Medical Discrimination: Understanding Bias in Healthcare

Purposes only. Please consult your doctor before starting any new treatment. This show is for you to be informed and empowered about healthcare issues that are important to you, and today we are talking about medical discrimination. Um I'm your host, Dr. Valda Crowder, also known as Dr. V. I'm a 30-year 30-year board certified emergency medicine physician, and I've treated patients during four pandemics, one mass shooting, and a category four hurricane. So you are in good hands today. We discuss all these topics every Monday at 10 a.m. and we try to actually pick the the topics that matter most to you. I get emails uh with questions and uh emails with topic suggestions, and people wanted to talk about medical discrimination today. And and medical discrimination is one of the most overlooked forms of inequality in our health care system. And it's really not just about individual prejudice necessarily, it can also be systemic uh within a system, and it is systemic within um our system. So, in order to heal, you must confront inequity head on. We've got to reform policies and look at how to make sure that anytime we interface with the healthcare system, we get compassionate, uh fair, uh, and equitable treatment. So I want to talk a little bit about uh medical discrimination because a lot of people uh primarily think of being discriminated against uh because they're black, um, or because they're Hispanic or because of their race. But really, there's lots of different types of medical discrimination, right? So you can be discriminated against obviously because of race and or gender, right? But we also see discrimination um based upon various things. We see ageism, you know, are you actually offered the same treatment as someone younger, or should you be offered uh the same treatment as someone that's younger? Who's actually making that decision? Um we also sometimes see medical discrimination related to weight, whether or not someone is severely malnourished or severely overweight, how does that actually affect their treatment? Um we will also sometimes see discrimination based upon disability. Um if someone is significantly disabil disabled, um, how far does a physician or a medical system want to actually go in providing that person care? Um and then we're we often see it um related to socioeconomic status. But socioeconomic status is a little bit different in the health care arena because people assume that they have good health care insurance. And even if you work at a job and you've picked the highest insurance that you can actually get at your job, um you that may not necessarily be the best insurance that that hospital system or that doctor is used to actually seeing come through their system. Right? So I know for myself, even I had a situation just recently where my dentist told me um, and I picked the premium dental insurance, um, and where they said, you know, this insurance is really not good, and we're not gonna be able to see you anymore. And that was that that happened to me just a couple of weeks ago. Um, so sometimes, you know, we think that we actually have uh a higher grade insurance than we actually have. Um and so you can also be discriminated based upon um uh your their your insurance status. And it's not just whether or not you have insurance or don't have insurance, it's actually related to what type of insurance you have. How do the reimbursements work? Um, what sort of information is that insurance company requesting? Um, how often does that insurance company actually deny claims from that physician or from that hospital? So these are things that often the patient doesn't know anything about, right? And so um you can see medical discrimination related to all of those of those issues. So we're gonna talk a little bit today about what is the impact of this, how does this actually impact your care, um, and what do you actually need to do about it. All right, what the health is happening, that is the real question. It's also the name of my new podcast where you can literally get life-changing advice. What the health is happening is where we give you the inside scoop on all medical matters, and we help empower you with information from everything that you could be dealing with, including uh any medical news or breaking news updates. What the health is happening is your dose of medical information um and your dose of medical reality. It's myself and some of my friends that I interview that are all on the front lines of health care. You can actually find what the health is happening on all podcast platforms. Uh so please download, subscribe, and comment. All right, news you can use. This segment is always done every week, and it's we always want to go over news that is important to people that can make a difference in their life that they can actually uh that they can actually use. Last week we talked a little bit about the government shutdown. Um I'm gonna talk a little bit more about that today because we have stretched now into, I think, our second or or third week of the government shutdown. I know on Friday we had uh the first government paychecks that were not paid as a result of this government shutdown that included our military employees, uh government and all government employees. So let's talk about this because there's five key things about this fight, um, because this is really a health care fight, which is um which is unfortunate, right? So so the main part of this health care fight is the public subsidies. So when you go on to get your health care insurance through the through the marketplace, through your state marketplace, a lot of people, um, up to really about$140,000 or so of income, are able to actually get uh subsidies to bring the price of their premiums down. So when they get that subsidy, they don't even know that the government is paying the difference between what the market rate of their insurance is and what they are actually being offered. So those people who are actually getting that, and these are usually working families, um, the big beautiful bill would actually take those subsidies away, and their health insurance premiums will double or triple. Um, some people are already