THAT ARE TANGIBLE, THE THINGS THAT WE CAN SEE, THINGS THAT WE CAN NOTICE ARE A LOT EASIER AND ALSO, WE'VE GOT A SYSTEM OF HELP THAT'S REALLY BASED MORE ON HEALTH CARE, DELIVERING INTERVENTIONS, RATHER THAN THINKING HOLISTICALLY ABOUT PREVENTION, LIKE DR. KO WAS MENTIONING EARLIER TODAY.

THERE IS ANOTHER COMPONENT TO THIS AS WELL WHICH IS THE PSYCHOLOGICAL PIECE, WHICH ACTUALLY DR. KO WAS MENTIONING BEFORE, DENIAL AND FEAR.

WHEN WE HAVE FEAR OF YOU'RE OWN VULNERABILITY WE TONED TURN DOWN OUR ABILITY TO REALLY LOOK AT, IN DEEP WAYS, WAY-OUT RISKS AND BENEFITS OF GETTING CARE, NOT GETTING CARE, UNDERSTANDING WHAT THE IMPACT IS PARTICULARLY ON AFRICAN AMERICAN MEN OR WOMEN OR ADOLESCENTS, THOSE PARTS OF OUR BRAINS TEND TO SHUT DOWN.

WHEN WE HAVE THAT FEAR, HAVE THAT ANXIETY, WE DO OUR BEST TO SORT OF PUT THAT ASIDE TO DENY IT.

WELL, IT MIGHT BE WELL I MIGHT FEEL SOME CHEST PAIN BUT I'M NOT EVEN GOING TO THINK ABOUT THAT.

I NEED TO GET THROUGH MY DAY, NEED TO MAKE SURE I PIE MY BILLS, PICK UP MY GRANDMOTHER, GET MY KIDS FROM SCHOOL.

WE DON'T DO VERY WELL WITH VULNERABILITY.

WE TEND TO LOOK AWAY FROM THE THINGS THAT ARE EARLY CLUES OF SOMETHING THAT MAY NOT BE RIGHT.

>> Crossley: SO ONE OF THE SOLUTIONS TO INTERVENTION DURING THIS PERIOD FOR EVERYBODY, BUT PARTICULARLY NOW, AS WE'RE TALKING ABOUT FOLKS ENDING UP IN ADVANCE STAGES OF DELAYED CARE HAS BEEN TELEHEALTH, TELEMEDICINE.

BUT EACH OF YOU HAVE -- YOU THINK IT'S A GOOD TOOL, BUT YOU HAVE SOME ISSUES.

CHIEF AMONG THEM, DR. ANDERSON, IS EQUITY FOR YOU.

>> ABSOLUTELY.

YOU KNOW, I THINK LOOKING AT ALL THIS THROUGH THAT LENS OF EQUITY IS REALLY IMPORTANT.

THERE IS A LOT OF LESSONS WE'VE LEARNED DURING THE PANDEMIC AND AS WE TALKED ABOUT EVEN IN THIS LAST SEGMENT JUST REALLY UNDERSTANDING THAT WHETHER WE TALK ABOUT THESE STOACIAL DETERMINE NATS,DETERMINANTS, MAKES SOMEONE MORE VULNERABLE THAN SOMEONE ELSE WHEN YOU HAVE A SITUATION LIKE A PANHANDLE, RIGHT?

THAT'S REALLY, I THINK THAT'S THE LIGHT THAT'S BEEN SHOWN ON THIS.

AND I ALWAYS START TO THINK ABOUT THESE TECHNOLOGIES LIKE TELEMEDICINE WHICH ON THE SURFACE SOUND FANTASTIC AND FOR MANY HAVE BEEN INCREDIBLY VALUABLE.

BUT IF YOU DON'T HAVE BROADBAND ACCESS, IF YOU'RE SHARING A PHONE, BETWEEN YOURSELF AND YOUR CHILD WHO'S TRYING TO ALSO DEAL WITH EDUCATION, NOW THAT'S DELIVERED THROUGH THAT SAME MECHANISM, HOW ARE YOU HAVING THE SAME EXPERIENCE AS SOMEONE WHO'S SITTING IN THEIR HOME WITH GREAT BROADBAND ACCESS AND MULTIPLE COMPUTERS AND ALL THE SORTS OF THINGS.

