The benefits of nontraditional healthcare with Dr. Charles Moore

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2:02This is TED Health, a podcast from TED. I'm Dr. Shoshana Ungerleiter. I'm a board-certified practicing internal medicine physician, and I'm your host for today's show. I've been thinking a lot about access to care, and not in the abstract, but in the very real, everyday ways it's showing up for people. In my own work doing telehealth primary care, I hear a version of the same story over and over. Patients find me online because they couldn't get in to see their primary care doctor, sometimes for months. Or they were referred to a specialist, but the wait was so long that their symptoms kept getting worse.

2:39By the time we connect, they're not just dealing with a medical issue. They're carrying frustration and uncertainty and sometimes fear. For many people, the system can feel both out of reach and hard to navigate, even when they're trying to do the right thing. And this brings me to my interview today with Dr. Charles Moore. He has deep clinical expertise and a long-standing commitment to community-based care. Dr. Moore is a leader in medicine. He currently serves as chief of service for otolaryngology at Grady Health System, one of the largest safety net hospitals in the country. And he's also a professor at Emory University School of Medicine.

3:18But Dr. Moore's work goes beyond the lab or the classroom. In 2013, Dr. Moore founded the Healing Community Center in Atlanta. But this project began quite literally out of the back of his car. He started by bringing care directly into neighborhoods where people weren't being served. And over time, the work grew into a network of community-based clinics offering primary care, mental health services, dental care, and more. At the center of his work is a clear and practical idea. if people can't get to care, care has to meet them where they are. And that means more than clinics. It means trust, relationships, and solutions with communities, not just for them.

4:04That approach extends to his work as the director of Emory's Urban Health Initiative, bringing students, clinicians, and community members together to address health challenges at the neighborhood level. And it extends into partnerships with programs like the IV Project at Grady Health System, which I find truly fascinating. This is a hospital-based program that works with young people who've been injured by firearms. It begins at the bedside in the immediate aftermath of a traumatic injury and continues with long-term support. It's not only medical care, but mental health services and mentorship and help navigating things like housing, education, employment.

4:43The goal is simple. To prevent another injury, another act of violence, another life cut short by supporting a person's holistic needs, not just their medical ones. I'm so blown away by Dr. Moore's work, and I'm excited to share our conversation with you today. We talk about what it really takes to close gaps in care, what gets in the way, what actually helps, and what each of us can do, even in small ways, to be part of that change.

5:16Dr. Charles Moore, welcome to TED Health. Thank you. Thank you. It's a pleasure to be here. You've spent years working in communities that are often described as underserved. When you think about a typical week in your work, what are the gaps in care actually look like in practice? Every day is a little bit different. Often when I meet with patients or with people in a clinic setting or in communities, there are some similarities with their having difficulty accessing care. Many of the communities that I work in, there can be competing priorities. So people may have to choose between feeding their kids or paying for parking or getting transportation to get to a medical facility.

6:10or they have to think about taking off from work, which is a huge issue. Everyone doesn't have the ability to say, I'm going to take off a certain period of time and go to a provider or a medical visit without losing a day's pay. And that can go on and on and on. Or, you know, if their kids are sick, they have to take off time to take their children to the doctor's office. All of that's something that you have to consider. And often people really don't think about what goes in behind all of that to make things happen. Yeah, what you're describing makes the phrase lack of access feel much more concrete and certainly more human.

6:56And I think it also raises the question of how we interpret the choices people make when care is hard to reach. What's the biggest misconception people have about why someone might not get care? Sometimes people think that individuals don't want the care, and I think that's a huge misconception. For example, sometimes you talk about a lack of providers in an area, but people will say, there are a ton of physicians and physician offices in this region, but you find out that they don't take the person's insurance. Or if they don't have insurance, where do they go? Now, there are facilities like federally qualified health care centers that will see individuals, regardless of their ability to pay and do it on sliding scale and take insurance or not insurance or no insurance.

7:49But all providers don't do that. So even though there might be a provider in that area, it's like there's no one there for them. And you learn that firsthand by meeting people where they were quite literally. You've shared that you started this work out of your car, driving into neighborhoods and offering screenings. What did those early conversations teach you? I had gone to medical school and residency and fellowship and thought I knew a whole bunch. And then after residency fellowship training, I came down to Atlanta and started working at a county hospital. And I do otolaryngology, head and neck cancer.

