BETA - How can the healthcare provider and healthcare system help bridge the gap in myeloma care?

What is the role of a healthcare provider in helping to eliminate some of these disparities? I think one, there are lots of components to that. One is understanding their own unconscious bias. We know that people, that Black and Hispanics and Asians don't have access to stem cell transplant, which we know helps prolong the progression of free survival of patients with myeloma. Some of those decisions of should a patient get a transplant and should a patient not get a transplant is done at the primary hematologist level. They have a bias that says, oh, they're to this, they're to that, they're not healthy enough, they have to travel too far. Not saying, offering transplant to everyone in line with transplant doctors help determine based on their criteria if a patient should be eligible. That goes for clinical trials, that goes for different medications, that the unconscious bias plays a role, and that the healthcare provider needs to be aware of that and needs to really examine, do I have a bias? Having an unconscious bias isn't a bad thing, but it does inhibit things. People aren't bad people. They all went good, but sometimes an unconscious bias of what we've been taught in the medical school, what society has taught us, isn't necessarily right, and we need to overcome that. The second thing I always tell people, and tell our fellows, is being culturally competent. Culturally competent isn't so much being able to go to different communities and blend seamlessly, but is really understanding the culture that your patient brings. One thing that we do is that everyone is bicultural. They have the culture that they grew up with and live within, and then there is the medical culture. When patients come in to the clinic, they usually have to push down the culture that they grew up in and adapt to this medical culture, which can be very sterile and can be very uniform, and that we don't allow our patients to be their genuine selves. Cultural competency means that you understand where your patient is coming from, that if a patient is from this, an African American from the South, how important the mother and the grandmother is in the decision making for those groups, how important nurses are in Latinx communities, how important the tribe leaders are for Native American communities, and understanding those dynamics. And so, this is giving a really good social history, saying, you know, who else in your family do you talk to? And not just going medicine, medicine, medicine, but saying to your patient, tell me about yourself, and understand, being culturally competent to understand where your patient is coming from. And I think the other important thing is understanding some of the disparities in care, and knowing a community doctor to say, you know, maybe I should talk to a myeloma specialist. I don't see this disease all the time. Maybe I should ask for a second opinion. Maybe I should. That helps level the playing field, because while things are still very siloed in myeloma and centralized in myeloma, you can decentralize a lot of that care because of telehealth, because of phone calls. I love when providers call me and say, I have this patient with myeloma. Can you give me some advice on that? Love that. I love that. That and that phone call decentralizes care in medicine. That equals the playing field, because, you know, someone that calls me from the Upper Peninsula and says, what should I do with this patient? That brings the myeloma care that we have directly to their doorstep without the patient traveling four or five hours from the UP down to Michigan State. That brings it right there. And telehealth does that. And so I think to help seeing that things are so centralized in that providers can decentralize it themselves helps make health care equity that much more possible. There is a health care system barrier in terms of, you know, we have data that shows that there are certain providers, there's certain disconnect in terms of communication with providers and patients. And so there may be the more novel agents, the triple therapies, transplant is not, it doesn't seem to be offered as much or seem to be presented as much to African American patients as it is to other patients. And these are standard therapies. So clinical trials are not offered as much in a lot of spaces in the country. And so the question becomes, why is that? Why is there discrepancy? And I don't think there's one answer to that question. I think it is affected in different ways. But I think as a system, a health care system, we can bridge some of those gaps and those barriers that exist. And we can improve upon that in terms of approaching all patients. All patients deserve optimal care. So approaching all your patients in a similar fashion. Clinical trials are available. Let's talk about clinical trials. This is an incurable cancer. So why not discuss clinical trials with every patient that comes in, letting them know that This is a voluntary choice, but it is available and it is a choice you have in terms of your treatment. And then also letting patients know that costs should not be the top thing that's thought about when it comes to your health. And so let patients know that there are avenues to support some of these issues with costs. A lot of times I will see patients that don't know, they're like worried about the bills that may come on the back end. The reality is, yes, it's expensive. Health care across this country is expensive. However, if you know that there is, for example, the Myeloma Lymphoma Society or another society that you can apply to for a grant that will help to support some of these out of pocket costs, that alleviates some of the stress that you're having in terms of going forward with getting the care that you do need. But some of these things are information is not apparent and the awareness of these resources are not always apparent. So we can do better in those spaces.