Coronavirus exposes income-driven health inequality [PODCAST]

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“It’s maddening to see the differences in health outcomes between the rich and the poor. Even more unsettling is reflecting upon the psychological pain accumulated when living in a fad-obsessed materialistic comparison-creating society, the postponed dreams, and the day to day compromise that those with less have to endure – thoughts that may be far removed from the ruminations of the those who have abundance.

I don’t mean to stereotype, and this is not intended to be a polemic, but the country is divided, and many are living in two different worlds. The resultant health consequences should be contemplated upon, especially in the midst of a pandemic where the differences have the opportunity to be most blatantly highlighted.”

Harsh Bhavsar is an internal medicine resident.

He shares his story and discusses his KevinMD article, “Coronavirus exposes the reality of income-driven health inequality.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Harsh Bhavsar. He’s an internal medicine resident, and he wrote the KevinMD articles “Coronavirus exposes the reality of income-driven health inequality” and “Coronavirus is a crisis. And an opportunity.” Harsh, welcome to the show.

Harsh Bhavsar: Thank you so much for having me on the show. It’s a pleasure to actually see you, like, in person, actually.

Kevin Pho: All right, so we’ll get into your articles in a bit, but first off, tell me your story and your journey to where you are today.

Harsh Bhavsar: Sure. I was born and raised in New Jersey. I was born in Hackensack, New Jersey, and I was raised in New Jersey, actually. My parents were both immigrants from India. Growing up, I wasn’t really sure what I wanted to do, but I had the opportunity to do anything that I wanted, best for my parents. We worked hard.

I went to Rutgers for my undergraduate education. I was a biology and economics major. I enjoyed economics just because I like to play with numbers and understand the economy. I subsequently did a year of research with neurodegenerative diseases. I did a few months in Boston at the Children’s Hospital of Boston, and then I moved back to Rutgers. After that, I went to Ross University for medical school, and then I matched in Philadelphia, which is pretty much close to home, close to Jersey, for internal medicine. I’m looking forward to being a hospitalist after I graduate this year.

Kevin Pho: You’re a third-year internal medicine resident. How is the pandemic affecting you and your institution?

Harsh Bhavsar: So far, we’ve sort of gotten off our peak, but we are preparing for the next peak. We have pandemic schedules for all the residents right now. We do have certain sections of the hospital that are open for elective surgeries that are COVID-free zones, but we certainly are still seeing a steady number of patients come in. I’ve certainly had at least three or four on my team just today that have come back positive. The number overall has decreased in this area, but I know that with other parts of the country peaking, we are worrying about another surge that will happen here in Philadelphia.

Kevin Pho: So let’s get into your KevinMD article, “Coronavirus exposes the reality of income-driven health inequality.” For my audience who haven’t read your article, can you walk them through it and share the story of why you decided to write it?

Harsh Bhavsar: The reason why I decided to write that article was because I am currently working in a health care system in a community that is relatively underserved and has a lot of population which does struggle financially, does struggle socioeconomically, and does have a hard time going to different specialists and having insurance coverage for their medical care. So for me, because I sort of compare my experiences with other colleagues of mine who are in areas of the country and areas of the world that have better access to health care, I think for me it resonated: The inability of the population here to have access to medical care would certainly exacerbate their morbidity and mortality when it comes to the coronavirus.

I specifically had many patients who have come to me and said that they’ve been having symptoms for a long time. They didn’t have insurance, and they didn’t want to go see a doctor early enough, even if some of these facilities and doctors were ready to see some of these patients and test them for COVID. That allowed them to sort of be in their communities for longer periods of time and be exposed to other neighbors and family members without really understanding what it means to socially isolate, not even having the opportunity to socially isolate, because some of my patients live in close quarters. A lot of them live in shelters. Many of them are homeless. I think in these populations of people and patients, that’s when we’ll see the worst effects of the coronavirus, because they don’t have options and they don’t have medical care. As much as we try to get the word out there that we’re available to see them here, a lot of times they don’t have ways to get to the hospital.

What I’ve seen on a daily basis is that, unfortunately, patients who do not have the financial resources, who do not have insurance, as much as we try to make sure that care is equally provided to everybody, I think that ultimately, I have just seen from the inpatient side and also my outpatient clinics that a lot of these patients just fall by the wayside. It’s quite disheartening to see, especially this early in my career, and that’s what sort of prompted me to write this article. I hope, going forward, that I somehow am involved in helping these people who really, really are suffering.

Kevin Pho: So what are some of the options that we could do from a more policy, societal level, and what are some things that we can do from an individual physician level to address this issue?

Harsh Bhavsar: Going with the individual physician level first, I think that a lot of physicians work hard to expand their networks. They work hard to allow patients who are uninsured or not very well off to get care for free, which is something that I would be looking forward to doing in the future, if I can somehow provide some level of volunteer work on the side with that perspective.

From a policy perspective, I do think from a health insurance standpoint, this is a larger discussion I think we need to have with the government, with lobbyists, and things of that sort. But I am personally in support of health insurance for all, to a certain extent. I do think that poverty in itself is something that needs to be tackled first. I think Philadelphia does do a good job of helping out its homeless in terms of getting them resources, getting them types of shelters that have links to medical establishments that can help people in shelters.