8:31and from almost day one I was seeing a lot of folks coming in at really late stages of their disease process and the way things were set up at that point it was really primarily me as the ENT person that was the consistent person on a regular basis so folks would come in barely able to breathe and I'd have to drop everything race to the OR to stabilize their airway by putting in a trach and then ultimately get them set up for palliative care. And as that kept happening, I started saying to myself, somebody needs to do something about this until one day I thought maybe that person should be me.

9:09So I just picked the top three zip codes, got in my car and started driving to grocery stores, to parks, to anywhere where people were and started talking to them. Didn't tell them who I was. I honestly didn't know what I was going to do or could do, but I needed to learn what was going on. And there I learned about what we now call the social drivers of health. So all of those conditions that determine how people live, work, and play. And at that point, I figured I'm a head and neck cancer guy. I'm well-trained. I should be able to do more than just chat. So I thought, look, why don't I do some head and neck cancer screenings?

9:51and I started bringing some materials along, loaded up my car at that time, Subaru, with some supplies, started doing screenings at grocery stores, in the parking lots, talking to people, talking to them about how they can prevent head and neck cancer. And then I saw all of the medical needs that weren't being addressed and started doing primary care as well as head and neck screenings. And then I saw, again, that people still weren't getting real good access. So I started going to nontraditional locations, under bridges, abandoned houses, which were really crack houses at that time, and providing care.

10:32From that, I really learned a lot about what people were experiencing, what a number of the barriers were, and started to develop a following where people were following me around. knowing where I was going to be to provide the care that they needed. And from that, step by step, gradually developed into a federally qualified health care center, healing community health here in Atlanta. So I think for me, I didn't know a lot about those social drivers of health. And it was a matter of feeling that I was inadequate in the care that I was providing to my patients because there were so many times where they couldn't make it back or that they were coming back with conditions that should have been avoided or could have been avoided if they had access to it.

11:25I learned kind of really on the fly, just trying to be really a better person, a better provider, a better physician. More of my conversation with Dr. Charles Moore after a quick break from our sponsors. This episode is sponsored by Kohler Smart Toilets. The objects we interact with most are often the ones we notice least. Kohler Smart Toilet challenges that assumption. What if the most overlooked space in your home could become the most considered? Their Veil Smart Toilet is a sculptural silhouette that isn't just intentional, it's a philosophy. That design changes everything. The Kohler Veil Smart Toilet is sleek, with a rounded shape that's more like architecture than just plumbing.

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13:30Dr. Moore, you mentioned that you were going to abandoned houses. Can you tell me a little bit more about that? Sure, sure. So in my daily routine working at the hospital, I have clinic and I have OR days. And one day in my clinic, a patient came in and she said, hey, you're the doctor that likes to help people, right? And I laughed a little bit and I said, I think most doctors try to help people. And she said, no, you don't get it. I have a group of people that desperately need your help, but they'll never come here. I want you to think about this. I want you to pray about it. And I'll come back to my follow-up and I'd like for you to tell me your answer.

14:23And so I did, and I didn't feel as though I could tell her no. So I went with her to abandoned houses, and there were people that were so happy to see me, just to have someone that was willing to take a step out of the traditional path to provide care for them, to even show that they cared, that we were able to see a lot of people. And I would then arrange for them to come to see me back in my clinic or get them plugged into clinics. And I would say about 95 % of those individuals all showed up. And at one point, I remember there was a guy, because it was a ways away, and he said, Doc, don't worry about it.

15:16no one's ever shown me this much interest. I'll be there. And at my clinic on that day, I remember it was raining really heavily. He was there early. He was drenched. He had walked over 10 miles to get there early for me to see him. He said, I told you I'd be here. No one's ever shown me any kind of care if I lived or died. So I was determined to be here. and we got him taken care of. Sometimes for me, it was overcoming that initial fear because I didn't know what I was going to be walking into, but I wanted to help her. So I did it. Wow. That's an incredible story. Thank you for doing that. Wow.

16:07One program that I have heard about is through the Urban Health Initiative at Emory University, the Walk with a Doc program that seems to embody this philosophy. Tell me about this and what makes it work. Walk with a Doc is really a phenomenal program. Years ago, I started walking with patients because a couple of reasons. One is I felt that many patients are almost intimidated to talk to providers, but in a setting like in a park or on a walking trail or in your neighborhood, if they saw me in sweats or shorts, that they would see that I'm just a regular person and that you can learn something by having a health topic first and then we exchange information because people really know a lot.

