Podcast transcript

INTRO
Welcome to Docs in a Pod, presented by WellMed. Over the next half-hour, Docs in a Pod will educate you about the health and wellness of adults everywhere. Co-hosts Dr. Rajay Seudath and former television broadcaster Gina Galaviz will share information to improve your health and well-being. And now here are Gina Galaviz and Dr. Rajay Seudath.

GINA GALAVIZ EISENBERG
Welcome to the award winning Docs in a Pod presented by WellMed. I'm your host, Gina Galaviz Eisenberg. Ron Aaron is on special assignment, and I'm so pleased to have you with us. Our program is available on podcast wherever you get your podcasts. We're also on the radio in several cities in Texas and Florida. Each week, as you probably already know, we talk about a variety of health and wellness issues that impact Medicare eligible seniors and many others. Our Docs in a Pod co-host is Dr. Rajay Seudath. Welcome, welcome. How are you today?

DR. RAJAY SEUDATH
Thank you so much. I'm doing great. Thank you so much for having me again.

GINA GALAVIZ EISENBERG
Well, I just want to toot your horn before we start this wonderful conversation today. You're a board certified family medicine physician, a Tampa native, and currently a physician for Optum, and you're at the university location in Tampa. You received your medical degree from the University of South Florida Morsani College of Medicine, and you have a passion for primary care and guiding your patients to meet their health care goals while maintaining their values. Dr. Seudath, you really do enjoy educating patients and caregivers, and I know that just by how we have these conversations, because I feel like you've been educating me all along on this journey, our radio journey. Today we're going to talk about education. Health equity and education. Teaching our elders about wellness early and why that's important. Our special guest today is Kristel Fernandez-Lopez. Dr. Lopez is a dedicated and compassionate physician at WellMed at San Benito. For those of you who are not familiar with Texas, that's on the border. She earned her medical degree from the Universidad de Tamaulipas in Tampico, MŽxico, where she developed a strong foundation in medicine and a passion for improving community health. The patients in RGV are just so warm and loving. I just love the culture. What's it like practicing medicine down there?

DR. KRISTEL FERNANDEZ-LOPEZ
It is awesome. Hello, everyone. I'm glad to be here. Thank you for the invitation. Working here really means a lot to me. I did my residency at UT Galveston internal medicine, and I did a conjoint program of community medicine. So really, it comes down to practicing all that I learned for those three years. Be close to the community. I think the topic that we're going to discuss today is really important. Of course, talking about education, which is what primary care physicians, what we do every day. We sometimes do not take into account the importance of how you have these conversations with patients and the fact that they listen to you and that you are a cornerstone part of their health. It's a lot of responsibility. But also, you see how they respond.

GINA GALAVIZ EISENBERG
How do you do that? How do you say, okay, I'm going to teach you about what you're going through. Here's how we either manage it or we cure it. And is it just with the patient? Do you use the whole family? Are they all involved in this?

DR. KRISTEL FERNANDEZ-LOPEZ
Yeah. Talking about education in the elderly and health equity, wellness overall. I'm very much into definitions. What is wellness? The state of quality of an excellent health. And sometimes simple changes, and that's what I try to communicate and tell my patients every time. We discuss a lot, and what I like to talk about is SMART goals. Even coming from your smoker, diet or exercise. I focus on little, small changes that are achievable by them. Of course, we also have to look at the resources that patients have. Some of them, they do not have all the resources at hand. Let's say a patient that has Alzheimer's dementia, of course, we're going to bring in a family member as well. If I have a conversation with this patient, it's going to be very different from a patient that does not have dementia. Of course, the conversation is going to be very different. So, we have to look at the background of our patients and individualize the care. So, health disparities, socioeconomic status, race and ethnicity, gender, geography, age and disability. Based on that, I focus on those goals for each patient.

GINA GALAVIZ EISENBERG
Dr. Seudath, it's similar when you have patients come in as well. Education is the key.

DR. RAJAY SEUDATH
Absolutely. I think she touched on so many important pieces. If your patient, you will be better equipped to guide them to the correct information that's for their disease processes.

GINA GALAVIZ EISENBERG
Before we continue, I just want to welcome folks who are just now tuning in, you're listening to the award winning Docs in a Pod with our co-host, Dr. Rajay Seudath. I'm Gina Galaviz Eisenberg, and our podcast is available wherever you get your podcasts. Our guest today is Dr. Fernandez-Lopez. We're talking about health equity in education, teaching elders about wellness early and why it's so important. Yeah. Dr. Seudath, when a patient comes in, maybe they're a brand-new patient, right? And they don't understand maybe while they're there or they're just coming for a checkup.

DR. KRISTEL FERNANDEZ-LOPEZ
Right. Oftentimes, I have patients who are over 65. Typically, they're coming with diseases. ThereÕs a Covey's Seven Habits of Highly Efficient People. Seek first to understand before you understand. So, oftentimes I try to say, okay I see you're on these medicines here. Do you have diabetes? Yeah. Tell me what about diabetes. Tell me what about your disease. That's a good way to get started to see where they are at in their level of the they are health care literacy. What's their level of knowledge? What's their level of control? And I think that's a good way to start it. And then from there, whatever foundation they've got, we can build up from there.

