Hope Starts With Us: Representation’s Impact on Health in Our Communities

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NAMI CEO Daniel H. Gillison, Jr., speaks to Dr. Hernando Carter, an internal medicine physician based in Birmingham, Alabama. They discuss the importance of caring for the health care professionals in our communities in honor of National Hospital Week, as well as bridging care gaps for underrepresented communities and developing increased representation within the health care field.

You can find additional episodes of this NAMI podcast and others at nami.org/podcast.

 

 

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00:00:00:00 – 00:00:21:03
Dr. Carter
We try to carve out health care like it is somehow immune to the social and systemic challenges that we face in this country. But it’s all baked in the same. Sometimes people, they don’t want to hear about bias and prejudice and racism in health care because they think that that labels them a bad person. No, that’s just your experiences,

00:00:21:23 – 00:00:46:17
Dr. Carter
your upbringing. Your background led you to this point, and it’s something that we need to work on. But that don’t make you a bad person. But we got to acknowledge it, right? So Black and brown patients either personally experience that bias and they lose trust and confidence in health care. And so they stop engaging or they don’t listen to recommendations.

00:00:46:19 – 00:01:16:02
Dr. Carter
So just pairing somebody up with a background similar to theirs, you are already overcoming a huge part of that barrier because there’s already that trust there. There’s already that ease of communication. In order to decrease health care disparities, we have to have more people in the pipeline that are involved in every facet of the health care system that look like the people that they take care of.

00:01:16:03 – 00:01:42:00
Dan
Welcome to Hope Starts With Us, a podcast by NAMI, the National Alliance on Mental Illness. My name is Dan Gillison and I am the CEO of NAMI. As we started this podcast, we really believe in three principles in terms of hope. Hope starts with us talking about mental health. Hope starts with us making information accessible. Hope starts with us providing resources and practical advice.

00:01:42:02 – 00:02:05:09
Dan
Hope starts with us sharing our stories, and hope starts with us breaking the stigma. If you or a loved one is struggling with a mental health condition and have been looking for hope, we made this podcast for you. Hope starts with all of us. Hope is a collective. We hope that each episode with each conversation brings you into that collective to know you are not alone.

00:02:05:11 – 00:02:32:07
Dan
Today, I’m joined by Dr. Hernando Carter to talk about how health care professionals receive care, especially as providers caring for other providers. So as we began, Dr. Carter will be talking about the importance of health literacy, creating health care, education, pipelines and support underrepresented groups, and how we can support the health care professionals in our communities, not only during National Hospital Week, but all year round.

00:02:32:10 – 00:03:00:03
Dan
Now we know you, Dr. Carter, practice internal medicine at ArchWell Health in Birmingham, Alabama, where you also work as the market medical director. You are particularly interested in overcoming the barriers that exist in physician-to-physician and physician-to-patient communication as well as care coordination. You also founded a nonprofit. We want to hear more about Prescription for Better Living, and we’ll be talking about that a little bit later in this episode.

00:03:00:05 – 00:03:26:01
Dan
Dr. Carter and I met in January at the Kappa Alpha Psi Founders’ Day event about balancing life, physical health and mental health while leading. And we know you as a leader, Dr. Carter, And with all the things that you do and how you show up every day in community and in work. So we want to say thank you really very much for lending your voice to this very important conversation.

00:03:26:03 – 00:03:47:03
Dan
And talking to us about providing care to patients, health literacy, and reducing the stigma and what it looks like in our community and how we can all be agents of change. So May 12th through 18th is National Hospital Week. It’s a time to show our support for health care workers and caregivers who support our communities throughout the COVID-19 pandemic.

00:03:47:05 – 00:04:14:18
Dan
NAMI responded to the needs of our frontline workers through frontline wellness. Our initiative provided information and resources about peer support techniques to build resilience, support for family members and more, making sure our health care providers had the care they need, particularly for their mental health. It is of critical importance for our health care system success supporting patients. You can’t retain the professionals in this work without giving them the resources.

00:04:14:20 – 00:04:26:20
Dan
So, Dr. Carter, I’d like to start our conversation today by asking you about what it means to you to be a member of the community of care providers over the last several years.

00:04:26:22 – 00:05:02:09
Dr. Carter
Well, first, let me say, Dan, thank you for the opportunity to join you and to have these important conversations. I am always excited and happy to be able to share in this space because it’s my life work for me as a member of the medical community. First of all, let me say I feel very fortunate and blessed to be able to do it because unlike most kids who, you know, when they were four and five, wanted to be a football player or, you know, something famous, I always wanted to be a primary care doctor.

00:05:02:10 – 00:05:29:01
Dr. Carter
I was inspired by my pediatrician, who is now a patient of mine, still my children’s pediatrician and my new little niece, Ms.. Haley, who’s one years old, she’s her pediatrician. So it’s kind of come full circle. So it’s all I’ve ever wanted to do was to do what I’m doing now. So I do feel blessed and fortunate every day to do it.

