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Closing the Gap

Closing the Gap

TV personality and OB-GYN Dr. Jessica Shepherd understands the importance of addressing health disparities from every angle.

One can rarely go a few weeks without seeing Dr. Jessica Shepherd on their television screen. Shepherd has made a name for herself both inside and outside of the medical world by turning medical jargon into comprehensive anecdotes and advice digestible for the average viewer. Along the way, Shepherd has also found a means to bring light to the needs and concerns of populations primarily ignored by the mainstream media such as limited access to medical care and discrepancies in treatment. Whether she is offering her tips on making self-care accessible for all in Women’s Health magazine or providing preventative care advice on “Good Morning America,” Shepherd proves bridging the cultural gap in medicine does not have to be a difficult task.

I arrived at her home on a Friday morning at the beginning of November 2018 during an unseasonably cold day in Dallas. In many ways, her home is not unlike Shepherd herself: sophisticated without being intimidating, elegant without seeming pretentious. Her family was still home, including her two young sons and loving husband. Shepherd’s move from Chicago, a city she once called home as the director of Minimally Invasive Gynecology at the University of Illinois at Chicago, to Dallas, where she now works for the Baylor Scott & White Women’s Health Group, was an easy decision.

I’ve found I can help women who don’t have that access, so that was important to me.

Dr. Jessica Shepherd

Besides offering an opportunity for Shepherd and her family to be closer to relatives, many of Dallas’ biggest concerns in women’s health and cancers mimic those of Chicago. A 2015 report from Susan G. Komen Dallas County found that “not only are Black/African-American women facing a higher death burden than other population groups in Dallas County, they are also more likely to receive a late-stage breast cancer diagnosis. The late-stage diagnosis rate of Black/African-American women in Dallas County is 1.2 times higher than the rate experienced collectively by all women in the county.”

As a medical professional intent on closing the racial and socioeconomic gaps for access to medical care, treatment, and rates of disease, addressing these numbers are of significant concern for Shepherd. “I’ve found I can help women who don’t have that access, so that was important to me,” Shepherd says.

Discrepancies in access to treatment are not just a personal issue for Shepherd. It is something of a national crisis, too. Rates across the country align with those in Dallas. According to the journal The Oncologist, in the United States, black women get 6 percent fewer cancers overall than white women but account for a 14 percent higher rate of cancer deaths. Additionally, the report states, “African-American women face a greater risk for being diagnosed with early-onset disease.” A 2009 report from the journal Cancer indicates African-American women were also 1.61 times more likely to develop metastasis than white women. These rates are due to a complex series of socioeconomic, cultural, environmental, and biological factors.

We have the most expansive health care system in the world, but when you look at statistics, we’re not necessarily doing any better…

Dr. Jessica Shepherd

According to Cancer, “African-American women may differ from white women in terms of specific patient characteristics, e.g., older age and more comorbidity, which might convey increased vulnerability to the development of metastases. Second, different type and extent of treatment received may affect the development of metastases. African-American women are less likely to receive indicated radiotherapy and later-generation chemotherapeutic agents than white women. Third, lack of access to care and contact with the medical system may result in delayed detection of metastases, and African-American women typically have lower access to medical care than white women.”

Photo by Michelle Khan

Other factors include a lack of access to surveillance mammography (which reduces the death rate for older women with breast cancer), and environmental concerns, such as a higher likelihood of living in severe segregation and more poverty-stricken areas, which reduces access to local resources, such as grocery stores selling fresh fruits and vegetables. As reported in the Spring 2019 issue (see “Nourish to Heal”), certain foods such as refined, processed carbohydrates and sugar fuel cancer cell growth. Psychosocial stress, another underreported factor, may “indirectly influence development of metastases through increased stress hormones and reduced immune function,” the report states.

Addressing these staggering rates will require a comprehensive overhaul of how we administer medical care to all populations. “When you think broadly […] about health disparities, it’s about approaching it from the physician side, the patient side, and legislative-wise,” says Shepherd. Advocates on the front lines like Shepherd are bringing these issues, which typically remain out of regular discussion in mainstream media, into the spotlight.

One way Shepherd addresses the health disparities is by advocating for earlier and minimally invasive treatment options. After receiving her medical degree from Ross University and completing an internship and residency at Drexel University College of Medicine in Philadelphia, Shepherd completed a fellowship in minimally invasive gynecologic surgery, something which, at the time, was not yet widely established in the medical community.  

