Have you ever walked into an exam room and felt hurried along or dismissed? Have you asked questions about a treatment plan been denied a test, referral, or medication? Have you ever felt like this might be related to your race, sex, age, culture, or insurance status?

Today, Jae and Angela are tackling the hard questions, biases, and situational statuses that impact the quality of medical care for different groups across the country. Listen up while they try to find ways to combat hurtful assumptions and empower people from all walks of life to speak up in the exam room.

Show Notes

  • Hi, Everyone! Today’s episode is our most serious to date and we hope that you’ll join us for the full experience. As many people are learning about the inequities of the healthcare system and we wanted to present a look at the facts, and a look into how you can advocate for yourself and loved ones when you think that you are being dismissed.
  • WARNING: We understand that healthcare and the topic of personal health can be triggering for some. If you need to, please skip this episode
  • Our Grey’s Anatomy intro story comes from Season 14, Episode 11: (Don’t Fear) the Reaper when Dr. Bailey had a heart attack
  • This was Jae’s first insight into how bad the issue could really get and Angela was screaming at the TV and ready to turn off the epis
  • Note: Discrimination in the health care system is real. It affects so many people every day, and if you have not experienced it personally, please listen to and learn from those who have
  • First, because there seems to be some confusion about this lately, Racism is defined as:
  • Racism is a system that categorizes people based on their race, color, ethnicity, and culture, by creating double standards that reward some and restrict and impact others negatively
  • Systemic Racism is the establishment of prejudicial policies and procedures as the standard within an organization’s foundation, governance, or educational system that directly influences the practices and patterns of it’s participants and are specifically meant to penalize or exploit people because of their race, color, culture, or ethnic origin
  • Now this is not a white verses non-white conversation, this is not about bashing or blaming anyone because of their color, we want to be very clear on that. This is reflection on privilege and a call for a everyone to do what they can to recognize their own and
  • In the healthcare field, this affects everything from doctor/patient interactions, scheduling appointments, insurance status, treatment options and plans, access to medication, and even more.
  • I think it’s also worth noting that not every flawed interaction or diagnosis is because of bias. Doctors are human too, sometimes they make genuine mistakes or give a negative impression because of outside factors related to their personal circumstances. We recognize that people are not 100% infallible, but for this episode we are talking about clear examples of a cycle that has fed into and still perpetuates bias
  • The Cycle
  • This cycle begins with the education of medical students
  • I first saw this last summer in a Tik Tok, but in 2017 students started to share some of the patient care stereotypes that were presented to them in their textbooks.
  • In Nursing: A concept based approach to learning, the following information was presented as helpful guidance to navigating patient care in a focus on diversity:
  • Jews may be more vocal and demanding of assistance AND they believe that their pain must be shared and validated by others
  • Hispanics may believe that pain is a form of punishment and that suffering must be endured if they are to enter heaven
  • Black people experience pain at a higher rate and believe that suffering and pain are inevitable in life
  • Native Americans will tolerate a high level of pain and may prefer medications that have been blessed by a Shaman
  • After this was brought to light, other examples began to surface from other text books and the following statements were included
  • Asians are hesitant to have their blood drawn because they believe it’s taking their life force
  • And that when interacting with black patients they should focus on non-verbal communication
  • Besides being vastly general and condescending statements, a lot of these draw from decades old stereotypes that these publishers are pushing as culturally specific information and to be applied to modern day patient interactions
  • Medical professionals are being encouraged to draw from this base when they could gain the same understanding by asking them questions
  • We’ll get into this later in the episode, but you have a guaranteed right to express your cultural or religious beliefs to your doctor and they must respect those in relation to your care
  • Patient background is important to consider, but at the same time assuming that most people within a culture will feel this way, is the opposite of helpful.
  • This is where we find the basis for implicit bias within the healthcare system. By virtue of this information being presented, it has the potential to be internalized, and then reinforced through the slightest experience. Particularly because this is being presented as accurate knowledge to students in training, who are then mentored in practice by others who have accepted this knowledge, so this cycle continues.
  • Learning example: Jae and I are from different cultures, we encounter things we are unfamiliar with about the others – when we teach each other we hold that knowledge as true
Implicit Bias
  • What is implicit bias?
  • Implicit bias is the process of associating stereotypical characteristics or attitudes to a person, group, or thing subconsciously
  • In healthcare, this could manifest in a variety of ways:
  • as a doctor unknowingly having a preference for one group over another,
  • Or a person being denied treatment for something that cannot happen to them
  • Ultimately, patients from the preferred group or set norm receive higher quality and more comprehensive treatment
  • Now the question that is posed most often when initially addressing implicit bias: how can we fault someone for something they are not even aware of?
  • To put it simply, implicit bias is severely damaging precisely because of this reason: when it’s harder to recognize, it’s more often categorized as a one-off glitch in the system that can be excused away.
  • When we open up the conversation, not for debate, but to actually focus on self-examination, that’s when we open a door to change and not
  • Also – There’s a test now that can measure your implicit bias
  • Whether it’s related to race, gender, age, sexual orientation – we can’t excuse it. And when it affects the standard of care, and gives us tangible documentation to prove it, the work has to start to rectify it.
To look deeper into the impact of implicit bias, I’ve compiled some statistics into a fact or fiction session for us:
  • Fact or Fiction: Non-white patients are more passive and do not accurately prioritize their health care
  • Non-white patients are often blamed for being passive in their health care; however studies have shown that this is more often not that the case
  • Black men and women lead the national statistics in high blood pressure, and this had long been attributed to lifestyle choices and their apathy towards seeking treatment
  • However, recent studies have shown that black patients also lead the way in missed opportunity for medical intervention for blood pressure control
  • This means that when their high blood pressure was discovered, they were not prescribed medication or marked as needed for follow ups regarding future intervention
  • Some patients with involved in this study had missed opportunities upwards of 20 times that their doctor, and he or she could have addressed it
  • Even when all things were considered equal, such as a good diet and exercise regime, yearly physicals, and insurance status, their doctors chose to not treat the issue
  • Fact or Fiction: white patients are admitted to the emergency room more often than non-white patients
  • Fact : Less likely to be admitted for emergency services
  • Studies have shown than non-white patients are admitted for emergency services at half the number of white patients,
  • To put this in perspective in my basic math terms, this 6 White patients, to 1 Black, 1 Hispanic, 1 Asian, 1 South Asian, 1 Jewish, and 1 Muslim patient
  • Even after being admitted non-white patients are not given access to testing at the same rate as white patients – still about 50%
  • While waiting, black patients have a higher chance of dying in the waiting room than any other race
  • Fact or Fiction: Black women are 41% more likely to die from breast cancer than white women
  • This is a fact
  • A 2020 research study showed that black women are less likely to develop breast cancer than any other race, but are the most likely to die from it.
  • This research has also shown they are more likely to develop it at a younger age (under 50), and often have a more aggressive form call triple negative breast cancer – which means it does not have the genes that most treatments seek to inhibit (20-30% more common)
  • But regardless of the type, they had far worse mortality rate and their average death happened about 3 years after diagnosis.
  • Most black women are not screened, are not properly screened, or not referred to proper treatment.
  • Insert mothers story.
  • Fact or Fiction: Asians can’t be alcoholics if they are ADLH2 deficient
  • Fiction, Asians have the same chance of alcohol addiction as any other ethnicity
  • This misconception actually came about because doctors are less likely to address addiction in the Asian community. In past research statistics Asians had the lowest numbers in association with alcohol and drug addiction, but when looking into these numbers, it was found that they were under diagnosing by about 20% for decades. This is largely thought to be because of the model minority myth affecting judgement during diagnosis – addiction doesn’t fit into success
