[Script Info]
Title: 
[Events]
Format: Layer, Start, End, Style, Name, MarginL, MarginR, MarginV, Effect, Text
Dialogue: 0,0:00:00.66,0:00:02.28,Default,,0000,0000,0000,,A few years ago,
Dialogue: 0,0:00:02.30,0:00:06.02,Default,,0000,0000,0000,,I was taking care of a woman\Nwho was a victim of violence.
Dialogue: 0,0:00:06.65,0:00:11.83,Default,,0000,0000,0000,,I wanted her to be seen in a clinic\Nthat specialized in trauma survivors.
Dialogue: 0,0:00:12.43,0:00:17.27,Default,,0000,0000,0000,,I made the appointment myself because,\Nbeing the director of the department,
Dialogue: 0,0:00:17.30,0:00:18.76,Default,,0000,0000,0000,,I knew if I did it,
Dialogue: 0,0:00:18.78,0:00:21.20,Default,,0000,0000,0000,,she would get an appointment right away.
Dialogue: 0,0:00:21.89,0:00:25.80,Default,,0000,0000,0000,,The clinic was about an hour and a half\Naway from where she lived.
Dialogue: 0,0:00:25.82,0:00:29.25,Default,,0000,0000,0000,,But she took down the address\Nand agreed to go.
Dialogue: 0,0:00:30.79,0:00:34.25,Default,,0000,0000,0000,,Unfortunately, she didn't\Nmake it to the clinic.
Dialogue: 0,0:00:35.34,0:00:39.63,Default,,0000,0000,0000,,When I spoke to the psychiatrist,\Nhe explained to me
Dialogue: 0,0:00:39.66,0:00:43.02,Default,,0000,0000,0000,,that trauma survivors are often resistant
Dialogue: 0,0:00:43.05,0:00:45.87,Default,,0000,0000,0000,,to dealing with the difficult\Nissues that they face
Dialogue: 0,0:00:45.90,0:00:47.78,Default,,0000,0000,0000,,and often miss appointments.
Dialogue: 0,0:00:48.30,0:00:49.48,Default,,0000,0000,0000,,For this reason,
Dialogue: 0,0:00:49.50,0:00:54.36,Default,,0000,0000,0000,,they don't generally allow the doctors\Nto make appointments for the patients.
Dialogue: 0,0:00:54.89,0:00:57.55,Default,,0000,0000,0000,,They had made a special exception for me.
Dialogue: 0,0:00:58.41,0:01:00.54,Default,,0000,0000,0000,,When I spoke to my patient,
Dialogue: 0,0:01:00.56,0:01:04.61,Default,,0000,0000,0000,,she had a much simpler\Nand less Freudian explanation
Dialogue: 0,0:01:04.63,0:01:06.96,Default,,0000,0000,0000,,of why she didn't go to that appointment:
Dialogue: 0,0:01:07.71,0:01:09.24,Default,,0000,0000,0000,,her ride didn't show.
Dialogue: 0,0:01:10.100,0:01:13.14,Default,,0000,0000,0000,,Now, some of you may be thinking,
Dialogue: 0,0:01:13.17,0:01:16.88,Default,,0000,0000,0000,,"Didn't she have some other way\Nof getting to that clinic appointment?"
Dialogue: 0,0:01:17.35,0:01:21.60,Default,,0000,0000,0000,,Couldn't she have taken an Uber\Nor called another friend?
Dialogue: 0,0:01:22.33,0:01:23.77,Default,,0000,0000,0000,,If you're thinking that,
Dialogue: 0,0:01:23.79,0:01:26.80,Default,,0000,0000,0000,,it's probably because you have resources.
Dialogue: 0,0:01:27.38,0:01:30.51,Default,,0000,0000,0000,,But she didn't have\Nenough money for an Uber,
Dialogue: 0,0:01:30.54,0:01:33.18,Default,,0000,0000,0000,,and she didn't have\Nanother friend to call.
Dialogue: 0,0:01:33.86,0:01:35.57,Default,,0000,0000,0000,,But she did have me,
Dialogue: 0,0:01:35.59,0:01:38.60,Default,,0000,0000,0000,,and I was able to get her\Nanother appointment,
Dialogue: 0,0:01:38.62,0:01:40.95,Default,,0000,0000,0000,,which she kept without difficulty.
Dialogue: 0,0:01:41.65,0:01:43.34,Default,,0000,0000,0000,,She wasn't resistant,
Dialogue: 0,0:01:43.36,0:01:45.20,Default,,0000,0000,0000,,it's just that her ride didn't show.
