(somber piano music) - This is the second worst
day here at IU North. (somber music) Yesterday, got a Doctor
Bannec, B-A-N-N-E-C, wanted to send me home. "You're not even short of breath." I said, "Yes, I am." (somber music) I was in so much pain from my neck. My neck hurt so bad. (somber music) I was crushed. It made me feel like I was a drug addict. (somber music) The CT went down a
little bit into my lungs and you could see new
pulmonary infiltrates, new lymphadenopathy
all throughout my neck. And all of a sudden, "Yes,
we'll treat your pain." You have to show proof that you have something wrong with you. I put forward and I maintained. If I was white, I wouldn't
have to go through that. (somber music) This is how black people get
killed, when you send them home and they don't know how
to fight for themselves. I had to talk to somebody,
maybe the media, somebody to let people know how I'm
being treated up in this place. (dramatic music) - Today we're gonna be
having a very important yet difficult conversation
about racism within healthcare, social disparities within
the healthcare system and to see what actionable
things we can do to fight back. I'd like to send our condolences
to Dr. Moore's family and a commitment that
I'm gonna make a donation on their GoFundMe page. I'm linking that down below as well, if you'd like to contribute to. In order to have this in-depth discussion, I've invited special
guests, Dr. Kadijah Ray, a pediatric anesthesiologist
and founder of the group, Physician Women SOAR. Let's get right into it. The difficult part of
having this conversation after the fact, is that because
of patient privacy rules, the institution cannot
really adequately say what was happening, what the results were. We can only go by the
information that was released by Dr. Moore herself. My question to you is based on her videos and her writings on Facebook, how did the topic of racism
enter the conversation and how should we be thinking about it when we're considering her own situation? - Yeah, I think after a
certain amount of time of this treatment and this denial of how serious her symptoms
were as she perceived them, and as we perceived them, being told, "Well, you're really not short of breath." I mean, anybody watching
that video, you don't have to have a medical degree to appreciate that she could barely
finish her sentences. One thing that we try to
explain to people in the work that I do is that we know
what racism looks like. Just like a woman knows
what sexism looks like. There are things and people,
the way people interact, certain things that are
said, microaggressions, macro aggressions, where,
you know what it looks like. And that's what she felt was happening. And she put that name to it. She felt that it became,
or it was racially driven. And maybe the doctor didn't even realize that was driving him. And we can talk about that
more later, but there was, you know, after a point
of being mistreated and mishandled, she
felt that it was racism. - And I've seen your response, but with the Physician Women's SOAR group to the response that the organization gave as to what they thought was
a breakdown in communication. And one of the main things you pointed out was that they did not even
address the word racism in their response. Ideally, how would you
have had that conversation say you were in the position of authority overseeing this incident? How would you have used the word racism? What would have been the
ideal approach there? - Well, I mean, I understand
that when you're in the shoes of a big organization, I'm
sure they had their PR people and their lawyers and everybody else kinda help craft that statement. But if I was in a position
where I'm making a statement and I want to have an honest conversation, you have to be transparent
and you have to not take away what a person is saying. You have to listen to
what the person is saying. We can't, as institutions,
make pledges to do better, to do better regarding social
justice, racial justice and then not listen when you're being told that you missed the mark. And I would just say exactly that. Dr. Susan Moore did not receive the care that she felt she should have received. She said that it was due to racism, and we are going to do everything we can to investigate this particular situation and to educate our team and our staff so that we can do better by
the community that we serve. We all have implicit biases. And unfortunately, sometimes
those implicit biases cause issues in the work
that we have been charged with doing. - To me, I see huge
inequalities that happen with communities of color. Access to medications
whether it's financial or physical, distance wise. When I recommend a
healthy diet to a patient, do they actually have the
ability to acquire that diet? Do they live in a food desert? Like the fact that zip codes
are oftentimes more predictive of someone's health than
their actual lab values. All of these things are partial factors that doctors who think
holistically should be thinking about their patients. How do we distinguish
systemic inequalities that a lot of times were
created because of racism in our past, how do we distinguish
