Transcript
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Speaker 1: Welcome to the
Healthy, Wealthy and Wise
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podcast with Dr William Chokta,
MDJD. Our mission is to empower
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you with the knowledge and the
tools you need to thrive in all
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aspects of your life. Join us
now as we discuss everything
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from nutrition and exercise to
money management and personal
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growth. Dr Chokta will provide
insightful advice on how to
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improve your physical and
financial health, as well as
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your emotional and mental
well-being. Whether you're
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looking to boost your energy
levels, unlock financial freedom
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or cultivate a more positive
mindset, we've got you covered.
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Get ready to become the best
version of yourself? So let's
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get started. Here's Dr William
Chokta, MDJD.
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Speaker 2: Good morning, welcome
to the Healthy, wealthy and
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Wise podcast. I'm Dr William
Chokta and I will be your
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facilitator for this program.
We're delighted to have you, and
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today we're going to talk about
health care disparities and
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give you some ideas and some
suggestions about how we can
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mitigate health care disparities
and provide quality healthcare
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for patients that we deal with.
As always, i like to start off
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with my beliefs. I believe that
life is about being of service
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to others. I believe knowledge
is power. I believe leaders can
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change the world. For our
discussion, we're going to talk
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about the definition of
healthcare disparities. We will
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talk about the definition of
healthcare equity and we'll give
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you some specifics about how to
merge the two. This is part of
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our masterclass series and, as
part of the series, the three
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areas that we address are
healthcare, some legal issues,
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potentially, and also some
financial issues, potentially.
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Change is one of those things
that will always be with us and,
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indeed, every day there will be
some change in your life. I
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suggest that if you are having
challenges with things that are
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going on, it has to do with your
relationship with change. If
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you have a good relationship
with change, then you are
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probably happy. If you don't
have a good relationship with
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change, then you're probably
dealing with more and more
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challenges. My point, very
seriously, is to look at what
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your issues are and how you feel
and to see what your
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relationship is with change.
Let's focus in on our primary
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issue today healthcare
disparities. Albert Einstein
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once said if I had 60 minutes to
solve a problem, i would spend
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55 minutes defining the problem.
Let's define what healthcare
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disparities is. What does it
actually mean? Very simply,
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healthcare disparity means
patients who are similar
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situated being treated
differently. Let me say that
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again Patients who are similarly
situated being treated
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differently. For example, two
patients come into the emergency
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room. They're both 20 years of
age, they've both been involved
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in automobile accidents,
separate parts of the city, but
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they're brought to the same
emergency room. Both are
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18-year-old men and have a
fracture of the left femur, left
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leg. Patient A is the son of a
member of the board of directors
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. Hospital has a policy that if
any member of or family member
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of a board member comes into the
hospital, they are to
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immediately notify the
administrator on call and to
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make sure that the administrator
gets involved with the care of
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that patient. Patient is placed
in a private room and someone
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from administration will come
down and welcome the patient and
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or their family member. Patient
B 18 year old young man
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different accident but same
problem fracture of the femur is
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brought into the same emergency
room. He is the son of a single
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parent. His family, his mother,
does not have insurance and he
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is basically healthy. Otherwise.
He is placed in the emergency
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room and individuals interview
him, x-rays are done and it's
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taken some time for them to get
the doctor in to see him. There
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is a particular orthopedic
surgeon on call and he's been
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called and they're trying to get
in touch with him. What's my
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point? My point is two almost
exact type of medical problems,
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but the treatment is different.
So what we're going to do is
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we're going to explore why is it
that some of the treatment is
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different in these situations
and exactly what all that means.
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If we look very closely,
situations like this happen in
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hospitals all over the country.
The reality is that patients are
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not always treated exactly the
same and there analyze the issue
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of health care disparity, and
this is what we're going to look
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into today. There are a number
of reasons for health care
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disparities. Certainly, it has
to do with one's ability to pay.