Dialogue: 0,0:01:46.67,0:01:50.59,Default,,0000,0000,0000,,I wish I could say that this\Nwas an isolated incident,
Dialogue: 0,0:01:50.61,0:01:53.64,Default,,0000,0000,0000,,but I know from running\Nthe safety net systems
Dialogue: 0,0:01:53.66,0:01:58.25,Default,,0000,0000,0000,,in San Francisco, Los Angeles,\Nand now New York City,
Dialogue: 0,0:01:59.18,0:02:02.78,Default,,0000,0000,0000,,that health care is built\Non a middle-class model
Dialogue: 0,0:02:02.80,0:02:07.09,Default,,0000,0000,0000,,that often doesn't meet the needs\Nof low-income patients.
Dialogue: 0,0:02:07.81,0:02:11.84,Default,,0000,0000,0000,,That's one of the reasons\Nwhy it's been so difficult
Dialogue: 0,0:02:11.87,0:02:15.51,Default,,0000,0000,0000,,for us to close the disparity\Nin health care
Dialogue: 0,0:02:15.53,0:02:18.93,Default,,0000,0000,0000,,that exists along economic lines,
Dialogue: 0,0:02:18.95,0:02:22.60,Default,,0000,0000,0000,,despite the expansion of health insurance
Dialogue: 0,0:02:22.62,0:02:25.99,Default,,0000,0000,0000,,under the ACA, or Obamacare.
Dialogue: 0,0:02:26.91,0:02:29.24,Default,,0000,0000,0000,,Health care in the United States
Dialogue: 0,0:02:29.26,0:02:36.21,Default,,0000,0000,0000,,assumes that, besides getting across\Nthe large land expanse of Los Angeles,
Dialogue: 0,0:02:37.39,0:02:40.22,Default,,0000,0000,0000,,it also assumes that you\Ncan take off from work
Dialogue: 0,0:02:40.25,0:02:42.71,Default,,0000,0000,0000,,in the middle of the day to get care.
Dialogue: 0,0:02:43.43,0:02:47.71,Default,,0000,0000,0000,,One of the patients who came\Nto my East Los Angeles clinic
Dialogue: 0,0:02:47.74,0:02:49.96,Default,,0000,0000,0000,,on a Thursday afternoon
Dialogue: 0,0:02:49.98,0:02:54.75,Default,,0000,0000,0000,,presented with partial\Nblindness in both eyes.
Dialogue: 0,0:02:55.45,0:02:57.57,Default,,0000,0000,0000,,Very concerned, I said to him,
Dialogue: 0,0:02:57.59,0:02:59.17,Default,,0000,0000,0000,,"When did this develop?"
Dialogue: 0,0:02:59.95,0:03:01.58,Default,,0000,0000,0000,,He said, "Sunday."
Dialogue: 0,0:03:02.46,0:03:03.93,Default,,0000,0000,0000,,I said, "Sunday?
Dialogue: 0,0:03:03.95,0:03:06.81,Default,,0000,0000,0000,,Did you think of coming sooner to clinic?"
Dialogue: 0,0:03:07.33,0:03:10.51,Default,,0000,0000,0000,,And he said, "Well, I have to work\Nin order to pay the rent."
Dialogue: 0,0:03:11.60,0:03:14.26,Default,,0000,0000,0000,,A second patient to that same clinic,
Dialogue: 0,0:03:14.28,0:03:15.73,Default,,0000,0000,0000,,a trucker,
Dialogue: 0,0:03:15.76,0:03:19.46,Default,,0000,0000,0000,,drove three days with a raging infection,
Dialogue: 0,0:03:19.48,0:03:23.80,Default,,0000,0000,0000,,only coming to see me\Nafter he had delivered his merchandise.
Dialogue: 0,0:03:24.49,0:03:30.83,Default,,0000,0000,0000,,Both patients' care was jeopardized\Nby their delays in seeking care.
Dialogue: 0,0:03:31.84,0:03:35.45,Default,,0000,0000,0000,,Health care in the United States\Nassumes that you speak English
Dialogue: 0,0:03:35.47,0:03:38.60,Default,,0000,0000,0000,,or can bring someone with you who can.