between issues like that and situations like Dr. Moore's where racism seems to be
a direct sort of claim against the people delivering the care? How do we balance those two? - I think it's really, it's
hard to balance the two. But we just have to be
honest with ourselves. There's a Harvard implicit bias test that I think every everybody should take. Most people are just shocked (giggles) at really what it tells
them about themselves. And I think that once we
start having a hard look at ourselves, doing an
active work to undo some of these things, then everything
kinda, will work together. The systemic issues versus
the individual issues. But we need to start with
ourselves individually. And then the institutions
need to make real commitments not just writing a pledge
when something is popular in the media, who are you
hiring to do this work? Who's monitoring this information? And where do you start? I would almost maintain
that, once you started having these conversations with
doctors who are already working, who've been in the field
for 20 years, 25 years, who were at the hospital,
it's a little late. I mean, I guess it's never too late, but we need to start much
earlier in medical school, having these conversations, these classes, and really unpacking this information. - In a court of law,
you're judging an action. Whether or not someone stole
a car or didn't steal a car. When you're talking about racism, you're talking about partially intent. And that requires a lot of difficulty 'cause unless they outwardly say something or write something, it's
almost impossible to prove. So while that is the case, I
think people take advantage of that fact that they say, "Oh, you can't prove I was being racist." Well, if someone with lived experience who understands the microaggressions, the tropes as well as you do,
we should trust that person to be able to make that distinction. And even if it doesn't mean that it's a, a judicial ruling, it
could mean as something as trusting an individual to
make the right call, right? - Correct. Correct.
- Yeah. - There has to be some
kind of accountability. We address that in the Medium article where the hospital systems
across Indiana made a pledge to better serve the communities and to start addressing on
racial justice within medicine. People have to start holding
each other accountable, one institution to the
other and, you know, help each other out. We need to have these conversations and really get to the bottom of what drives us and
drives our decision-making and acknowledge that there's a lot of data and literature there. Open up the New England
Journal of Medicine and find so many studies
documented of pain control not being the same amongst black. Black infants having the
highest mortality in the NICU, black women not surviving breast cancer at the same rate as white women. That's not because of
their genetic makeup. It's because of later diagnosis, not having the same
treatment options offered. And by the time these things
are caught, it's too late. The same with black men
and prostate cancer. The data is there. It's not being made up. So if that's there and we know it, then we have to start asking
the question of the why, how is this happening? Why are people of color not receiving the same types of physical
exams as their counter parts? Why is that happening? And then try to do something about it instead of then when we get the result that goes into this data
and literature saying, "Well, but how do we know?" I mean, it's there, it's right there. - Yeah. - And we just have to acknowledge it in order to do something about it. - Yeah, these disparities existing, should not necessarily lead us to say, "Well, the whole system is racist." At least I don't think it
should be labeled this way. You can disagree with me or agree with me. I'm curious actually but perhaps to say
these disparities exist, we need to figure out why. And if it's because of past
racist medical research, past racist based systemic
inequalities of housing, of red lining, that inherently
makes the systemic inequality happen as a result of racism, not necessarily the fact
that the individuals involved in that current system
are racist themselves. - You have the systemic and
the institutionalized racism where you have people
who don't have a quality of living, you know, they
don't have the food available. And they're living in places
where there's chemical racism as far as the environment, there's a lot of people doing
some great work in that field. And then you have the doctor who may be from some small town, who's never seen a black person, and now they're not
doing that physical exam the way they should and they miss that this
woman has breast cancer. - I love that with this channel, that we can perhaps put some pressure on some of these institutions. How would you go about encouraging them, as a nice word, of making a
change for both black patients, black communities, minority communities but also their physicians
and other healthcare workers? - We have to put value on lives. We can't say that this one
life that's in this suburb is more valuable than the life that's here in this inner city. And without resources,
