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There is an often told story in New Orleans….. about a
two neighbors who lived side by side by for many many years in one
of those typical "shot gun" houses found in just about every area
of this city.
This man and woman were excellent neighbors and friends who
would look after each other, watch over the homes, pick up their
mail and packages, and sometimes cook for each other particularly
that staple of every New Orleanian's diet Gumbo…. and
provide support to each other
As fate would have it….one day the male neighbor passes
away....and in grand New Orleans tradition….there is a
large, boisterous wake service held in a local funeral
parlor…..and it is filled with the deceased extended family
and friends, co-workers and dozens of flower bouquets and floral
About mid way thru the wake, his grieving neighbor appears at
the door of the funeral parlor holding what appears to be a large
She steadied herself and began to weave her way thru the crowded
funeral parlor of astonished friends and family and headed straight
for the open casket where her friend and former neighbor lay in
She walked right up to the edge of the casket and "plopped" the
pot on the very edge of the casket
Now this scene was just too much for the presiding minister as
he watched this woman make her way towards the
casket…..whereupon he made a bee line towards the
woman….and proceeded to ask her…..Madam, what in the
world would lead you to bring a pot of god knows what to your
former neighbors wake.
The woman gazed at the minister…and then the open casket
of her friend and said….Reverend, if my dearly departed
friend can smell of these lovely flowers….he can eat my damn
Moral of this story is that as we know if New
Orleans….you should enjoy the bouquets that come your way
while you can enjoy them….and colleagues I am honored to be
with you today to speak to you about an issue near and dear to my
heart and life's work.
Good morning and welcome to New Orleans…..
….The Crescent City, NAWLINS, the City that Care forgot,
NOLA, Hollywood South, The Big Easy…. or whatever you choose
to call it ….I just call it home….and isn't it great
to be back in New Orleans!!!
….yes it is …at a time when my beloved hometown is
….and reinvigorated….. after
Hurricane Katrina….the mighty storm for the ages knocked it
to its knees and caused so much strife, misery, pain and
But, this is a city imbued with an amazing spirit of
resilience and perseverance that
we all can admire and emulate in our work of service as
Now…..Just a few short miles away from
here………..there is indeed a different New
Orleans…..where the "glitter just doesn't shine"… and
for which the health and well being of many is not very good at
And so as we gather in this great city, the city of my birth and
formative years in our much anticipated spring ritual ….if
you will…. our super bowl…. final four…. or
the Stanley cup, if you will….. of our great specialty of
internal medicine …..where we come together to hail embrace
numerous advances in the treatment of disease …. gain
insight into best practices…. and be mesmerized and
enchanted by the newest technology that can easily fit within our
white coats and we hope….get into our offices, clinics and
While I too look forward to being refreshed,
reinvigorated and reenergized at
our annual sessions…..there is a worrisome- and I would
suggest thorny reality faced by many Americans….some who
reside not too far from where we sit this morning…..that no
matter how edified we leave him at the end of this exciting and
glorious week….it will not matter to those in our
communities who grapple and face stark, real and frustrating health
inequity and healthcare and health disparities ….and no
amount of sugar coating will obscure the fact that wide swaths of
populations in this town… and yours…will likely
never benefit from all that we will take in and
learn this week.
The sobering facts are these:
I can put this in no better context than was done by a
distinguished Master of the college and the President of the Robert
Wood Johnson Foundation when she related a true to life story about
a patient she had encountered at a community health clinic not too
far from her office in Princeton New Jersey….Mrs. Jones a 56
year old African American women diagnosed with diabetes with strong
family history of diabetes which had led to the amputation of her
mother's foot some time in the past.
When Mrs. Jones showed up to the clinic struggling to walk,
examination revealed that her left great toe was badly
infected….her blood sugar was over 600 and her HBA1C was 13.
She was told that she had to go to the hospital
immediately….she burst into tears, not because she badly
needed to work because she was paying off a six thousand dollar
bill for a previous preventable hospitalization….Mrs. Jones
is employed in one of the toughest and most difficult occupations -
she works as a full time home health aide for elderly and disabled
patients….she was upset and emotional because she worried
about what would happen to her patient is she did not show
up…and Mrs. Jones always showed up.
