Dr. Uché Blackstock is an emergency medicine physician who is passionate about addressing the detrimental effects of structural racism on health outcomes. We discuss the origins of structural racism and how this continues to influence the health outcomes of minorities. She then gives us some tools for reflecting on our own biases and how we can work to address them. In addition to patient care, we talk about improving the diversity of faculty, and the importance of mentorship and sponsorship. We end by discussing something each of us can start doing tomorrow in order to address our own biases.
Dr. Blackstock went to Harvard for both undergrad and medical school, did her emergency medicine residency at SUNY Downstate/ King’s County Hospital Center and then a fellowship in ultrasound at St. Luke’s Roosevelt. She is now associate professor at NYU as well as the faculty director of recruitment, retention and inclusion at the office of diversity affairs at the medical school. She recently started her company Advancing Health Equity, which aims to partner with healthcare organizations to address some of the critical factors that contribute to health inequity, through educational trainings and racial equity culture analytics. She can be found at advancinghealthequity.com and on Twitter @dr_uche_bee.
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TJ Blackstock is an emergency medicine physician who’s passionate about addressing the detrimental effects of structural racism on health outcomes. We discussed the origins of structural racism, and how this continues to influence the health outcomes of minorities. She then gives us some tools for reflecting on our own biases, and how we can work to address them. In addition to patient care, we talked about improving the diversity of faculty and the importance of mentorship and sponsorship. We end by discussing something each of us can start doing tomorrow. In order to address our own biases. Dr. Blackstock went to Harvard for both undergrad and medical school did her emergency medicine residency training at SUNY Downstate Kings County, and then a fellowship and ultrasound at St. Luke’s Roosevelt. She’s now associate professor at NYU as well as the Faculty Director of recruitment, retention and inclusion in the Office of Diversity affairs at the medical school. She recently started her own company advancing health equity, which aims to partner with healthcare organizations to address some of the critical factors that contribute to health and equity through it Educational trainings in racial equity cultural analytics, she can be found at health advancing health equity calm and on Twitter at Dr. JB.
Welcome to the physicians guide to doctoring A Practical Guide for practicing physicians. Dr. Bradley Block interviews experts in and out of medicine to find out everything we should have been learning while we were memorizing kreb cycle. The ideas expressed on this podcast are those of the interviewer and interviewee and do not represent those of their respective employers.
Now, here’s Dr. Bradley Block.
Dr. ej Blackstock, thanks so much for being on the podcast today,
So you are the director of recruitment, retention and inclusion in the Office of Diversity affairs and the founder of advancing health equity. So how did this becomes such a passion of yours.
Oh, good question. So I mean, the issues that I deal with in my role as Faculty Director and officer diversity affairs issues have always been, you know, very important to me as a as a, you know, as a position of color. And I had the opportunity about two years ago to take on this role. And so some of the things that I have developed while I’ve been in the role is focusing on unconscious bias trainings as a way to help educate other physicians about unconscious biases that they have that may be influencing how they communicate and make decisions about patient care. And then I started doing this work and I really enjoyed it and I got a great reception and I started giving grand rounds at other academic institutions and then other health care organizations came calling and I decided to start my own company advancing health equity, because I felt like it was my way to help to contribute to this problem of healthcare disparities. By focusing on educating the healthcare work for, for us, right unconscious bias and structural racism.
So So let’s take a step back and talk about the the origins of the unconscious bias and structural racism, racism, right? In theory, we should all be treated equally, but we aren’t. So why is that? Like, how did this How did this all start? If you want to talk about America specifically?
Yeah, yeah, no, this is such a great question. I mean, you know, when we look at, like the health care disparities today, you know, we talk about we’re in the middle midst of a black maternal mortality crisis now, where black women have three to four times more complications around pregnancy as white women and we wonder why we’re in this situation, and a lot of it, you know, has to deal with actually legacy certain practices and policies that sort of encompass structural racism. So we talk about no slavery and Jim Crow and black codes that have really led to chronic generational poverty. That, you know, influences inequality, lack of access to care. And then even when the Civil Rights Act was passed in the 1960s, and black people were allowed to being taken care of in hospitals, there were still issues with receiving quality care. And then there are also issues of internalization of racism, like we know that there’s data that shows that there’s a weathering effect on people that actually can be passed down across generations. And so, these are some factors to why we arrived where we’ve arrived right now.
