Bridging Gaps in the Healthcare System

In this lesson, we'll dive into how unconscious bias affects patient care, the importance of cultural awareness in healthcare, and how decentralizing healthcare can bridge these gaps. Why are there discrepancies and unconscious biases in healthcare? 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 healthcare system, we can improve upon that. We can bridge some of those gaps and those barriers that exist in terms of approaching all patients, right? All patients deserve optimal care. Patients need allies. Doctors who are allies with getting the information out, with looking at patients and not accepting the standard, because the standard is not based on us. Some of those decisions of should a patient get a transplant and should a patient not get a transplant is done at the primary hemoc doctors level, that they have a bias that that 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. And not offering transplant to everyone, and letting the transplant doctors help determine based on their criteria if a patient should be eligible. And 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 really examine is, you know, do I have a bias? And having an unconscious bias isn't a bad thing, but it does inhibit things. So people aren't bad people. They all went good. But sometimes an unconscious bias of what we've been taught in medical school, what society has taught us isn't necessarily right, and we need to overcome that. 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. Because of these barriers, there are certain treatments that patients of color aren't as likely to receive. Let's hear what Dr. Cole has to say about why this happens and the role culture plays. The healthcare industry, the healthcare, the clinics, and the hospitals are built on a cultural construct that is very European. And we, and all of us are bicultural. We have a hospital that's a European construct, and we go home and it's an African American, or it's a Latino culture, or it's an Asian culture that we have at home. And every time we go to the clinic, the unfortunate thing is that you have to end up leaving some of who you are behind to adapt to the culture of the hospital. colleagues, you really need to meet your patient halfway, at least, to understand and be curious about and ask about their home life, their culture, but what's happening at home? Who at home do you talk about this disease with? Who at home helps you make decisions? Who at home do you discuss having myeloma with? Have them come in and engage their culture, engage what's happening to them. One big problem that we have with the electronic medical record is that we don't get social histories. Back when I had hair, we would spend a lot of time, are you married? Are you single? Do you smoke? Do you drink? But we would ask, where do you live? What job do you have? Are you retired? We understood patients a bit more. When Allison met up at record, we just kind of gleam over that and I say, you got to be curious about your patients because A, it builds trust. It helps to meet them culturally and that changes the game because all of a sudden it goes from a doctor-patient relationship to two colleagues that are working together to try and treat and cure myeloma. An example is my grandmother was an LPN. She came from the South and when my grandfather got prostate cancer, she was diagnosed with colon cancer, but she was taught you have to take care of your husband before you take care of yourself. My grandmother was super smart. She completely understood the ramifications of that, but this is how her grandmother and her mother taught her. And so I think, and I think that if her doctor would have realized that, her doctor would have realized that there are cultural differences between different races and you can't force a, you can't force feed one culture onto another person's culture, that she would have seen that my grandmother isn't non-compliant. She has a different set of priorities than you have. So I think that what we need to do is to, as physicians, be conscious of that. Now that we've discussed some of the cultural differences that may come into play, let's get into decentralizing healthcare. Decentralization of healthcare uses technology to move some or all of patients' care to the community setting using the academic setting as a guide. How can healthcare decentralization help reduce disparities? 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 and 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 healthcare equity that much more possible. I want to say something that I think is very important too. And so I don't want to make it sound like it's so easy to have a myeloma specialist. You know, again, I'm in Philadelphia, and so there's a ton of places that you can go in Philadelphia. But, you know, I have a close friend who's in Idaho and there are no myeloma specialists there. And so, you know, the travel to see a myeloma specialist in person is a chore and it's very difficult. You know, fortunately, there's still telehealth, and so you can get consultations with myeloma specialists who can direct the care, you know, through a lot of times the local oncologists. And that's a very workable scenario. So I want to, you know, just make, you know, make that point because I think it's very important. I think it's very important for us, as a myeloma specialist, to say, oh, well, everyone should have a myeloma specialist when I'm sitting here and literally my doctor is, you know, on a good day. And if I wanted to challenge myself, I could walk to my treatment. You know, I know it's not that easy for everyone, but I think it is a prerequisite. With how fast the myeloma landscape is changing, it's important that you work with a specialist How else can gaps in health care be bridged? 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. If you know that there is, for example, the Myeloma Lymphoma Society or, you know, 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. How can policy changes at the national or institutional level help to reduce disparities in myeloma care? We do have some policy changes or some policy recommendations that are evident nationally and institution-wide that is evolving over time in terms of treating patients with multiple myeloma. One of those policy changes is through the FDA, where there is an increased amount of effort to, you know, change eligibility criteria of some of these clinical trials so that we can have a more wider population that's included in the clinical trials, such as looking at the kidney function and, you know, adjusting the estimated glomerular filtration rate, adjusting that parameter so that we may have a little bit more leniency in terms of getting patients enrolled in clinical trials. Another thing we sometimes see is the use of the absolute neutrophil count restricting the eligibility criteria, and that might prevent some myeloma patients from being eligible for the trial. So there's a lot of changes that are suggestive that we should make these edits to improve our inclusion of patients in clinical trials through this process. If your clinical trial is a large phase three study that is a nationwide study, then the of patients that are included in that trial should reflect what the national patient population looks like in terms of percentage. So a good example is for years we have seen that the Black American population included in clinical trials was about 5 to 7 percent. That is not reflective of the national population. And so those numbers need to be improved upon, and some of these parameter changes and eligibility criteria changes are to help with that process and improve those inclusion of these patient populations. Unconscious biases and cultural deficits can make it more difficult for patients of color to receive equitable care, and there's a lot that doctors can do to help to make treatment more accessible. You can learn more about this topic in the health equity lesson of this course. We'd like to thank our doctors, our sponsors, and of course our audience for making this video possible.