Table Of ContentPatient-Centered
Clinical Care for
African Americans
A Concise, Evidence-Based
Guide to Important
Diff erences and Better
Outcomes
Gregory L. Hall
123
Patient-Centered Clinical Care for African
Americans
Gregory L. Hall
Patient-Centered Clinical
Care for African Americans
A Concise, Evidence-Based Guide
to Important Differences and Better
Outcomes
Gregory L. Hall, MD
Partnerships for Urban Health
Cleveland State University
Cleveland, OH
USA
ISBN 978-3-030-26417-8 ISBN 978-3-030-26418-5 (eBook)
https://doi.org/10.1007/978-3-030-26418-5
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This book is dedicated to my wife, Melanie,
and our sons, Alex, Nick, and Greg Jr., for all
of their sacrifice and unwavering support.
Preface
In the fall of 2002, I was appointed to the Ohio Commission on Minority Health.
My name had been submitted to Ohio Governor Bob Taft by Cleveland’s Mayor
Jane Campbell because they needed a medical professional from the Cleveland area
to better balance the representation to the state-wide board. As a Cleveland Clinic-
trained internal medicine and primary care provider in an urban practice that was
over 90% African American, I could provide in-the-trenches perspectives. Upon
joining, I was embarrassed to admit how little I knew about health disparities and
how they impacted minorities, but I attended the meetings regularly … and
quietly.
The commission was largely a funding organization and specialized in advanc-
ing smaller grants for unique approaches to shrinking health disparities. We also
advocated for policies that impact health in the larger scheme. The commission is
composed of the directors of key statewide departments including the Departments
of Health, Job and Family Services, Education, Medicaid, Developmental
Disabilities, and Mental Health and Addiction, in addition to four elected officials
and eight governor appointees, of which I was one.
Bringing a “high-end” group like this together was initially intimidating but
before long we began to fill our roles appropriately. As a physician, I initially
believed that health disparities were almost completely driven by poverty and/or the
lack of access to medical services. I also falsely believed that “minorities” had poor
health outcomes and the “majority” populations had better health outcomes.
Because of my work with the commission, I soon joined the Medical Care
Advisory Committee for Ohio Medicaid. In this capacity, I saw not only the finan-
cial burden that poor health outcomes put on a strained state budget but also the
disconnect between providers of Medicaid recipients and state agency representa-
tives with good intentions.
My exposure to the breadth of urban healthcare delivery was rounded by my
experience as medical director of multiple urban extended care facilities including
two with large psychiatric populations, continued inpatient care with patients at an
vii
viii Preface
inner city hospital (St. Vincent Charity Medical Center), and some time as medical
director of home health and hospice agencies.
As the years passed, I was elected vice-chair and then chairman of the Ohio
Commission on Minority Health. A part of my duties was to prepare an educational
chairman’s report to be presented at each meeting. As I became familiarized with
research articles involving quality outcomes, I was struck by the significant health
disparities between minority groups and that the specific health issues were not
addressed by the same solutions. Problems in the Asian American or Hispanic/
Latino communities consisted of issues regarding immigration, communication,
language, and access. African American disparities were pervasive across a range of
categories: the worst cardiovascular issues, worst cancer outcomes, longest length
of hospital stay, lowest referrals for accelerated care, and so on. Put simply, the
health-related problems for African Americans were too serious, too unique, and too
severe to simply be “bunched” with other racial/ethnic groups.
My second revelation was that physicians, clinicians, and other providers were
indirectly contributing to some of these disparities. This perspective was first
brought to my attention by the Commission Executive Director Cheryl Boyce, who
had noted these differences from both a professional and a personal perspective. I
remember initially shrugging off her viewpoint as isolated because variability in
care delivery can occur, but when I reviewed the wide-ranging research, the perva-
sive clinician-driven differences in the care of African Americans were undeniable.