So Dr. Blackstock, can we take it back even a little further, like, let’s talk about even the foundations of racism because I think in order to understand the unconscious biases, it’s going to be important to understand the origin of all of this. So where did this all come from?
right and so you know, the foundation in order for, for slavery to to persist in order for there to be society. Where one group of human beings or another group of human beings, there had to be a narrative that those people that were more felt they were more superior held true. That was that black people were inferior. And so there were different ways that this was communicated, right. Like there was. There’s phonology where, and that phonology is something that originated in Germany, it’s now been debunked as pseudoscience. But it’s this idea that the bumps on the surfaces of a person’s skull correlate to certain personality characteristics. And so the bumps that slip that enslaved Africans had, were supposed to be correlated with the fact that they were tailorable or able to be tamed. So, so obviously, like there’s this idea that, you know, throughout slavery in order to justify slavery, this idea that black people are inferior, and that has obviously been perpetuated across generations across centuries. And it’s still really embedded in In our medical culture and within health care overall,
right, because everybody’s the hero of their own story. So in order for these slave owners to be able to sleep at night thinking that they were an upstanding and decent human being yet perpetrating these these horrible things, they need to be able to rationalize their actions and you rationalize these actions through the racism by thinking that, that these other people are inferior to you in these certain ways. And so, therefore, what you’re doing is, is justified, right Al Capone is the example that I that I use for this is he’s the hero of his own story. He was bringing entertainment to the masses. So that’s how he slept at night, even though he’s responsible for murdering countless people, right? you commit these horrific acts, but you’re still able to sleep at night because you find a way to rationalize it. And then that crept its way into the culture and has stuck around Yeah, trees later.
Yeah. And even also in the 1800s che Marion Sims, which many people know up as the the grandfather, the father of ob gyn obstetrics and gynecology because he’s the one who discovered the battle speculum. He’s the one who developed surgeries to fix vesicle vaginal fistulas. He actually performed all of these surgeries of these experimentations on women who were enslaved. And there was one slave who actually performed, I think, almost 20 to 30 surgeries on and at the time, I believe local anesthesia had not been created yet so are developed yet. And so these surgeries were obviously very, very painful. But in order to for him to do these surgeries on these women, there had to be this acknowledgment that they were not he did not consider them to be full human beings, right? Because otherwise how would you be able to justify doing that, although the discoveries ended up being leaving to really ground the ground, our ground for And, um, contributed greatly to medicine. They were performed on women who could not give consent to the procedure. Wow.
Wow. And I’m sure for a long time this individuals picture was up in a hall in a medical school. And
yeah, actually, there’s a statue of him in Central Park across the street from the New York Academy of Medicine. And it was taken down last year after multiple protests by people who just said, No, this is not right. And actually, it’s been moved to Greenwood Cemetery in Brooklyn, where not many people can see it.
Yeah. Yeah. Well, and to think you know, how far we’ve come and that was just a year ago.
Okay, so that’s, that’s the origins of it. And so how do we start addressing it so if I want to improve my ability to treat myself Patience, and yet want to be able to recognize not yet but not and yet, but I want to be able to recognize my own biases in order to improve my ability to do so. Hey, where do I start?
Right, I want to back up just a little bit and saying that I do think that our medical education system and our training system could do a better job in terms of preparing us. So I mean, I think probably like you, I really didn’t learn about any of this in medical school. I didn’t learn about the origins of racism or origins of racism in healthcare. And so I came to being a clinician almost very unprepared because I didn’t know about this history. So here we are, and what do we do now? You know, I think that people talk a lot about unconscious bias trainings, and even I provide unconscious bias trainings. I think that’s only part of it. So you can have the unconscious bias trainings where you take I have participants take the Implicit Association test, which is on the Harvard implicit website. And you can take a lot of different tests, often I have them take the race Implicit Association test. And that uncovers a lot of unconscious biases that people don’t know that they have. And often people are really shocked by their results.
Yes, I’m sure. I’m sure most of not all of us would be. So we’ll definitely include a link to that in the show notes. So, so we’ve taken the test, we recognize that we have these biases. So how do we say now that we’ve not not recognized that great, I’m a terrible person? How do I improve that?