Dialogue: 0,0:03:39.16,0:03:44.00,Default,,0000,0000,0000,,In San Francisco, I took care of a patient\Non the inpatient service
Dialogue: 0,0:03:44.03,0:03:49.16,Default,,0000,0000,0000,,who was from West Africa\Nand spoke a dialect so unusual
Dialogue: 0,0:03:49.18,0:03:54.74,Default,,0000,0000,0000,,that we could only find one translator\Non the telephonic line
Dialogue: 0,0:03:54.76,0:03:56.58,Default,,0000,0000,0000,,who could understand him.
Dialogue: 0,0:03:56.61,0:03:59.80,Default,,0000,0000,0000,,And that translator only worked\None afternoon a week.
Dialogue: 0,0:04:00.70,0:04:05.43,Default,,0000,0000,0000,,Unfortunately, my patient needed\Ntranslation services every day.
Dialogue: 0,0:04:06.53,0:04:09.95,Default,,0000,0000,0000,,Health care in the United States\Nassumes that you are literate.
Dialogue: 0,0:04:10.48,0:04:15.69,Default,,0000,0000,0000,,I learned that a patient of mine\Nwho spoke English without accent
Dialogue: 0,0:04:15.72,0:04:17.22,Default,,0000,0000,0000,,was illiterate,
Dialogue: 0,0:04:17.25,0:04:22.93,Default,,0000,0000,0000,,when he asked me to please sign\Na social security disability form for him
Dialogue: 0,0:04:22.96,0:04:24.27,Default,,0000,0000,0000,,right away.
Dialogue: 0,0:04:24.30,0:04:27.59,Default,,0000,0000,0000,,The form needed to go\Nto the office that same day,
Dialogue: 0,0:04:27.62,0:04:29.50,Default,,0000,0000,0000,,and I wasn't in clinic,
Dialogue: 0,0:04:29.53,0:04:31.10,Default,,0000,0000,0000,,so trying to help him out,
Dialogue: 0,0:04:31.13,0:04:34.88,Default,,0000,0000,0000,,knowing that he was\Nthe sole caretaker of his son,
Dialogue: 0,0:04:34.91,0:04:39.13,Default,,0000,0000,0000,,I said, "Well, bring the form\Nto my administrative office.
Dialogue: 0,0:04:39.15,0:04:42.06,Default,,0000,0000,0000,,I'll sign it and I'll fax it in for you."
Dialogue: 0,0:04:42.08,0:04:44.58,Default,,0000,0000,0000,,He took the two buses to my office,
Dialogue: 0,0:04:44.60,0:04:46.76,Default,,0000,0000,0000,,dropped off the form,
Dialogue: 0,0:04:46.78,0:04:49.15,Default,,0000,0000,0000,,went back home to take care of his son ...
Dialogue: 0,0:04:49.17,0:04:54.60,Default,,0000,0000,0000,,I got to the office, and what did I find\Nnext to the big "X" on the form?
Dialogue: 0,0:04:54.62,0:04:56.05,Default,,0000,0000,0000,,The word "applicant."
Dialogue: 0,0:04:57.56,0:04:59.22,Default,,0000,0000,0000,,He needed to sign the form.
Dialogue: 0,0:05:00.26,0:05:03.71,Default,,0000,0000,0000,,And so now I had to have him\Ntake the two buses back to the office
Dialogue: 0,0:05:03.73,0:05:08.56,Default,,0000,0000,0000,,and sign the form so that\Nwe could then fax it in for him.
Dialogue: 0,0:05:08.58,0:05:10.75,Default,,0000,0000,0000,,It completely changed\Nhow I took care of him.
Dialogue: 0,0:05:10.77,0:05:15.73,Default,,0000,0000,0000,,I made sure that I always went over\Ninstructions verbally with him.
Dialogue: 0,0:05:17.10,0:05:19.95,Default,,0000,0000,0000,,It also made me think about\Nall of the patients
Dialogue: 0,0:05:19.97,0:05:23.27,Default,,0000,0000,0000,,who receive reams and reams of paper
Dialogue: 0,0:05:23.30,0:05:27.35,Default,,0000,0000,0000,,spit out by our modern\Nelectronic health record systems,
Dialogue: 0,0:05:27.37,0:05:30.00,Default,,0000,0000,0000,,explaining their diagnoses\Nand their treatments,
Dialogue: 0,0:05:30.03,0:05:32.95,Default,,0000,0000,0000,,and wondering how many people\Nactually can understand
Dialogue: 0,0:05:32.98,0:05:35.17,Default,,0000,0000,0000,,what's on those pieces of paper.