00:05:29:02 – 00:06:20:05
Dr. Carter
However, I will say that over the last decade or so, especially since COVID, and I think what COVID did, just like COVID kind of unmasked a lot of the inequities in health care that we already knew existed, right? But it just exposed them a little bit more COVID did the same thing for health care providers. We always knew that in the community of health care providers, there are providers that suffer in silence. Suffer as relates to physical health and neglecting their own physical hell, but certainly suffering in silence in the realm of mental health.

00:06:20:07 – 00:06:55:16
Dr. Carter
And some of that we acknowledge that was kind of systemic and kind of baked into the licensing process and the credentialing process in order to practice medicine. And so it caused providers, physicians to have to kind of suffer in silence. So it’s been kind of a mixed bag, I would say, especially since COVID, because, again, it’s fortunate and it’s a blessing to be in this position, to be able to help take care of people when they need you and have that special place in their lives.

00:06:55:18 – 00:07:35:21
Dr. Carter
But then also understanding the pressures that physicians and providers are facing and understanding that many do not seek the help that they need and suffer in silence and many times it ends, unfortunately, in a very kind of tragic way. So I am happy that we are discussing this because I think that first, in order to help the issue, you have to discuss it, shed light on it, increase awareness and normalize just the whole subject in talking.

00:07:35:21 – 00:07:49:12
Dr. Carter
And if you don’t talk about it, it adds and creates to this stigma. So, you know, I think talking about it in a, you know, open manner is one of the very first and most important steps to addressing this.

00:07:49:17 – 00:08:21:14
Dan
You know, Dr. Carter, I appreciate that so much. And and I’ll say, Hernando, at this moment, you shared something with me when we met. As a primary care physician we moved off of that topic in January. Just you and I were talking, breaking bread together. And you talked about your own care and you said that this is important for people to understand and you just mentioned suffering in silence, the pressure and many in the profession not seeking help and really wanting to normalize that conversation and increase awareness.

00:08:21:14 – 00:08:29:05
Dan
So I wanted to ask if you would share with our listeners about your own self-care.

00:08:29:07 – 00:08:29:15
Dr. Carter
Sure.

00:08:29:16 – 00:08:34:22
Dan
Because a lot of times we judge a book by its cover and you care for others. What about your care?

00:08:35:00 – 00:09:17:04
Dr. Carter
Right. Right. I think it’s more common than people realize that physicians and providers suffer with depression and anxiety. And I would say that is at similar rates to the rest of our society. But the rate at which we access care for those conditions is lower than the rest of society. Personally, I had my first kind of struggle with depression in medical school, which we see that a lot.

00:09:17:06 – 00:09:47:12
Dr. Carter
You know, you have the pressures. It’s just a very stressful time in your life. You are deprived of sleep, deprived of food, deprived of the physical connections with people outside of your medical school, your training, those relationships that kind of sustains you prior to going to medical school aren’t nurtured because there’s so much demand on your time.

00:09:47:13 – 00:10:21:20
Dr. Carter
And so what happens is, is that a lot of times in training, we just kind of lock in on getting it done, completing the mission, pass the exam, doing the rotation, taking the shift, performing well, and we neglect everything else. Like I say, we don’t sleep. We don’t eat. Sometimes it’s hard to maintain relationships. Certainly, you know, a lot of times don’t have time to do things like exercise, you know, all those things that kind of help keep balance and keep you healthy and help you manage stress.

00:10:21:22 – 00:10:44:08
Dr. Carter
So you got a big stress burger you eat and and you don’t have anything to give you an outlet. You don’t have any relief. And so we see a lot of depression and anxiety kind of exacerbated during medical training. And that’s what happened to me. Didn’t really know what was going on with me at the time. I just knew I was not myself.

00:10:44:10 – 00:11:09:17
Dr. Carter
And I decided to kind of speak up about it when I was driving down the highway one day. And I just heard a kind of internal voice say, you know, just yank the car over to the right, which I was going over a bridge on the highway and if I had yanked the car over to the right, I would have gone over the bridge and likely would have died.

00:11:09:19 – 00:11:43:05
Dr. Carter
But the internal voice said, yank the car over to the right, and if you do that, it’ll all be okay because it’ll all be over and I knew that that was not normal. And I also knew that I didn’t want to do it and I didn’t want to die. So at that point, I confided in my mother-in-law, actually the first time.

00:11:43:07 – 00:12:12:02
Dr. Carter
She’s a very spiritual person. So I confided in her. She encouraged me to let my wife know. And I did. And at that time, I had a huge kind of outpouring of support, support system around me. Got into some pastoral counseling and got, you know, guidance about I needed to kind of help with that balance of, you know, why don’t you eat more?

