Voice: Dr. Carolyn Chen

Dr. Carolyn Chen is a medical doctor and director of the Pecos clinic for Clinica Family Health Services.

“We’re putting a lot of specialty care services higher on the reimbursement scale than primary care preventive services. It’s like if somebody gets there and is obese and has really bad gestational diabetes and they need insulin, then their health insurance or Medicaid or whomever will authorize the payment of X number of dollars to the highest-degree specialist they can get … and that compensation would be markedly different than, let’s say, a nurse midwife, who would come out and do home visits, or even group visits with somebody, in an arena where they could have met with that person and prevented that problem, would have saved all of us a lot of money, including that patient.”

There are a lot of people that definitely have risky health conditions. Probably the one that we see the most of, with our population is largely Latina pregnant patients, so when you’re talking about health disparities in people who are pregnant, if they have a health disparity they are more likely than not to also be obese, or to suffer from other chronic conditions like depression or anything else. But obesity clearly is an epidemic, and it’s affecting everybody, and included in that is fertile women of child-bearing age, and then they get gestational diabetes, and with gestational diabetes you really have to be on top of what you’re doing or else there are a lot of health risks that you can have.

Dr. Carolyn Chen

Dr. Carolyn Chen

So we’re talking about a population at higher risk already for a bad outcome, and then you stack on top of that obesity for whatever reasons people individually or you or I want to believe in.

Ok, so maybe you had a really bad outcome, and your baby – I have a patient like this – was born at 10 pounds because of uncontrolled gestational diabetes. I kid you not – it was crazy. And they’re trying their best, but maybe they have five kids at home, maybe their faith, in my patient population, doesn’t allow them to use various forms of birth control, which we could have a whole ‘nother discussion about. So they have five kids and uncontrolled gestational diabetes and then their kid pops out, 10 pounds, and has a lot of problems, but dad’s working two jobs and they’re trying their best with their diet. And this person, actually in lieu of knowing what to do with her diet, just got a little bit frustrated with, OK, you can eat lentils and whole grains and fruits, but not these fruits, you know, and eat like a bunny for these nine months. Well, OK, it’s not easy for me to buy those vegetables if I live in an impoverished area of town where they’re not readily available or they’re rotten, or I buy them out of a can, or no matter what, face the fact and say, I’m going to try the best and I’m going to be a great mother for this child, but my kids are eating tortillas or tamales or hot dogs, or whatever. What person is going to say, I’m never going to have a bite of that, when it’s on the same dining room table that I’m eating at?

When you have a person like that, it’s like, gosh, where do you even begin? Well, we have a registered dietician, who is herself Latina, who can say, you know what, when you’re cooking those beans, why don’t you try to use low-fat canola oil instead of lard – and just try it. Maybe it doesn’t taste that good. Or, you know – hot dogs, boil them, don’t grill them. All kinds of different ways where you can do just little modifications and it’s the same information that they need to get. But here I am, wealthy by nature of me being a family doc, Asian, second generation immigrant, trying to tell some Latino family who – I’ve worked here for six years – a lot of them know me, but they know that I’m not them. And I can’t really understand what their life is like – sit there in front of them and be like, you should eat more carrots and salad instead of your beans and tortillas because you’re diabetic. I might as well have just told them, you know, that if it were the equivalent of me, you can never eat a bowl of white rice again. I’m just not listening to that.

And so maybe it comes better from somebody else. And if that’s what they need, then that’s fine. And we should keep them at the center of what’s going to be better for a patient instead of trying to figure out what’s better for the health system.

We’re putting a lot of specialty care services higher on the reimbursement scale than primary care preventive services. It’s like if somebody gets there and is obese and has really bad gestational diabetes and they need insulin, then their health insurance or Medicaid or whomever will authorize the payment of X number of dollars to the highest-degree specialist they can get … and that compensation would be markedly different than, let’s say, a nurse midwife, who would come out and do home visits, or even group visits with somebody, in an arena where they could have met with that person and prevented that problem, would have saved all of us a lot of money, including that patient.

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