Dialogue: 0,0:05:35.95,0:05:40.56,Default,,0000,0000,0000,,Health care in the United States assumes\Nthat you have a working telephone
Dialogue: 0,0:05:40.58,0:05:42.19,Default,,0000,0000,0000,,and an accurate address.
Dialogue: 0,0:05:42.78,0:05:46.13,Default,,0000,0000,0000,,The proliferation\Nof inexpensive cell phones
Dialogue: 0,0:05:46.16,0:05:48.01,Default,,0000,0000,0000,,has actually helped quite a lot.
Dialogue: 0,0:05:48.38,0:05:51.38,Default,,0000,0000,0000,,But still, my patients run out of minutes,
Dialogue: 0,0:05:51.41,0:05:53.66,Default,,0000,0000,0000,,and their phones get disconnected.
Dialogue: 0,0:05:54.92,0:05:59.34,Default,,0000,0000,0000,,Low-income people often have\Nto move around a lot by necessity.
Dialogue: 0,0:05:59.36,0:06:05.40,Default,,0000,0000,0000,,I remember reviewing a chart of a woman\Nwith an abnormality on her mammogram.
Dialogue: 0,0:06:05.85,0:06:11.34,Default,,0000,0000,0000,,That chart assiduously documents\Nthat three letters were sent to her home,
Dialogue: 0,0:06:11.36,0:06:14.42,Default,,0000,0000,0000,,asking her to please\Ncome in for follow-up.
Dialogue: 0,0:06:15.13,0:06:17.37,Default,,0000,0000,0000,,Of course, if the address isn't accurate,
Dialogue: 0,0:06:17.40,0:06:21.82,Default,,0000,0000,0000,,it doesn't much matter how many letters\Nyou send to that same address.
Dialogue: 0,0:06:23.40,0:06:28.41,Default,,0000,0000,0000,,Health care in the United States assumes\Nthat you have a steady supply of food.
Dialogue: 0,0:06:29.04,0:06:32.18,Default,,0000,0000,0000,,This is particularly\Nan issue for diabetics.
Dialogue: 0,0:06:32.59,0:06:35.78,Default,,0000,0000,0000,,We give them medications\Nthat lower their blood sugar.
Dialogue: 0,0:06:36.39,0:06:38.99,Default,,0000,0000,0000,,On days when they don't have enough food,
Dialogue: 0,0:06:39.02,0:06:42.79,Default,,0000,0000,0000,,it puts them at risk\Nfor a life-threatening side effect
Dialogue: 0,0:06:42.81,0:06:45.79,Default,,0000,0000,0000,,of hypoglycemia, or low blood sugar.
Dialogue: 0,0:06:46.94,0:06:50.19,Default,,0000,0000,0000,,Health care in the United States\Nassumes that you have a home
Dialogue: 0,0:06:50.21,0:06:52.69,Default,,0000,0000,0000,,with a refrigerator for your insulin,
Dialogue: 0,0:06:52.71,0:06:55.35,Default,,0000,0000,0000,,a bathroom where you can wash up,
Dialogue: 0,0:06:55.38,0:06:57.38,Default,,0000,0000,0000,,a bed where you can sleep
Dialogue: 0,0:06:57.40,0:07:01.69,Default,,0000,0000,0000,,without worrying about violence\Nwhile you're resting.
Dialogue: 0,0:07:02.38,0:07:04.06,Default,,0000,0000,0000,,But what if you don't have that?
Dialogue: 0,0:07:04.69,0:07:06.93,Default,,0000,0000,0000,,What if you live on the street,
Dialogue: 0,0:07:06.95,0:07:09.20,Default,,0000,0000,0000,,you live under the freeway,
Dialogue: 0,0:07:09.23,0:07:11.52,Default,,0000,0000,0000,,you live in a congregant shelter,
Dialogue: 0,0:07:11.54,0:07:15.47,Default,,0000,0000,0000,,where every morning\Nyou have to leave at 7 or 8am?
Dialogue: 0,0:07:16.03,0:07:18.10,Default,,0000,0000,0000,,Where do you store your medicines?
Dialogue: 0,0:07:20.85,0:07:22.62,Default,,0000,0000,0000,,Where do you use the bathroom?
Dialogue: 0,0:07:24.21,0:07:28.39,Default,,0000,0000,0000,,How do you put your legs up\Nif you have congestive heart failure?
