Mastering Your Healthcare Decisions: A Comprehensive Guide to Advanced Directives with Dr. William Choctaw

0:00 Speaker 1: Welcome to the Healthy, Wealthy and Wise podcast with Dr William Chokta, MDJD. Our mission is to empower you with the knowledge and the tools you need to thrive in all aspects of your life. Join us now as we discuss everything from nutrition and exercise to money management and personal growth. Dr Chokta will provide insightful advice on how to improve your physical and financial health, as well as your emotional and mental well-being. Whether you're looking to boost your energy levels, unlock financial freedom or cultivate a more positive mindset, we've got you covered.

0:41 Get ready to become the best version of yourself? So let's get started. Here's Dr William Chokta, MDJD. Speaker 2: Good morning, welcome to the Healthy, wealthy and Wise podcast. I'm Dr William Chokta and I will be your facilitator for this program. We're delighted to have you, and today we're going to talk about health care disparities and give you some ideas and some suggestions about how we can mitigate health care disparities and provide quality healthcare for patients that we deal with. As always, i like to start off with my beliefs. I believe that life is about being of service to others. I believe knowledge is power. I believe leaders can change the world. For our discussion, we're going to talk about the definition of healthcare disparities. We will talk about the definition of healthcare equity and we'll give you some specifics about how to merge the two. This is part of our masterclass series and, as part of the series, the three areas that we address are healthcare, some legal issues, potentially, and also some financial issues, potentially.

2:06 Change is one of those things that will always be with us and, indeed, every day there will be some change in your life. I suggest that if you are having challenges with things that are going on, it has to do with your relationship with change. If you have a good relationship with change, then you are probably happy. If you don't have a good relationship with change, then you're probably dealing with more and more challenges. My point, very seriously, is to look at what your issues are and how you feel and to see what your relationship is with change. Let's focus in on our primary issue today healthcare disparities. Albert Einstein once said if I had 60 minutes to solve a problem, i would spend 55 minutes defining the problem. Let's define what healthcare disparities is. What does it actually mean? Very simply, healthcare disparity means patients who are similar situated being treated differently. Let me say that again Patients who are similarly situated being treated differently. For example, two patients come into the emergency room. They're both 20 years of age, they've both been involved

3:39 in automobile accidents, separate parts of the city, but they're brought to the same emergency room. Both are 18-year-old men and have a fracture of the left femur, left leg. Patient A is the son of a member of the board of directors . Hospital has a policy that if any member of or family member of a board member comes into the hospital, they are to immediately notify the administrator on call and to make sure that the administrator gets involved with the care of that patient. Patient is placed in a private room and someone from administration will come down and welcome the patient and or their family member. Patient B 18 year old young man different accident but same problem fracture of the femur is brought into the same emergency room. He is the son of a single parent. His family, his mother, does not have insurance and he is basically healthy. Otherwise. He is placed in the emergency room and individuals interview him, x-rays are done and it's

5:11 taken some time for them to get the doctor in to see him. There is a particular orthopedic surgeon on call and he's been called and they're trying to get in touch with him. What's my point? My point is two almost exact type of medical problems, but the treatment is different. So what we're going to do is we're going to explore why is it that some of the treatment is different in these situations and exactly what all that means. If we look very closely, situations like this happen in hospitals all over the country. The reality is that patients are not always treated exactly the same and there analyze the issue of health care disparity, and this is what we're going to look into today. There are a number of reasons for health care disparities. Certainly, it has to do with one's ability to pay.

6:18 Sometimes It may have to do with one's ability to understand the environment, education, language All of these may. There will be limitations, or there certainly be influences about how quality care is rendered at a time. Whose responsibility is this? I'm going to argue that this is the responsibility of the caregiver either doctors, nurses and hospital employees, and my operational definition of caregiver is anyone who works in a hospital that has impact on a patient. Anyone who works in a hospital is a caregiver. Whether you're in food services, whether you're environmental services, whether you are provide my secretarial services or in surgery, or a nurse or a physician, it does not matter If you have impact on that patient's experience. You indeed are a caregiver And you're part of that team of individuals who are responsible for providing quality care for the patient. So one of the things that we've noticed is that, more recently, more and more patients are diverse, and one of the reasons for this is that in 2010, when the Affordable Care Act was passed, that increased the number of individuals who basically have health care. It

7:53 expanded health care coverage, fortunately for large, for millions of individuals, of patients, so that they could be provided quality care and live long and thrive like all the rest of us. Along with that that has brought in more challenges in the health care area, and it is our responsibility as healthcare providers, like myself and others, to meet those challenges and provide the very highest quality of care possible. So there are a number of reasons for these disparities , and let's say, on the patient's part, age, genetic health behavior, chronic illnesses. There may be community factors such as education, health care access, community norms, neighborhoods. There may be system factors, such as local public health services, social services, social, economic and health systems. Never the least, it is the responsibility and my judge of caregivers those of us involved with the process of caring for others to make sure that we eliminate health care disparities as much as possible.