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Sometimes It may have to do
with one's ability to understand
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the environment, education,
language All of these may. There
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will be limitations, or there
certainly be influences about
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how quality care is rendered at
a time. Whose responsibility is
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this? I'm going to argue that
this is the responsibility of
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the caregiver either doctors,
nurses and hospital employees,
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and my operational definition of
caregiver is anyone who works
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in a hospital that has impact on
a patient. Anyone who works in
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a hospital is a caregiver.
Whether you're in food services,
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whether you're environmental
services, whether you are
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provide my secretarial services
or in surgery, or a nurse or a
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physician, it does not matter If
you have impact on that
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patient's experience. You indeed
are a caregiver And you're part
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of that team of individuals who
are responsible for providing
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quality care for the patient. So
one of the things that we've
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noticed is that, more recently,
more and more patients are
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diverse, and one of the reasons
for this is that in 2010, when
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the Affordable Care Act was
passed, that increased the
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number of individuals who
basically have health care. It
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expanded health care coverage,
fortunately for large, for
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millions of individuals, of
patients, so that they could be
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provided quality care and live
long and thrive like all the
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rest of us. Along with that that
has brought in more challenges
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in the health care area, and it
is our responsibility as
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healthcare providers, like
myself and others, to meet those
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challenges and provide the very
highest quality of care
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possible. So there are a number
of reasons for these disparities
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, and let's say, on the
patient's part, age, genetic
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health behavior, chronic
illnesses. There may be
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community factors such as
education, health care access,
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community norms, neighborhoods.
There may be system factors,
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such as local public health
services, social services,
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social, economic and health
systems. Never the least, it is
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the responsibility and my judge
of caregivers those of us
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involved with the process of
caring for others to make sure
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that we eliminate health care
disparities as much as possible.
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So what are some of the
solutions to health care
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disparities? First thing is that
whenever there's a problem or
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circumstance that one is dealing
with, it's important to, as
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some say, not to bore the ocean.
I am sure you, like me, have
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been involved with many
different meetings about many
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different issues involved in
health care. But what happens,
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what tends to happen sometime,
is that we try to solve all the
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problems all at once and to the
extent that many times one feels
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overwhelmed and feel like that
it's almost an impossible task.
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One of the things that I have
learned in my 50 years of health
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care is to do the very opposite
. It's to start small and then
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grow and do something larger, to
start with the basics. So I
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would suggest number one let's
not bore the ocean, let's not
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try to solve world peace or
create world peace, etc. Etc.
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But let's do the things that we
can do. Let's control the
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control of the boats, and indeed
there are things that are under
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our control, and these are the
things, in my judgment, that we
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should work very closely on. So
let's simplify it. So how do we
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simplify it? First, let's start
with the individuals involved.
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We have caregivers, like those
of us who work in hospitals or
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provide health care services,
and we have patients. We have
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two entities. Our goal is
quality health care. Our goal is
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quality health care. So, in
effect, the caregiver patient
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association is a relationship.
It is a relationship, whether
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it's a doctor patient
relationship, nurse patient
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relationship, caregiver patient
relationship. It is a
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relationship. And we have some
understandings about
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relationships, right. So we're
going to apply those
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understandings to this very,
very large and seemingly complex
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problem. So the first thing
that we're going to start with
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is perception. Perception is
reality. And let me be more
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specific. We know from our
anatomy and our psychology and
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our psychiatry that what we
believe affects how we think.
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What we think affects how we
feel And how we feel affects how
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we think about that. What we
believe affects how we think.