17:03But sometimes they're just a little hesitant to talk about it. And also in certain communities, people don't feel secure to walk alone, but they'll come out in a group. And so that helps to build a sense of community. I found that the neighbors got to know their neighbors that way, coming out and learning about that. And I've had a number of patients that have said, because of what you're doing, it gave me enough confidence to ask questions when I was at my doctor's office, which I had never done before. I'm like, that's fantastic. That's exactly what we want. You need to understand what's happening and how it can be useful to you in your life.

17:46And together you can make a plan. So keep asking questions. I so appreciate how simple the idea is while still addressing something so profound. People need opportunities to move their bodies, to connect, to ask questions in a safe environment, and then build trust without the pressure of a formal maybe doctor's appointment. And so for somebody listening, how could they create a version of this kind of connection and movement in their own community? There are a lot of ways to do that, I think. It's helpful to have a person that has some type of affiliation with a medical degree or some kind of health-related program, but you don't have to have that.

18:30We, as part of our program, we also have a virtual version so people can join in and learn about it. And they can be wherever they are, even if they're in their house alone. They can tune in on Saturday mornings, listen to the health topic. They can comment, and then hopefully have some type of movement afterwards in their own space. But I think a simple way is just if you wanted to talk to your neighbor or someone in your family and say, you know, let's go for a little walk. And there's so many things online these days. Even if you don't tune in, you can pull up a health topic or any topic. It's really a great way to exchange knowledge.

19:13It's such a wonderful reminder that meaningful community health work doesn't always have to start with a major institution or a perfect plan even. You've been involved in supporting efforts like the IV project, working with young people recovering from firearm injuries. Tell me about that. The IV project is a fantastic program that was the brainchild of Dr. Randy Smith. She's a trauma surgeon here in Atlanta. And the purpose of this program is to meet people in hospital. Many times if there has been an injury of some sort from gunshot or whatever, that's a golden moment when people are often interested in learning ways that they can have a new trajectory in their life.

20:07At that point, bring a violence intervention specialist. There are people that have the lived experience with what the folks that are there in the hospital are going through. Meet them at the bedside. And then while meeting them at the bedside, walk them through each step, everything they have to do in the hospital, help get them connected with the resources and stay in contact with them. Most go above and beyond. They bring their life experiences, they meet with folks, they help them move through the program, and then everyone in there really cares about the individual. Most of the individuals stay in contact with them for up to a year, sometimes longer.

20:51What's really phenomenal about this particular program is that nationally there are hospital violence intervention programs, and they usually have about a 30 % or higher recidivism rate, meaning that folks that have been shot may be shot again in a year or whatever period of time frame is chosen. With the IV program, and it's been in existence for now about three years, it's a little bit less than 3%. So it's phenomenal. What we also do through the Urban Health Initiative is provide resources for folks in their communities. So we do things like provide walk with a doc, ways for folks to get out and move their bodies.

21:42We provide art therapy, music therapy, dance, journaling. We've been active in a number of schools. There was a shooting at a school, and we had been trying to work with the school that had not really been all that successful. After the shooting, one of the teachers said, let's try the journaling. And so we brought journaling into the classroom, and the students really responded to it. they were so engaged that the teacher said, we've never had this much engagement from students before. We'd love to have whatever services you can provide. So we've also started doing gardening and horticulture there, as well as bringing music and dance.

22:32And that school is very special because they've created what they call the well. So whenever anyone has any concern, any loss, the entire school comes around them, whether it's students or teachers, and brings them whatever resource that they need. So it's just a way of allowing people to express themselves because sometimes words aren't enough and you need another way to do that. So we try to provide all those resources for folks to help them take the next step. Wow. It's powerful to hear that impact described not only through outcomes, but through the relationships behind those outcomes. And I think that brings us to something that seems central to all of your work, and that's listening before acting, right?

23:24Absolutely. Why is that so important? And what happens when we skip that step? Many times people, if they don't listen, they have preconceived ideas and they try to, in my opinion, force what they think folks should do or what they need into the situation or on the situation. And people know what they need. You just need to listen. And sometimes it's really more about the power of presence. Sometimes you don't really need to say anything, but just be there. It makes me wonder why something so fundamental has often been treated as secondary. So why do you think this has been ignored so often, especially in medicine?