00:12:12:02 – 00:12:38:12
Dr. Carter
Why don’t you get some exercise, why don’t you rest? And so that helped. It helped for a while. And I made it through medical school, made it through residency, practicing as a physician and then kind of the anxiety started bubbling back because now you are a physician in practice and you have all those pressures. But it was manageable, right?

00:12:38:14 – 00:13:23:02
Dr. Carter
And so I’m pushing through. And in 2013, my father passed suddenly from a stroke, and then I became the patriarch of the entire family. And there was a little bit more stress and then a little bit more depression. And then COVID came, right? And then here we go again. So I had started back having those thoughts again. I confided in a fraternity brother of mine and said, “Hey, I think I may need you to come and get my gun, take it away from me.”

00:13:23:04 – 00:13:57:02
Dr. Carter
He said, well, what’s going on? And I told him. At this time I had not told my wife anything. I did nothing. And he was very helpful to me on that. I don’t know if I would have done it, but I had that thought. And to me, that thought was alarming enough to say, you know, I need to at least to take this potential tool away from me right now.

00:13:57:04 – 00:14:21:03
Dr. Carter
I still didn’t deal with it fully as I should. I will say that I was also seeing a therapist at the time, but I did not tell the therapist about how these thoughts really we were dealing with my anxiety and I was talking to him about my anxiety and, you know, having panic attacks and those kind of things.

00:14:21:03 – 00:15:05:21
Dr. Carter
We were working through that. But I mean, I didn’t I didn’t tell him I had doubts about you know, not wanting to wake up or, you know, so it came to a head when my wife confronted me about the way I was interacting with her and my behavior at home. And she thought that I was unhappy with the marriage, that maybe I was angry with her or she had done something wrong because I was edgy, short tempered, and not in an abusive way.

00:15:05:22 – 00:15:32:19
Dr. Carter
I wasn’t verbally abusive, but I was withdrawn. I was silent short in my conversation, isolating. And so she thought we were having marital problems. And so one morning she asked me, “are we going to be okay?” And I said, “what do you mean?” “Is our marriage is going to be okay? Are we going to get a, you know, are we having problems?

00:15:32:21 – 00:15:54:17
Dr. Carter
Did I do something? You know, is there someone else that you want to see? Do you not want to be in this marriage?” “Why do you ask me that?” And that’s when she started talking to me about my behavior. And then I said, you know what? Let me go ahead and tell her what I’ve been thinking and how I’ve been feeling.

00:15:54:19 – 00:16:22:16
Dr. Carter
Because now this person who’s one of the most important people in my life thinks that I don’t want to be with her. I don’t love her. And it’s, you know, the farthest thing from the truth, right? And so I told her, I said, no, is not that. I said, mornings I don’t want to wake up and I feel like you and the boys would be better off if I didn’t wake up.

00:16:22:18 – 00:17:03:04
Dr. Carter
And she was horrified. And she made me reach out to my doctor, let my doctor know what was going on. And that’s one of the best decisions I ever made because I was able to get the treatment that I needed, you know, not only with the therapy, but I needed some medicine and I was afraid of that, of taking the medicine, you know, a doctor afraid of taking the medicine.

00:17:03:04 – 00:17:42:14
Dr. Carter
But I was afraid of first of all, what implications would this have on my own, my practice, on my license, What changes in my personality would I experience from taking the medication? I had all those apprehensions because now outside of home, I wore the mask. I’m an easy going, jovial person. I am serious when I need to be, but I like to be light-hearted.

00:17:42:15 – 00:18:08:17
Dr. Carter
I like people. I’m a cancer is my zodiac. So I’m a sociable– I’m an extrovert, you know? And so, you know, outside of home, I wore the mask, but it was exhausting. And so I didn’t have any more in me. By the time I got home. So the people who deserve my best, you know, I don’t have anything left to give them.

00:18:08:22 – 00:18:46:05
Dr. Carter
So I started the medication and it’s one of the best decisions that I ever made because it didn’t change who I am. It didn’t change my personality. It helped me be me. It helped me feel like me. And that’s what I needed. You know, I can’t say that now. I am totally better. Do I still have, you know, down days or sad days?

00:18:46:07 – 00:19:24:19
Dr. Carter
Do I still have anxious times? Yes. But I can say that I’m 180 degrees away from where I was. Now I still have things to work on, as we all do. I had to kind of examine why I didn’t want to tell my therapist about that. And I said, well, maybe I wasn’t, for whatever reason, comfortable. Maybe there was a problem with connecting on that level.