9:13 So what are some of the solutions to health care disparities? First thing is that whenever there's a problem or circumstance that one is dealing with, it's important to, as some say, not to bore the ocean. I am sure you, like me, have been involved with many different meetings about many different issues involved in health care. But what happens, what tends to happen sometime, is that we try to solve all the problems all at once and to the extent that many times one feels overwhelmed and feel like that it's almost an impossible task. One of the things that I have learned in my 50 years of health care is to do the very opposite . It's to start small and then grow and do something larger, to start with the basics. So I would suggest number one let's not bore the ocean, let's not try to solve world peace or create world peace, etc. Etc.

10:18 But let's do the things that we can do. Let's control the control of the boats, and indeed there are things that are under our control, and these are the things, in my judgment, that we should work very closely on. So let's simplify it. So how do we simplify it? First, let's start with the individuals involved. We have caregivers, like those of us who work in hospitals or provide health care services, and we have patients. We have two entities. Our goal is quality health care. Our goal is quality health care. So, in effect, the caregiver patient association is a relationship. It is a relationship, whether it's a doctor patient relationship, nurse patient relationship, caregiver patient relationship. It is a relationship. And we have some understandings about relationships, right. So we're going to apply those understandings to this very, very large and seemingly complex problem. So the first thing that we're going to start with is perception. Perception is reality. And let me be more specific. We know from our anatomy and our psychology and our psychiatry that what we believe affects how we think.

11:43 What we think affects how we feel And how we feel affects how we think about that. What we believe affects how we think. What we think affects how we feel And how we feel affects how we act. If we have a belief system about a certain patient population, i guarantee you that's going to translate into our actions in dealing with that certain patient population, positively or negatively. So one of the things that we can control or have some control over is our belief system, and so I would suggest, to start with, if you're starting to have negative beliefs about a certain patient, you don't even know the patient, but you walk into the room and already you get an impression. And if that is, if that impression is negative, i suggest to you that you pause and take a step back and regroup, because already you're starting down a path that's probably not going to be beneficial to you and or the patient. So that's a very, very easy first step. Second thing is we're dealing with systems, hospitals of very, very large systems, offices, or significantly complicated systems, and what I have learned and what many of us have

13:14 learned in quality management and quality improvement is that when problems develop or outcomes are not ideal or outcomes are not what we want them to be, nine times out of ten is the process, not the people. Let me say that again When problems develop, let's say in a hospital, mistakes occur. Well, things don't occur the way they're supposed to occur. Nine times out of 10 is the process, not the people. I remember at my hospital as Chief Transformation Officer, i used to say when in one of the regular C-suite meetings and the issue would come up where maybe a nurse has given the wrong medication to a patient, oftentimes the result would be folks would be fired. I would make the plea when people make mistakes, when caregivers make mistakes, do not fire them immediately. Send them down and have a conversation with them and say tell me what was going on on your ship when XYZ happened? Why? What's my point? Nobody comes in to work planning to make a mistake. As a matter of fact, that's an oxymoron. If you plan it, it's not a mistake. When a mistake occurs, it is not planned. What you will discover, as many have, is that you have a process that this nurse or doctor or healthcare

14:48 giver is involved in. That creates an environment that causes them to make a mistake and not reach their 100 percent potential. What's my point? My point is look at the process, not the people. Now, certainly, you're going to look at the people to some extent and maybe one-tenth of one percent will be a people problem, but I guarantee you 99 percent of the time it's going to be a process problem. The one way you will know that is that you will have a problem. You'll have a big meeting and you'll do all sorts of brute-cost analyses on those problems and then you will come up with a solution for their problem. Six to eight months later, the same problem will occur again. After you have fired Nurse John or Nurse Mary.