getting letters about it. You more people will begin to get letters uh the beginning of November. So this is one of the main things that the health care fight is about. These were subsidies that were put in place under the Obama administration, under Obamacare. Um, and the the goal is the Republicans' goal and the the road that they're on right now is to take those those subsidies completely away. Um, and um the issue is really urgent because open enrollment and everyone changes their insurance in October. So um those dates have kind of been pushed back to November 1st, but basically, health insurance companies cannot actually give us rates right now because they don't know what's happening. Are these subsidies going to be in place or are they not gonna be in place? Um, most of the southern states actually use the health care subsidies more than the northern states. So rural areas and southern states, mainly because they have not expanded Medicaid. So for the states that did not expand Medicaid, they rely more heavily on these subsidies. So it is about um this is roughly, you know, uh one or two trillion dollars that we have already been spending, um, and we have been spending it to make sure that 20 million, 20 to 25 million people in America are insured. So thus the thing to know, and that's what this fight is really about. Um, I'm personally a supporter of these subsidies because I know what happens when people don't get these subsidies. Um, they get sicker, they come in with more advanced disease that we are that is more difficult to treat. They use the emergency department more. Our emergency departments get crowded and overwhelmed, which makes it very, very difficult to sort of navigate. And the most important thing is hospitals and clinics close. So it makes it harder and harder for all of us to get care in our community when we are all not insured. Um, the the other news you can use that I thought was very interesting was the$20 billion bailout for Argentina. And I bring this up because often in the health care conversation we say that we do not have the funds to actually uh insure everyone and provide health care for everyone. Um and I find I I think I think that's not actually true. Um I think that what is happening is we have funds for the things that we want to have funds for. Um and I I'm not exactly sure why we've decided to bail out Argentina. Argentina has been bailed out about seven or eight times in the past, so it's a chronically um um dysfunctional government monetarily wise. Um, but we have decided to um bail them out, I think, for the ninth time. Um and I think it's it's just it's just something to put a peg in and to notice when you have politicians who say we don't have the funding for this or we don't have the funding for that, when we do have the funding to do other things that we decide that we want to do. Alrighty. So if you've experienced health care discrimination um and you uh want to know what your rights are, this is the show for you. All right, there are some folks that have already emailed me about this topic, so I'm gonna go through some of these questions um because I think that it's these questions are really um important. And I got a ton of questions when I announced that we were going to be doing this uh this particular topic. So I got a call, uh I'm sorry, an email from Horace, and Horace says, What is medical gaslighting? So this is this is interesting. So so medical gaslighting is basically when a physician or nurse or a medical provider of some sort dismisses or downplays or minimizes or invalidates your concerns, right? So basically, you know, you're complaining about whatever you have going on medically, um, and they're just not taking it seriously, right? Now that's different from you're in an emergency department that has to handle critically ill patients and you're coming in because maybe you cut your hand. The fact that you cut your hand is still very uh important, but in the emergency department we are looking for the person that's having a heart attack and a stroke, right? So so sometimes I think what happens in the medical field is you have to look at what what environment am I in. If I'm in the emergency department, they actually should be looking for the person with the heart attack and the stroke. And my cut is important, and I do want my cut to be taken care of, but I am gonna have to wait a little bit longer. Now, what happens with medical gaslighting? Because sometimes people experience medical gaslighting at their primary care doctor's office, which is a completely different issue, right? You should actually have all of your concerns that you bring up in a primary care visit where they have more time and they you have an allotted appointment and you can actually bring up your concerns. That is an area where your concerns should be taken seriously, and there should be some sort of a treatment plan for that. Now, what's important is if it's not, you might need to get a new doctor, right? If you're dealing with medical gaslighting over and over again, it may be important to get a new physician. What happens with medical gaslighting is it can lead to a delay in diagnosis, it can lead to a misdiagnosis, and it really causes increased distress for a lot of different families. So that's basically what medical gaslighting is and why it is actually so important. All right, I've got another question here. Um, and it says, um, my dad is from Peru, and English is not his first language, which which creates a barrier when he's alone or at the doctors. What role does language access play in medical discrimination and what happens when patients don't speak English fluently and struggle to communicate with providers? This is a really, really, really big issue. All right, so um, and I don't know uh how primary care offices handle it, but I can tell you how we handle it in the emergency department. We have a thing called um voice V-O-Y-C-E, and basically it is a language app that is on an iPad. I also have it on my phone, and it allows me at any point in time to actually speak with anybody of any language. So I get all types of languages coming through the emergency department where I work. It's a very, very international uh community. Um I