Dialogue: 0,0:07:29.06,0:07:35.37,Default,,0000,0000,0000,,Is it any wonder that providing people\Nwith health insurance who are homeless
Dialogue: 0,0:07:35.39,0:07:38.42,Default,,0000,0000,0000,,does not erase the huge disparity
Dialogue: 0,0:07:38.45,0:07:40.82,Default,,0000,0000,0000,,between the homeless and the housed?
Dialogue: 0,0:07:41.86,0:07:47.43,Default,,0000,0000,0000,,Health care in the United States assumes\Nthat you prioritize your health care.
Dialogue: 0,0:07:47.97,0:07:49.66,Default,,0000,0000,0000,,But what about all of you?
Dialogue: 0,0:07:50.47,0:07:54.72,Default,,0000,0000,0000,,Let me assume for a moment\Nthat you're all taking a medication.
Dialogue: 0,0:07:54.74,0:07:56.97,Default,,0000,0000,0000,,Maybe it's for high blood pressure.
Dialogue: 0,0:07:56.100,0:08:00.19,Default,,0000,0000,0000,,Maybe it's for diabetes or depression.
Dialogue: 0,0:08:01.27,0:08:03.71,Default,,0000,0000,0000,,What if tonight you had a choice:
Dialogue: 0,0:08:04.63,0:08:09.18,Default,,0000,0000,0000,,you could have your medication\Nbut live on the street,
Dialogue: 0,0:08:10.51,0:08:15.91,Default,,0000,0000,0000,,or you could be housed in your home\Nbut not have your medication.
Dialogue: 0,0:08:17.88,0:08:19.38,Default,,0000,0000,0000,,Which would you choose?
Dialogue: 0,0:08:21.29,0:08:23.09,Default,,0000,0000,0000,,I know which one I would choose.
Dialogue: 0,0:08:24.54,0:08:28.63,Default,,0000,0000,0000,,This is just a graphic example\Nof the kinds of choices
Dialogue: 0,0:08:28.66,0:08:31.77,Default,,0000,0000,0000,,that low-income patients\Nhave to make every day.
Dialogue: 0,0:08:32.42,0:08:35.34,Default,,0000,0000,0000,,So when my doctors\Nshake their heads and say,
Dialogue: 0,0:08:35.37,0:08:39.96,Default,,0000,0000,0000,,"I don't know why that patient\Ndidn't keep his follow-up appointments,"
Dialogue: 0,0:08:40.55,0:08:45.44,Default,,0000,0000,0000,,"I don't know why she didn't go\Nfor that exam that I ordered,"
Dialogue: 0,0:08:45.47,0:08:49.15,Default,,0000,0000,0000,,I think, well, maybe her ride didn't show,
Dialogue: 0,0:08:49.17,0:08:50.94,Default,,0000,0000,0000,,or maybe he had to work.
Dialogue: 0,0:08:51.51,0:08:57.37,Default,,0000,0000,0000,,But also, maybe there was something\Nmore important that day
Dialogue: 0,0:08:57.39,0:09:01.21,Default,,0000,0000,0000,,than their high blood pressure\Nor a screening colonoscopy.
Dialogue: 0,0:09:01.87,0:09:05.27,Default,,0000,0000,0000,,Maybe that patient was dealing\Nwith an abusive spouse
Dialogue: 0,0:09:06.25,0:09:10.12,Default,,0000,0000,0000,,or a daughter who is pregnant\Nand drug-addicted
Dialogue: 0,0:09:10.14,0:09:13.39,Default,,0000,0000,0000,,or a son who was kicked out of school.
Dialogue: 0,0:09:13.87,0:09:19.29,Default,,0000,0000,0000,,Or even maybe they were riding\Ntheir bicycle through an intersection
Dialogue: 0,0:09:19.32,0:09:21.48,Default,,0000,0000,0000,,and got hit by a truck,
Dialogue: 0,0:09:21.50,0:09:25.96,Default,,0000,0000,0000,,and now they're using a wheelchair\Nand have very limited mobility.
Dialogue: 0,0:09:27.62,0:09:31.18,Default,,0000,0000,0000,,Obviously, these things also happen\Nto middle-class people.
Dialogue: 0,0:09:32.16,0:09:33.92,Default,,0000,0000,0000,,But when they do,
Dialogue: 0,0:09:33.95,0:09:38.33,Default,,0000,0000,0000,,we have resources that enable us\Nto deal with these problems.
Dialogue: 0,0:09:38.84,0:09:44.06,Default,,0000,0000,0000,,We also have the belief that we\Nwill live out our normal lifespans.
