Dr. J. Nwando Olayiwola is the newly appointed Chief Health Equity Officer at Humana.
Dr. J. Nwando Olayiwola, affectionately known by colleagues as Dr. O, is the newly appointed Chief Health Equity officer at Humana. It’s a role she’s been working towards for her entire life. When Dr. O was only six years old, she visited her parents’ home country of Nigeria, where she accompanied her aunt, a general practitioner, on house calls to see patients. “People were just so happy to see her coming,” says Dr. O. “I saw that she was really making a difference in people’s lives and I thought, ‘this job is amazing.’” There was no question about what Dr. O wanted to be when she grew up.
She continued to pursue her dream of becoming a physician, but Dr. O began to notice flaws in the U.S. healthcare system. When Dr. O was in elementary school, her grandmother came to visit from Nigeria. During the trip, she suffered a small heart attack and was taken to the hospital. “My grandmother was incredibly smart, but she didn’t speak much English.
When we got to the hospital, she couldn’t understand what the doctors were asking her.” Instead of trying to address the language barrier, doctors began speaking slowly and loudly to Dr. O’s grandmother, as though she had a hearing problem. “I remember thinking, ‘they’re treating her like she’s dumb, and she’s not dumb.’ It was so demeaning and disrespectful. Even then I felt like, ‘there’s got to be a better way to handle this. She can’t be the only person that doesn’t speak English who’s ever come to this hospital.’” It was Dr. O’s first real experience with health inequity, or “systematic differences in the opportunities that groups have to achieve optimal health, leading to unfair and avoidable differences in health outcomes,” according to the National Academies of Science, Engineering and Medicine. “I realized if you didn’t have a certain level of language or literacy, this system would not work for you,” Dr. O recalls. It was then that she made it her mission to try to change the system.
Practically speaking, it would be impossible to have doctors who could interpret every language or understand every person’s cultural background at every hospital. Instead, Dr. O proposes a simple yet radical solution within the healthcare industry: teach doctors to prioritize both cultural competency and empathy. This isn’t, Dr. O explains, just about language: “I am a Spanish speaking physician, so I have patients from Mexico, Latin America, Spain, the Caribbean… they may all speak Spanish, but their cultural experiences are vastly different.” These cultural differences can have implications when it comes to everything from whether a patient is comfortable seeing a doctor of a different gender to whether they want their family in the room during their visit.
How people best understand and retain information should also be a huge factor when it comes to patient communication. Dr. O explains “If you’ve got someone who reads English at a fourth-grade level, you can’t hand them instructions that are written for someone who has a high school level of literacy. It can waste the patient’s time or make them feel inadequate. You can’t care for someone if you don’t understand each other.” So how can a physician possibly ensure that every patient is getting information in a way that makes sense for them? For Dr. O, the answer is simple: “I just ask them. What’s the easiest way for you to process this? Do you want me to tell you verbally, do you want me to write it down for you, or can I message it to you in the portal? Maybe someone speaks perfect English but reads best in Mandarin. You won’t know unless you ask. Understanding the language needs and literacy level of your patient populations can more broadly help you anticipate materials or resources they may need.” Knowing why it’s crucial to ask these questions requires empathy.
In her experience, Dr. O has found that there is a notion among doctors that empathy takes up valuable time. “Working in medicine is busy and fast-paced…Most doctors feel pressured to see patients as quickly as possible.” The average primary care doctor is only able to spend about fifteen minutes with each patient, and that doesn’t leave a lot of time to build relationships. But as Dr. O explains, “You can find out a lot more about people when they feel respected. If you empower a patient by building a relationship with them, say by asking about their grandkids or some of their hobbies and passions, they might be more willing to offer information that’s crucial to you as a doctor.”
In a conversation with Katie Couric, Dr. O offered a personal example of what happens when doctors don’t take the time to learn about their patients. She had been seeing and prescribing increasingly higher doses of insulin to a diabetic patient for weeks, but his blood sugar levels wouldn’t budge. It wasn’t until later that she learned the patient was homeless– he had nowhere to store the insulin he was being prescribed. “I wasted so much time because I hadn’t asked him about his personal and social environment,” Dr. O says. “That was a huge lesson for me.”
It’s a lesson that Dr. O has taken with her to her role as Chief Health Equity officer at Humana and a great example of why Humana believes addressing and filling social needs gaps is critical to improving health and well-being. Humana was already a leader in the health equity space, and Dr. O now has the gargantuan task of defining how health equity can be incorporated into every decision the company makes. “Whether you’re answering phones in the call center, delivering care in one of our clinics, or you’re negotiating a pharmacy contract, I want to make sure that we are all aligned and working together to get every patient the best possible treatment… Because every single member, every single patient, regardless of their background, matters to us. And they should know it.