I decided to highlight some of these care differences on my practice website,
drgreghall.com, in order to educate the African American community to be better
stewards of their medical care. As I composed these short articles with hyper-
links to verified research in PubMed, I was progressively finding more nuances
in clinical care.
I realized that my aim to educate about the differences in the clinical care of
African Americans was directed to the wrong audience, and I needed to move
“upstream” and bring these differences to the notice of medical providers. That
realization soon led to the process of compiling a collection of best practices for
African American clinical care, one that is long overdue and deserving of the medi-
cal community’s singular attention.
Cleveland, OH, USA Gregory L. Hall, MD
June 18, 2019
Acknowledgments
This book was definitely a group effort and the culmination of a number of partner-
ships and affiliations across my career. I started the book by interviewing a number
of highly successful physicians who had predominant African American patient
populations. As a provider for African Americans, I knew that my approach to this
patient population was different, but I needed to know if there was a distinct pattern.
I particularly appreciate the input of Ronald Adams, MD; Lloyd Cook, MD; Giesele
Greene, MD; Carl Jackson, MD; Toye Williams, MD; and Harold James, MD, for
their assistance early on. I also need to thank my brother, Bill Hall, for introducing
me to his physician colleagues for interviews in the Maryland region including
Elmer Carreno, MD; Geoff Mount-Varner, MD; and Don Shell, MD. Another
important interview was with my good friend since our Cleveland Clinic residency
days, Mark Spears, MD, in Florida.
Many thanks to my colleagues and the staff at St. Vincent Charity Medical Center
including Chief Medical Officer Joseph Sopko, MD, one of the earliest reviewers;
Department of Medicine Chairman Keyvan Ravakha, MD; and supportive col-
leagues, Mukul Pandit, MD; Donald Eghobamien, MD; Sam Ballesteros, MD; Alan
Rosenfield, MD; Mona Reed, MD; Jill Barry, MD; James Boyle, MD; John Marshall,
MD; Emmanuel Elueze, MD; Oluwaseun Opelami, MD; and Lonnie Marsh, MD.
The residency program at St. Vincent Charity Medical Center produces top-
notch physicians who also contributed to this book. Randol Kennedy, MD, and
Anita Mason-Kennedy, MD, reviewed and added to the entire book with particular
contributions to the chapters on cardiology, hematology, and rheumatology. I also
appreciate and thank graduate Medical Education Manager Nicole Allen-Banks.
Other residents proofreading include Nana Yaa, MD, and Adeyinka Owoyele, MD.
My cousin, Kim Simpson, MD, was my first reviewer and got this book off to a
great start particularly contributing to the first three chapters. Good friend Joan
Reeder, MD, also reviewed the book early on.
ix
x Acknowledgments
I was honored to have the chapters on cardiovascular and renal disease reviewed
with significant input by Jackson T. Wright Jr., MD, PhD. Sherrie Dixon-Williams,
MD, reviewed and contributed to the pulmonary chapter.
I appreciate the ongoing support of Janet Baker, DNP, dean of Ursuline College
School of Nursing, for her support in reviewing the book. The chapter on stories and
patient counseling was reviewed by William Tarter Sr., and I appreciate his ongoing
guidance and counsel.
I would also like to express my gratitude to Cheryl and Russel Boyce; Nick and
Yvette Petty; Thomas Ferkovic; Georgia State Senator Emanuel Jones; Georgia
State Rep. Al Williams; Donald Wesson, MD, MBA; John McCarthy; Charles
Modlin, MD; Angela Cornelius Dawson; Cora Munoz, PhD, RN; Danny Williams;
Deborah Enty; Mary E. Weems, PhD; Michael Oatman; Reggie Blue, PhD; Paul
Lecat, MD; David Whitaker, JD; Tim Goler, PhD; Robert Ankrum; Ronald Duncan;
Robert Dennison; Earl King; Terry Ford; Alana Smith; and a host of other physi-
cians, nurses, and professionals with whom I work in various capacities.