00:19:24:20 – 00:20:22:17
Dr. Carter
And so I went a long time without any therapy, but I know that I still need it just for maintenance. And so I actually have an appointment next week with a new, you know, therapist to, you know, just kind of continue the therapeutic relationship. I’m of the opinion. I tell my patients all the time, you know, whether you feel like you have depression, anxiety or not, even if you feel like you don’t have any kind of mental health challenges, I still recommend everybody have a therapist, because you know, what a therapist is a neutral, objective of party who is not judging you that you can just unload on and the things that you need

00:20:22:17 – 00:21:19:08
Dr. Carter
to get out that you can’t say to your loved ones or your coworkers or your fraternity brothers or your friends. You can say to your therapist and just kind of that process of expelling that stuff that’s in you is therapeutic within itself, number one. But then number two, the therapist is trained to identify patterns and things just from which you say it can help you with an action plan on how to help improve that situation or help you identify triggers that you don’t even know exist.

00:21:19:10 – 00:21:50:08
Dr. Carter
You know, that could be something in your routine or in your life that’s kind of exacerbating or setting off that depression or that anxiety. And you don’t even acknowledge that trigger, right? And a therapist can help you identify that. So, you know, but I certainly think that everyone needs a therapist, someone that’s objective to be a sounding board. And my patients

00:21:50:08 – 00:22:21:10
Dr. Carter
tell me all the time, you know. “Well I have my pastor.” You know, “I go to counseling at church” and that’s fine. I mean, I don’t discourage that. Do that because sometimes you need that spiritual connection. If that’s where your belief is. But let’s be real. This is your pastor that you’re seeing all the time, right? You hold this person in high esteem, you respect them.

00:22:21:12 – 00:22:49:19
Dr. Carter
And so when you hold someone in high esteem and you respect them and you love them, it’s real hard to be totally transparent. I went to a minister at my church one time and it was shortly after my father passed, and I was coping with the anxiety and the insomnia by drinking heavily. And my wife said, When you have someone you know and she was like, No, you’re self-medicating.

00:22:49:21 – 00:23:44:12
Dr. Carter
And during one of my therapy sessions at the church, I told the minister there and it became a conversation about the lack of virtue in consuming alcohol. And that ain’t what I needed at the time, you know, so I sounds like I shouldn’t have told him I drank at all. So even if you do have a spiritual counselor, which I don’t discourage, I encourage because sometimes there are some moral and spiritual dilemma that we deal with that a therapist is not qualified to advise on, and someone who is called and trained spiritually according to your beliefs, may be able to address that better for you.

00:23:44:14 – 00:24:04:23
Dr. Carter
But you need someone who’s objective, who you know you don’t really care what they think of you and you feel that, you know what? They’re not going to judge me because they’ve seen it all. They’ve heard it all. So there’s nothing I can tell this person that he or she hadn’t seen her before. So I’m gonna get it out.

00:24:05:01 – 00:24:26:09
Dr. Carter
And when I leave here, I don’t have to see them again until the next time I come. And I’m not seeing them at the funeral or the wedding or the bake sale. You know what I mean? And I got to look you in the eye and tell you I’ve been having all of these thoughts and desires and all of this stuff.

00:24:26:11 – 00:24:34:08
Dr. Carter
And then now I got to see you in another situation when I’m supposed to have it all together, right? So.

00:24:34:10 – 00:24:34:22
Dan

00:24:34:22 – 00:24:38:02
Dr. Carter
Yeah, I guess I went on a tangent, but–

00:24:38:04 – 00:25:01:03
Dan
That’s alright. No, Dr. Carter, this is important for our community to hear. You know, we’re a cosmetic society to a great extent, and we tend to judge books by its cover, and we don’t get into the table of contents of the chapters. So we see you, Dr. Carter, you’re a primary care physician, your industry, all of our primary care physicians, all of our doctors,

00:25:01:06 – 00:25:31:18
Dan
we look up to our doctors. We almost sometimes think of our doctors as superhuman. We don’t actually understand that our doctors are human, too. Yeah, they are. They are fathers. They are mothers, They are aunts, uncles. They’re godparents, they’re grandparents. They navigate things just like all of us do. So thank you for sharing what you just shared, because it will, you know, sharing your story will help hundreds of others.

00:25:31:21 – 00:25:51:16
Dan
Because one–and let’s talk about men. Men, first of all, Dr. Carter, me included, I’m very resistant to going to the doctor. I do not. My wife is always after me. And I recently did go, but it took, I don’t even want to tell you whether it was a year or two years or whatever, but it was longer than it should have been.

00:25:51:18 – 00:26:16:06
Dan
But she’d been after me to go to the doctor. So that’s the first thing. The second thing is medication. And you just shared two things a therapist and medication, two things that we as men and particularly as Black men are resistant to. We’re resistant to medication or resistant to going to the doctor. So thank you for being a human being and in your sharing of your vulnerability, you’ve shown your strength.

00:26:16:07 – 00:26:25:23
Dan
So I just wanted to say on behalf of NAMI, on behalf of us in our relationship, I appreciate it very much, very much so thank you.

00:26:26:02 – 00:26:54:08
Dr. Carter
This is how you beat it. And I’m not talking about my own personal battle, but this is how you address the problem. First, you got to talk about it and normalize talking about it, destigmatizing, right? And once you remove the stigma, it gives other people license to say, you know what? I felt the same way. That opens the door.