Right? So not a terrible person. I like to see that we’re all like good ish people. We’re all works in progress. And so a lot of times when I run my sessions, I tell them, make sure you have a growth mindset, meaning that realize that with effort, time and feedback that you can get better at anything and so I say the same thing about unconscious bias. That you can actually help to mitigate your bias by using certain strategies. And really the major strategy that is often recommended is self reflection. And so you got you have your results and sort of thinking about when you say when you go to see a patient, like, Is there something about this patient that is reminding me of a person I know, like, Is it good or bad? So that’s kind of like a priming questions that you ask yourself, just to make sure that you’re not making assumptions about the patient. And so those are different strategies you can use there actually are more advanced strategies called like, one is called stereotype replacement, like replacing sort of the reaction that you have about a patient. So the assumption that you’re making like labeling it and saying, okay, that’s not right. Let’s replace this with a positive feeling. And let’s move forward. There’s another one called counter stereotype imaging, where you can replace the image of the person with a positive Have a positive image or like a positive stereotype, like people say, oh, like brock obama, you know, he’s like a positive image of a black man, right. But these are strategies that you have to use every day. Like they don’t just use them when you’re seeing your patients use them in all aspects of your life.
So I just want to take a step back to the whole, I’m a terrible person thing, because I think a lot of us are going to be reluctant to even want to take the test because I show things about ourselves that we would rather let what we would rather leave covered. And I think it’s important for people to recognize that the fact that you are taking the test means that you are not so even if you have the biases, the fact that you’re looking to improve on them. The fact that you have the means that you’re human actually we covered cognitive biases in in a podcast a few episodes ago with an evolutionary biologist named Nathan lense, who, who wrote a book on how imperfect human the human body really is. And you know, the biases are there. functionally, to help us simplify the world so we can actually process it. So this is just a function of being, being being human. what actually makes you a good person is the fact that you acknowledge that and you’re, you’re willing to work on it. So,
yeah, exactly. That’s what I tell people. I said, you know, we all have biases, right? Like, like, My children are biased towards me, if you put me and you next to each other and asked my kids, like, Who are you gonna run to? They’re gonna run to me, right? Because they are biased. And they I’m their mom, you know, I mean, so they’re, and that’s protected to them. That’s like, that’s for survival reasons. That’s like, that’s evolutionary. And I think also, it’s important for people just to realize that we do grew up we, you know, we do grew up in a society where there’s a lot of discrimination, and that sometimes it’s, it’s impossible not to sort of sort of read that in, you know, even if you don’t explicitly want to. And so I think just acknowledging that and saying, Okay, I see that I appreciate that. Now, I’m going to try to do better. It’s really important.
So can we can we go back to that example that used of of putting a positive image in our head? Like, like brock obama? Mm hmm. So can you give me a scenario in which I would use that?
Oh, for example, like, an example would be to say that you were on your way to a meeting, and you saw a black man in front of you. He had like a long trench coat on he was like carrying a lot of bags. But and and just for whatever reason, your immediate impression of him was you just kind of got a little bit tense. And then like five minutes later, he actually ends up going to the same meeting as you like, he’s actually in the meeting with you. And you had sort of made this assumption that this guy was actually a threat to you. And so what you would do is, we would rewind and so instead of that initial feeling of apprehension, you would say you would acknowledge that apprehensive feeling, label it and Say, you know, that’s me being bias, replace it with a positive feeling. Or think about Oh, I know, other black men that have positive images like brock obama or like Martin Luther King, you know what I mean? Like some think about that. And so that should engender more positive feelings. But again, it’s something that you have to do all the time.
So how do I if I if I’m with, say, a trainee medical student resident, how do I talk about something like that? Because I think especially as a white male physician, if I if Hi, if I walk into a room with a black male patient, and I say to my trainee, okay, when you’re addressing this individual if he makes you tense, think about brock obama. That sounds
Yeah, that sounds horrible. No, no, it’s not. So I mean, these are, these are strategies I would talk about in a training but the self reflection piece is the piece that I think is Not necessarily offensive. So it’s sort of a general conversation that you have with your trainees, it may not necessarily be specific to the patient, but just say that I want you to before you go see a patient, be really open minded. Try not to make assumptions about a patient. I know that in medicine, a lot of times that we’d like to categorize patients, right, we have a 50 year old person with cardiac risk factors coming in with chest pain, we think heart attack, right. So we, you know, we’re just used to this pattern recognition. By being sometimes it’s important, we take a step back, realize practice what we call a constructive uncertainty that we don’t have all the information at hand. Don’t make assumptions about your patient and try to go in with an open mind. So I think I think you can speak generally like that, and that will be fine. Got it
and it and it doesn’t necessarily just pertain to race, right? You’ve got anything, a white patient with torn clothes, missing teeth, lots of tattoos, right? You’re gonna you know, you’re gonna walk to the room and make a bunch of assumptions. If you have a train With you make sure that the first thing you do first is that you acknowledge, listen, you’re going to walk in the room, you’re going to see what the space looks like, you’re going to have some things that go through your head that some assumptions that you’re going to make, really to take a step back, reflect on those know that you don’t know the whole story. In fact, you don’t know any of the story. Right? And you need to you need to build from from there.