  • This is still a relatively new finding in the last few years, but it has been attributed to doctor’s falsely believing that flushing, or Asian glow, meant that alcohol addiction was not possible, and
  • In the hospital, while white and non-white patients came in for the same reasons, non-white patients are often not given pain medication at the same rate or dosage as white patients
  • This is particularly evident for black patients, and when looking into why, it was found that a lot of doctors actually believed that black people did not feel pain as much as others did.
  • This goes back to the times of slavery, when this argument was invented to justify the treatment of black people. This has absolutely no merit, but this and several other completely false assumptions about black bodies were
  • A study in patient preferences conducted in 2017 showed that doctors felt better treating white patients than they were black patients.
  • Black men are more likely to have high blood pressure go undiagnosed – when researchers started investigating why, they found that more than half of these men kept their doctors’ visits, ate and exercised well, but doctor’s had not actually checked their blood pressure
  • Black people have a 2% higher chance of dying in a waiting room
  • To test the implicit bias test, they studied white oncologists and with their black patients and those that showed higher bias had shorter interactions and the patients rated the interactions as less helpful and noted that they did not have confidence in their treatment plan – 2016 study
  • The Model Minority Myth
  • The model minority – The term model minority is used to highlight a specific group that is particularly successful in comparison to other minorities. This is most often attributed to Asians
  • People of Asian descent are more likely to have health issues go undiagnosed, because they are considered model patients. They are believed to be hard working, intelligent, competent, self-controlled to an exceptional level, which has created a false stereotype dictating the idea that they are less likely to have health problems because they take such good care of themselves
  • This is particularly damaging when it comes to diagnosing and treating addiction within the Asian community
  • For example, a belief long held within the medical community was that Asians were less likely to develop alcoholism, because the statistics reflected their demographic as around 10% under the average annual new cases ascribed per year, for almost 2 decades.
  • However, as recent studies have begun to investigate these numbers, it has been found that doctors were less likely to find alcoholism as a diagnosis, which created an inaccurate data set
  • Further studies then showed that there are 2 main reasons:
  • 1) because of the model minority myth, Asians were assumed to have too much self-control to fall into alcohol dependence
  • 2) a prejudicial stereotype had been assigned to them because of flushing, or as you might have heard of it, Asian glow: i’ve created a little adage here: if you have asian glow, you can’t be an alcoholic ; and all asians have asian glow, therefore., no asians can be alcoholics
  • Flushing is a result of an enzyme deficiency (ADLH2) that makes it difficult for the body to metabolize the alcohol.
  • associated with those of east asian descent – but has been attributed to all
  • Conversely, Indigenous and Native people are believed to have a predilection for alcoholism
  • Representation
  • 35% of the Latinx community does not have access to health care, in comparison to 10% of the white community
  • In total, Latinx physicians and patients make up less than 20% of the healthcare field
  • Most research studies feature 0-10% of Latinx people as doctors
  • Only 1-4 regularly goes to the doctor
  • Latinx people are 60% less likely to report unfair or wrong treatment
  • In 2018 – 56% of doctors were white, 5.8 % Latinx, 5% Black, 17% Asian, – I think it’s interesting to look at this because non-white patients are more likely to receive better treatment from non-white doctors
  • Sexism
  • Just like Bailey  a lot of women show up with real physical symptoms, and then they try to investigate their mental health and this dates back to the centuries old idea of treating hysteria – which is the idea that women’s anxiety, fainting, frustration, sexual appetite, insomnia, and a whole lot of other physical symptoms needed to be managed through their wombs
  • Hysteria was only officially removed from mental health diagnosis in 1980
  • Hysteria – hysterectomy, enough said
  • Misc. Healthcare Inequity Examples and Information
  • Infant mortality – 5/1000 black babies in 2017, which is double the amount of white or Hispanic babies – low birth weight, pre-term complications, birth related complications – made up 37% of the infant mortality rate
  • Studies have shown the black mothers are far more likely to have pre-term births, and their babies have significantly more health problems. Doctors note this is believed to be directly related to the lack of care given – but aren’t doing anything about it
  • The note that black women need more access to doctors, health programs, and insurance, but it’s not a matter of just seeking it out
  • While segregating hospitals is illegal now, in predominately non-white areas, facilities are often understaffed, underfunded. So while they note, that people in these areas need more, they don’t give them more
  • Black neighborhoods, areas where the population is 60% black or more, also have the fewest supermarkets- so they have less access to fresh food
  • Black neighborhoods also lack primary care physicians by 67%
  • In studies comparing cardiac treatment, like Miranda bailey, and in pain management women are treated differently than men and are more likely to have poor outcomes because of this treatment
  • Heart disease is the leading cause of death for women in the united states
  • In 2019 more than half of women believed that they could be treated differently because of their gender, and 17% of them felt that they had experienced this
  • Hispanic Panic – When women in the Latinx community are characterized as over excitable by medical staff
  • It’s a way of minimizing feelings of pain, anxiety, fear as just being overly dramatic
  • What Can We Do – Be Your Own Advocate
  • Within the healthcare system, facilities are actively examining their bias and practices to see what needs to be improved on and what just needs to stop. On an individual level, staff are given more diversity and sensitivity training, as well as other resources that are designed to help them address their internal bias, and many doctors and nurses who have seen the personal failures of the system are reaching out as well, and extending advice and support to colleagues as they tackle these changes.
  • However, I’ve read a lot of these statements from hospitals going back about 6 six years, and a lot of them still say the same thing. They are working it, it’s being handled, they will be better in the future because they must be better in the future. but a lot of our current statistics don’t show much of a change between these numbers as diversity training has gone on.
  • So today, the best thing you can do for yourself is show up, be prepared, and know your rights.
  • Now unfortunately, I can’t tell you anything about directly combating racism. The best thing you can do is be informed, and be vigilant and active in your
The foundation for advocating for yourself is knowing your rights as a patient; however Like so many other things, these can vary depending upon the state or even the healthcare facility, but I’ve compiled a list of the basics:
  • First, is the right to information, which is the right to know everything about the nature of your diagnosis, your care options, the risks and benefits involved, and who will be providing the care. This also involves informed consent, which is the authorization from a patient to receive medical intervention after having a full discussion about the intervention plan. Informed consent should also be given in writing and noted in your medical record.
  • Second, is your right to personal respect, which ensures that your cultural and religious beliefs will be honored in regards to your treatment. This also includes the right to ask for and receive visits from religious persons, or observances of modesty.
  • Third, is your right to choose visitors and advocates. At any time you can enable or restrict access for visitors in your regular office visits and in the hospital, this includes family and outside persons. You have control of who you want to see. You also have the right to ask for a nurse to be present during exams, or to see a social worker during your visit as well.
  • Fourth, is The Right to Care and the right to emergency care. You have the right to know your medical team, and also make the decision to remove them if you feel that you are receiving a diminished quality of care. Additionally, if you are in need of emergency services, you cannot be denied care. It doesn’t matter if this is not your regular hospital, if it’s not in your insurance network, if you do not have the ability to pay – they have to help you.
  • If anyone insists on sending in a billing representative during your intake, tell them they can bill you later – and they have to walk away.
  • And fifth, we have the right to privacy which ensures that your medical information is not shared without your approval, and also entitles you to access to your full medical file.
  • Sixth, and finally, is the right to complain and appeal.
  • This means that you have the right to complain about your care provider, wait times, lack of services provided, and the actions of healthcare personnel.
