Panel Takes a Constructive Look at Health Inequities

By Dirk Hoffman

The program was intentionally structured to move beyond problem identification toward constructive discussion, empowering attendees to reflect on their roles as future and current health care professionals in addressing inequity.

The event was sponsored by the Offices of Medical Education (OME) and was moderated by David A. Milling, MD, senior associate dean for medical education and executive director of the OME, who said the purpose was to “advance the conversation on health inequities and have an interactive discussion.”

The panel consisted of:

• Fred D. Archer III, MD, associate dean and director of admissions, and a clinical assistant professor of pediatrics
• Mona Lisa Delva, MD, a third-year general surgery resident
• Leonard E. Egede, MD, Charles and Mary Bauer Endowed Chair and professor of medicine, president and CEO of UBMD Internal Medicine, and a nationally recognized health disparities researcher
• Daphine M. Musisi, MD, a fourth-year general surgery resident
• Osman A. Sharif, MD, a clinical assistant professor of medicine and a hospitalist at Buffalo General Medical Center

Milling started the discussion by asking the panel members to describe how their work impacts health equity in the local community.

“Children do not have folks lobbying for them so one of our jobs as pediatricians is to be a voice for them, to be an advocate,” Archer said. “One of the first things I do is health literacy. I talk to families in language that they can understand — not talking down to them.”

Archer pointed out that people have two ears and one mouth, indicating that listening is more important than talking.

“You take the time to actually listen to the person because the biggest disservice you can do to anybody is to dismiss them or give them the perception that they have been dismissed,” he said.

“Take the opportunity to listen to everybody. It will only make you a better physician and you will be able to address where they are telling you they’re coming from.”

Egede also noted that “you also have to respect that people communicate in different ways.”

Delva said health equity is not just providing the same resources to all the different patients regardless of where they are coming from.

“We need to make sure we tailor those resources to what they need so that everyone can get to the best health outcome,” she said.

Delva said while surgery residents are learners, their work also impacts patients directly with respect to information translation.

“We need to be the voice in the room to advocate for the patient who may not be getting the appropriate management for their condition or for the whole care team who needs a level of cultural competency reminders to better understand a patient,” she said.

Milling then asked the panelists what experiences, both personal and professional, shaped how they approach health equity.

Musisi acknowledged in a trauma setting it is more difficult to consider where a patient may be coming from but said “when you learn about the background of your patients you stop being judgmental and understand more where they are coming from.”

Sharif said he is a hospitalist at the Buffalo General Medical Center so most of the patients he sees are already in the hospital.

“The hospital is a safety net so this is where the sickest patients are, they are the patients that maybe could not make their appointment as an outpatient or missed several appointments,” he said. “When I see someone, it means they are using that safety net and they want me to help them navigate the outpatient role when they are discharged as well.”

Sharif shared the story of two different patients to illustrate the need for physicians to ensure their patients have the proper support.

He told of one patient who suffered a heart attack and upon discharge was told he would need a medication that had an expensive co-pay.

Sharif said the patient said, “whatever I need to do” and was very happy and was willing to get that medication.

In contrast, he told of a patient who years later was in the hospital for a blood clot in their leg. They were sent to the pharmacy and could not afford the medication they needed. They ended up going home without it. Months later, they came back to the hospital with a pulmonary embolism.

“So, one of the first questions I ask my patients is who do they live with, to see what kind of support system they have,” Sharif said.  “And now every time I prescribe a medication that I know is going to cost a lot I speak with the pharmacist and make sure the patient can afford it.”

Delva concurred, noting “to be competent in our cultural decision-making, it is our responsibility as physicians to know what resources are available to the patient. You cannot just go and blindly say ‘yes, you have to do x, y and z.’”

“Your patients are going to be the people who teach you the most about your own community,” she said.

Egede came to UB from the Medical College of Wisconsin in 2024 and Milling asked what he thought of the Western New York landscape as it pertains to health care now that he has been in the area for two years.

Egede said cities like Buffalo and Milwaukee have similar social determinants of health, such as housing, education, transportation and access to health care.

“Western New York is very unique in that it has a lot of resources to address health inequities, yet we have gaps,” he said.

He said it is important to frame the concept of equity and praised the Jacobs School’s new Well Beyond curriculum for getting medical students out into the community sooner.

“We are seeing more and more rotations embedded in community partners,” he said. “I think one of the things we need to do is to create more empathy in our residents. We need to spend time creating opportunities for people to engage.”

“Team science is an easy way to become engaged in the community,” Egede added. “You need to find an area that you are passionate about.”

Archer also noted the importance of involving the community.

“We have all these great ideas. We have all this amazing medical knowledge, but one thing we need to do with that is involve the community,” he said. “We actually need to ask people what they want from us.”

“Because we can offer all these ideas, but if they don’t trust us or know us, it’s not going to go anywhere.”

A brief question-and-answer session concluded the program that was conducted in the M&T Auditorium in the Jacobs School building.