Health Equity Is ‘Core of Who I Am’ for 2023 Fellow
Q&A With Lillian Holloway, M.D.
April 13, 2023, News Staff — On a corner of Lillian Holloway, M.D.,’s desk sits a small, framed black-and-white photograph.
“Her name was Lillian Frances Holloway. I’m named after her,” Holloway said. “I never met her. She was the daughter of enslaved folks, and as far as I hear from the stories, went to school diligently,” receiving a teaching degree from the school that would later become Bethune-Cookman University.
Holloway shares more than just a name with her paternal grandmother, though.
“As I was exploring things about her, I noticed her birthday and the day that she died is March 3,” said Holloway. “For me, 20 years ago on March 3 I started my first day of medical school. It forever changed my life … So that’s why I keep her photo on my desk: to remind me of why I do what I’m doing.”
What Holloway is doing is transforming the delivery of patient care through telehealth. She is a family physician at Arise, a comprehensive virtual clinic based in Houston, Texas, that specializes in the screening, diagnosis and treatment of eating disorders. As a 2023 AAFP Health Equity Fellow, her capstone project, “You Can’t Fight an Invisible Foe! Addressing Cultural and Identity Bias in Eating Disorder Treatment,” aims to bridge gaps between knowledge and equitable access to care by using resources such as telehealth.
Holloway sees both advantages and drawbacks to telehealth.
“It’s like the new frontier in terms of structuring medicine,” she said. “In a brick and mortar (setting), you know that the patient’s going to be in front of you; … you can physically lay your hands on everything, including the patient. In telemedicine, regardless of whatever medical knowledge you have, you are … building the airplane in the air. You’re trying to structure patient safety, front-end issues and back-end issues, but the thing that’s really intriguing to me is how you’re structuring equity.
“It’s one thing to say we have more access to care,” Holloway added. “You can pick up your cell phone and reach a doctor, but I always say that doctors aren’t curing people with their good looks. It’s not just a matter of being able to talk to me; it’s about the system that’s in place to be able to get you not just care, but the best care, taking into consideration all of those different social determinants of health. My project is on precisely that.”
Watch this video interview with Holloway and hear her open up about topics including:
Her passion for health equity: “Health equity is very much just the core of who I am … It’s what literally led me into medicine, but also what led me to want to be a family physician, because I think we are really on the front lines of not just being able to see the health inequities, but also to be able to address them.”
Her experiences caring for pregnant women in correctional facilities: “When I’d have a pregnant patient in front of me, there was no anticipation of how long she would be under my care. She could get bonded out in three minutes; she could get sentenced to 30 years. Quite literally, I’ve had patients that while I’m doing the prenatal visit, they’re getting bonded out. It shaped the care that I gave in that it wasn’t equal care. It really meant that I was trying to take the situations that patient was in and then apply the care that I gave for her to have the quality of care that she needed ...
“I would always say, in this moment, I’m providing an espresso shot of care. I’ve got to be able to analyze how fast she might not be my patient or under my care; how much care she’s gotten up to now, which unfortunately a lot of times, was none; what risks she has ahead of her (like) substance use or unstable housing or transportation issues or violence; and then approach my care to her with all of that in mind. That is the difference between equality and equity.”
What physicians should remember about health equity: “One (is) access to care. It’s great. It is definitely a first step in bridging that divide in health equity, but it’s not the only step and by no means is it the most important step. It takes a really discerning eye to be able to say fine, we have this access, but how are we delivering that care that is more equitable, and I think that requires a really hard look at how we do things.
“The other thing that I think is really important to me, and a concept that I learned very early in my medical career and my medical training, is this concept of solidarity … In the American health system, for instance, we know that Black women that are pregnant have better pregnancy outcomes if they have a Black doctor. That is a very easy concept of solidarity. I see you as me, and so I provide you with care. That makes sense to me, it makes sense to you. But I would venture to say also, you don’t have to be of the same race or class or ethnicity or immigration status to provide care that is in line with solidarity. It really is more about your lens …
“When I speak to patients, oftentimes I use the analogy, ‘We are in a car together.’ My job is not to get in the car and drive you to where I think you need to go and then kick you out. We are in the car together. We hopefully have a common place where we’re going to go. You are driving the car; all I’m doing is sitting next to you reading the GPS or the map and saying, ‘Maybe we should turn here, maybe we should turn there.’ That route might have many different stops along the way or places that we turn off because there’s too much traffic. But in the end, it has to be the patient that’s driving and we are supporting it.”
Learn more on the AAFP Health Equity Fellowship webpage, and check back for more stories from the 2023 class.