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What we think affects how we
feel And how we feel affects how
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we act. If we have a belief
system about a certain patient
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population, i guarantee you
that's going to translate into
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our actions in dealing with that
certain patient population,
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positively or negatively. So one
of the things that we can
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control or have some control
over is our belief system, and
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so I would suggest, to start
with, if you're starting to have
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negative beliefs about a
certain patient, you don't even
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know the patient, but you walk
into the room and already you
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get an impression. And if that
is, if that impression is
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negative, i suggest to you that
you pause and take a step back
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and regroup, because already
you're starting down a path
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that's probably not going to be
beneficial to you and or the
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patient. So that's a very, very
easy first step. Second thing is
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we're dealing with systems,
hospitals of very, very large
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systems, offices, or
significantly complicated
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systems, and what I have learned
and what many of us have
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learned in quality management
and quality improvement is that
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when problems develop or
outcomes are not ideal or
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outcomes are not what we want
them to be, nine times out of
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ten is the process, not the
people. Let me say that again
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When problems develop, let's say
in a hospital, mistakes occur.
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Well, things don't occur the way
they're supposed to occur. Nine
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times out of 10 is the process,
not the people. I remember at
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my hospital as Chief
Transformation Officer, i used
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to say when in one of the
regular C-suite meetings and the
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issue would come up where maybe
a nurse has given the wrong
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medication to a patient,
oftentimes the result would be
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folks would be fired. I would
make the plea when people make
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mistakes, when caregivers make
mistakes, do not fire them
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immediately. Send them down and
have a conversation with them
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and say tell me what was going
on on your ship when XYZ
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happened? Why? What's my point?
Nobody comes in to work planning
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to make a mistake. As a matter
of fact, that's an oxymoron. If
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you plan it, it's not a mistake.
When a mistake occurs, it is
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not planned. What you will
discover, as many have, is that
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you have a process that this
nurse or doctor or healthcare
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giver is involved in. That
creates an environment that
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causes them to make a mistake
and not reach their 100 percent
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potential. What's my point? My
point is look at the process,
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not the people. Now, certainly,
you're going to look at the
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people to some extent and maybe
one-tenth of one percent will be
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a people problem, but I
guarantee you 99 percent of the
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time it's going to be a process
problem. The one way you will
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know that is that you will have
a problem. You'll have a big
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meeting and you'll do all sorts
of brute-cost analyses on those
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problems and then you will come
up with a solution for their
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problem. Six to eight months
later, the same problem will
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occur again. After you have
fired Nurse John or Nurse Mary.
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Somebody will say but I thought
we solved that problem when we
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let so-and-so go. Well, you
didn't solve the problem. Yeah,
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you did fire somebody, but the
problem is in the process. It is
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not in the people. All you did
was change and put somebody else
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into that same broken process.
I would encourage you that if
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you were having challenges with
quality, with your patients, to
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look at your processes more than
you're looking at your people.
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That's more difficult, arguably,
but it is most important to
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solve the problem. What is the
solution to health care
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disparities? Well, the solution,
obviously, is health equity,
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equality and treatment for
patients, for all patients,
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irrespective of their status in
life, irrespective of what
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families they're from, etc. If
you are a human being, you have
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a fundamental right to quality
care. Indeed, that was one of
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the principles of the Affordable
Care Act that was passed and
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signed by President Obama in
2010. You have a fundamental
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right to quality care. That is
our responsibility as caregivers
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. One of the reasons why this is
a bigger problem now than it
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was 30 years ago is that, with
the expansion of the Health Care
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Act and more people coming into
the system, the complexities
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have significantly increased,
and all the more reason for
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those of us in leadership
positions And basically I'm
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talking about a caregiver now,
any caregiver, as compared to a
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patient. It is our
responsibility to solve these
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issues, and one of the ways to
solve the issue is health equity
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, and one of the ways to create
health equity is to start with
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what I call the person in the
mirror. Let's say I'm Dr Chokta,
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i'm a general surgeon And I
have called to the emergency
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room to see a patient. It is my
responsibility to go into that
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environment with a certain
attitude mentally before I even
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get there, and beliefs need to
lead to thoughts. Thought leads
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to feelings and feelings lead to
behaviors. And so if I want
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things to come out of certain
way, i need to start with a
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certain attitude before I even
get to the emergency room to see
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that patient. You would be
amazed at how we predict outcome
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by our belief systems and by
our attitudes. And so if you're
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seeing a lot of negativity
around you, take a look again at
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the person in the mirror and
begin to question what your
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beliefs are. So what have we
learned? in conclusion?