My office practice would not be able to stay afloat without my office manager,
Robin Smith, holding everything together. Medical Assistant Jasmine Williams
always has a happy and caring smile for both my patients and I. My long-term
administrative assistant, Katrina Hurt, also deserves credit for her support over the
years. I am also grateful to my patients who have supported my work and encour-
aged me. My patients are the best in the world, and I treasure their support and
commitment.
My position as co-director of the Northeast Ohio Medical University-Cleveland
State University Partnership for Urban Health has allowed me to work with an out-
standing array of people. My predecessor in this position is a modern medicine leg-
end and is dedicated to excellence and inclusion in all he does, Edgar Jackson Jr.,
MD. Ronnie Dunn, PhD, is an outstanding leader in diversity and inclusion and was
very instrumental in getting this book published. Celeste Ribbons is an outstanding
operations manager, organizer, and counselor. Lena Grafton is an excellent teacher,
researcher, and outreach officer. Antoinette Speed does a great job keeping us orga-
nized and successful in our projects. Peggy Irwin is an outstanding grant writer,
teacher, and manager. Dr. Julian Earls has been a constant inspiration to me and is a
champion among educators. School of Health Sciences Director Beth Domholdt is
the perfect collaborator due to her insight, experience, and compassion. Dean
Meredith Bond of the College of Sciences and Health Professions has also been very
supportive of our work and has great intuition and knowledge. My sincere thanks
also go to the provost of Cleveland State University, Jianping Zhu, PhD.
Acknowledgments xi
I am an active faculty member at the Northeast Ohio Medical University College
of Medicine and appreciate the support provided by my department chairs, Joseph
Zarconi, MD, and William Chilian, PhD. I also thank the leadership of the College
of Medicine Dean Elisabeth Young, MD, and Vice Dean Eugene Mowad, MD. I also
recognize the talents of my co-director, Sonja Harris-Haywood, MD.
Having been on the Cuyahoga County Board of Health for almost 10 years, I
have had the opportunity to see how a world-class public health entity can work. Its
commissioner, Terrence Allan, was instrumental in my initial appointment and has
always been supportive, inclusive, and incredibly productive. We have a great team
at CCBH lead by our board president, Debbie Moss-Batt, and my fellow board
members, Jim Gatt, Doug Wang, and Sherrie Williams, MD.
Working with the Saber Healthcare Group and its leaders, George Repchick and
Bill Weisberg, has been a highlight of my career, and I sincerely appreciate their
support and encouragement throughout our many years together. I also appreciate
Gia Weisberg and Lynda Repchick for their support as well as Grant and Lisa
Weimer.
My high school classmates, Kevin Goldsmith, JD; Martin Davidson, PhD; and
Henry Butler from University School also helped greatly through advice and coun-
sel. My Williams College classmates, Ray Headen, JD, Deborah Marcano, and
Peter Graffagnino, also contributed support through networking and advice.
Thanks to Richard Lansing for his support throughout the publishing process and
for immediately seeing the potential of this book.
And finally, thanks to the Hall family, my mother and father (Louise and Albert
Hall) who supported me unconditionally and my brothers and sister, Tyrone, Wanda,
Bill, and Barry, who always made sure I was loved and nurtured. With marriage
comes my extended family that has also been supportive including my sisters-in-
law, Robin, Stacie, and Lorraine, and my brother-in-law, Sherman, who have always
provided expert counsel and advice. My wife Melanie’s side of the family has also
been supportive and accepting, and I will always treasure my mother- and father-in-
law, Mamie and Jesse Coats, as well as my brother-in-law, Michael, and sister-in-
law, Valeri. I love and thank all of our nieces and nephews and the rest of the Hall
and Coats families. Other supportive family members include Martin Kelly; Jeff
Johnson, JD; Duane Morton; Geovette (GiGi) Houston; Tony Whitaker; Cynthia
Simpson; Cheryl Staples; Lynette Bennet; Judith Dunn; and our great friends, Paul
and Valencia Stephens.
It truly took a village to get this book written and published.