00:26:54:10 – 00:27:27:11
Dr. Carter
I got my first colonoscopy last year, and what I decided to do was to kind of do like Instagram and Facebook posts about my process, everything up until like the actual colonoscopy, right? But, you know, so did videos of me making the prep, mixing it up, drinking the prep. And then after I got the colonoscopy, I did another video, came back and said, Hey, I had my colonoscopy.

00:27:27:13 – 00:27:56:05
Dr. Carter
This is what the experience was like. This is how I’m feeling now. This is what they found, which with my colonoscopy, they found several pre-malignant polyps. So I was glad that I did it. And I had so many people reach out to me and say, thank you for sharing because, you know, seeing you mix up the prep and drink the prep and I saw you put some crystal light in it and I saw you did this.

00:27:56:05 – 00:28:19:13
Dr. Carter
And then you said in the video that when you got back there, you didn’t even remember. You didn’t feel anything. It just took the fear of the unknown and then anxiety level down and then it reduced the hesitancy. I mean, sometimes people just need like a a cue, right? They need a cue or a positive trigger.

00:28:19:15 – 00:28:46:13
Dr. Carter
You know, they see that. They say, yeah, I’ve been thinking about getting my colonoscopy. This is a sign, let me go in and get it. So same thing with this, right? Talking about it in a public manner with someone who has it all together, right? I am. I’m a medical doctor. I’m a father, and I’m a leader in health care and outside.

00:28:46:17 – 00:29:08:20
Dr. Carter
And here’s the thing. I’ve had a lot of great things happen to me in the last 6 to 12 months. It seems like I’v just been winning, winning, winning. If the job is available, I’ve gotten it. If the promotion is available, I’m up for it. I got it. I ran for vice-chairman of the medical board. I got it.

00:29:08:21 – 00:29:34:02
Dr. Carter
Got recently nominated for a minority business award here in Birmingham as a leader in health care. And so I’m one of the nominees. And so, like, all this good stuff is happening. I can’t lie to you. Then it was scary because I said all this good stuff is happening. I’m winning too much.

00:29:34:04 – 00:29:35:06
Dan

00:29:35:08 – 00:29:38:05
Dr. Carter
Okay. When am I going to mess up, right?

00:29:38:07 – 00:29:39:16
Dan
That other thought. Yep.

00:29:39:18 – 00:30:00:15
Dr. Carter
When am I going to miss? When are they going to realize that you are a phony, that you don’t deserve these accolades, that you don’t really know what you’re doing?

00:30:00:17 – 00:30:01:20
Dan

00:30:01:22 – 00:30:29:09
Dr. Carter
So everybody sees my LinkedIn, they see my Facebook and my Instagram and they see all this good stuff. And that’s what I have to tell my children. You see all this good stuff and everybody that you’re following on Instagram or TikTok seem like they have it all together. But they are showing you what they want you to see.

00:30:29:11 – 00:31:10:19
Dr. Carter
They’re showing you they’re representative. But what I’m here saying is that here’s the whole me, not just my representative. I am my own best marketing agent, but this is important. This is more important than that. I’m being vulnerable to, again, help someone, even if it’s just one person. You know, I almost backed out. It is because I was like, you know, I’m on NAMI and they got a big national platform because, you know, I could do it on like my Instagram.

00:31:10:19 – 00:31:43:07
Dr. Carter
I got about 2000 followers. You know, only 2000 people will see it, you know. But this is a national organization with chapters all around the country. And somebody that I don’t want to see this is going see it, but that’s okay. I’m alright with that, because at the end of the day, the mission that I’m on, I have a tagline on my LinkedIn and the tagline says, “I add value to the lives of people.”

00:31:43:09 – 00:32:28:20
Dr. Carter
And if I have to say what my mission statement is for my life or give a one-liner for my personal calling in everything that I do, I feel like my purpose is to add value to the lives of people, to add and not subtract, to give and not take, to speak life and not death. And so if I can sacrifice a little bit of my pride and my reputation to keep someone from killing themselves–We had a physician, a dermatologist, actually my wife and my son’s dermatologist just this year they went to see her.

00:32:28:21 – 00:32:43:01
Dr. Carter
One week she was, dead the next. Suicide. Beautiful lady, successful practice, a husband, beautiful children, but suffering in silence.

00:32:43:02 – 00:33:08:02
Dan
You know, we’ve got to have these conversations. There’s only one Dr. Carter, but we need more from the profession to be as strong as you, Dr. Carter. We need it because we, as John Doe citizens, we hold our primary care physicians to this position of, like I said, almost being superhuman. And when we come to see you, it’s about what’s going on with us.