Exactly. Okay. Okay. And a lot of times, you know, I see my trainings, a lot of times why sometimes I will, I will emphasize race is because just because of the healthcare disparities that we have in the country are mostly the health outcomes are along racial lines, like the most profound disparities that we have in the country are not along gender or sex, sexual orientation, but they are along racial lines. And so that’s why I do tend to emphasize that more in my trainings, but yes, you can be biased about a lot of different aspects of a person down to their accent, right, or how they’re dressed right or whether their clothing looks clean or not. Yeah,
So that’s for the physician seeing patients, but but you also do this for recruitment. Right? That’s how you’re the director of recruitment, retention inclusion in the diversity affairs. Wait. So let’s take us through the three steps. How do you recruit, retain and include?
Well, so so you know, in even thinking about unconscious bias, and all of those different areas. So even like in in terms of recruitment, sort of thinking about like, what kind of language we use for ads that we put in, you know, magazines, or journals, or websites, make sure that we’re not being exclusive of certain types of people. And so of course, we all have blind spots. So we want to make sure that we’re as inclusive as possible in the language that we use. And even in interviewing processes, you want to make sure that you use structured evaluation tools. So you always want to ask everyone the same question because we know that the same questions because we know that off the cuff interviews, like where you’re like, hey, Oh, I’m sorry. New York Oh, you’re familiar. Oh, cool. And you just sort of start talking about being from New York and you end up feeling like you’re developing rapport between this person, and you think this person is great, you get like Halo bias, like this person will be great for the job, when 30 minutes later, you really don’t know much about their skills, you all you know, is that you get along really well. And so we know that that actually, that’s a situation where unconscious bias could actually really flourish. And those off the cuff interviews, so you always want to use structured evaluation tools or structured processes in the recruitment process.
So aside from trying to standardize the recruitment process, that how does that help you to recruit more, once you got to the interview, but what about even pre interview? How do you go by recruiting a more diverse medical staff?
No, no? Yeah. No, great, great, great question. And that’s the challenge because you know, only 4% of physicians are black. I think another 5% are Latino No. So the numbers are already quite quite, quite small. And so we really have to be intentional about our efforts, we will go to certain professional organizations, so like the National Medical Association, which is the largest organization of black doctors, so we’ll try to focus our efforts, they’re the same for predominantly Latino organizations as well. And so we’re go to different affinity groups, or actually talk to faculty of color that we have and find out what they have any people that they can recommend for positions, but I will say that the recruitment part is really a challenging piece because the numbers are ready are very small. And New York is a high cost of living, you know, as you know, city to live in and so you have to really incentivize the offer to people.
Okay, so now you recruit you found them, you interviewed them, you’ve hired them. The next step is retain Yes, recruiter to include, so How do you retain? How do you retain?
Yes, stuff? So yes, so I think the retaining and the inclusion piece are become hand in hand because you need an inclusive environment in order to retain people. So you need an environment where the faculty aren’t just surviving, but they’re thriving. So where they’re feeling like their voices are heard and appreciated, you know, their unique issues, that issues that are unique to them that they feel like they’re being addressed. But I think importantly, and we see this even among women faculty that you know, mentoring efforts are very important because we know that with mentoring, if people have mentoring, that’s a huge key to success and promotion. And so having focused mentoring programs or, you know, assigning junior faculty, a mentor in the senior faculty that often helps. Sponsorship is important. So making sure that institutional leadership is aware of opportunities for faculty of color They may be interested in if there’s a position that opens, make sure that you are considering, you know, a diverse group of possibilities for that position. And so mentorship and sponsorship, we know are key to retaining and promoting not just faculty of color, but all faculty, we know that faculty of color definitely do have special needs that need to be addressed as well.
