Interview: Understanding Chronic Illness with Palliative Care Specialist Dr. Amit Desai, DO, MPH

By Mike Gosalia

A discussion between friends on understanding chronic illness treatment

After getting a job as an editor for Réapparition Journal, I immediately thought of my longtime friend Dr. Amit Desai, DO, MPH, someone with whom I grew up. As the Director of Internal Medicine at a Virginia Mason Franciscan hospital in the Puget Sound area in Washington, his expertise in palliative care (pain mitigation) for the chronically/seriously ill made him an ideal interviewee for Réapparition. I recently caught up with him, and this is what he had to say about the state of chronic illness in today’s healthcare system.

1. Can you describe your work and how it helps in treating the chronically ill?

I’m the Director of Internal Medicine at the Virginia Mason Franciscan Health hospital in Federal Way, Washington called Saint Francis Hospital. I oversee the clinical and operational performance of the Hospital Medicine team there. As such, I see chronically ill patients on a regular basis. My training in palliative care has played a pivotal role in helping me understand the importance of empathetic listening and shared decision-making so that chronically (and seriously) ill patients can make informed choices based on their values and preferences. 

2. Do you believe chronic illness is stigmatized in society? If so, in what ways?

Yes, people with chronic illness often face stigma and discrimination that can be explicit and/or implicit. Sadly, this stigma can prevent them from reaching out for help. Stigma can include social rejection, lack of adequate workplace accommodation, and poor access to healthcare. Such biases pose the greatest hardship to low-income populations who are more likely to suffer from other forms of disadvantage such as housing insecurity, transportation barriers, and socioeconomic strain. Health inequity arising from such obstacles prevents the chronically ill from achieving their full potential. 

3. How can health care practitioners assist in destigmatizing chronic illness?

First and foremost, healthcare practitioners can communicate with empathy. They can listen intently to their patients’ needs and offer hope through timely access to evidence-based treatments. They can offer resources to help cope with stigma. The resources could include access to support groups or information that could help them secure employment and financial independence. Participation in civic life and gainful employment can be powerful ways for those with chronic illness to manage their disease and normalize their lives.

4. In your years as a physician, have you seen improvements and/or worsening in the way chronic illness is treated within the healthcare system?

While there have been improvements in the way chronic illness is treated—in many cases, there are better treatments to alleviate suffering and dedicated centers for patients to go to now—most communities don’t have those kinds of places, and practitioners still fall short of providing enough time necessary for the patient. I am concerned that the corporatization of healthcare prevents physicians from having meaningful bonds with their patients. The bureaucracy in healthcare can trivialize connections with the patient as well as obscure understanding of the patient's perspective—multiple stakeholders assessing quality but not enough on trying to understand the lived experience of the patient. Current healthcare continues to prioritize volume over value—this leads to relationships that are transactional. This is compounded by the fact that the healthcare system does not have a strong primary care presence in communities across the country.  

5. Recent study has shown that providing patients with best care and best possible outcomes requires providers to ask about patients’ individual preferences, values, and concerns. As a physician, how do you think the increased narrativization of patient experiences can better facilitate care for chronic illness patients?

The narrative plays a crucial role in understanding the patient's perspective. It is through a narrative that we can get a holistic understanding of the patient’s challenges. Narrativization forges a close bond between patient and physician, which becomes the foundation of support that patients need to cope and recover from their health challenges. It also makes the physician's job more meaningful. These kinds of connections with the patient would be the antidote to the epidemic of burnout that we’re now seeing among health care practitioners today, especially after the COVID-19 pandemic.

Dr. Desai’s thoughts on healthcare are not uncommon. Echoing what I’ve heard from other doctors and in books on chronic illness, he stressed that America’s tertiary-based healthcare system, which relies heavily on specialization—and expensive treatments—has fallen short of being able to provide the primary care needed to address the chronically ill patient holistically (and not as a disease). Dr. Desai explained that studies show that a more primary-based kind of care is better for the individual’s health, and that it would do America well to return to that older kind of system, which existed more prevalently in prior years.

We are lucky to have physicians such as Dr. Desai who work tirelessly in pursuit of their patients’ health, and it is only prudent to pay heed to their words of wisdom. In particular, Dr. Desai’s insistence that healthcare is too corporatized and bureaucratic leads to many questions, including: how can we carry forward advances in medical technology while retaining the quality that can only be found on an individualized physician-patient interaction basis? There is much to learn from Dr. Desai, and I’m glad he took the time to interview with Réapparition Journal.

Dr. Amit Desai, DO, MPH

Dr. Amit Desai, DO, MPH, is Director of Internal Medicine with Virginia Mason Franciscan Health in Washington. He is passionate about providing his patients with the best care possible so that they can lead happy and productive lives. When free, he enjoys reading, hiking in the Pacific Northwest, and spending time with his wife and daughter. Dr. Desai lives near Seattle.

mike gosalia, editor

Mike Gosalia has published a novel and is currently doing his MFA in creative writing from The Rainier Writing Workshop at Pacific Lutheran University (’22). He received a BA in English from the University of Chicago. Mike enjoys making music on guitar and keyboard, going on long nature walks, and spending time with friends and family. He made a basic music studio in his home during the pandemic and has been recording his songs ever since. Mike lives in Kansas City.