Chronicles from the Street: A multi-part series about community perspectives on health and care

Nearly two years ago I moved into the community I serve. Soon after, I resigned from my role as Chief Medical Officer for DC Medicaid. Since then, in my quest to better understand why we spend so much on health care yet have embarrassingly poor outcomes, I’ve been observing and listening-- to my neighbors, to patients, to community partners, to men at the homeless shelter where I volunteer, in the grocery store, on public transportation--- on the street. Listening is the gift that keeps on giving. I’ve learned about why some people don’t:

1.    Feel heard

2.    Trust the health system or its stewards

3.    Make positive health decisions despite knowing what to do

4.    Want to know their diagnosis or health condition

The last one is the most humbling for me. People avoid or delay care because they don't want to know. What are the implications for value-based care systems if the outcomes we should be measuring are linked to understanding and acting upon why a person is on the road to a poor outcome?

Community voices provide context so often absent from the design and implementation of innovation and health system transformation. The stories I'll share over this series are from honest, random conversations in varied settings. When we speak some people know I am a doctor, others don't. Knowing isn't always pertinent. And some, like my neighbor, don't believe I am a doctor and need to be convinced because I am "too nice".

Motivated by insights directly from community, Grapevine Health, aims to demystify health care, give people courage to know and feel supported in the process. Please follow along and comment!