So does the mentor and Does the sponsor need to look like that?
That’s such a great question. Because sometimes the numbers are so small, but that necessarily cannot happen. But I also often tell people that, you know, your mentor does not have to look like you, but they, but they do care about you as a person. And they do care about the issues that affect you. And so there’s some literature about mentoring across differences. And so there, there are resources that are out there, if there is a mentor of a different race than them a junior faculty member and just sort of kind of being attuned to the specific issues that may come out of that mentoring relationship. So, for example, for me, perhaps my mentors with nothing, nothing like me, but they’ve been incredibly supportive along the way since I’ve been at NYU, and I, and I credit them with a lot of my success.
I would think that if you were to assign a mentor to a minority, trainee or faculty member, that would lead to siloing. Right? Like, if you’re like, well, you look like this person, so you should be their mentor. Oh, and, you know, then they end up like doing your fellowship, because you’re their mentor, and now, like, you’ve got one department that’s filled with one race, and then another department like,
That hasn’t happened. They’re not they’re not in the faculty of color. So that, you know, that hasn’t happened. And then also, I mean, these are people like on both sides, that the mentors are people that are interested in helping, they’re all all different departments. And I mean, because what you’ve seen is that actually what does happen? often is that minority faculty often don’t have mentorship. So that’s what a lot of the literature has shown. And so targeted mentoring efforts have been shown to be really, really helpful to promotion and success.
So are you saying if there is someone that can mentor this individual that does look like them, you should try to match them? Yes. And if not, you’re not available then then someone else plays is fine. Yeah. Or do you think you know, diversifying their mentors would be more advantageous?
No. I mean, I think that if there are enough people to mentor one person, that’s great. But often that’s not the case. Okay. Yeah, unfortunately.
Okay. So you should try and someone that that’s able to understand their experience more is going to be able to be more effective men. Yeah. Okay. So, okay. Is there any advice that you give to your minority trainees that you think that it’s either not necessary that may not be necessary to give to Non minority training. Yeah,
I mean, yeah, I mean, I think, you know, I talked to a lot of our medical students and our residents, I think, I think often they feel very isolated because their numbers are small. And sometimes they feel like the certain experiences that they have, like maybe dealing with microaggressions you know, I had actually a student who came to me like very, very upset after she was on rounds with her team. And a patient like, singled her out and basically was asking her if she had enough education, or should she if she had a good education to be at that medical school, like, you know, were grades good enough, you know, and, and no one said anything No, and her team her attending didn’t say anything. Her clear coat her co students didn’t say anything. And so she came to me and I just, you know, I felt horrible, but I, I told her, you know, these things like this are going to happen if you try to speak up when when you can, but I also want them to know that in the Office of Diversity affairs, I think we are a resource for them. And that’s my way they’re like, where they’re at To help support them, especially when these sort of situations happen, and we were actually able to talk to the attending and the situation. And he didn’t realize like, it totally went over his head, he didn’t even realize that this interaction was so painful and traumatic to the student. And so I basically tell the students that, you know, we’re here to support you, you’re going to have these experiences, and some of them are going to be very, very unpleasant and we affirm, you know, we affirm those concerns, but we’re also there to support them.
Right? Because Because imposter syndrome, right, that’s much more prevalent in women that’s much more present prevalent in minorities and that’s because of everything we’ve been talking about today. And so then you have some someone calling them out and physically vocalizing their imposter syndrome. And if someone’s there, that doesn’t have imposter syndrome, right? Because it’s much less common in white males right? Then they’re not going to understand that that’s even a problem like of course your your your grades were good. You deserve to be here. While up, they don’t know what’s going on in that individuals head. I guess that kind of makes your point about trying to pair minority faculty with married trainees for mentorship and sponsorship because they, they get it more I know.
Yeah, exactly. Okay.
So, one thing I like to cover is is brass tacks, advice for physicians, right? Okay, something that we can anything given doctor can start doing tomorrow, like, put on a sticky note and leave next to my computer so that every time I go to my computer, I look at it, I remember to do it, and hopefully it becomes habit. So what should I write on that sticky note so I can start doing better with regards to my, my biases?