then you're not gonna have good doctors who are
gonna wanna go work there. Because like you said,
they're gonna get burned out. They're not gonna last,
they're gonna leave. But until these institutions
make a real commitment and say, "These communities are just
as valuable as the next. And we have to find
ways to put the money in so that we have the
resources so that our doctors and our staff are supported so they can do the jobs
that they need to do," it's a really tough hill to climb. And then once you get past that, then what are we going to do internally to assure that we have the skills? And I don't mean just the medical skills, but all the skills that we
need to be able to communicate, educate, interact, and serve the community in which we're choosing to be in in whatever institution that is. - You've mentioned also
some great practical points for providers, as far as
knowing your obligation, being introspective, going
past the science and thinking about lived experiences
and communication factors. Anything, if anything, do
you think that you would say to patients, perhaps minority
patients who feel like, that they would like to do
something to improve the quality of their care? Is there anything you
counsel your patients on? - Well, you know, it's interesting because this question it's come up a lot. I am, I did a radio show
for a show in Minnesota where people were asking
like, "Wait a minute, if this doctor couldn't
advocate for herself, then how are we supposed to when we don't speak the language, we don't have the
knowledge or the resources? But what I can, what I
try to tell people is to do your best to advocate for yourself. If a doctor is speaking to you and you don't understand
what they're saying, you know, what tests they're ordering, why they're telling you, you
need to take a medication, ask them to explain it
again until you understand. If you feel like you are being mistreated, then if it's an option
to seek another opinion or to switch doctors, then do so. If you feel like you're
not getting the care and the treatment that you deserve, then know that you can
get a patient advocate within the hospital to
come and be by your side, to try to help you navigate the system. And then I would tell people, if you feel like you're not getting what you need, then maybe try to find a doctor that you can better relate to. If you are a man and you
feel more comfortable with a male physician,
then maybe seek that out so that you're able to better communicate and openly discuss your medical concerns so that you can get the
care that you deserve. - And this isn't an
obligation for patients. It's our obligation to make sure that the patient understands. When you're listening
to a patient's reaction to your instructions, is
the same when a doctor is performing a speculum exam
should be making eye contact with the patient as well to
make sure they're comfortable. So it's the doctor's obligation and the institution's obligation to make sure the patient's
getting good care. The reason we're giving these extra bits or you're giving these tidbits to patients is to go the extra mile. And it's not their
responsibility to do this. We have to constantly
remind providers that because they say, "Well, then why didn't the
patient advocate for themselves?" Well, while they can,
and that oftentimes fails as seen in Dr. Moore's case. It's just something that I
would tell my family member almost to expect the medical
system at times to fail. And if they're able to advocate
and educate themselves, they will statistically
have better outcomes. And perhaps that will not
solve all our problems but it can at least give
some practical advice for those who are
interested in seeking it. How do we go about talking
of, about racism historically and present, without further deteriorating the doctor patient
relationship that exists between the black community,
as an example, and doctors? - We can't put that acknowledgement potentially causing a
problem back on the community that has been wronged. So the-
- For sure. - The talking about it
and the conversations, the acknowledgement is not the issue or the problem of the
black community, okay? So we have to, 'cause we know. There's a wonderful book
called "Medical Apartheid" that talks about how these, while the medical establishment
has not documented a lot of the abuses, these situations, these experiences have been passed down amongst our communities even
verbally for hundreds of years. So it's well known. So what do we do, for example, when we are now faced
with the COVID vaccine and how do we get communities
to then say, "Okay, well, I'm gonna go get this vaccine," when there's this long
historical relationship where we haven't been treated that well, we've been tricked many times. It comes into education, having
people who look like them, who they trust, providing that information and being available to answer questions which is a whole other conversation about how we are
underrepresented in medicine and in medical school and why? That's a whole other conversation. But there are plenty of
studies that have been done that show that black patients do better with doctors who look like them. Instead of saying that those communities don't trust