  • These are part of what is known as the Patient Bill of Rights. All health facilities and most insurance providers have them, including government run services like state and county hospitals, and Medicare and Medicaid.
  • Outside of knowing your rights, coming prepared and knowing how to advocate for yourself is the next important thing you can do.
  • The most important thing you can do is know your rights and know how to advocate for yourself : Your Rights As A Patient
  • Advocating For Yourself
  • On regular doctor’s visits and trips to the hospital, you may find yourself in a situation where you need to advocate for your care, and if it happens it’s important to be prepared.
  • But before we get to the actual visit, I think it’s important to address the first step of self-advocacy and that is making and keeping an appointment.
  • It sounds so simple, but showing up really is the first step because it’s so easy to say you’ll get to it later, reschedule, or just email your doctor about it when you have time. And it’s easy to find good excuses too – maybe you’ve had a really busy time at work, the craziness of the holidays, you’re focused on your family
  • Or maybe you find it overwhelming or even scary to see the doctor – I get it, you feel dreadful, something weird might be going, or maybe you’ve even had a past experience yourself or with family that impacts the way you feel about doctor’s, exam rooms, blood draws, or the ED (because the ER is out and ED is in?)
  • But avoiding the inconvenience or uneasiness isn’t the way to go – so make that appointment.
  • The second step is coming prepared for your visit, and there are a few good ways to do this
  • If you’re someone who gets nervous or overwhelmed during doctor’s visits, you can bring a friend or family member you trust with you. Having another person can be a great source of comfort or even a nice distraction while you’re waiting for the appointment. I know this isn’t really allowed during covid times, but it can do wonders to calm you down before a visit. You can also take a step further if you’d like, ask to have your companion accompany you, for the exam, or after when discussing next steps or getting test results for an extra layer of support, and now you have someone who knows what you do and can help your process information afterwards.
  • I was actually reading about body doubles, in the ADHD sense where one person will sit another person who has ADHD, and their presence helps make it easier to focus or handle difficult tasks, and I think something similar will happen here. By physically being with another person, it helps your brain combat the feelings of isolation that sickness can sometimes bring.
  • Another good way to come prepared is by writing down a list of your symptoms, any questions you might have for your doctor. If you’re worried you might forget something, this is a great resource to refer to during the visit, and you can add notes to it based on your doctors answers for future reference.
  • Some questions you can think about are?
  • Can you explain more about this diagnosis?
  • What are the treatment options?
  • Is this a short-term or long-term illness?
  • Will I need follow up’s or additional testing down the line?
  • Will this affect my job or work capacity?
  • If this is your second or third visit for an unresolved problem, this can be a powerful tool. When you have a persistent illness, this can help your doctor rule things out or adjust your treatment as necessary. And if you get to the point where you want or need a second opinion, you already have a complete history of what you’ve been experiencing that’s separate from your medical record, in case something you said was omitted or lost in translation.
  • Additionally, I think lists like this are great for potential language barriers, because you can physically give it to a doctor or translator and they can read, and this might help you have better discussions – because the majority of care visits involve 10% physical examination, and 90% questions and answers – I would just keep 2 copies, or ask for it back.
  • Know your family history and your history
  • Try to learn as much about your family medical history as you can and then share it with your doctor to have it entered into your medical record. This can help doctors evaluate your risk for things like heart disease, high blood pressure, diabetes, certain cancers, or strokes, or even rare disorders. Having one or more family members with the same conditions in their history does not mean that you will have them, but this gives you the opportunity to discuss screening and preventative action plans for the future.
  • If you’re adopted or if you don’t have that relationship with your family this can be difficult – so while this is helpful, it’s not the only thing you can do
  • If you ever transfer physicians it is very important to bring your medical transcript with you, especially if you are under an active treatment plan. Maintaining your complete medical history is so important, especially if you are transferring physicians for an active treatment purpose. All of your allergies, procedures, x-rays, test results, everything, no matter how small you think it is, needs to come with you.
Building a relationship and Finding the right doctor – Area Needs Work
  • I think finding the right doctor is important because you’re odds are you will most likely see a lot of this person. If it’s your primary care physician, you’ll interact with them for everything from strep throat to sprained ankles. If you’re looking into something more specialized, you’ll have a set series of appointments, but it’s still important to feel comfortable because you want to be able to connect and communicate openly and constructively.
  • Some people may prefer a soft bedside manner, others may like a more to the point approach. Ultimately, after your visits think about if you feel heard, if the prescribed after care plan is in your best interest, and if you feel comfortable going back to this doctor.
  • It’s important to remember, you are within your rights to find a new doctor at any time. Just remember to consider your options carefully, and make sure you have been accepted as a patient by the new doctor you wish to see before leaving the old one.
  • Depending upon your healthcare or insurance process, there are a wide variety of different ways to go about finding a new doctor, but the important takeaway here is to know you can do it, you have a right to it .In some cases it might be difficult, but you can do it.
  • If you’re moving to a doctor outside of your insurance network, or out of the area, sometime you will need to submit a written request to your doctor’s office for those records, as well as letting them know, that you’re seeking care somewhere else
  • Sometimes this is referred to as firing your doctor which sounds so dramatic, it can be if you make it, but it really isn’t all that dramatic. I’ve switched doctors once and I actually got to do it through my healthcare portal, so it was very easy
  • A few of the factors that impact finding a new doctor are healthcare or insurance provider, provider status, location, the services you are looking for, and whether the physician you are interested in is accepting new patients. This is a where the process starts to get more complex, and we start moving out of the basics and into Advocacy with a capital A, which starts with
  • Second Opinions
  • Which starts with asking for a second opinion
  • So you don’t need a second opinion for everything, but it’s something to consider as an extra level of assurance if you are diagnosed with a chronic or rare illness, if you will need a life changing treatment plan, or if you’ve yet to be given a firm diagnosis at all.
  • Second opinions are about gaining a better understanding of the diagnosis, as well as the pros and cons of different treatment plans. It’s not about finding what you want to hear or having someone agree with you, it’s about taking an active role in your treatment and finding the best path for your personal health
  • Not every treatment may be right for you, but it also doesn’t mean that it’s bad for you, but sometimes
  • Sometimes finding a second opinion is about seeking advice from a specialist, a physician who’s area of expertise is focused just on the part of your body that is affected, or maybe they even work specifically with people who have your same affliction
  • Most specialists are not in your primary caregivers office so you will have to do some research or speak with your doctor about finding the person you need,
  • And for full transparency
  • Seeing a specialist can be expensive, even with insurance,
  • And there it may take a while to actually be seen. The average wait time for a referral, scheduling, and appointment is 40 days
  • Without a referral, unfortunately, it’s sort of about knowing how to play the game – this means calling into the office and being really nice to staff, because sometimes you might encounter a receptionist who knows he or she holds the keys to the kingdom
  • Or it could be getting on the waiting list and checking in to see if there are any cancellations that might get you in sooner
  • Or truly for most people, it’s about who you know, and leveraging social connections to get in front of doctors – white people are most often the ones to do this
  • Most of the time without a referral, specialist are not covered by your insurance – so be prepared to pay
  • But sometimes second opinions are about actually finding a doctor who will listen to you, believes you, is invested and wants to help
  • If you’ve ever been told to wait and see what happens with something like cancer, or diabetes, chronic migraine – anything that severely impacts or could potentially end your life – find someone who believes in you. If you’ve ever had undiagnosed pain that’s last for years, find someone who is invested in you.
  • We know our bodies, we know when something is wrong, so if something very out of the ordinary is happening to you