Dialogue: 0,0:09:44.68,0:09:46.96,Default,,0000,0000,0000,,That's not true for low-income people.
Dialogue: 0,0:09:47.58,0:09:51.71,Default,,0000,0000,0000,,They've seen their friends\Nand relatives die young
Dialogue: 0,0:09:51.73,0:09:53.14,Default,,0000,0000,0000,,of accidents,
Dialogue: 0,0:09:53.16,0:09:54.36,Default,,0000,0000,0000,,of violence,
Dialogue: 0,0:09:54.38,0:09:58.69,Default,,0000,0000,0000,,of cancers that should have\Nbeen diagnosed at an earlier stage.
Dialogue: 0,0:09:59.21,0:10:01.92,Default,,0000,0000,0000,,It can lead to a sense of hopelessness,
Dialogue: 0,0:10:01.95,0:10:04.23,Default,,0000,0000,0000,,that it doesn't really matter what you do.
Dialogue: 0,0:10:06.13,0:10:11.24,Default,,0000,0000,0000,,I know I've painted a bleak picture\Nof the care of low-income patients.
Dialogue: 0,0:10:11.27,0:10:14.30,Default,,0000,0000,0000,,But I want you to know\Nhow rewarding I find it
Dialogue: 0,0:10:14.32,0:10:16.78,Default,,0000,0000,0000,,to work in a safety net system,
Dialogue: 0,0:10:16.81,0:10:21.16,Default,,0000,0000,0000,,and my deep belief is that we can\Nmake the system responsive
Dialogue: 0,0:10:21.18,0:10:23.54,Default,,0000,0000,0000,,to the needs of low-income patients.
Dialogue: 0,0:10:24.94,0:10:29.05,Default,,0000,0000,0000,,The starting point has to be\Nto meet patients where they are,
Dialogue: 0,0:10:29.08,0:10:31.90,Default,,0000,0000,0000,,provide services without obstacles
Dialogue: 0,0:10:32.68,0:10:35.50,Default,,0000,0000,0000,,and provide patients what they need --
Dialogue: 0,0:10:36.26,0:10:38.11,Default,,0000,0000,0000,,not what we think they need.
Dialogue: 0,0:10:39.62,0:10:43.51,Default,,0000,0000,0000,,It's impossible for me\Nto take good care of a patient
Dialogue: 0,0:10:43.53,0:10:45.92,Default,,0000,0000,0000,,who is homeless and living on the street.
Dialogue: 0,0:10:46.93,0:10:51.44,Default,,0000,0000,0000,,The right prescription\Nfor a homeless patient is housing.
Dialogue: 0,0:10:52.47,0:10:54.29,Default,,0000,0000,0000,,In Los Angeles,
Dialogue: 0,0:10:54.31,0:11:00.34,Default,,0000,0000,0000,,we housed 4,700 chronically\Nhomeless persons
Dialogue: 0,0:11:00.37,0:11:05.00,Default,,0000,0000,0000,,suffering from medical illness,\Nmental illness, addiction.
Dialogue: 0,0:11:06.06,0:11:10.68,Default,,0000,0000,0000,,When we housed them, we found\Nthat overall health care costs,
Dialogue: 0,0:11:10.70,0:11:12.59,Default,,0000,0000,0000,,including the housing,
Dialogue: 0,0:11:12.61,0:11:13.77,Default,,0000,0000,0000,,decreased.
Dialogue: 0,0:11:14.22,0:11:18.70,Default,,0000,0000,0000,,That's because they had\Nmany fewer hospital visits,
Dialogue: 0,0:11:18.72,0:11:23.12,Default,,0000,0000,0000,,both in the emergency room\Nand on the inpatient service.
Dialogue: 0,0:11:24.11,0:11:26.71,Default,,0000,0000,0000,,And we gave them back their dignity.
Dialogue: 0,0:11:27.37,0:11:29.19,Default,,0000,0000,0000,,No extra charge for that.
Dialogue: 0,0:11:30.65,0:11:35.27,Default,,0000,0000,0000,,For people who do not have\Na steady supply of food,
Dialogue: 0,0:11:35.30,0:11:38.96,Default,,0000,0000,0000,,especially those who are diabetic,
Dialogue: 0,0:11:38.98,0:11:44.39,Default,,0000,0000,0000,,safety net systems are experimenting\Nwith a variety of solutions,
Dialogue: 0,0:11:44.42,0:11:48.55,Default,,0000,0000,0000,,including food pantries\Nat primary care clinics
Dialogue: 0,0:11:48.58,0:11:53.31,Default,,0000,0000,0000,,and distributing maps of community\Nfood banks and soup kitchens.