00:33:08:02 – 00:33:39:06
Dan
And we never walk in your shoes to say, well, wait a minute, how is Hernando doing? How is Dr. Carter absolutely doing? What’s going on with him? And it’s not necessarily about getting into your business. It’s looking at you as human versus superhuman, and it’s valuing the overall person and talking about the fact that while we may come to you about what’s going on with us from the neck down, there’s also what’s happening with all of us from the neck up.

00:33:39:08 – 00:34:08:16
Dan
You know, thank you. And I want to go to the theme of National Hospital Week for a second. This year it iis, “We are health care,” emphasizing how health care professionals care for patients and strengthen communities. We are working on strengthening communities by advancing equity and access to care for people in Black and African ancestry. Communities experiencing serious mental illness concerns through our Community Health Equity Alliance Initiative.

00:34:08:18 – 00:34:20:15
Dan
As you know, equity is central to improving care delivery and strengthening communities. Can and would you tell us more about the links between patient care and strong communities?

00:34:20:17 – 00:34:59:02
Dr. Carter
Absolutely. We talk about health care equity, and we know that there is a problem with disparities in health care outcomes, right? That’s a well-known thing. And so the question is, how do we address it? You can control for all of the different social determinants of health. You know, you can have someone that has a college education who has a good job with benefits, who lives in a middle class neighborhood.

00:34:59:04 – 00:35:47:13
Dr. Carter
Right? You control for all of those things. So same income, same education level, all that. But if you give them Black or brown skin with all of those social determinants of health being addressed, their outcomes are still worse than their non-Black and brown counterpart. You know, why is that? It goes to the problem that we have with health care in our country, and that is we try to carve out health care like it is somehow immune to the social and systemic challenges that we face in this country.

00:35:47:15 – 00:36:27:06
Dr. Carter
But it’s all baked in the same. There is a problem with social competence, cultural competence, right? People who are not culturally competent, who are not culturally informed, who are not culturally sensitive, taking care of people who need that sensitivity, right? And then there is going back to this thing of of isolation, but isolation as it relates to our health in our community. We don’t take a community approach.

00:36:27:06 – 00:37:06:17
Dr. Carter
I mean, even in families, children don’t even know their family history. They don’t even know the medical conditions that their parents have or had or their siblings have or had because that’s not any of my business. You know, that’s their business, it’s private. You know, so there’s an issue with cultural competence and systemic racism. And then there’s this issue again, that thing of stigma about health and illness and not communicating.

00:37:06:18 – 00:37:37:19
Dr. Carter
And, you know, so it all kind of comes together and it affects the way we as health care providers deliver care. But it also affects the way our patients accept or receive care as it relates to compliance with medical recommendations, as it relates to follow up or as it relates to even just engaging in health care or primary care.

00:37:38:01 – 00:38:11:19
Dr. Carter
A large majority of Black and brown people who don’t have primary care physicians use the emergency department as their primary care. Horrible outcomes. You just can’t do that. And so the importance of community, in having community that’s culturally competent, community that understands the barriers that exist to people, getting and receiving good health care is very important.

00:38:12:01 – 00:38:42:12
Dan
Thank you for that. And I want to go to something that you’re doing as a way of giving back. And this is a foundation you started and it’s called Prescription for Better Living. You aim to increase the number of Black and brown youth pursuing health careers. What have you learned about the importance of this as a strategy to reach patients in these communities, and how does it help address health equity?

00:38:42:14 – 00:39:35:20
Dr. Carter
Right, so going back to what I was saying before, having that cultural competence, you know, there was a study that looked at pairing patients with primary care providers that were of similar backgrounds, so similar racial cultural backgrounds. And what we found is, that particularly when it came to looking at like prostate cancer screening, when it looked at vaccinations, like getting the flu vaccine and all those things, when you paired a patient, particularly a Black male patient with another Black male, the likelihood that they would get the prostate cancer screening or that they would take the vaccine increased astronomically.

00:39:35:21 – 00:40:15:07
Dr. Carter
The reason is, is because there was better communication and there was trust. So we all you know, we’re all human, as you said earlier, and just because you have a bias, whether you know you have a bias or not, that don’t make you a bad person, right? And so sometimes people say, you know, they don’t want to hear about bias and prejudice and racism in health care because they think that that labels them a bad person.

00:40:15:07 – 00:40:47:01
Dr. Carter
No, that’s just your experience, it’s your upbringing, your background, you know, led you to this point. And it’s something that we need to work on. But that don’t make you a bad person, But we got to acknowledge it, right? So what happens is,that Black and brown patients either personally experience that bias, they don’t feel seen or heard, and they lose trust and confidence in health care.

00:40:47:03 – 00:41:26:11
Dr. Carter
And so they stop engaging or they don’t listen to recommendations. So just pairing somebody with a background similar to theirs, you are already overcoming a huge part of that barrier because there’s already that trust, there’s already that ease of communication. And so what I know is that in order to decrease health care disparities, we have to have more people in the pipeline that are involved in every facet of the health care system that look like the people that they take care of to help reduce those disparities.