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Transcribed by https://otter.ai

Jae 0:00

I pledge myself to the pod loyal I'll always be a P to start a D at the end, and an O sitting in between.

Welcome back to In Omnia Paratus. I'm Jae like the letter.

And I'm Angela also known as AVO.

We're two friends diving to our past present, evaluating if we were ever truly ready for anything, we discuss all things from the definition of dating to all the things school didn't prepare us for. Listen, as we talk about career changes, give plenty of unsolicited opinions and work on becoming the people we want to see in the world. As we are in the process of rebranding and aging of our podcast.

I

Angela 0:39

thought of this my most practical topics that I wanted to have Angela share with me, us we queens we they them's everyone is about medical advocacy. I don't know about anyone else. But like, I still had my mom make my doctor's appointments through college, one my doctor was on at the city in which I was going to school. So scheduling wasn't the easiest and two, I don't know the psychology behind it, but it's one of those things where you like have your parents do until the last possible second if you happen to do it yourself. So the idea of on top of that having to like go into the office and be able to disagree or ask more questions or anything far out of my reach. I know Angela has a very different experience with this but something that kind of had us originally bring up this discussion is one of our other favorite shows Grey's Anatomy season

14 titled don't fear the Reaper, is that like a sci fi reference or like a Bible reference? We're gonna go more Bible,

Jae 1:38

okay. Oh, also

the Grim Reaper,

so that would be sci fi. Yes.

Angela 1:42

No, just general terms.

Jae 1:44

But like, what's the Grim Reaper from isn't it from like mythology? Or like, someone didn't just come up with the term? Was it in a movie

a book?

Angela 1:51

I'm pretty sure this has been around for centuries.

Jae 1:53

But like, where

did it originate from?

Angela 1:55

Like, is it a book? Is it in a movie a hieroglyphic Bigfoot? I was actually not prepared for this question. So I googled it really fast. The Grim Reaper, according to Google, first appeared in 14th century Europe when dealing with

Jae 2:12

the plague. So like someone just coined the term.

Angela 2:15

Yes, I will update this more in the show notes. But this is what I'm getting. Got it.

Jae 2:21

Okay, so the actual episode, Brenda Bailey goes to a neighboring hospital, not grey Sloan Memorial. I think she has to Seattle Presbyterian. Yes. That's really not the point. She goes in and tells the doctor she is having a heart attack. For those who don't know, Grey's Anatomy, Miranda Bailey was chief resident now chief of general surgery. And now chief of all surgery at this point, I believe, yes. So she's pretty experienced in the medical field, one could say goes in to this hospital, because she does want to go to her own and scare her colleagues and tells the doctor or whoever sees her. I'm having a heart attack. No one believes or no one takes it seriously. They asked her if she stressed. She also has OCD. She's been diagnosed with OCD. So people go to psychology, they keep trying to refer her to a psychologist rather than give her the medical help she needs as she's pushing and pushing and pushing and trying to get the help. She knows she needs as the Chief of Surgery at what I'm assuming is the number one hospital in Seattle. Eventually she brings over some of her colleagues and gets treated for the heart attack that she knew she was having. So Angela, and I started discussing this kind of experience and kind of what they showed. And in the show, they give some statistics and although the medical accuracy versus anatomy isn't top notch they typically do when pushing or bringing up a social issue. Do you have relatively accurate statistics? I hope so this was something that I had never really thought of experienced known to be a systemic issue until I talked to Angela about this episode afterward. Your turn.

Angela 4:03

I have to admit I was a little bit shocked when we first started this conversation because I didn't realize that we had never talked about this before. Just to piggyback off of what Jay started telling us here that when Dr. Miranda Bailey came into the hospital with her heart attack, she did not come in with a classic set of symptoms she came in with heartburn

Jae 4:25

define classic symptoms.

Angela 4:27

So technically, with heart attacks, chest pain and or discomfort is still the most common symptom for both men and women. However, research has shown us that most women are more likely to experience other less classic symptoms like pain in the arm, neck or jaw. Or just like Bailey experienced only nausea, indigestion or vomiting. And oh my gosh, the second I saw her pop the antacid in the car. I knew exactly where this episode was going to go. She was having a heart attack. She wasn't going to be treated properly. They were going to bring her mental health into it. And she would most likely be near death if not die. Because unfortunately, this is something that happens to so many women and people of color in this country. And it's something that's only started to really gain traction with people in the past few years. So, before we started out our episode here, I just want to let everyone know we are not doctors, nurses or scientists, we have no connection to the medical field, and that we do consider ourselves students of Grey's Anatomy, we cannot actually give you any legal medical recommendations. So today, we are here to discuss and bring awareness to some of the conversations happening now regarding patient care and equity throughout the United States. In setting up our outline, we realized that this would be best explored as an ongoing series. So today, we're starting out with a focus on discrimination at the heart of the system. In the healthcare field, it might not always be easy to spot discrimination. But if you feel like you've ever been dismissed, unheard, or misunderstood, talked down to not given access to tests or medication, refuse treatment, or if you even need to leave the area you live in for adequate treatment, we don't think you're crazy and you didn't read too much into the situation, there is a very high chance that this was related to discrimination. And that can come in a variety of forms. It can be related to race, gender, sexual orientation, weight or age, it could be related to a physical disability, chronic illness, mental health, or your insurance status. And you could even face multifaceted discrimination where one or more of these areas is used to negatively qualify you. But for the purpose of our discussion today, because we are using Miranda Bailey as our premise, we are focusing mainly on systemic racism.

So Jae,

Jae 6:42

sounds like you're ready for a TED talk. Holy shit.

Angela 6:44

Oh, I know, I had to I had to create a very large disclaimer here, because we are not trying to cancel anyone. We are not trying to create any sort of divide or schism here. We just want to have a conversation. And we want everybody to be aware of what's going on. Yes. And just a quick little addendum, as if I have much to add to this conversation. It's hard enough to advocate for yourself, as in my belief, when I think the system is on my side, not completely. Yes, insurance, bureaucracy, red tape, all of that is something that I'm sure you can research yourself, Google's a great place to start. I know we most of us have access to it, libraries, newspapers, something. But when those factors aside, you think you can trust your doctor and what they're recommending, it's already hard enough to ask the right questions and to disagree with someone who has such an education and who you know, goes through all of this process. And then it's even harder now knowing when discrimination within the teaching and profiling

Jae 7:50

is added on to that

Angela 7:51

exactly. Because when you go to the doctor, you're most likely not feeling well. Or you're already scared because something weird is happening to your body. So of course, you want to trust the people you're working with. And most times because they are the officials in this scenario, we don't really think to question it either. But unfortunately, sometimes you have to. So today, we have a lot of different studies and statistics, personal anecdotes, and a whole host of advocacy tips for you. But in the interest of not giving you informational overload. We're going to try to keep this to an hour, and we're going to touch on a variety of topics quickly. And if you have any additional questions or comments or concerns or would like to see our research, you can visit our show notes at WWW dot insomnia pod calm and search for today's episode under the podcast tab. Or like Jay said, we encourage you to do your own research and Google library, medical journal, all that good stuff.

You're here. so jealous to dabble it can make. So Jay because there seems to be some confusion about this lately. I have a definition of racism. May I read this into the record? You may I do have a little bit of a concern that you spell discrimination like discrimination on this entire document I'm looking at Oh, yeah, and racism like race schism?

Wait, really, and it didn't catch it.

Jae 9:12

My grandma was catching a bunch of stuff.

Angela 9:14

Oh, this is this is gonna be really fun. As I read through my notes here, everyone will see how many of these things I pronounce incorrectly

Jae 9:21

the definition

of racism according to

Angela 9:24

According to the American Association of family practitioners, I tried to put all the knowledge from medical sources here and I think that they actually did a good job though. So they define racism as a system that categorizes people based on their race, color, ethnicity, and culture to create double standards that reward some and restrict and impact others. negatively. systemic racism is the establishment of prejudicial policies and procedures as the standard within an organization's foundation governance or educational system that directly influences the practices and patterns of its participants. And it specifically meant to penalize or exploit people because of their race, color culture, or ethnic origin. Now, I think it's important and worth noting that this is not a white versus non white conversation. And this isn't about bashing or blaming anyone because of their color, we want to be very clear on that. But a lot of the statistics that we're pulling today are measured in terms of privilege. And in this case, privilege rests with a few and not really, with minorities. So what we would like is for everyone to reflect on this and see what they can do to recognize their own privilege and how they can help others. So in the health care field, this type of privilege affects everything from doctor patient interactions, scheduling appointments, insurance, status, treatment options and plans, access to medication, and even more. And I think like Jay said earlier, this cycle starts with education, the education of our medical professionals,

Jae 10:52

I think, I hope most people listening to this and people in our country where racism exists, it's here, it's one of the forms of one group having more than another. And I think we all kind of understand the history within that. If not, there are plenty of great people to follow and resources to look into again, but I think the more important conversation that we're gonna get into is systemic racism, because I feel like it's one that is harder to quantify when one in a position of privilege doesn't feel that privilege because of their very valid other hardships or things they've overcome to get to the point they are, if that makes sense.