have had uh languages like uh, in fact, just this week I had someone come in who spoke uh Uzbekistan. Um I've had Urdu, I've had all different types of languages. So it's really important that if you actually are um if you are someone where English is not your first language, it is really important that you go to a primary care provider where you can actually have um a translator. So I have on at the in the emergency department a voice translator and I could also bring up a video and the person can see that person speaking their language. I can also get languages in different dialects. So it's really, really important. And sometimes what happens is patients think they speak enough English, and I encourage them to speak in their native language so that I can help them better. Um, because usually there is something missing if they're if they're if if they're not as proficient at English as they think. Um on the other hand, I can tell you as for myself as a um as a medical provider, I do actually order a little bit more and just check a little bit more things if I'm dealing with someone who is non-English speaking, just because I want to really, really make sure that there is nothing that I'm actually uh missing. So, great question. All right, we've got a question from Teddy from DC. He says, Many of us are facing losing our jobs and health insurance. How have you seen socioeconomic discrimination manifest in the medical setting? And please share why a patient's zip code may be important in their health outcomes, or maybe more important in their health outcomes than their genetic code. So, great question, Teddy. Um, so yes, your zip code can actually be more important than your actual genes in determining a couple of things. Um, how long you'll actually live, um, and also how how well you'll actually live. So there's a lot of things that go along with your zip code. Um, what goes along with your zip code is what in that environment, in that community that you're in, how insured are the people? Are the people more insured or less insured? Is there a high density of Medicaid or a low density of Medicaid? So when hospitals actually go to actually be in certain communities or physician offices decide to plant themselves in certain communities, they look at that information and decide whether or not to put an office or a hospital in that area, right? So I know we had a situation here where we had no hospital basically east of the river for a very, very long time, right? And so um you will see sometimes that there will not be um enough uh uh primary care specialties um or hospitals. There may be long drive times for an ambulance that has to actually drive you when you're having your heart attack or having a stroke. If you have a 45-minute drive time or an hour drive time to the nearest hospital, your outcomes are not gonna be as good. So there are many, many treatments that are time dependent, and we have to actually get that medication in you within a particular period of time. Um, the things that I'm thinking of most are strokes and heart attacks, which are very, very common in our community. So your zip code absolutely dictates what is going on. There are some things though that can be done about this. I think it's really important if you're in a zip code that has poor health outcomes to actually talk to your local representatives. There can be government subsidies or incentives that can be put in place to actually get physicians and doctors' offices and hospitals to open up in areas where there is um where where there may not, where there may be a medical desert. I know the DC government was very involved in actually getting that hospital open that opened up in um opened up in Southeast. Um you need that type of partnership to actually bring these programs and bring these services into your community. I want to talk before I go on to the next question, I want to talk a little bit about what do you do if you're in the hospital and you are being discriminated against or you feel like you're being discriminated against, because a lot of folks don't know what are the resources that are actually available to you in the moment as it happens. So one of the main things I tell people is if you're in a hospital setting or even in an outpatient setting and you feel uh you're being discriminated against, I there is a patient advocate or a complaint department or some sort of advocacy in every single hospital. And you need to ask for it. And you can simply say, I want to lodge a complaint and I would like to speak to the people that I that the the the the complaint department or the patient advocacy department. If you are in a hospital and it is, you know, midnight, one o'clock, two o'clock in the morning, they may give you a phone number or an email. Um if you feel well enough, you should call them while you are still there. One of the things that is taken more seriously is if a patient is actually complaining while they're actually still in the department, right? The complaints that occur after people get their bill are taken or are seen in a different light. So it's very important to make sure that you actually lodge your complaint while you're still there, or a family member lodges it on your behalf if you are not feeling well enough to lodge a complaint. The other thing that is important is that all hospitals are regulated by the Department of Health or the Board of Health. Sometimes they're called the Department of Health, sometimes they're called the Board of Health. You can also lodge a complaint there, right? And those also are taken very seriously. Um you can also lodge a complaint with the Joint Commission. The Joint Commission accredits all hospitals in the nation. It's called Joint Commission.org is their website. They have a whole video called Speak Up about Discrimination. And basically, the Joint Commission has said we recognize and acknowledge that discrimination occurs. And we recognize and acknowledge that it has a negative impact on health outcomes. And we actually want to be a part of the solution, not a part of the problem. So if you go on to jointcommission.org and you look up their speak up discrimination, they actually have videos where they actually, in their cartoon-like