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Healthcare disparities is a
horrible situation that creates
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poor healthcare for a number of
people. It leads to mistakes in
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healthcare. It leads to less
than quality care. We can do
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better. We can do better, we
should do better, and the best
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way to do better is to start
with the person in the mirror,
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make sure that our beliefs are
positive and are in alignment
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with our thoughts And our
thoughts are in alignment with
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our feelings and that our
feelings are in alignment with
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our behaviors. If we do that on
a positive level, we're setting
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ourselves up to succeed, and if
we succeed, our patients succeed
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, because ultimately, we're
talking about a relationship,
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and relationships are based on
three things Mutual respect,
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mutual trust and good
communication. And even though
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this is a relationship, keep in
mind that we, and we, the
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caregiver, have the authority
and the power in this
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relationship that the patient
does not have. Consequently, we
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must take the lead. We have that
responsibility to take that
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lead and to make sure that the
patient does well and receives
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the very highest quality of care
. One of my friends used to
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always mention, when we talk
about healthcare quality is to
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use the mom test. What type of
care would you want your mother
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to get If she were a patient who
had been in an auto accident
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and had a fractured femur and
was rolled into the emergency
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room? Your approach works for
you as fine, as long as you make
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sure that your beliefs are
positive and fair and honest,
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because that will dictate what
the result is going to be in
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terms of your actions. That is
my only conclusion. Our
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relationships are based on
mutual respect, mutual trust and
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good communication. I believe
with my basic principles. Number
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one God is in charge. I am a
physician of faith and indeed it
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has been my faith that has
sustained me over the years and
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has allowed me to do the things
that I wanted to do and to
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succeed and be helpful in a
positive way. My second basic
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principle is I don't have any
bad days. I decided many years
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ago that whether my day was good
or bad was completely up to me,
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so I decided I didn't have one
anymore bad days, and so now my
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days are all good or great.
Principle number three my basic
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principles I don't sweat the
small stuff, and most stuff is
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small. What I have learned is
that when I get upset or about
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to get upset about something,
nine times out of ten it's going
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to be something that's
relatively small, it's going to
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be something I can let go and
it's not that big a deal. And
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I've learned to pause and go
more slowly. Don't do it all the
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time, but I'm better at
evaluating those situations than
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I used to. Principle number
four forgiveness is therapy.
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Many times in life, certainly in
healthcare, whether it be a
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patient or whether it be a
fellow caregiver individuals
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will say or perceptibly do
things to you that you believe
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were not in your best interest.
My suggestion to you is to
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forgive them. Has nothing to do
with who's right or wrong, has
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nothing to do with the facts.
Just forgive them and you would
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be amazed at how not only that
is empowering for you, but how
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therapeutic that is for you as
you move forward and try to make
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the world a better place. And
basic principle number five that
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we've been talking about
already everything is a
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relationship. Everything is a
relationship. Today we talked
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about the caregiver-patient
relationship, but my suggestion
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to you, whether it's
doctor-patient, whether it's
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husband and wife, parent, child
co-worker, co-worker, boss,
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employee relationships are based
on the same thing mutual
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respect, mutual trust and good
communication. If you have those
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three things, you have a strong
and a viable relationship. If
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you do not, then you need to
work on the areas of how, work
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on the areas that you can
improve to get that relationship
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to where it should be. Final
thought be the change you want
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to see in the world. Be the
change you want to see in the
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world. Have a great day.
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Speaker 1: Thanks for listening
to the Healthy, wealthy and Wise
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00:23:26,452 --> 00:23:31,548
podcast with Dr William Choctaw
, mdjd. We hope you enjoyed this
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episode and, if you found it
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at the words, dr William
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, live your best possible life
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the best possible way.