00:41:26:11 – 00:41:55:20
Dr. Carter
Because, again, like I said, giving people access is important. So I think the Affordable Care Act was important. I think Medicaid expansion is important. I think Medicare expansion is important. But what that does is, that provides someone with the vehicle to access health care, but that doesn’t guarantee that they will access it just because you give them insurance.

00:41:55:22 – 00:42:25:07
Dr. Carter
And then when they do access it, that doesn’t guarantee that they’re going to follow the recommendations, right? And so we do have to expand access to health care into insurance. But we got to get people in the pipeline who can better identify with the patients that they are taking care of. And that’s what Prescription for Better Living is all about–

00:42:25:09 – 00:43:03:02
Dr. Carter
You know, there was the Flexner Report was a report that came out that looked at, you know, kind of the quality of medical schools and it was back in the 1800s. And Flexner looked at, you know, Johns Hopkins and, Harvard and Yale, and he compared those institutions to Black medical schools like Howard and Meharry and, you know, others.

00:43:03:02 – 00:43:39:03
Dr. Carter
There were about eight others at the time The Flexner Report came out, and it said that all medical schools had to meet this standard. And it was you know, it had more to do with like resources. So finances and, you know, opportunities as far as different types of rotations, etc.. And so that report caused the closure of eight of the ten Black medical schools that existed at that time.

00:43:39:05 – 00:44:26:00
Dr. Carter
And the only ones that survived were Howard and Meharry. Because of that and because of systemic racism, you had fewer Black doctors graduating and so have a situation now where the number of Black doctors that are practicing, the number of Black students that are being accepted into medical school don’t even reflect our representation in this country. We are short about 30,000 Black and brown health care providers.

00:44:26:02 – 00:44:27:02
Dan
Wow.

00:44:27:04 – 00:44:54:06
Dr. Carter
30,000 were shown. And it’s a palpable absence because I can tell you, being in Birmingham, Alabama, and being a Black primary care physician, I am in high demand. My wife is in high demand. There are more patients than we can take care of because people have had bad experiences. I have patients come in, tell me, you know, I just did my routine physical exam on a patient.

00:44:54:06 – 00:45:19:00
Dr. Carter
You know, I looked in their ears and eyes and mouth. I listen to the hearts and lungs. felt on their lymph nodes and skin. I pressed on their abdomen and they were astonished. They say, “man, you did all that?” I said, “yeah.” And they said, “I’ve been going to the doctor for years and I have never had a doctor touch me.”

00:45:19:02 – 00:45:48:11
Dr. Carter
So if you go to the doctor for health care and the doctor treats you like you have leprosy and they don’t touch you, which means they’re not doing a physical exam, how do you have confidence in that? Or they walk in the room and stand by the door and don’t even sit down? How do you follow those recommendations?

00:45:48:13 – 00:46:19:12
Dr. Carter
So I already have hesitancy about getting this colonoscopy. I’ve heard some, you know, I heard at the barbershop or at church, somebody had a bad experience and I’m afraid it’s going to happen to me. And then you won’t even sit down. You won’t come near me. You won’t touch me. You just type on your laptop and without touching me, you’re giving me a prescription and then you’re telling me to go get this procedure.

00:46:19:14 – 00:46:48:19
Dr. Carter
How can I trust you? That’s why we need more culturally competent people in health care. And we need them as nurses. We need them as doctors, we need them as nursing assistants. And medical assistants, radiology technicians, dental hygienist. We need all across the board in order to help our community get healthier.

00:46:48:21 – 00:47:14:16
Dan
So Dr. Carter, how are you exposing young people and demystifying the field of health care, demystifying the field of mental health care, and getting young people interested in the field. Like you mentioned yourself at a very young age, you wanted to be a doctor. Your pediatrician was your role model for what you wanted to be. You didn’t want to be a football player, basketball player, baseball player.

00:47:14:17 – 00:47:27:08
Dan
That’s what you want it to be. How do we– what are you doing to demystify, to share, to excite young people, to go into the health care profession?

00:47:27:08 – 00:47:54:20
Dr. Carter
Yeah. So right now it’s about it’s about exposure. Exposing them to the possibilities, right? So right now locally a lot of work in the community going to you know speak at, you know, schools and churches and those kind of things and just making sure that again, there’s exposure, exposing them to, hey, here’s this whole community of Black doctors that you did not know about.

00:47:54:21 – 00:48:19:17
Dr. Carter
I do some mentoring on a smaller scale, but the plan for the future is to scale that and make it larger. The plan for the future also is to create a kind of what we call a health careers interest group that would, you know, take young people who may be interested and give them, you know, exposure to that.

00:48:19:20 – 00:48:48:13
Dr. Carter
I am about to kind of try my hand in a podcast myself where I cover a variety of topics. But one of the things I want to do is just bring on, you know, a bunch of different Black and brown providers in health care. And so they can just kind of talk about their path and you know, what made them want to go into medicine, What made them choose the field of specialty that they are going into.