Oh, it’s here biases. Okay.
Anything else that we’ve talked today about whether it’s trying to recruit, retain, retain and include, you know,
any anything over today? Yeah. So so there’s this idea that I would write to two notes, two words of a sticky note, structural competency and when That is, is the kind of this idea, but it’s actually been in development for over the last 10 years with this idea of structures and systems sort of influencing the health of communities, right, and the health of patients. And so, there’s this idea that, you know, we always talk about cultural competency, like, as if a physician could actually become competent in someone else’s culture. But more importantly, it’s understanding how systems like you know, like structural racism can impact a patient’s health. And so when you’re seeing a patient, you want to think in the larger conscious, the larger context of society right, in terms of how they ended up in front of you with the issues that they’re having. So I would ask opposition’s really to think broadly, about how um, practices and policies have influenced your patient’s health status.
That sounds complete anathema to that recent article that came out in the Wall Street Journal, about how we need to hire What does it call me by my pronoun or something like that? Which is just the lead in? Yeah, it was. It was just it was very disappointing. And effectively, what it comes down to I think what that what it was Stanley gold for progressive. Yeah, Pennsylvania. Yeah, what was trying to say was that these these issues should not be at the detriment to learning the sciences. But I think one thing that I try to make my podcast all about is everything we should have been learning while we were trying to learn the Krebs cycle.
Exactly. We need
to learn the Krebs cycle because I know the fact that I now no longer remember where Fumarate and maleate are in the Krebs cycle aren’t going to help me to treat my patients. Yeah, but acknowledging that there are structural systemic issues that that occur outside my office that led this patient to be now in front of me. Yeah, are gonna help me to become a better doctor. Exactly, exactly. I didn’t Put that in the questions. I apologize because that that article isn’t out yet. But I’m wondering what what were your without making your head explode? Right, because I’m sure I’m sure you wanted. I wanted to break something after reading that, but what what were your thoughts on that article? Yeah.
I mean, my, my immediate thought was that okay, well, that perspective is how we’ve gotten ourselves into a situation where we are, like the of all industrialized countries, we have the highest rates of health disparities and health inequities. It’s because of that idea that we’re always what’s the focus on the clinical aspect and not thinking about the broader structures and systems and so I think we can do better. I disagree wholeheartedly with the premise of that article. And I think a lot of a lot of physicians who want to do good work, I think they disagree as well.
I would agree. I would agree. I think I think all my listeners if you’re listening to this right now, and you’re trying to improve Prove your ability to interact with your patients. Clearly you think that that is, yeah, that is more important than memorizing some of the basic science that
Yeah, never end up applying. Because Because when we look at like, which interventions make the biggest impact and health outcomes, actually what we do as physicians, like the clinical interventions we make, we make the smallest impact, what makes the biggest impact on health outcomes are so sick anomic factors like poverty, education, housing and inequality. And so that’s why we as physicians need to be aware of those issues and to be educated about them as well. And humbled by them.
Yep. There’s, there’s and I could see how you’re right. You’re in the emergency department. I could see how that could be extremely frustrating, right? Because you’re treating the malady that you’re seeing in front of you, right, but, but you can’t improve the person’s housing situation Exactly. Right. You can’t help them find healthy food, you can’t help them to afford their medications regularly, which is why they keep ending up back In the Er,
Okay, well, let’s let’s go back to what we were talking to earlier. Is there anything that cringe worthy that you see doctors doing that you just want to throttle them and say, Stop doing that, right? What’s something that that that you see? Maybe regularly maybe not that you would want to just take someone sit them down and say, Stop doing that?
Oh, not related to bias, right? You’d be in general right
would be in general. Or, or you know, either way,
you know, I think for me, because I am, I’m in emergency medicine. I think often what I see is physicians, like not really listening to patients. And so, I know it sounds so simple, but a lot of times I will try to just sit down on the stretcher with the patient. At least look them idi and try to try to really listen to them because I feel like a lot of people come to the emergency department and a good number actually ended up being okay but they come for free. assurance. And the thing sometimes we don’t realize that because we’re in a rush. And so I think just sitting down with them for a few minutes, and really listening to them can do a lot of good.
Right? That empathy that that empathic listening in and of itself is, is therapeutic. Yeah. Because if they came in for insurance and they feel like you weren’t listening to them, they’re not reassured. Right? Exactly. Okay. Same question, but now related to bias. So anything cringe worthy that you see doctors doing really?