Angela 11:40

Yes, I think it's important to remember if we said earlier, we understand that discrimination happens in a variety of ways. But this also isn't a measure of one person's struggle being more valid or important or difficult than another's.

Jae 11:55

This is rough.

Angela 11:56

It is. And we understand that this is a hard conversation to have, especially in your everyday life when you've never thought about it before. So if it if it takes a minute, it takes a minute, we're happy to give you that minute.

Jae 12:09

Did you want me to put it in a minute of

silence?

Angela 12:12

No, it's okay. I don't think we need one there we have we have too much information to share today.

Jae 12:16

So the education system, the textbooks and the studies that our doctors are learning from in America are incredibly biased and are a direct correlation causation of the systemic racism in this country. Now, not every study is however, a lot of the foundational ones are the one example I'm going to go into before I'm sure Angela can go into a plethora of I recently learned that the BMI scale was only tested on white men, meaning for anyone who is not a white man, this study doesn't really accurately figure out your body composition and your health index me being someone who has a gender chronology problem. This study impacted my life since elementary school and learning that this study didn't have any results based on Asian women, women period, they just took the male numbers and did a proportion. It was like yeah, this should be right for women was so vindicating,

and then also so traumatic.

Angela 13:26

I think it's absolutely ridiculous, because how on earth could they think to apply something like that to half the population without any sort of real research,

Jae 13:35

and it's the standard for school, I don't know about in your county, but in mind to pass the physical fitness test, BMI was one of the tests. So if you didn't pass the BMI test, it was one of the reasons you had to retake PE. And just the idea that that was a factor of whether or not you could not take physical education anymore was based on something as I don't want to say trivial, because I think health is important, but BMI is not an accurate representation of health. And that did not matter. I have friends who can't put on weight. I have friends

Angela 14:07

Oh, completely, who put on

Jae 14:09

a lot of weight. But they're also it doesn't take account football players, bodybuilders, there are so many things outside of that, and people who would just fail that test. And it would be one thing against them from the start of this frickin physical fitness test

is literally no indication of health.

Angela 14:25

I think the most damaging thing that we hear from health professionals is, oh, you're skinny, it's okay, you're fine, you're healthy. Your weight is not an indication of your health. Like just because you're skinny, it doesn't mean that you're fit. It doesn't mean that you're eating well, it doesn't mean that you're getting the proper nutrients that you need. And just because you don't necessarily fall into the idea of a range of normal doesn't mean that you're unhealthy either. I know people who also have endocrinology issues, and they're some of the fittest people that I know even though they don't know conform to the idea of skinny and healthy. So I think overall, we just need to we need to abolish that

get rid of the BMI 2021 Yep, there is my soapbox. What is yours? Well, it's funny that you touched on the textbooks because that's actually my and so I wasn't aware of this until last summer in a tick tock. But this actually started in 2017. That's my one play to Gen Z today. Hi, I use Tick tock, I'm not the total Boomer. I mean, mine was on Tick Tock too. So take Talk brought these things to our attention. They're not the foundation of the claims and studies we are citing and referencing today. These brought us ignited something for us to research and look into using medical journals, medical textbooks, credible sources in this field. tik tok is not the source of our information, nor should it be forever. Listen

Jae 15:59

to this. Thank you.

Angela 16:00

Yeah, everyone, please don't trust all of that Tick Tock info out there. Like everyone who's getting their tax information and advice from tech stocks. Maybe don't do that. stocks. Yeah, maybe don't write up not all of it is exactly legal. Moving on. Yes, I first saw this as a tech talk. But it actually led me back to the original articles bringing light to the issue in 2017, when students started to share some of the patient care stereotypes that they were presented in textbooks, so I'm going to read you some of them right now, Jay, and you tell me on a scale of one to 10 how outraged you are

Jae 16:35

okay, I'm always out. Right? So we start out for if we're being honest, but I'm ready.

Angela 16:41

Okay, so number one, Jews may be more vocal and demanding of assistance. How No? No. Okay.

Hispanics may believe that pain is a form of punishment, and that suffering must be endured if they are to enter heaven.

Jae 16:57

I feel for all of my friends

and

Angela 17:00

sorority sisters and people I affiliate with, who are of that group. Very not objectified. What was the word? We're going with outrage?

Jae 17:07

There we go.

I'm outraged before them Mm hmm.

Angela 17:10

Okay. Yeah, listeners, I will tell you right now, if anyone ever told me if I denied pain medication, anyone ever came back and said, Oh, it's okay. You'll get into heaven. Anyway, I'd be very confused and a little angry.

Jae 17:23

Are these all from the same textbook?

Angela 17:25

No. So these are from the read different textbooks, okay. Asians are hesitant to have their blood drawn, because they believe it steals their life force.

Jae 17:34

Isn't that like more Jehovah's Witness?

Don't they actually believe that?

Angela 17:38

I'm not 100%? Sure. But it, I know that there's, there is a feeling about giving blood and receiving blood there. So we will look into that.

Jae 17:50

Got it. I just want to know how many doctors I want to know the people who thought of these things. Hopefully you researched and talk to people of these Asians Latins Jews grew, and then felt they have the authority to make these statements to be printed in textbooks

to how

medical students would treat all patients of these groups because there are a lot of stock points along the way.

Angela 18:18

So Oh, yeah. So looking into this, I actually was able to find that these stereotypes are not only decades old, but they were disproven A long time ago, but it's still being presented as information for people to draw from when interacting with patients. And Okay, so we're actually going to get into this later in the episode as well. But you have a guaranteed right to express your cultural and religious beliefs to your doctor. And they must respect those in relation to your care. So while patient background is important for everyone to consider, and to have a basis of going in, it's so much more important to actually interact with your patients, and ask those questions to understand how they are feeling in that moment, and what is going on with them. So I actually I have like 10 other examples, but we're moving it along here. Because I think that this is where we get into the basis of implicit bias in the health care system. So now

Jae 19:13

we're into patient care. So yeah, that was where the information that our medical professionals are learning starts. And now we're going into their practice,

Angela 19:25

right? Because it's been presented. So now, when these students go out, and they start their rounds, rounds, residency rotations, the learning portion of their studies, when they encounter something that looks even a little bit like this, it has the potential to reinforce the stereotype without actually being directly related to it. Or if they hear another one of their colleagues say something about it. That's what starts to build that bias into your head.

Jae 19:55

Do we have any examples

Angela 19:57

just so we're all on the same page here? implicit bias is the process of associating stereotypical characteristics or attitudes to a person, group or thing subconsciously. And in healthcare, this could manifest in a variety of ways, such as a doctor unknowingly having a preference for one group over another, a person being denied treatment for something that cannot happen to them or not being given an entire set of treatment options, because a doctor or nurse assumes that they are unable to understand the information route, right? So I've got more statistics here. But just so we all understand why implicit bias is not okay. Because unfortunately, we need to break this down a little bit, because I don't know about you. But I've actually had several people try to tell me in the past year, that prejudice is not always a bad thing, some of the most confusing conversations I've ever had.

Jae 20:51

Yeah, I don't understand that. And then I'm going to be completely honest here for a second, because I feel like more people need to understand that was a bias. I had some rough middle school experiences with black and Latino students, my teachers would pair me with them in projects, and then the process of that would get pencil stolen will get called a racist for not letting them cheat. It shaped the way I acted for years. And it didn't, I didn't want it to I mean it to I feel like I'm love and want to fight for the rights of everyone and try to include everyone. But when you're have those negative experiences, you associate things with them. And it's really hard

to stop and to call yourself out on those Association.