00:48:48:13 – 00:49:11:16
Dr. Carter
So it’s all about exposure, it’s about mentoring, making sure people have the correct information about how to get from point A to point B, and then providing resources. So right now we give scholarships to graduating seniors from high school in the Birmingham area who are interested in going to health care. But I want to scale it.

00:49:11:16 – 00:49:40:23
Dr. Carter
I want to be able to give more scholarship dollars eventually. I want to be able to provide grants for Black and brown people who are in college, who are getting ready to take whether it’s the entrance exam for medical school or dental school or optometry school to help provide them resources to study. Because these review courses like Kaplan Review or Princeton Review are extremely expensive.

00:49:40:23 – 00:50:07:10
Dr. Carter
You’re talking about, you know, 2000 or more dollars for a course. And sometimes that cost can be a barrier. So I want to provide grants for young people to help them pay for their review course so they can be properly prepare and perform well. You know, that’s our mission. That’s what we– the work that we’re doing. And that’s kind of our contribution to trying to help solve this problem.

00:50:07:16 – 00:50:29:08
Dan
Yeah. Dr. Carter, thank you so much. And we’re going wrap up with this last question in the spirit of respecting your time. But I just want to say to you before we do that, that you’re doing in terms of exposing young people to careers in health care, you know, if you can see it, you can see it. And our young people need to be see it in order to realize they can be it.

00:50:29:08 – 00:50:49:04
Dan
And so I want to say thank you to you and your wife for what you’re doing and that work. And, you know, I did something years ago. I did something at a workshop called Hidden Heroes, and I decided that the hidden heroes were folks that were in your profession and in other disciplines, that it’s not what we see on TV, and that’s why we call them hidden.

00:50:49:06 – 00:51:09:01
Dan
And they’re the heroes in our community. And we brought in young people that we asked, what were the ages of the most able to influence them on their career selection? So we brought in young people and we use the community to bring them in. We brought not just health care, we brought an inventor and, we got a scientist, and we wanted them to see different kinds of people.

00:51:09:01 – 00:51:35:01
Dan
And we also just tried to make it something that was enjoyable for them so that they had other views. So that’s what you all are doing and what you are doing. So, you know, folks who are listening, Dr. Carter mentioned the organization and I just want to repeat the name of the Prescription for Better Living, and it’s an important foundation that you need to be aware of and appreciate that.

00:51:35:01 – 00:51:52:04
Dan
So before we conclude, Dr. Carter, I’d like to ask you a question that we ask every guest at the end of the podcast. The world can be a difficult place, and sometimes it can be hard to hold on to hope. With each episode, we dedicate the last couple of minutes of our podcast to a special segment called Hold On to Hope.

00:51:52:06 – 00:51:59:05
Dan
But you tell us as we wrap up, what helps you, Dr., hold on to hope?

00:51:59:07 – 00:52:32:05
Dr. Carter
My family. My children, me operating in my purpose again, trying to add value to the lives of people, but then also reminding myself that no matter how bad today was, tomorrow is a new day. It is opportunity to be better and it typically works out that way. So as long as I lay it out, I’m able to get back up. It’s a reset.

00:52:32:07 – 00:52:40:12
Dr. Carter
And, you know, I have a chance to kind of win more than I did the previous day.

00:52:40:14 – 00:53:01:22
Dan
That’s outstanding. And one of the things I also wanted to say is that I want to thank you and the fraternity for providing this to me. And I’m sharing it because one of the things that NAMI is to do is to be more involved with the Divine Nine, because you can’t help a community unless you’re part of community.

00:53:02:02 – 00:53:24:02
Dan
So I just wanted to thank you because this was from the inaugural Leadership Summit and your Founder’s Day program and your leadership, the tone that you set and how you operate, how you show up every day, Dr. Carter is just incredible. As I do the little wrap up, is there anything you would have liked to have said that we did not give you the opportunity.

00:53:24:04 – 00:53:29:08
Dr. Carter
No, you gave me all the opportunity. I think I said that and then some.

00:53:29:10 – 00:54:08:00
Dan
All right. Well, let me just close by saying this has been Hope Starts With Us, a podcast by NAMI, the National Alliance on Mental Illness. Learn more about our commitment to achieving equity through our Community Health Equity Alliance Initiative by visiting chea.nami.org. That’s chea.nami.org. If you are looking for mental health resources, you’re not alone. To connect with the NAMI helpline and find local resources, visit nami.org/help, text ‘HelpLine’ to 62640 or dial 800-950-6264.

00:54:08:02 – 00:54:22:16
Dan
If you are experiencing an immediate suicide, substance use or mental health crisis, please call and text 988 to speak with a trained support specialist or visit 988lifeline.org. I’m Dan Gillison. Thank you for listening and be well.

 

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