15:40 Somebody will say but I thought we solved that problem when we let so-and-so go. Well, you didn't solve the problem. Yeah, you did fire somebody, but the problem is in the process. It is not in the people. All you did was change and put somebody else into that same broken process. I would encourage you that if you were having challenges with quality, with your patients, to look at your processes more than you're looking at your people. That's more difficult, arguably, but it is most important to solve the problem. What is the solution to health care disparities? Well, the solution, obviously, is health equity, equality and treatment for patients, for all patients, irrespective of their status in life, irrespective of what families they're from, etc. If you are a human being, you have a fundamental right to quality care. Indeed, that was one of the principles of the Affordable Care Act that was passed and signed by President Obama in 2010. You have a fundamental right to quality care. That is our responsibility as caregivers . One of the reasons why this is a bigger problem now than it was 30 years ago is that, with the expansion of the Health Care Act and more people coming into the system, the complexities have significantly increased, and all the more reason for

17:13 those of us in leadership positions And basically I'm talking about a caregiver now, any caregiver, as compared to a patient. It is our responsibility to solve these issues, and one of the ways to solve the issue is health equity , and one of the ways to create health equity is to start with what I call the person in the mirror. Let's say I'm Dr Chokta, i'm a general surgeon And I have called to the emergency room to see a patient. It is my responsibility to go into that environment with a certain attitude mentally before I even get there, and beliefs need to lead to thoughts. Thought leads to feelings and feelings lead to behaviors. And so if I want things to come out of certain way, i need to start with a certain attitude before I even get to the emergency room to see that patient. You would be amazed at how we predict outcome by our belief systems and by our attitudes. And so if you're seeing a lot of negativity around you, take a look again at the person in the mirror and begin to question what your beliefs are. So what have we learned? in conclusion?

18:34 Healthcare disparities is a horrible situation that creates poor healthcare for a number of people. It leads to mistakes in healthcare. It leads to less than quality care. We can do better. We can do better, we should do better, and the best way to do better is to start with the person in the mirror, make sure that our beliefs are positive and are in alignment with our thoughts And our thoughts are in alignment with our feelings and that our feelings are in alignment with our behaviors. If we do that on a positive level, we're setting ourselves up to succeed, and if we succeed, our patients succeed , because ultimately, we're talking about a relationship, and relationships are based on three things Mutual respect, mutual trust and good communication. And even though this is a relationship, keep in mind that we, and we, the caregiver, have the authority and the power in this relationship that the patient does not have. Consequently, we must take the lead. We have that responsibility to take that lead and to make sure that the patient does well and receives the very highest quality of care . One of my friends used to always mention, when we talk about healthcare quality is to use the mom test. What type of care would you want your mother

20:06 to get If she were a patient who had been in an auto accident and had a fractured femur and was rolled into the emergency room? Your approach works for you as fine, as long as you make sure that your beliefs are positive and fair and honest, because that will dictate what the result is going to be in terms of your actions. That is my only conclusion. Our relationships are based on mutual respect, mutual trust and good communication. I believe with my basic principles. Number one God is in charge. I am a physician of faith and indeed it has been my faith that has sustained me over the years and has allowed me to do the things that I wanted to do and to succeed and be helpful in a positive way. My second basic principle is I don't have any bad days. I decided many years ago that whether my day was good or bad was completely up to me, so I decided I didn't have one anymore bad days, and so now my days are all good or great. Principle number three my basic principles I don't sweat the small stuff, and most stuff is small. What I have learned is that when I get upset or about to get upset about something, nine times out of ten it's going to be something that's relatively small, it's going to be something I can let go and it's not that big a deal. And

21:39 I've learned to pause and go more slowly. Don't do it all the time, but I'm better at evaluating those situations than I used to. Principle number four forgiveness is therapy. Many times in life, certainly in healthcare, whether it be a patient or whether it be a fellow caregiver individuals will say or perceptibly do things to you that you believe were not in your best interest. My suggestion to you is to forgive them. Has nothing to do with who's right or wrong, has nothing to do with the facts. Just forgive them and you would be amazed at how not only that is empowering for you, but how therapeutic that is for you as you move forward and try to make the world a better place. And basic principle number five that we've been talking about already everything is a relationship. Everything is a relationship. Today we talked about the caregiver-patient relationship, but my suggestion to you, whether it's doctor-patient, whether it's husband and wife, parent, child co-worker, co-worker, boss, employee relationships are based on the same thing mutual respect, mutual trust and good communication. If you have those three things, you have a strong and a viable relationship. If you do not, then you need to work on the areas of how, work on the areas that you can improve to get that relationship

23:12 to where it should be. Final thought be the change you want to see in the world. Be the change you want to see in the world. Have a great day. Speaker 1: Thanks for listening to the Healthy, wealthy and Wise podcast with Dr William Choctaw , mdjd. We hope you enjoyed this episode and, if you found it helpful, you can support and subscribe to the podcast on your favorite podcast platform. Look at the words, dr William Choctaw, click on the. Support the show and you've got it. This will also help ensure that you don't miss any future episodes, and then share this podcast with your family, friends and all your co-workers. They'll be glad you did So. Until the next time , live your best possible life the best possible way.