the medical establishment, we have to change our
speech, which then starts to change the way we think. The medical establishment has
not done what they need to do to earn the trust of those communities. - So, if I'm hearing you
right, just to reiterate, in order for us to do better in the medical space
to treat our patients, because ultimately as a whole,
we wanna help everybody. That's the goal, the oath
that we take as physicians, as nurses, we need to do better in reaching out to communities, creating more diversity
within our own groups so that they can communicate
better and take this long road to improving our ability to communicate with the black community for example. - Yes, that's correct. For example, you know, you
have primary care doctors who say, "Oh my goodness,
it's just so frustrating. Mrs. so-and-so just won't take
the blood pressure medicine," or, "won't take their diabetic
medications," or, you know, "they're just not
compliant, just don't..." You have to have a conversation,
a real human conversation, and this can apply to any patient really. The why, why is that? Is it access? Is it financial? Is it some kind of belief system where they're afraid
to take the medication? If you really have an honest
conversation with yourself as a physician, did you
stop and really explain and assured that they
understood the importance of whatever it is, whatever
treatment, tests, whatever it is that you're trying to communicate? Did you communicate in a
way that they understand? Did you read the body language to see was there some kind of
trepidation on the part of the patient and really
get to the bottom of why? - A good friend and colleague
of mine, Dr. Judy Washington actually works with the STFM organization to increase diversity in medicine, to have this conversation. They actually have an
underrepresented minority fund to help with scholarships. Is this the sole solution or do we need to think past
scholarships, past admissions? Is there something we're missing here that we haven't yet tried? - Oh boy, Dr. Mike, that's
a whole other segment. (Dr. Kadijah laughing) Yeah, I mean, it does go
past the scholarships. By that time, it's almost too late. We have to start by figuring out what's going on in the
public school system? What's going on in the inner cities? What's happening with the STEM programs in those schools and those children, when they're in elementary school? They don't have the resources. And I think COVID has exposed
a lot of those disparities. People don't even have computers or access to wifi and the internet. So how could they possibly, you know, get involved in and do
what they need to do for some of these classes and programs? You know, there are issues
at the primary school level, the inner city schools and we
are missing potential doctors because they're just not being fostered. They're going to high schools that don't have a strong AP program. If you don't have AP
classes or honors classes then how are you gonna get
into a competitive college? So it goes back to that
institutionalized racism that nobody likes to discuss,
but it's certainly there where there are children
all over this country who don't have the same
opportunities and while their minds and their capabilities
are just like others, there's nothing there to foster it. They don't have the programming. And so they don't have those
opportunities to even go to a college that would
be competitive enough to prepare them. I grew up in the inner
city, South side of Chicago. And there is a program that's been around for a very long time since the seventies called the CAHMCP, Chicago Area Health and
Medical Careers Program. And it was a housed over at the IIT. There was a college, IIT on
the South side of Chicago and that was what their
program was all about. Taking young children who
had some kind of propensity or interest in science and
math and following them all the way through
high school, all the way to medical school and
without a program like that, coming from the inner city, I don't think I would be
sitting here with you today. - That's such a sad point to hear, but an important point to hear that young folks are trapped
in this vicious cycle that either they're not exposed
to good education early on or even if they have interests early on, their communities are not set up to foster that sort of enthusiasm or they get pulled into
crime ridden communities. And as a result, they lose
focus on their education or it's not a knock at all
on STFM and the scholarships and the amazing work that they're doing. It's just showing that, while that is part of what we need to do, there's this whole other
under-addressed section of the beginning, of how we get students to
get these scholarships. And the reality of the fact, when we look at a lot of
the assistance programs that we have, even in my
hospital where I work, a lot of them go unclaimed. And it's partially because
our lack of communication, it's because failed communication. And because we're not
addressing that initial stage that you talked about,
of starting people up to know that these programs
exist, to get them excited about becoming a pediatric