IF YOU THINK ABOUT THAT, IT BASELINE, THERE IS A SYSTEM THAT ALLOWS DIFFERENT INDIVIDUALS TO HAVE DIFFERENT VIEWS OF THE GAME, SO TO SPEAK.

THERE'S INDIVIDUALS WHO ARE GOING TO BE COMPLETELY LEFT OUT OF THE BENEFITS OF THIS SORT OF TECHNOLOGY.

IF WE'RE NOT ABLE TO LOOK AT THIS AND UNDERSTAND THAT WE'RE GOING TO HAVE TO CHANGE SOME FUNDAMENTAL COMPONENTS OF SYSTEM, THROUGH A VERY INTENTIONAL MECHANISM TO MAKE SURE THAT THERE IS EQUITY.

AND I THINK WE HAVE THE OPPORTUNITY TO BE ON THE RIGHT SIDE OF THIS NOW.

WE KNOW WHAT IT IS.

MANY OF US HAVE KNOWN IT FOR A VERY LONG TIME BUT NOW THE LIGHT'S SHINING ON IT.

WHAT ARE WE GOING TO DO?

AND TELEMEDICINE IS A GREAT EXAMPLE.

GREAT BENEFIT BUT HOW DO WE MAKE SURE THAT EVERYONE HAS ACCESS?

>> Crossley: MARK, WOULD YOU FOLLOW UP ON THAT?

WHAT IS THIS -- WHAT IS YOUR FEELING ABOUT TELEMEDICINE, TELEHEALTH?

>> WELL, IT'S SIMILAR AND IT ACTUALLY EXACERBATES SOME OF THE OTHER TYPES OF MESSAGING WE'VE HEARD ABOUT TELEMEDICINE THAT FALLS INTO THE EXACT SAME CATEGORY THAT DR. ANDERSON IS TALKING ABOUT.

FIRST OF ALL, AGAIN, YOU HAVE TO UNDERSTAND WHO WE'RE TALKING TO WHEN WE SAY THIS, MY POINT IS THIS: AT THE BEGINNING OF THE PANDEMIC, EVERYBODY WAS TALKING ABOUT OKAY, IF THERE'S NO REASON TO GO OUT, STAY HOME.

BECAUSE THAT'S THE SAFEST PLACE FOR YOU TO BE.

ASSUMING THAT YOU HAVE SPACING ADVANTAGES, AND THINGS OF THAT NATURE.

WHEN YOU LOOK AT THE HIGH COST OF LIVING IN BOFD, AND -- BOSTON, AND YOU'RE TALKING ABOUT MULTIGENERATIONAL FAMILIES AND TALKING ABOUT PEOPLE THAT NEED TO HAVE ROOMMATES IN ORDER TO AFFORD THE HIGH LEVELS OF RENT, THERE ARE A LOT OF PEOPLE WHO LIVE IN TWO, THREE, 4,000 SQUARE FOOT HOMES THAT HAVE A LOT OF WAYS TO SPACE THEMSELVES OUT AND A LOT OF PEOPLE THAT JUST DON'T.

OKAY?

SO THE STAY AT HOME ORDER, AS IT WERE, IS A WHOLE LOT DIFFERENT DEPENDING ON WHO YOU ARE, WHERE YOU LIVE AND HOW MUCH SPACE YOU HAVE.

SAME THING WITH TELEMEDICINE AND THE MECHANISMS THAT ALLOW YOU TO HAVE ACCESS TO INTERNET.

IF YOU ARE SHARING THOSE THINGS OR IF YOU ARE EXPERIENCING THOSE THINGS DIFFERENTLY, IT'S A WHOLE DIFFERENT PHENOMENON.

SO AGAIN IT IS A GREAT ADVANTAGE TO SOME.

NOT SO MUCH TO OTHERS.

AND I THINK THAT'S CONSISTENT WITH A LOT OF OTHER THINGS THAT WE'VE BEEN HEARING ABOUT.

IN TERMS OF AFFECTS OF THIS EXPERIENCE -- ASPECTS OF THIS EXPERIENCE BECAUSE IT'S NOT JUST A SITUATIONAL PIECE.

HOW DO PEOPLE EXPERIENCE THIS?