Photo by Michelle Khan

“I felt that minimally invasive surgery was something that was becoming popular in medicine, but when we look at the numbers for women’s health and how that correlated, the numbers were still so low,” explains Shepherd. “When you look at hysterectomies, myomectomies, taking out fibroids, anything that had to do with the pelvis, as far as the surgical aspect, those numbers [were low]. I found that a bit interesting, and a little bit frustrating on why if now it’s a women’s health issue the numbers for that type of surgery weren’t skyrocketing.”

Minimally invasive surgery, according to Shepherd and others, can prove to be a beneficial and preventative first step in addressing some gynecological cancers, especially for populations like African-American women who are more likely to receive mentally and physically invasive forms of treatment. A 2017 report from the American College of Surgeons National Surgical Quality Improvement Program found, “employing minimally invasive surgery to treat women with gynecological cancers seems to be crucial to accomplish the best outcomes both for patients and physicians as well as for hospitals.” Comparing surgical outcomes in more than 2,000 surgeries for endometrial cancer performed by laparotomy or minimally invasive surgery between 2006 and 2010 in the United States found fewer days of hospitalization, fewer complications, and a yearly savings of $534 million.

However, getting the country’s most disenfranchised populations into medical facilities at the right time to receive such beneficial treatments requires multifaceted effort. Shepherd believes changing society’s perception of health as a necessity for all will help address these staggering rates. “When you look at health statistics as far as populations, the populations that do the best are countries that have socialized medicine to some degree,” Shepherd says. “We have the most expensive health care system in the world, but when you look at statistics, we’re not necessarily doing any better, so I think legislative-wise, those are the things that could be approached and looked at differently.”

Photo by Michelle Khan

On a more local scale, diminishing the impact of hypersegregation would make great strides in addressing medical discrepancies. Who has access to a city’s best hospital systems? Where are they located, and would the average patient have the ability to travel to an appointment without sacrificing their work day? Would they find treatment despite not having the best insurance—or any insurance at all? Organizations such as Susan G. Komen, which works with partner organizations in less centrally located areas of a city, or A Silver Lining Foundation, which pays for free breast screenings, are filling in the gaps. However, their work can only go so far to address a complex, systemic problem.

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In the meantime, the easiest and quickest form of change might require doctors and other medical professionals to improve their communication practices. While most doctors don’t have the opportunity to appear on national television to advocate for their causes, Shepherd still believes more work is necessary. While winding down our conversation, she reiterated how much is missing from contemporary medical practices.

“Sometimes [physicians] have difficulties communicating with patients because when we speak, we’re speaking scientific and study-based and evidence-based. [When] patients hear that […] it’s either information they don’t even understand or […] the connection is not very personalized,” says Shepherd. “At the end of the day, someone just wants to be validated with whatever their issue is.”

Improving lines of communication can include simple tasks like offering more comprehensive preoperative counseling, regularly facilitating cancer prevention initiatives, offering easy-to-understand questionnaires, or frequently training medical staff to work with a variety of different populations. “On our end, we could do a better job of creating those communication lines, and it does show that when there’s better communication, there’s better understanding, there’s more compliance, and from the patient perspective […] they feel empowered in their health.”

When you think broadly […] about health disparities, it’s about approaching it from the physician side, the patient side, and legislative-wise.

Dr. Jessica Shepherd

Studies confirm Shepherd’s anecdotes. A 2016 review from the journal Preventative Medicine states, “Provider-patient communication regarding screening tests may play one of the strongest modifiable roles in cancer-screening behavior. Physicians and other primary health care providers can serve as a key health information source by assessing patient screening eligibility, negotiating a course of action, and helping to coordinate screening tests and follow-up care.”

Shepherd believes in setting different expectations for her practice, whether that involves asking patients to come back if she does not answer all of their questions or asking her patients to relay information back to her to ensure they understand the information she has given them. “How we take everything in and process it, mentally, has a lot to do with our outcomes, kind of like input-output,” Shepherd says. “What we allow our brains to process […] is how we have [better] outcomes.”

However, for those who are unable to visit Shepherd’s practice, she recommends patients take charge and advocate for their health. “I think many women have led their lives more on the page of what they shouldn’t do rather than what they can do,” Shepherd says. “When [a patient] walks out, they should feel empowered by having whatever they came in for discussed and treated or addressed. They have tools to continue improving their health that will get them better and better outcomes.”

Photo by Michelle Khan

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