24:09There are potentially many answers to that. Part of it is sometimes people are probably afraid to hear something that they won't know how to respond to. I think it's important to realize that it's okay to say, you know, I don't know. But I'd love to see if I can help you find an answer for this. But at this point, I really, I don't know. Let's try to research it together. Sometimes people have that preconceived idea. And rather than look at each case as that individual case, they try to just say, I did A, B, therefore I must do C and D. as opposed to sometimes you might do A and B, but you need to skip C and D and go to G and then come back to C and D.

25:02Yeah, it speaks to how in medicine sort of leading with more curiosity, even though sometimes we feel like it can take more time, which is something we're in short supply of, is a really good idea.

25:18We'll be back after a quick break.

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27:53Dr. Moore, can you give an example of a community-driven healthcare solution that really worked? Absolutely. There's a very, really new program here in Atlanta that we've just recently kicked off and it's called Our Words Heal. It was a program that initially started in Philadelphia as a ground up kind of community of young people that were responding to trauma and they realized that healing can take a lot of different forms, but sharing how you are healing can help someone else. In Philadelphia was the doctors Ted Corbin and John Rich. They were working together with the Mighty Engine to initiate that program.

28:48And we brought it to Atlanta and I've been working with them. And from that, we've added an additional layer of talking with organizations that are out doing the work in a lot of different ways. So there's an organization called Gangsters to Growers that brings folks that have had issues in their past together to help teach them skills, get them the ability to work with additional people and build their own business, potentially. We are partnering with another's as Mothers Against Gang Violence that brings individuals together and families together and sharing through all of this what makes you heal.

29:34For some people, it's music, as I've mentioned. So what music makes you heal? How can you share that with others? And the process of sharing it can be healing for the individual, but the process of hearing it can also be healing for others as well. So that's a new initiative that we've just started. And it's really been phenomenal at how people are responding to it, because it's very simple. As you said, words really can be healing. They can also be harmful. So let's flip that and let them be healing. And those are just two of a lot of different organizations. These examples reinforce a theme running through this conversation.

30:15And that's that the effective solutions are not always the most complicated ones. And often they work because they respond to what people have said they need. And I want to bring this back to where we started with how hard it can feel to access timely and trustworthy care. And what do seemingly simple programs like Walk With a Doc offer that people may not be getting from the traditional health care system? And what does that tell us about what people are really looking for right now? I think those programs offer, just as you said, simplicity. and access in places that are everyday spaces. So you don't necessarily have to go to an elaborate facility where there can be complicated ways to navigate the system.

31:06Providing programs, providing access in your neighborhoods with people that have shared values makes a huge difference. And together by doing those simple things, everyone can be stronger, everyone can be healthier. It doesn't really take a lot. I wanted to offer the chance to speak directly to anyone listening right now who feels maybe like the health care system isn't built for them. And if they could take one thing from this conversation, what could change for them? I think if there's one thing that I would love for people to know is that things can be different. Things can be better. Don't be afraid to ask questions.

32:00Reach out to folks because there will be someone that you can talk to. And don't be afraid to do that. there are a lot of resources out in communities that can help address specific issues. And it's okay to reach out to them to see if there are things that will help you move to the next step, if that's what you choose to do. It can be better. And it just takes one little step. And there are so many people that want to help you take that step. Dr. Moore, thank you for reminding us that better care often begins with not having every answer, but showing up and listening and walking together. Thank you.

32:44It's truly been a pleasure.

32:50And that's it for today's episode. Thank you so much for listening. TED Health is a podcast from TED, and I'd love to hear your thoughts about this episode. Send me a message on Instagram at ShoshanaMD. This episode was produced by me, Shoshana Ungerleiter, and Jess Shane. Edited by Alejandra Salazar and fact-checked by Vanessa Garcia-Woodworth. Special thanks to Maria Lages, Farrah Degrunge, Daniela Balarezo, Constanza Gallardo, Tansika Sangmarniwang, and Roxanne Highlash.

33:37With no fees or minimums on checking accounts, it's no wonder the Capital One bank guy is so passionate about banking with Capital One. If he were here, he wouldn't just tell you about no fees or minimums. He'd also talk about how most Capital One cafes are open seven days a week to assist with your banking needs. Yep, even on weekends, it's pretty much all he talks about. In a good way. What's in your wallet? Terms apply. See CapitalOne.com slash bank. Capital One N.A. Member FDIC. Guessing is for game shows, not your business. Workday is the enterprise AI platform for HR, finance, and IT. With AI grounded in your context to get work done and done right.

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