Dialogue: 0,0:11:53.84,0:11:55.66,Default,,0000,0000,0000,,And in New York City,
Dialogue: 0,0:11:55.68,0:11:58.24,Default,,0000,0000,0000,,we've hired a bunch of enrollers
Dialogue: 0,0:11:58.26,0:12:03.48,Default,,0000,0000,0000,,to get our patients into\Nthe supplemental nutrition program
Dialogue: 0,0:12:03.50,0:12:06.88,Default,,0000,0000,0000,,known as "food stamps" to most people.
Dialogue: 0,0:12:08.67,0:12:12.31,Default,,0000,0000,0000,,When patients and doctors\Ndon't understand each other,
Dialogue: 0,0:12:12.33,0:12:14.10,Default,,0000,0000,0000,,mistakes will occur.
Dialogue: 0,0:12:14.72,0:12:16.66,Default,,0000,0000,0000,,For non-English-speaking patients,
Dialogue: 0,0:12:16.69,0:12:20.53,Default,,0000,0000,0000,,translation is as important\Nas a prescription pad.
Dialogue: 0,0:12:21.21,0:12:22.70,Default,,0000,0000,0000,,Perhaps more important.
Dialogue: 0,0:12:23.27,0:12:26.14,Default,,0000,0000,0000,,And, you know, it doesn't\Ncost anything more
Dialogue: 0,0:12:26.17,0:12:30.98,Default,,0000,0000,0000,,to put all of the materials\Nat the level of fourth-grade reading,
Dialogue: 0,0:12:31.01,0:12:35.10,Default,,0000,0000,0000,,so that everybody can understand\Nwhat's being said.
Dialogue: 0,0:12:35.94,0:12:39.34,Default,,0000,0000,0000,,But more than anything else,\NI think low-income patients
Dialogue: 0,0:12:39.37,0:12:43.12,Default,,0000,0000,0000,,benefit from having a primary care doctor.
Dialogue: 0,0:12:43.68,0:12:46.31,Default,,0000,0000,0000,,Mind you, I think middle-class\Npeople also benefit
Dialogue: 0,0:12:46.33,0:12:49.12,Default,,0000,0000,0000,,from having somebody\Nto quarterback their care.
Dialogue: 0,0:12:49.63,0:12:52.76,Default,,0000,0000,0000,,But when they don't, they have others\Nwho can advocate for them,
Dialogue: 0,0:12:52.79,0:12:56.14,Default,,0000,0000,0000,,who can get them that disability placard
Dialogue: 0,0:12:56.17,0:13:00.20,Default,,0000,0000,0000,,or make sure the disability\Napplication is completed.
Dialogue: 0,0:13:00.74,0:13:06.04,Default,,0000,0000,0000,,But low-income people really need\Na team of people who can help them
Dialogue: 0,0:13:06.06,0:13:10.74,Default,,0000,0000,0000,,to access the medical and non-medical\Nservices that they need.
Dialogue: 0,0:13:11.23,0:13:14.53,Default,,0000,0000,0000,,Also, many low-income people\Nare disenfranchised
Dialogue: 0,0:13:14.55,0:13:16.94,Default,,0000,0000,0000,,from other community supports,
Dialogue: 0,0:13:16.97,0:13:22.98,Default,,0000,0000,0000,,and they really benefit from the care\Nand continuity provided by primary care.
Dialogue: 0,0:13:23.62,0:13:26.48,Default,,0000,0000,0000,,A primary care doctor\NI particularly admire
Dialogue: 0,0:13:26.50,0:13:31.58,Default,,0000,0000,0000,,once told me how she believed\Nthat her relationship with a patient
Dialogue: 0,0:13:31.60,0:13:33.09,Default,,0000,0000,0000,,over a decade
Dialogue: 0,0:13:33.11,0:13:37.45,Default,,0000,0000,0000,,was the only healthy relationship\Nthat that patient had in her life.
Dialogue: 0,0:13:38.79,0:13:42.73,Default,,0000,0000,0000,,The good news is, you don't\Nactually have to be a doctor
Dialogue: 0,0:13:42.75,0:13:47.36,Default,,0000,0000,0000,,to provide that special sauce\Nof care and continuity.