IT'S THIS FUNDAMENTAL DIFFERENCE BETWEEN PUBLIC HEALTH AND POPULATION HEALTH WHEN YOU TALK ABOUT CERTAIN SEGMENTS OF A POPULATION THAT ARE EXPERIENCING THE PHENOMENON VERY DIFFERENTLY THAN OTHERS.

I THINK DR. ANDERSON MAKES A GREAT POINT IN THAT REGARD.

>> Crossley: WELL DR. KO YOU'RE JUST NOT AT ALL A FAN IT SEEMS.

>> I HATE TO SAY I'M NOT AFAN.

I THINK THERE ARE SOME POSITIVES, FOR SURE.

I'M NOT A FAN BECAUSE IN MY WORK, I FEEL THAT THE PRESSURE IS ON US AS DOCTORS.

AND OUR HOSPITAL SYSTEM TO EARN THE TRUST OF OUR PATIENTS THAT WE CARE FOR.

AND AT BOSTON MEDICAL CENTER, WE CARE FOR A LOT OF THE BLACK AND BROWN COMMUNE IN THE CITY OF BOSTON.

SO I'VE ALWAYS FELT THAT IT'S ON US TO EARN THAT TRUST BACK FROM THESE PATIENTS.

THAT'S A HARD THING TO DO OVER THE PHONE.

I THINK A LOT OF WHAT WE DO IN OUR ENCOUNTERS WHERE I AM IS TO SHOW OUR WARMTH AND OUR ABILITY TO LISTEN.

AND SO MUCH OF COMMUNICATION IS NOT VERBAL.

IT'S YOUR BODY LANGUAGE AND YOUR TONE.

AND WE'VE GOT PATIENTS THAT DON'T SPEAK ENGLISH, AND TRYING TO DO A SENSITIVE AND VERY, YOU KNOW, THOUGHTFUL CONVERSATION WITH A NON-ENGLISH SPEAKER, YOU KNOW, THROUGH AN INTERPRETER OVER A TELEPHONE, THERE ARE CHALLENGES THERE.

AND SO I JUST FEEL THAT, YOU KNOW, DEPENDS ON THE PATIENT.

I'VE GOT SOME PATIENTS WHO I JUST LOVE USING THE TELEVISITORS FOR.

IT WORKS -- TELEVISITS FOR.

WE CAN JUST CALL THEM AND BE ABLE TO ACCOUNT FOR OUR TIME IN TALKING WITH THEM.

BEFORE WE DO THAT ANYWAY AND IT WASN'T PART OF ANY OF OUR TIME THAT WERE ACCOUNTED FOR.

SO THERE'S DEFINITELY SOME POSITIVES.

BUT I DO THINK WE NEED TO BE CAUTIOUS OF WHERE THERE MAY BE SOME UNINTENDED CONSEQUENCES THAT COULD BE REALLY HARMFUL IN FACT FOR SOME PATIENTS AND WE SHOULD BE THOUGHTFUL ABOUT IT.

>> Crossley: DR. WEBSTER FROM THE BEGINNING TELEHEALTH HAS BEEN A BIG PART OF HOW YOU'VE COMMUNICATED WITH SOME OF YOUR PATIENTS.

BUT YOU TOO HAVE WORRIED ABOUT MISSING SOME THINGS AS YOU'RE TRYING TO COUNCIL.

>> ABSOLUTELY.

IT'S BEEN VERY MIXED.

I WILL SAY THAT MANY OF MY PATIENTS, I WOULD SAY THAT IT'S WILDLY CONVENIENT.

THEY DON'T HAVE TO GET IN THE CAR.

THEY DON'T HAVE TO SIT IN TRAFFIC.

THEY DON'T HAVE TO FIND PARKING.

THEY DON'T HAVE TO TAKE THAT TIME OUT OF THEIR DAY.

AND IT COULD BE REALLY QUITE RELIABLE IN THE SENSE PEOPLE DO HAVE GOOD INTERNET ACCESS, ACCESS TO LIKE BROADBAND CONNECTIONS AND THEIR DESKTOP COMPUTERS, DPOINS AND ALL THOSE THINGS, IT CAN BE WONDERFUL THAT WAY.

THE -- iPHONES AND THOSE THINGS.

I'VE GOT THIS ONE YOUNG MAN FOR EXAMPLE I'VE SEEN FOR A VERY LONG TIME.