videos, they're done in English and Spanish, and they actually share with you what it looks like when you're being discriminated against. So I recommend I recommend if you ever wonder, like, was I really being discriminated against? Was that really discrimination? Go to their website and actually check out their videos. Um you can also lodge a complaint with the joint commission. You can also lodge a complaint with the attorney general's office. You can also lodge a complaint with your insurance, with your insurance company. Because remember, your insurance company will be paying the hospital. So your insurance company is very interested to know if something did or did not occur that was supposed to occur. So all of these things are sort of tools. It's really, really important. I know sometimes it can feel onerous, but it's really important to speak up and say something. Um, because um we're not gonna solve this problem unless we actually call it out as it actually occurs. Alrighty. Let me get back to a couple questions here because I want to try to get through as many of these as possible. Um again, if you want to join the conversation, you can join the conversation and call us at 1-800-450-7876, 1-800-450-7876, and you can join our conversation. All right, so Blaine asked me, he said, as a non-binary person, I believe that LGP LGBTQ plus patients, particularly transgender individuals, often face discrimination ranging from being denied care to experience inappropriate questions or hostility. What barriers do do you believe our communities face in accessing respectful health care and what can be done when we feel disrespected? So this is a really this is a really good question. Um so a couple of things. I I I can tell you what we actually do at our hospital, which is actually really important when we have transgender patients. One is we ask them what name do they want to be referred by, because sometimes the name that is on their ID is not the name that they want to be referred by. We also ask them what pronouns they want to be referred by. And in general, we actually make a really a really heroic attempt to actually follow that. Um I think that um there there are times when I know my staff may have uh in my emergency department. May may slip up and call a he or she or something like that. And I think that it's important that we that we recognize the effort that the staff is actually making. We are in a very fast-paced environment when we're working in the emergency department. Certainly in a primary care office, that physician should actually know you. And that physician should actually be caring for you longitudinally, long term, and should actually know who you are and how you want to be referred to. And there should be notes on the charts related to that. I know one of the things that also is done is there is a, because I've seen some of my fellow physicians do this, they have a pin on their lapel that actually identifies them as someone that is trustworthy to the LGBTQ community. We actually, obviously, there are physicians that are a part of that community. And so there are physicians sometimes that wear that pin. You will see sometimes if you go to select a physician, they may say something about that when you go to the network and you want to actually select a physician. So I think it's really important to actually if you're if you're healthy, make sure that you if you feel disrespected, whether or not it's related to being, you know, overweight, a female, uh black, Hispanic, non-English speaking, LGBTQ, no matter what you feel, if you're being dis discriminated against or you feel disrespected, you know, you can always march out with your feet. Um and if you can't march out with your feet because you're not feeling so well, you know, and you have family members that are around you, you have them actually advocate for you. Um so yeah, so so I think that it's I think that um we we see it also with with the gender assignment as well. So all right, we've got uh another question from Shawnee. Shawnee says elderly patients sometimes experience ageism in healthcare. Yes, they do. Their concerns are just dismissed as just a part of getting older. How does age discrimination affect diagnosis and treatment? So this is really, really important. Um, a lot of times when patients come to the emergency department or or interface with the healthcare system and they are older, we may not know what their baseline is. So it's really, really important that it is communicated to us what is this person's baseline. Because we could be looking at you laying in a stretcher and we may think that you never were able to walk or that you weren't able to walk in the last, you know, ten years or so. It's really big difference to know, hey, this person was actually able to walk, they were able to walk last week. Uh we want to actually be able to get them back to that baseline. Um, there are times though when you also have a deterioration of your health care and your health care deteriorates to the point where you have a new baseline. And one of the things to ask physicians is, are we unable to get this patient back, my mother or grandmother, whoever it may be, back to their baseline, and is this going to be their new baseline? If the physician says this is going to be their new baseline, that tells you they're not intending upon doing anything about it. Um we've got a caller. Do we have time real quick to take a call? On no, we don't have time, sorry. Uh sorry, sorry about that. Um, yeah, this this this show is now 30 minutes, so with the 30-minute format, we've actually if you want to call in and be a part of this conversation, you got to call in almost at the top of the hour. So, so if you believe that the elderly patients should not have a new baseline, you want to make sure you you you you want to make sure to actually get a new physician if you don't believe that that should be their new new baseline. All right. Um, no, the act the Ask Dr. V show is produced by the nonprofit Channel of Health, and the mission of Channel of Health is to inform, educate, and empower communities. It's a wrap, folks. Thank you for joining me. Be sure to email me and send me a message at info at as doctorv.us. Thank you.