Dialogue: 0,0:13:47.71,0:13:51.93,Default,,0000,0000,0000,,This was really brought home to me\Nwhen one of my own long-term patients
Dialogue: 0,0:13:51.96,0:13:54.54,Default,,0000,0000,0000,,died at an outside hospital.
Dialogue: 0,0:13:54.89,0:13:58.62,Default,,0000,0000,0000,,I had to tell the other doctors\Nand nurses in my clinic
Dialogue: 0,0:13:58.65,0:14:00.03,Default,,0000,0000,0000,,that he had passed.
Dialogue: 0,0:14:00.46,0:14:04.47,Default,,0000,0000,0000,,But I didn't know that\Nin another part of our clinic,
Dialogue: 0,0:14:04.50,0:14:06.52,Default,,0000,0000,0000,,on a different floor,
Dialogue: 0,0:14:06.55,0:14:09.07,Default,,0000,0000,0000,,there was a registration clerk
Dialogue: 0,0:14:09.09,0:14:13.11,Default,,0000,0000,0000,,who had developed a very special\Nrelationship with my patient
Dialogue: 0,0:14:13.13,0:14:16.13,Default,,0000,0000,0000,,every time he came in for an appointment.
Dialogue: 0,0:14:16.85,0:14:20.54,Default,,0000,0000,0000,,When she learned three weeks later\Nthat he had died,
Dialogue: 0,0:14:20.56,0:14:23.30,Default,,0000,0000,0000,,she came and found me\Nin my examining room,
Dialogue: 0,0:14:23.32,0:14:26.25,Default,,0000,0000,0000,,tears streaming down her cheeks,
Dialogue: 0,0:14:26.27,0:14:31.88,Default,,0000,0000,0000,,talking about my patient\Nand the memories that she had of him,
Dialogue: 0,0:14:31.90,0:14:35.97,Default,,0000,0000,0000,,the kinds of discussions that they had had\Nabout their lives together.
Dialogue: 0,0:14:38.07,0:14:39.94,Default,,0000,0000,0000,,My patient had a hard life.
Dialogue: 0,0:14:40.70,0:14:43.78,Default,,0000,0000,0000,,He was by his own admission a gangbanger.
Dialogue: 0,0:14:44.23,0:14:47.85,Default,,0000,0000,0000,,He had spent a substantial\Namount of time in prison.
Dialogue: 0,0:14:48.89,0:14:51.70,Default,,0000,0000,0000,,He suffered from a very serious illness.
Dialogue: 0,0:14:52.32,0:14:53.84,Default,,0000,0000,0000,,He was a drug addict.
Dialogue: 0,0:14:54.53,0:14:57.63,Default,,0000,0000,0000,,But despite all that,\Nhe rarely missed a visit,
Dialogue: 0,0:14:58.69,0:15:04.17,Default,,0000,0000,0000,,and I like to believe that was because\Nhe knew at our clinic that he was loved.
Dialogue: 0,0:15:05.79,0:15:11.15,Default,,0000,0000,0000,,When our health care systems have the same\Ncommitment to low-income patients
Dialogue: 0,0:15:11.18,0:15:13.08,Default,,0000,0000,0000,,that that man had to us,
Dialogue: 0,0:15:13.10,0:15:14.64,Default,,0000,0000,0000,,two things will happen.
Dialogue: 0,0:15:15.64,0:15:20.44,Default,,0000,0000,0000,,First, the system will be responsive\Nto the needs of low-income people.
Dialogue: 0,0:15:20.47,0:15:24.44,Default,,0000,0000,0000,,It will speak their language,\Nit will meet their schedules,
Dialogue: 0,0:15:24.46,0:15:26.38,Default,,0000,0000,0000,,it will fulfill their needs.
Dialogue: 0,0:15:27.17,0:15:31.11,Default,,0000,0000,0000,,Second, we will be providing\Nthe kind of care
Dialogue: 0,0:15:31.14,0:15:33.94,Default,,0000,0000,0000,,that we went into this profession to do --
Dialogue: 0,0:15:33.96,0:15:36.77,Default,,0000,0000,0000,,not just checking the boxes,
Dialogue: 0,0:15:36.80,0:15:40.15,Default,,0000,0000,0000,,but really taking care of those we serve.
Dialogue: 0,0:15:41.40,0:15:42.64,Default,,0000,0000,0000,,Thank you.
Dialogue: 0,0:15:42.67,0:15:46.89,Default,,0000,0000,0000,,(Applause)