IT HAD BEEN A MONTH OR SO BEFORE I REALIZED THAT HE HAD A BOOT, HE HAD AN ANKLE INJURY, THAT WOULD BE SOMETHING I WOULD BE ABLE TO SEE AND OBSERVE, COMING INTO MY WAITING ROOM BUT I WOULD HAVE NO COMPLOO SEEING HIS TORSO AND HIS FACE ON THE SCREEN.

>> Crossley: THAT MIGHT HAVE SOMETHING TO DID WITH THE CONVERSATION YOU'RE HAVING AS A MATTER OF FACT.

>> ABSOLUTELY.

IF HE'S HAVING DIFFICULTY AT WORK GETTING AROUND, GETTING FRUSTRATE WEDNESDAY THAT THAT MAY HAVE SOME IMPLICATIONS IN HIS GENERAL MENTAL HEALTH, HIS ADAPTABILITY.

IT'S NICE TO SEE PEOPLE'S HOMES, I GET TO MEET PETS, I GET TO MEET SPOUSES, BUT CONVERSELY THERE IS PROBABLY NOT AS MUCH PRIVACY TO DISCUSS THINGS THAT MIGHT BE CLOSE TO THE HEART.

>> Crossley: JUST A QUICK ROUND ROB FRIN ALL OF YOU, DO THIS SITUATION OF DELAY WITH PARTICULAR EMPHASIS OF COMMUNITIES OF COLOR GET WORSE FOR THE TIME, WHEN DO YOU SEE IT BREAKING, MARK GET WORSE?

>> WELL, I THINK IT'S GOING TO CONTINUE TO GET WORSE AS IT BEGINS TO GETS BETTER.

I THINK THAT WE'VE BEEN ENGAGED IN SOME BACK DO SCREENING SORT OF ENCH MANAGING TO THE CITY -- TO OSORT OF MESSAGING, DANA FARBER CANCER INSTITUTE, SOUTH SHORE HEALTH, TRYING TO GET PEOPLE TO COME BACK INTO THE SYSTEM.

I THINK I HAVE SEEN SOME NUMBERS THAT SAY IT HAS WORKED TO SOME DEGREE.

I THINK WE'RE GOING TO BE LOOKING AT SOME SUBSTANTIVE LEVEL OF PEOPLE COMING BACK BUT I THINK WE'RE STILL SORT OF IN THE SLOW SIDE OF THAT BELL CURVE.

>> Crossley: DR. ANDERSON.

>> I SAY IT GETS BETTER, THE REASON I SAY IT GETS BETTERS IS WE ARE ACTIVELY ENGAGING, WE ARE ACTIVELY ON OUR CAMPUS REACHING OUT TO THE 19,000 LIVERS THAT WE SERVE AND LOOKING AT IT IN THAT SORT OF LENS.

IT IS VERY OFTEN IN A POSITION LIKE THIS THAT YOU START RETHINKING HOW DO YOU WHAT YOU DO AND WE ARE THINKING HOW WE DO OUR LEVEL OF COMMUNITY ENGAGEMENT AND NOT JUST RELYING ON THE TRUSTED RELATIONSHIP WE HAVE OVER 150 YEARS WHERE WE ARE SITUATED IN ROXBURY.

SO IT GETS BETTER BECAUSE WE'RE WORKING TO MAKE IT BETTER.

KRESS DR. KO YOU HAVE 30 SECONDS.

>> I THINK IT GETS WORSE ACUTELY AND I THINK IF WE DO IT RIGHT IT'S GOING TO GET BETTER IN THE LONG RUN BUT IT'S GOING TO TAKE EFFORTS LIKE THESE, BEING ON BASIC ABLACK, SUPPORTING EACH OTHER IN THE BIGGER WORK THAT GETS DONE.

>> Crossley: YOU HAVE TEN SECONDS DR. WEBSTER.

>> IT WILL BE UNEVEN.

FOR THOSE HISTORICALLY LEFT OUT IT WILL BE PERHAPS DIFFICULT TO BE LEFT BEHIND.

>> Crossley: THAT IS THE END OF THE BROADCAST AND THE END OF THE SHOW.

THANKS TO ALL OF OUR GUESTS AND THANK YOU FOR JOINING US.

STAY WITH US AS WE CONTINUE OUR CONVERSATION, ONLINE ON OUR Captioned by Media Access Group at WGBH access.wgbh.org