Angela 21:39

Exactly. And I think just another thing that we all need to recognize here, everybody has some type of implicit bias, it just happens, unfortunately, within the way that our society is set up. And the different structures that we have here, it happens way too easily. And the whole part of implicit bias is that we don't even realize that

it's happened.

Jae 22:01

I feel like the problem is when our brains are meant to recognize patterns. So if everyday hypothetically enjoy, you were pushed into a locker by a person x rays, you would feel something about of X rays, whether you mean to or not, because and it's harder to unlearn things, especially when they're traumatic.

Angela 22:24

And part of the work that we all need to do is begin to understand why we think these things and how we can move into a more equitable and understanding place in the future. And I will actually, well, no, here you know what, we can talk about it now. Did you know Jay, there is actually a test now that can measure your implicit bias?

Jae 22:44

Oh, yeah, there are several I've taken them.

Angela 22:46

Oh, okay. I did not know that. The question that is posed most often when initially addressing it is a How can we fault someone for something that they are not even aware of. And to put it simply, implicit bias is very damaging precisely because of this reason, when it's harder to recognize it's more often categorized as a one off glitch in the system that can be excused away. So when we start to open up the conversation and actually focus on self examination, that's when we see the outline of that door for change.

Jae 23:17

Oh, quick other note, I've been listened to a lot. I recently converted Angela and a few of our other friends to back to our nation. I'm sure if you're anywhere near Instagram, or anywhere in the vicinity, you understand that some of the issues that have been brought up and brought to light with the franchise. And as I've been listening to podcasts and things from contestants who are in the bipoc community, one of the main things, especially with one on summer, and what's going on now is when looking at systemic racism, implicit bias, racism, we can't look at ourselves under the moral grounds of good versus bad because no one wants to consider themselves bad, nor really wants to look at themselves in that way. So that needs to be removed from the conversation, especially with implicit bias. Implicit bias sounds crappy because just think of having to admit to yourself, wow, I really will treat x differently because of insert Middle School story here or insert bad breakup here or insert thing on the news here, my brain has now recognized a pattern that is one of the foundational ways of how I move through the world and it's harming others, I think, most compassionate people, that's a hard thing to admit, I will say at least for me, that's a very hard thing to come to terms with that this isn't about being a good person or a bad person. It's about fundamentally having to tell myself and teach myself to call those things out. I don't think I mean, this is a little off topic. I don't think we'll ever end implicit bias, but I think we need to be better at catching it and calling it out in ourselves and others when we see it. I don't think I could have said it better. I'm sure you could have English major. I could do all the math this time.

Angela 24:55

I know I'm really sorry guys. I'll have j check the math after this. Especially as we now Okay, I'll find someone to check the math after this, especially now as we move into our factor fiction section, where we're going to measure some of the statistics that we have gained through studies and implicit bias. So Jae,

Jae 25:17

I'm guessing if these are real statistics are whether they're true or not,

Angela 25:20

whether they're true or not. So j factor fiction, non white patients are more passive and do not accurately prioritize their health care.

Jae 25:28

I would say that one's probably false. If I were to take a very wild guess,

Angela 25:33

oh my gosh, and you're right, non white patients are more often blamed for being passive in their health care. However, studies have shown that more than often, this is not the case. Black men and women actually lead the national statistics and high blood pressure. And this has long been attributed to lifestyle choices, and they're considered apathy towards seeking treatment. However, recent studies have actually shown that black patients also lead the way in missed opportunities for medical intervention for blood pressure control. So this is this

Jae 26:03

because they aren't advocating or because they're being misdiagnosed.

Angela 26:09

This means they're not being diagnosed at all. So basically, what this shows is that even when tests showed that they had high blood pressure, and it was recorded by their doctor or nurse, they were still not prescribed medication are marked as needed for follow ups regarding future intervention. Some patients involved in this study had missed opportunity upwards of 20 times that their doctor could have addressed it but didn't even when all things were considered equal, such as good diet and exercise regimen, yearly physicals, active insurance status, and access to the same doctors, their blood pressure was their high blood pressure was seen and just written off. I don't

Jae 26:49

even know what's next.

Angela 26:51

Right? So factor fiction, white patients are admitted to the emergency room more often than non white patients.

Jae 26:58

Again, wild guess and I don't know what in the mercury horoscopes like making me feel this way. I'm gonna go with true

Angela 27:05

Yes, it is true. So non white patients are actually less likely to be admitted for emergency services. Studies have shown that on intake, they are often found as not in need and sent home or made to wait. And these numbers are about half and half. So to put this in perspective, and my very basic math terms, six white patients would be admitted to admit one black, one Hispanic, one Asian one South Asian, one Jewish and one Muslim patient into the ER. So it's basically a one to one ratio.

Is that right? Well, one to one means equal. It's one to six. Oh, okay, sorry. It is a one to six ratio j does the math.

Jae 27:43

Good try sweetie. Right? Yep.

Angela 27:44

While waiting in the emergency room, black patients also have a higher chance of dying while waiting than any other race factor fiction. Black women are 41% more likely to die from breast cancer than white women. Correct. This is true a 2020 research. The earliest research study I could find out in this actually showed that black women are less likely to develop breast cancer than any other race, but they are the most likely to die from it, as I know. So the research has shown that they're more likely to develop it at a younger age. And so the standard necessarily the standard age for breast cancer, but 50 and over is when breast cancer is considered to be normal as in they expect biological defects to start forming under 50 is very rare, and they often have a more aggressive form called triple negative breast cancer, which means that it doesn't have the three main genes that most treatments seek to inhibit in other breast cancers. I'm gonna need you to rephrase that. So they have a type of breast cancer that all most treatments do not work for this. Does that makes sense? Yeah. Okay, so triple negative breast cancer is is it diagnosed differently so that I'm a little bit unclear on but they are 20 to 30% more likely to have this form of breast cancer, but they also are the least screened and least properly screened group. Or when it actually is found a lot of them are referred to wait and see. So my mom is not black, but this happened to her and I am very passionate about this. When I was in the fourth grade. She was diagnosed with stage zero breast cancer, which is which is is very lucky because it's when the cancer is at its smallest. It hasn't spread a lot. There's a lot that you can do for it. The doctor who found it told her that it was nothing she should wait and see come back in a year but it was definitely cancer. So my mom was like, No, absolutely not. I would like a second opinion. He refused to give her a second opinion. She had to go out of her insurance network. Find a doctor Who would treat her and then go out and get completely separate scans and all of this stuff for this treatment? In total, she was really lucky. I think it took her about eight months from diagnosis to her mastectomy. And she has been cancer free ever since. But the fact that Thank you, yes, but the fact that a doctor literally saw cancer and wanted to wait and see what happened is mind blowing.

Jae 30:26

I'm not like being a white man here playing devil's advocate, but like, I genuinely have a question about this. Why would a doctor whether it's through their training, they're not like they're biased, but like, what is the thought process of telling someone with cancer to wait and see, to see if it can go away, like HPV can to see how it develops to see where it spreads? Like, why would a doctor think it's all right? Not morally, but like medically to tell someone with the cancer diagnosis to wait and see, I don't know if I know how to answer this. So I'm not dressed up. I don't think there's any justification for telling this. But I want to know, the medical like, if this is a common practice, what are doctors taught or thinking to tell someone with a cancer diagnosis that they can wait.

Angela 31:10

So I don't think that this is necessarily a common practice at all. I think that this doctor saw my mother who I was a late in life, baby. My mom was actually lucky enough that when I was in first grade, she was able to take an early retirement and stay home with me. So this doctor saw a non white woman without a job and an expensive surgery. So he gave her so he told her that it would be better to wait and see what happened down the line. But wait for what though breast cancer is not? Exactly breast cancer is not one of those things that just goes away, he more likely thought like, Oh, she can't afford treatment. So I'm not even going to give it to her. But then the fact that he made it so hard for her to even see someone else is astounding question. Yes. Did your mom work for the health care system at this time? Or was that after that was after a little side tip for everyone, if you happen to work for the health care system, you usually get really great insurance, you usually don't have a problem going in for anything. So if you do work for the healthcare system, congratulations, you're pretty lucky.

