Dr. Akshay Pendyal is a fellowship-trained cardiologist with top credentials. But he’s also an old-fashioned physician at heart. When he meets with patients at his new office at the Novant Health Heart & Vascular Institute - North End in Charlotte, the first thing he does with patients is simply listen.
“There is a real tendency in medicine today to rely on a lot of fancy testing,” he said. “I think the most valuable piece of medicine remains what patients themselves have to say about their conditions. That's the most important part of it – really listening. It’s the best place to start in establishing trust among populations that historically have had good reasons not to trust the medical establishment.”
Listening to a patient isn’t just a nicety. It informs Pendyal’s decisions about how to manage disease. “It takes creative thinking,” he said. “I need to think through things like which medications are going to be most affordable for you, which medications are on the Walmart $4 list, which medications NC MedAssist carries.”
“If a patient works nights, that very much informs how I might go about prescribing certain cardiovascular medications,” he said. “My patients are faced with real-world obstacles. Finding out what a patient's life is actually like is vital.”
Pendyal (pronounced Pen-dee-all) has a passion for serving “underserved” populations – people without transportation who work third shift, or who can’t afford health insurance or who may not speak English. He shuns the spotlight – and would prefer not to be the focus of this story – but he does want people who need his services to know about them.
An issue of access
That’s who he’s been serving at the Movement Family Wellness Center on Freedom Drive for nearly two years. In August, he added the new Novant Health Michael Jordan Family Medical Clinic - North End to his practice while maintaining his practice at Movement. The Jordan clinic offers general care – wellness visits, annual physicals, back-to-school physicals and the like – and specialty cardiac care.
The Michael Jordan Clinic largely eliminates the first hurdle vulnerable populations face in getting medical care: access. The clinic is part of Novant Health’s commitment to reducing health care disparities in the communities it serves.
Pendyal was a natural fit for expanding cardiac services to the North End. He worked with people living on the margins during his Yale fellowship, too. “New Haven, Connecticut is home to problems associated with concentrated poverty in an urban environment – homelessness and housing insecurity, segregation,” he said.
He saw it in his clinical work and research: “I was interviewing patients struggling with chronic homelessness and congestive heart failure, learning about their experience managing a very tricky and difficult disease under taxing and trying circumstances.”
He also practiced cardiology at a federally funded health care center in New Haven serving low-income, largely Spanish-speaking patients. He’s seen, up close, the chasm that exists in health care access in America.
More than acute care
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“The gap is even more extreme when you're talking about patients with chronic cardiovascular conditions,” he said. “In medicine, we're very good at focusing on immediate treatments for life-threatening conditions, but I think the real work is moving toward chronic outpatient management of diseases.”
And for some patients, he said, managing a chronic condition is a huge challenge: “One card falls over, and that proverbial deck of cards will collapse. Whether it's being evicted, losing your job and your employer-sponsored health insurance or caring for a family member who falls ill – there are all these compounding difficulties that many patients face that make it hard for them to take care of themselves.”
Some of Pendyal’s patients – people with high blood pressure, for instance – require ongoing care. Seeing a doctor regularly has traditionally been tough for someone who can’t miss work and doesn’t have transportation.
“How frequently I see a patient depends on the severity and complexity of their condition,” Pendyal said. “Just having the brick-and-mortar clinic in that neighborhood – getting people in the door, having a place where patients don't have to take three different buses to simply get to a doctor's appointment – is huge.”
Many of Pendyal’s patients are referred through Physicians Reach Out (PRO), part of the nonprofit Care Ring, which allows patients without insurance to access specialty care. “It’s a great service – especially in North Carolina, which didn’t expand Medicaid through the Affordable Care Act,” he said.
Meeting patients where they are
The clinic team works to provide an exceptional patient experience.
“First, the building itself is beautiful,” Pendyal said. “It’s got a well-lit, nice waiting room. Our team does a great job of making patients feel welcome. So many of our patients’ first language is Spanish, so having staff that speak Spanish is important. I speak Spanish – but it’s an ongoing effort. I'm trying to get better, but my MA (medical assistant) is fluent in English and Spanish and is a certified interpreter.”
The clinic has an on-site social worker and staff can direct patients to food pantries and resources for housing or rental assistance. There’s also a lab on-site.
“If patients need blood work, I can get that done,” he said. “And any kind of advanced cardiovascular testing, whether it's imaging or stress tests – it’s my job to figure out what's appropriate.”
With the addition of the new North End clinic, Pendyal said, “I think we can really make an impact among this patient population.”