The economics of her problem will sound familiar:
Her choices were as simple as they come
A healthier life vs. livelihood itself
Now I know each and every one of you have encountered a Mrs.
Jones…who made us feel helpless….even though we knew
what to do….all the right tests to order…and
referrals to make.
With all our training, all our technology - even with all the
arsenal of drugs and therapies at our disposal….she needs us
to help figure out a system than can serve her others like her
This case and far too many like it reflects the sobering reality
that when we view the spectrum of medical practice….in our
great, ethnically, culturally and racially diverse "gumbo" of a
nation…it is very clear that outcomes of our treatment are
very good in general…but are woefully
inadequate and disparate….and even more
concerning…is that treatments are often applied unequally
and lead to marked health care disparities….
Case in point, an example that hits right here at home in the
It was at this meeting in 1996 that Kevin Schulman and
colleagues highlighted that fact that subtle bias is sometimes
present in the way even we internists and other family physicians
when it comes to being presented patient vignettes with similar
symptoms and the different rates that recommendations for cardiac
catheterization experienced was influenced in a negative way how
patients managed chest pain.
This interesting phenomenon is captured in the different views
among physicians and the general public about treatment
The perspectives in physicians of different racial/ethnic
backgrounds are sobering: Anywhere from 54 - 89% of physicians
clearly do not think that African Americans with heart disease are
just as likely to get specialized medical procedures and surgery.
Now to put it further in context….this month marks the 44th
anniversary of the death of one of our greatest Americans.
Dr. Martin Luther King Junior who reminded us in 1966 that of
all the forms of inequality, injustice in health is the most
shocking and the most shocking and the most inhumane.
Now I could go on and on…but I suspect that you get the
point…..we have a lot of work to do….and in my
view….the House of Internal Medicine must assume to mantle
and burden of leadership….because if not us who….and
if not now when. Along me to be a little "jingoistic" to emphasize
….we are INTERNISTS….the physicians who are
trained best to forge therapeutic alliances with our patients,
inform policy makers and encourage our patients to get all the care
they need….and no more than they rightfully
deserve….no matter their race or background, their sexual
orientation or where they live.
We can and must do better….because we know better
…..This is our calling….this is our
task…..to address in a forceful, comprehensive, coordinated
and cost effective way the rampant disparities which renders too
large a portion of the population of our great country unable to
enjoy their lives…their communities…and their full
potential as fellow citizens.
In spite of the rancorous and sometimes silly debates about
health reform that we have witnessed over the past two
years….it is an incontrovertible fact that the a major step
in addressing and fixing health care disparities is for the 30
million Americans, approximately half of which are black, Latino
and minority get an insurance card in their hands….it
clearly is not the only answer, but it is a start that must take
place as we work on some of the other issues to ensure that our
patients get the care they need. I am so appreciative and proud of
the forceful and effective leadership in your American College and
the leadership that represents us so well in leading from the front
to support the Patient Protection and Affordable Care Act,
embracing cost conscious care and offering real solutions to reform
Now as I move to close, I remind you that, New
Orleanians….now mark time as being before or after
Katrina…A city that will forever mark time in a way that few
of us can fully comprehend or even imagine which serves as a
perfect backdrop to highlight this discussion….because in
many ways it is the classic tale of two cities so well described by
Charles Dickens a long time ago
….I also come at it having devoted five years of my
professional career before becoming a physician to serving this
city as an Executive Assistant to the Mayor of New
Orleans….working side by side for long hours and days for
the great, good and honorable man for which this cavernous
Convention Center is named…Ernest N. Morial, the first
African American mayor of New Orleans is one of my life's mentors
who set me clearly on a path of service that I am honored to have
traveled these many years as I followed my passion to be the best
internist I could possibly be and to bring the message of the
presence of health inequity and health disparities… to a
And so, this week, enjoy the greatness of New Orleans - grab a
bowl of gumbo, a few oysters on the half shell, partake in a
Sazerac cocktail…or two…stroll through the French
Quarter and hear the sounds of jazz that define this city all over
the world. And remember that the story of New Orleans can animate
our work as Internists to do the work that needs to be done.