Jae 32:17

I'm just gonna throw this here as my completely own opinion. Or if you're a senator, or the president, or an ex president or family member of any of those I just listed, they get really good health care. And Angela, do you know who provides this health care to them? It's part of their package as the business would say, the people of this country. Yes, they are on government health care, and it's really good health care. I don't really know what it includes if I'm going to be completely honest again, a quick Google will tell you they get really good health care for life. And it's tax paid government funded health care in my opinion, and only my opinion some of these people actively advocating for private health insurance are guaranteed public amazing health insurance till they die. Hmm. But let's all take a deep breath. Ooh, saw as I was taught where's that from? l? I don't know what culture it's from or anything but Oh, is the word like calm Okay, factor fiction. Asians cannot be alcoholics because they are a dl h2 deficient What?

What is that?

Angela 33:21

Um, okay, so you might know this as Asian glow. It's where you some Asians have an enzyme deficiency of a D Lh two, and it basically means that their body has a harder time metabolizing certain enzymes within the alcohol and it causes facial flushing. Hmm. I mean, obviously, since like, I don't know, any Asian alcoholics like that just must be true. It's actually fiction. So

Jae 33:47

that was a joke. I feel like unfortunately, I will be putting this in the thing. And we'll one has not been on the sarcasm game two and a joke that I think people need to realize that just because you don't personally have an experience does not mean that experience doesn't exist within your city, state country planet universe, as I've recently been getting into the MCU, which we will be discussing in another episode. Other planetary beings. Oh,

Angela 34:12

my sarcasm game really has been bad. It's the quarantine. But yes, this false misconception actually came about because doctors were found to be less likely to address addiction in the Asian community. In past research statistics, Asians had the lowest numbers in association with alcohol and drug addiction. But when they started actually investigating these numbers to see if they could prove this, they found that they were under diagnosing by about 20%. So there are two working theories as to how this happened because this research is still pretty new one some doctors believed that of the ADL h2 deficiency and facial flushing, it was impossible for Asians to be alcoholics. The second one is that doctors were putting too much store into the model minority. Myth and the idea a successful group of people could fall into addiction was not something that they could easily wrap their minds around.

Jae 35:10

That is terrible. Right? So I just have one question for you. And then we're gonna go into the what to do. But I have one question for you. Okay, so this term that's recently bipoc, black blank, and people of color, why haven't I heard that much about indigenous people during this lovely chat? So, Jay,

Angela 35:26

that is an excellent question. I promise indigenous people, I did not try to leave you out. Unfortunately, there are not that many statistics and research projects going on that feature many people of indigenous descent. So within the health care community right now, medical professionals of indigenous descent, and by that I mean, Native American and Hawaiian measure out about 4%. Oh, and maybe Alaskan as well. I will double check that for the show notes. But that's 4%. And then, as far as study is going into how different things affect indigenous peoples, I haven't found very many. So I used the Okay, I equate this to Grey's Anatomy, which was the NIH which is not correct. I think it's the NIH I or NIH C is where I pulled a lot of my research studies from most of them features zero to 5% indigenous people within their studies,

Jae 36:24

which is not enough on colonized land, it is not. Okay. So now, if you made it this far, congratulations, I would give a timestamp. But frankly, I'm afraid of how long this is going to go and how much this can be. I would love to cut this in two parts. However, I think leaving just with the information that was given in that it's kind of dark and sucks. But now let's go with the area of expertise in which I wanted to speak of which is how to advocate when to advocate I think why to advocate we've already just covered quite a bit. But when and how are the best practices? Any one particularly as we can tell, we have particular Will you wanting for bipoc individuals but how can anyone get a firmer grasp on speaking to their doctor asked him for a second opinion all of that. I guess the first question I'll ask personally is I'm not a hypochondriac, but I do Web MD and Mayo Clinic I know what's not good at me know it's bad knowledge is power. However, I think no matter how much Grey's Anatomy or Web MD I'm on I will not have the knowledge of someone who goes to medical school. So I always feel kind of older the doctor they know better. But how do I know that point of what my body is telling me something that I need to get a second opinion and not just what he told me? I'm

dying today because I sneezed. It's okay, I do that too. Okay, so Okay, I'm not gonna lie. I do Web MD and all of that, too. I usually do it after I've gone to the doctor, though.

Angela 37:56

Okay, so I'd like to hear what they have to say first, because like you said, we don't know as much as they do. But at the same time, just within the interest of making sure that everything has been looked at, well, I like to look up what my diagnosis has been. And then go through some of the symptoms and look at the treatments that other places are doing and see if I should ask any questions about these other things. I think this is also really helpful as well, if you're not necessarily given a firm diagnosis, either. If you go in and doctors say, Oh, well, it could be this or it could be that we're gonna have to do some more tests and see what's going on. Look up the tests, look up what those two things are. See if there's anything else that's related to it, do not go back to your doctor and say, I think I have this or Web MD told me that because unfortunately, I don't even think this is really specific to doctors. I think that this can happen to anyone any line of work. If someone comes to you and your expert field and tells you Well, I think it's this because the internet told me that they don't exactly take too kindly to that.

Jae 38:59

That's why we can't

use Wikipedia as a source.

Angela 39:01

Exactly. So I think that it's just about knowing your symptoms, knowing your body, knowing what your baseline is. So example for me, I know that my temperature runs about 97.3. Say so when I'm yeah. So when I'm at 98.9 I feel like I have a fever when I get to 99 I'm absolutely miserable. So when I go into the doctor, like oh, it's just a low grade fever. It's fine. I'm like, No, look, again, this is my version of

100. That makes sense.

Jae 39:30

So just so trust, but verify exactly trust but verify. And then if you have that, what's the word for it?

England intuition.

Angela 39:39

If you have that gut feeling that something's wrong, something's been missed. Or if you don't still don't have a solid diagnosis. After two or three visits, you can totally seek out a second opinion on your own, you can let your doctor know depending upon how your healthcare network is set up. You can schedule an appointment with another person. Sometimes you can even go direct to a specialist, but I think in most cases, you actually still need a referral. I'm not gonna lie, seeing a specialist can be hard because it can be expensive. There's often wait times I think the average wait time in the US to see a specialist is about 40 days. Yeah. So if you're not feeling great, that can seem interminable. I know when my IBS was being diagnosed, I was on a waitlist to see a specialist. That was four months. And so I still actually hadn't been diagnosed, I was in horrible pain, I actually ended up in the ER, and oh, my God, okay, I get that this, I think I scared the doctor, because I was telling him that I had been in really horrible stomach pain for almost a year. And He kind of looks a little panicky. And he's like, this could be cancer. Why didn't you come in? I've been trying to come in, sir, I've been on waitlist for months.

Jae 40:47

I heard this on Tik Tok. But I think it's a good practice. And I'm sure Angela with all of her research and knowledge can back this up. If the doctor you're seeing refuses to run more tests, give you a second opinion, any sort of obstruction to some of the care you feel you deserve, or need. Tell them to put that in your chart that they're refusing extra assistance for you, right? No,

Angela 41:09

I actually haven't heard that one. I've heard of documenting when you are refusing a treatment plan. But that that does make sense. The one thing I will say to that, though, is that I've heard a lot of first hand accounts. And I've actually experienced this myself to where not everything is noted into my chart. So what I started doing was writing down everything that I talked about post visit. So that way, if I did ever need to see another doctor, I had a record of it in my own words. And I think this is actually really helpful to going into any doctor patient visit, whether it's in the hospital or just seeing your regular primary caregiver, write down all of your symptoms track what's been going on in tangible ways. When I move this way, this happens when I eat this, this happens when on the third day of every month, I get a migraine, keep a record of it. And you can literally hand that to your doctor. And when they can see all of your symptoms lined up together, they're actually more likely to give you a better diagnosis on the first try. This is also really helpful as well, if there's any potential language barriers between you and your doctor, because you also have a record to give to a translator. The one thing I would say though, is that if you're ever handing this over, get it back or keep a second copy of it. Because that way, if you do need a second opinion, or you need to see a specialist, you have that record in your own words to go along with your medical chart. Got it.