anesthesiologists like yourself. And that initial start is
such an important place to talk about and focus on that I really hope as we move forward in the era of investing into
healthcare, into children, we really think about
that educational aspect. And I hope that's where
a lot of change happens. I'm one of those perhaps naive believers that if with education, you
could change almost everything. If you have an educated patient, in that, it won't solve every problem, it'll improve their outcomes. If you have education to young folks they'll be excited to be providers and then be providers for the people who perhaps look more like
them and have better outcomes. So I really would like to see
more incentivization early on as opposed to going to high
school solely and saying, "Well, if you go, we can
give you this scholarship," that early on aspect is something I'm really passionate about as well. - Yeah, I think, I
mean, I think it's great those scholarships and the scholarships like the one that your friend is doing is important and again,
all things like that is what allowed me to
get through the system and many of my friends. So it's all very important. We just have to continue to look at every level because we're missing out on a lot of people who could do very well but they're just not given the opportunity and they don't have that access. - I know we covered a lot. I'd love to leave you with the last word. What do you think should
be the ultimate message to the million plus people hopefully that will watch this video? - I think that I would just
like to impart on people that the discussion about race is a very difficult discussion but it's one that's necessary. People are dying and people
are dying needlessly so because of, just because
of the color of their skin and that's unacceptable. We have to reach out to our neighbors and try to understand each
other, have conversations, get to know each other and don't deny other people's experiences. My condolences go out to
Dr. Susan Moore's family. We lost a big part of
our medical community. And I think that we should
all walk away from that. Just remembering that when somebody, when a black person or a person of color or whatever the situation
is, when somebody speaks and they're saying
something, we have to listen. She knows what, she knew what racism was. She called it, and it may have
possibly cost her her life. I say that Dr. Moore passed
away due to two things, two pandemics, the
pandemic, the COVID pandemic and the racism pandemic. We have to have these conversations so that we can take that off of the table. People need to be treated fairly. We know what our experiences are and just because you
have not experienced it, you have to approach these conversations with an open heart and ear and have some empathy so that
we can get some real change. - Thank you so much, Dr. Ray. I'm linking all of your
information down below where people can find you,
your Physician SOAR group and to continue their education
much like I need to do in reading "Medical
Apartheid", other resources to continue learning,
'cause we're all imperfect. We all have implicit biases. And I thank everybody for watching and Dr. Ray for her wise words and advice. (upbeat music)
My son has autism plus a rare disorder, and early on, without an advocate, he would have died. Being a medical advocate for someone is of upmost importance. If someone you know that is from a marginalized group (or from any other group!) gets ill, please be there for them as an advocate. Be the person that asks questions, see's what medications they are being put on, googles the types of med/treatments and checks to see if they are getting the upmost care 100% of the time.
I work in the medical field and it's fucking crazy how much it resembles McDonalds, just less efficient and consistent. The care given can be so inconsistent that you (as a patient) feel like you have a mental illness based on the quality of care you receive dependent on the doctors/nurses/hospitals you have working on you. When I lived in Scotland, the quality of care was way more consistent, so you could have a plan that would work, based of previous experience. But in the US, it's so inconsistent, one patient a room over could receive the opposite care than yourself...for the same condition.
My girlfriend is black, and I'm constantly afraid that if she ends up in the hospital she won't be taken seriously and the worst will happen as a result.
I appreciate Dr. Susan Moore for being direct with her answers. I feel Dr. Mike sometimes tries to downplay the racism aspect when he has talked about this in the past and he's kinda doing it a little in this video.
edit: fixed some typos
I’m not black but I am another poc. One day, my mother was in so much pain we rushed her to the ER. She told the doctors that she didn’t know if she could handle the pain for much longer.
They were quite dismissive and rude. They sent her home with pain relief meds.
The next day, she went back bc the pain didn’t get any better. And guess what? She needed to get a hysterectomy. Would they have been so rude if we were white and spoke “good English”? I don’t think so....