Yeah, I mean, like, in the emergency department a lot. And I see people saying, Oh, yeah, I got it, you know, this patient with sickle cell disease, or, oh, here is all I got a domiciled homeless guy over there. I’m like, we’re just like really quick to put patients in categories. And I think because our brains are kind of lazy, and we like to do that in order to conserve energy. But sometimes I just tell them like, hey, just, I know you feel like you’ve seen this patient before, but you haven’t seen this one before. Even though they may seem similar to you, just take your time and go over there and just talk to them without making the assumption. So, practice that constructive uncertainty that you need to do so that you’re not making assumptions about information that you don’t know.
Excellent. Yeah, I think that’s that that’s, that’s very helpful. But But when we’re we are, you know, if you have a resident that’s that’s presenting to you, how does the presentation differ? If they’re doing that, right, at least like the first line of the presentation? How would How would you see that change?
Well, that’d be like, Oh, yeah. So I got this this guy, you know, this little call, like, oh, a stickler instead of seeing a patient and a patient with sickle cell disease, you
know, like, they’ll
just, and so that kind of signal to me that they are just sort of,
it’s flippant, exactly. Flipping gas.
Yeah. And we know that a lot of these patients actually ended up being very sick. But because you’re like, Oh, yeah, I’m just gonna give them some pain medication. That Hopefully, they’ll go, then you end up actually missing something very serious on them.
So I actually did an interview a while ago with with Stephanie SOG, who’s a PhD in the weight Center at Harvard. And we just talked about obesity. And one thing that she said was referring the pain refer to the patient as having obesity, not as the obese patient, the patient with obesity, actually, she talks about not using the word obesity. But yeah, that her whole idea was that language matters. Yes, because language shapes our thoughts, sometimes in the direction that we don’t think it’s not just thoughts that shape our language, but language that shapes our thoughts. And if you change the way that you’re speaking about patients that can actually be infectious and affect others. So you know, so So use that goes back to the modeling that we were talking about earlier. So if you start saying this is a, you know, 24 year old male with sickle cell anemia, that right then becomes infectious. There. Hopefully the residents We’ll start thinking of the patient’s different talking about the patients differently and then, right and that improves everybody’s outcomes. Yeah. Yeah. So So tell us about I think that’s a good segue. Tell us about advancing health equity, your business venture.
Yeah. So financing health equity actually formed the company earlier this year, I never thought I would be an entrepreneur, especially going into medicine. It definitely wasn’t something I had considered that as I may have mentioned, before, I started getting these unconscious bias trainings and getting really great reception that I started being asked to get them outside of outside of the organization. And then I realized, okay, I need to take this show on the road, I should start my own business. And so I’ve been working with public health organizations, large position groups and doing trainings around unconscious bias, inclusive leadership, structural racism, and health care developing an analytic tool to assess race equity in the culture of organizations. And so this is my my small contribution to helping to To address health disparities by making sure that we have a workforce that is trained to take care of a diverse patient population, and to make sure that we have work environments and workplaces where a diverse workforce can can thrive.
So if people are interested in learning more about it finding you online, how do they find you?
You can go to my website www advancing health equity. com.
Any final thoughts for our listeners on either advancing health equity or recruiting, retaining and including people and I just, I read this on Twitter. I think it was fod foreign, other different someone who has foreign other different organization?
Yeah, you know, I think I just want everyone to remember especially if people who are in the health care professions realize that we have a huge impact even in personal interpersonal interactions with our patients on their health outcomes. And so we should really be thinking about the biases that we’re bringing to that encounter. But also about the systems and structures around that patient and, and where that patient lives and where they work that are also influencing their health status. And so I think if we realize both those things that we can actually provide better care to our patients.
Fantastic. Well, you are extremely busy between your family, your practice and this new business. And I wish you the best of luck with advancing health equity. So thank you so much for taking the time to talk to me today.
Oh, thank you so much for having me.
That was Dr. Bradley Block at the physicians guide to doctoring. He can be found at physicians guide to doctoring calm, or wherever you get your podcasts. If you have a question for previous guests, or have an idea for a future episode, send a comment on the webpage. Also, please be sure to leave a five star review on your preferred podcast platform. We’ll see you next time on the physicians guide to doctoring.
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