Jae 42:36

So kind of to summarize spark note, Cliff note all of this, it's if you think something's wrong, ideally track it, as long as you can note it calendar, so you can see your doctor, they will recommend hopefully something and then look into those things. Okay, that's a little bit for more kind of advice for someone like me, who actively likes to go to the doctor, not like a like I go more than I need to but I take full advantage of my health care and the things that come with it because I unfortunately, currently it is a privilege and it's a privilege and prevention is easier than treatment. So I actively go to my six month checkups, get my bloodwork done for health things I need and take advantage of all the resources I can but what about for people who for all of the things we described, don't go to the doctor or are afraid to go or have had bad experiences.

Angela 43:30

So I think so if you're uneasy about going to the doctor, I think that one, it's important. Just make that first step, make the appointment, keep the appointment, do everything that you can to make yourself comfortable. You can bring someone with you, like a family member or friend that you trust to sit with you in the waiting room. You can even ask for them to come into the exam room with you or after your exam when you're speaking with your doctor or a non pandemic, during non pandemic times. Yes, I know, it's very sad. But so unfortunately, during COVID times, we can't do this. But trust me having someone with you can be a really big source of comfort. So I was actually reading about body doubles in the ADHD sense where one person will sit with another person who has ADHD. And their physical presence makes it easier for them to focus or handle difficult tasks. And I think that something similar happens here when you bring someone with you to the doctor's office. Additionally, with that list of symptoms that you wrote down, you can also write down questions, and this person can help you go through those questions and push for answers. If you feel like you're just being dismissed. I have a list of questions here. But I'm actually just going to leave these in the show notes for you all but they cover what to do on your first visit your second visit follow ups if you need surgery, all kinds of things like that. And then also I think it's very important for I know you haven't really touched on this yet, but just going along with this and bringing someone with you. I think that it's important to know your family. History. So if you can bring a family member with you who can help you flush out your family history for your profile, this will actually help your doctor get these things entered into your medical record and actually help you set up preventative treatment plans for things like heart disease, high blood pressure, diabetes, certain cancers, strokes, or even rare disorders. I do know that if you're adopted, or if you don't exactly have that relationship with your family, this can be a little difficult. So while it's helpful, it's also not the only thing that you can do. I think the next step here and making sure that you're setting yourself up for success is finding the right doctor. And sometimes this takes some time. But if it's your primary care physician, you're going to interact with them all the time, from everything from strep throat to sprained ankles. And if you're looking for something more specialized, you're more likely to have a set series of appointments. But it's still important to feel comfortable, because you want to be able to connect and communicate openly and constructively with this person. Because essentially, you're collaborating on your life, that's important. That's a good way to put it. Some people may prefer a soft bedside manner, others may prefer more to the point approach. But ultimately, after your visits, think about if you feel heard, if you feel that your care plan has been prescribed in your best interest. And if you feel comfortable going back to this doctor, and then do your research, just to see if there's anything that you need to touch on and your aftercare visit, especially if you've been asked for a follow up

Jae 46:23

all good things. I think that normally, these words are ones I don't have in my vocabulary, and also are very noxious. But you are entitled to have a good relationship with your doctor, you deserve to get medically treated for what you think you have or what you do have. And you really need to put yourself first because like Angela said, this is your livelihood. This is your future, this is your existence to not get too deep, but kind of and those things, there are great doctors, and there are great staff who will advocate for your tests and who will give you these things. So you just you don't need to settle

Angela 47:06

period. Exactly. Even in your everyday life, you can seek out a new primary caregiver, like depending upon your health network. The process varies from company from facility to facility to facility and insurance provider, even the state, but you can do it and you're entitled to do it through which I was going to walk us through here but we we've taken up so much of your time already the patient Bill of Rights. So I'm going to summarize this really fast first, every healthcare facility most insurance providers and each state actually have their own of these. So depending upon where you are, look it up. No it these are rights that are guaranteed to you as a patient and must be respected.

Jae 47:50

Are these through hospital chains or per state, like can we put a resource so people can find their or per,

Angela 47:56

per what it totally depends.

Some states have them, some don't like some you just have to go through the health care provider, it'll take some research, but these are guaranteed to you. And so every state and every providers are actually going to be a little different. But these are the core rights. One, you have the right to information, which is the right to know everything about the nature of your diagnosis, your care options, the risks and benefits involved. And this now involves informed consent as well, which is the authorization from a patient to receive medical intervention after having a full discussion about the intervention plan with the doctor. Also, this should be noted in writing in your medical chart and you can go back to that at any time. Second is your right to personal respect, which ensures that your cultural and religious beliefs will be honored in regards to your treatment. This also includes the right to ask for and receive visits from religious persons and observances of modesty. Third is your right to choose visitors and advocates at any time, you can enable or restrict visitors and your regular office visits or in the hospital and this includes family and outside persons you have complete control over who you can see and you also have the right to ask for a nurse to be present during exams or to see a social worker during your visit. Fourth is the right to care and the right to emergency care you have the right to know who was on your medical team know how they're making decisions. You have the right to make the decision to remove them at any time if you feel that your quality of care has diminished and if you need emergency services, you cannot be denied I It doesn't matter if it's a public or private hospital in your insurance network three states away from you live if you have an emergent condition they have to treat you that is their right that is your right and they are legally obligated to do that. Fifth is the right to privacy which ensures that your medical information is not shared without your approval and also entitles you to full access to a copy of your medical file and six is the right to complain and appeal. This means that you have the right to lodge any complaints about your care provider wait times lack of services provided The actions of health care personnel, and I believe that the standard is that these must be accounted for by the entity that you have made the complaint to within 180 days. So yeah, so that is the patient Bill of Rights. That's the summary. Yes, that is the summary. It's been around since 1980. I know it's a lot of information. But a lot of people don't know this. And I think it's so important that when you go in, especially to a hospital, that you know that you have these rights,

Jae 50:27

most definitely Justin, kind of our wrap up here. The second part of the advocacy is things we all as human beings deserve and should get and should put into practice. However, through our experiences, and being women of color, we need to do it even more, because the system unfortunately, as a whole, not individual doctors on individual hospitals, medical facilities, people, but the systems were not made for us. But we're here to try to change that or at least inform you, or at least inform you of how you can get the best out of your treatment.

Angela 51:04

We'll start there. And then hopefully, we'll change it. I know we'll actually we'll save the story for our next medical episode. But one of my aunts actually believes that she officially got hospital policy changed through an observation of hers.

Jae 51:18

Nice Good for her.

Angela 51:19

Yeah, so we know it's been a lot of information today. We ultimately we hope you found it helpful. And if there's anything you want to know more on, please don't be shy, head over to the podcast website and check out the show notes. We've got a ton of links there for you or DMS and I will make sure Angela is the one to answer

that too. And on that note, thank you for listening to this episode of In Omnia Paratusgrab your coffee bowl and don't forget to rate download and subscribe on Apple Spotify or wherever you get your podcasts as always where you lead will follow so head on over to @inOmniapod on Instagram and let us know what you want to hear about in the comments.

Bye

Jae 51:57

bye

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Jae & Angela Here! We are two friends diving into our past and present, evaluating if we are ever truly ready for anything. Quarter-life crises are real and we want to be with you SIA (stumbling in action) as well as give council wherever possible.