This happened to another woc I know, except instead of a hysterectomy, her appendix burst. And another one of my friends (black woman) had severe pain, but the doctors kept dismissing her. Turns out, she had Stage IV cancer....
Dr. Mike can go to hell, he preaches about social distancing and wearing masks and then gets on a plane to Florida to party. Disgusting and hypocritical.
Interesting change of tune. Dr Mike has gone out of his way before to put distance between insufficient care of women and patients of color and medical biases held by Doctors.
So lots of good content brought up here about all the problems proceeding a patient walking in the door. Very well known associations with postal codes, incomes, race with health care access. Also well known improvements in health outcomes when POC receive medicine from POC, and also known barriers to creating more POC MDs.
What I wish was discussed more is the problems at the intersection of race and health care once a patient has come in the door. Coming at things from a (Canadian) physician perspective, I would say that the honest truth is that doctors often do not take patient's subjective experiences anywhere near as seriously as blood work, ECGs, and CT scans.
Medicine is understaffed and underfunded. Most hospitals have huge patient censuses and hospitals are often operating above 100% capacity. There is massive pressure to avoid admitting patients to hospital that conceivable can be seen as outpatients, and to discharge them as soon as possible (at my hospital administrators will often pester staff over getting patients out before 11am vs. after lunch). Medicine isn't like the 1950s where patients come in with one or two medical issues, stay until they're fully resolved and back to their usual, and then walk off home. A large number of patients (especially those over 70 years) do not "feel ready" to go home at the time that the medical team thinks they are "medically safe" to discharge. Often they are not back to their baseline mobility status, they may still require some supplemental oxygen, they may still have fluid to diurese, etc. But many of those problems have long tails of resolution and can be followed in the community, and discharging sooner will help patients avoid acquiring nosocomial infections, delirium, and other problems that occur in hospital.
Pain can be another one of those problems - lots of patients have lots of pain. But on the medical team, you're constantly trying to balance pain control (usually by maxing out things like tylenol and voltaren) and the complications of opioids including constipation, delirium, and long-term dependence (if the underlying cause is going to be chronic).
This is all sort of a long way of saying that your average patient's subjective experience is often not a huge priority at the best of time. I'm interested in where and how racism layers into that equation vs. the medical system being fucked up to begin with. Is it in subjective decisions on who gets a CT scan for abdo pain vs. who you're going to given tylenol to and watch for another day? Is it in decisions in who's mobilizing just well enough to go home and who still needs another day? Is it in who's pain is tolerable and who needs an additional medication ordered?
One point mentioned very briefly in this video that merits its own entire video is on medication compliance. Depending on the patient population, we often assume patients are taking half their meds half the time. The diabetic population is notorious for not recording sugars often enough, not taking all their meds as prescribed, under dosing their insulin, etc. Most doctors (at least within hospitals) don't spend a ton of time lecturing people to take their medications - it's often more of a gallows humour of either they will take their meds or they'll be back. I wonder how much racism factors into the rare times doctors really spend the time eliciting "why and how" an individual patient isn't getting or taking their medications?
TL;DR: The entire medical system has perverse incentives that make it kind of messed up to begin with. I'm sure racism makes all of that worse - I just wonder how much worse compared to baseline.
I wish we talked more about the barriers even to become a doctor: 8+ years of schooling and a mountain of debt for a career that, except for a handful of specialists, pays a lot less than what people think. This system creates social and economic road blocks for many to getting the experience and credentials to be an MD or DO.
There's so much research into how medical and helping professionals having better results with patients who share the same "lay person" (non clinical) understanding of a clinical situation as them. This layperson understanding is so structured around lived experiences, in/out group biases, heuristical knowledge, that even well meaning and open professionals report feeling a lack of confidence in creating that mental space to share with a client from a different background as themself.
The quickest solution to overcone this problem would be for more diversity in providers but class and caste barriers in the US make it hard or impossible for many to make the sacrifices needed to be competently trained
Still not over Dr Mike throwing a party in the middle of pandemic but I appreciate him tackling this topic