But I think that what we need to do is first take away the stigma that is still there about patients who are impoverished, patients who have difficulty with socioeconomic issues, and take away this stigma that they have sometimes, that these patients are people who have experimented with drugs or have had different types of diseases that might not be able to be easily taken care of, like HIV, AIDS, and things of that sort. I think that there is this overwhelming need to get rid of this stereotype of an uninsured patient, where maybe some people might be thinking that they’re taking advantage of the system or living off of welfare. I think that we need to get away from these types of stereotypes that we make sometimes.

I think that we need to get down to the brass tacks and sort of give them opportunities to thrive and survive, and I think that what we really need to do is make sure that everyone has access to health insurance and has access to medical facilities within a close radius from their home, or where they live. I think that would be a good start. I think I need to also look into further ways of dealing with it, which I’m not too familiar with yet.

Kevin Pho: As the pandemic is spreading throughout the country, testing is obviously a big issue now. What are some of the socioeconomic impacts on the access to COVID-19 testing?

Harsh Bhavsar: Well, one, I’ve noticed with my patients, is that sometimes they’ll have symptoms, but they won’t have any way to get to any close facility that has the actual testing. The second is that some of these tests are taking longer than expected. I know our facility is working on getting a test that would actually give us a result within eight minutes, but I know that the sensitivity of the test actually does go down because of that.

I think the other barrier to getting tested is that there’s not as much infrastructure in place. A lot of these patients have family members and young children at home. They don’t feel comfortable keeping their children home alone; they need people to help them with that. I think making sure that people can actually get tested very quickly, so I was thinking of an idea where possibly someone who is equipped with PPE can technically go to someone’s house, if an elderly person cannot leave their house or is impoverished, to actually test them at home and get them tested. Broad-scale testing is certainly necessary. I completely agree with you, Dr. Pho, and we’re trying our best on our end to do that right now.

Kevin Pho: As the fall approaches, there’s a big discussion of whether schools should open or not, and different parts of the country are taking different approaches to that. In terms of schools specifically, what are your thoughts in terms of the socioeconomic impact of whether schools open or not?

Harsh Bhavsar: Right, so that’s an excellent question, because I am practicing in a community where the school systems definitely need help even at baseline, whether there is COVID or not. I think that students here do struggle to get a good education sometimes, an education that allows them to go to college or to trade school, wherever they need to go.

I think that the debate around opening schools is especially resonating with me here, because if the students here do not go to school, they’re certainly at even more increased risk of perpetuating the cycle of poverty: not being able to take care of their families, not having access to health care, then having chronic conditions that worsen over time and eventually get to the point where some of these chronic conditions cannot really be taken care of.

So my thoughts in this area, at least where I practice, are that I do think that if we can allow schools to open up in a way where social distancing can be in place and students have the opportunity to do interactive education, that would be the most ideal approach. I know that a lot of people have discussed that on different news channels. However, the challenge that we have here in certain parts of Philadelphia is that finding a way to have each student have internet access at home, and also making sure that they have laptops, tablets, the electronic infrastructure, and the technology infrastructure in place to do remote learning, is a bit of a challenge.

So what I would think is that I would be in support of opening up schools as long as we can have strict social distancing, which, to be honest, I’m not quite familiar with: whether the school districts here would be able to do that. But I do think that the government and different organizations should find a way to provide internet access to all grade school students and make sure that they have at least one computer at home, a tablet if they need to ensure that they get their lessons in place.

There’s always going to be a risk when you get people together, even in schools, but I think that we have to try our best to balance the need for education in this system here and the risk of COVID. It’s very difficult, and I think that day to day we’ll have to find a plan for that. I can’t really answer that completely in terms of what I would 100 percent do yet.

Kevin Pho: We’re talking to Harsh Bhavsar. He’s an internal medicine resident, and he wrote the KevinMD article “Coronavirus exposes the reality of income-driven health inequality.” Harsh, my last question: What is your take-home message for the KevinMD audience?

Harsh Bhavsar: My take-home message for the KevinMD audience: Well, first, I would say from a resident standpoint, I want to say to all the other resident colleagues of mine that I personally am very appreciative of all the work that you guys do. I’m appreciative of all the authors of KevinMD. I am looking forward to writing my next post, and I’m glad that throughout this COVID crisis we are all coming together and we have this camaraderie as medical professionals, whether it’s nurses, doctors, physicians, pharmacists, residents, or all medical students.

I am very grateful to have an avenue where I can project my thoughts or discuss my thoughts with other people, and I also want to thank you for allowing me to publish some articles on your platform, because we’re all dealing with coping, we’re all dealing with issues with our patients. I think that this website, this blog, is not only important to share with the world our medical perspectives and things in medicine, but also it’s a way for us to express our emotions in a very thoughtful way, which will allow us to practice our jobs better and be better physicians. At the end of the day, we’re all here for our patients.

I actually truly believe that my being able to read posts and have a sense of relatability with everyone on KevinMD has made me a better physician and has allowed me to practice a lot more physician wellness, resident wellness, and has allowed me to de-stress and be creative with my posts. So I thank you again.

Kevin Pho: Well, thank you so much for your kind words, insight, and wisdom. Thank you for being on the show.

Harsh Bhavsar: Thank you so much, Dr. Pho. Thank you.

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