GINA GALAVIZ EISENBERG
Do you find that most of the patients that are coming in RGV maybe didn't have medical insurance while they were younger, but now that they're 65 and now they're coming to a doctor more so, what were the obstacles to working in underserved communitiesÕ health insurance?

DR. KRISTEL FERNANDEZ-LOPEZ
I think yes, definitely. I'm glad you brought that question up because during my residency program, they implemented and started teaching residents way more about social determinants of health. We are familiar with this term, the non-medical factors that influence a person's health and well-being. Of course, once patients reach that, there are so many tools in their backpack that maybe they do not have. If we make a study, we choose different patients from the Valley based on their education, social and community context, health care access and quality. It's different. For the most part, when they come as new patients, maybe they have had another appointment before with a physician but as you are saying, as you guys are mentioning, inside of their disease is huge. The cultural context of the disease as well. All that they have learned over the past or things that they do not know. So, it's our job to really try to find out if a patient is non-compliant. Why is a patient non-compliant? How much of their disease do they understand? Do they know about the risks? Have we discussed in a smoker for example. Why is it that you smoke? Is there a specific reason maybe there's a baseline anxiety going on? We haven't diagnosed and this patient has been doing it for so long and nobody ever told them. I'm talking about habits. Basic things like diet. Not even going through the medications. When you sit with them, and you discuss the medications do your list? Well, no. You should have it in the computer. I always tell them it's very important that you bring your list, that you are aware of the medications that you are taking. Mistakes can happen, but you need to be very well-educated about what medications you are taking and why. So, the insight that a patient has about their diseases, it is very well related to how compliant they are going to be.

GINA GALAVIZ EISENBERG
Exactly. The point you're bringing up wellness and the whole definition. I mean, it's not just access to care. Access to ensure access to transportation, access to housing, access to food. Do they even know what a healthy diet is? And do they have access to a grocery store? Some underserved communities, it's maybe 10 miles away. You can't walk there. Or you could but it would take you a while and you wouldn't do it because it's so long, right?

DR. KRISTEL FERNANDEZ-LOPEZ
And we do have those in the valley where patients do not have access to the resources that you may have in a different city or in a different place.

DR. RAJAY SEUDATH
]Understanding that with your patient is one of the things that we try to do. A person maybe in what's called a nutritional desert. Well, I think you really need to cut back on carbs. Well, doc, right now, with the money I have, all I can afford is ramen noodles. But that's a bunch of carbs, right?

GINA GALAVIZ EISENBERG
And sodium.

DR. RAJAY SEUDATH
Right, and sodium. So, how can we leverage where you can go? How far is Save a Lot? How far are farmer's markets? The $5 you're spending for four packages of ramen, how much cabbage can that buy you? How many tomatoes can you get? Can you get them on a sale price? Can you get them on half the price? How are you cooking those? Sometimes you have to be a little more understanding. Sometimes you have to wear more than just your physician hat or your nurse practitioner hat or your health care hat. Sometimes you've got to wear your chef's hat. How exactly are you making your food? Well, I just put it in the microwave and whateverÕs in the freezer section, that's what I eat. Okay, that's a problem because freezer section food is actually a little more expensive than fresh food. Sometimes, if you're going to a farmer's market, if you're going to someplace where you can get more for your dollar, and you put in the effort to cook it, I don't know how to cook, doc. Well, that's something we can work on. I see you watching YouTube on your phone in the lobby. Maybe instead of the NCAA playoffs, you can watch a couple of cooking shows on that. Oh, that's a good point. So, sometimes we have to kind of look at the whole person in order to improve their wellness. In order to improve their health care literacy.

GINA GALAVIZ EISENBERG
I guess also directing them to classes. Maybe there's cooking classes. I know a lot of communities, besides a farmer's market, actually have some of those. We're going to talk more about this topic in just a minute. We're going to take a short break. I'm Gina Galaviz Eisenberg along with Dr. Rajay Seudath. Don't go away. We'll be right back.

AD
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GINA GALAVIZ EISENBERG
Thanks so much for staying with us on the award winning Docs in a Pod. Our podcast is available wherever you get your podcasts. I'm Gina Galaviz Eisenberg. Back to our elders and their well-being. Dr. Fernandez, one thing that came to mind when you're talking about education, it's diabetes. So many folks will go in and say, well, I was going to get it eventually because everybody has it. But that doesn't have to be the case.

DR. KRISTEL FERNANDEZ-LOPEZ
Exactly. Genetics play a huge role in diabetes. We know it. Even when it is associated with other diseases, we know a patient with diabetes and an infection doesn't have the same prognosis, meaning the results that a patient that does not have diabetes. All the complications that are around that diabetes, I think we need to work more in how we discuss diet, exercise and adherence to medication with our patients. Education is a huge part. It's funny that you brought that up. I just finished an encounter with a patient, and we were going through his medications. He is compliant. I changed my diet, doc. I promise I'm not eating carbs as I used to. I'm cutting sugars. Tell me, what do you eat in a day? Just tell me in a day. Your diet. Tell me, what do you have for breakfast, lunch and dinner? Well, it ends up that he was drinking five sugar beverages a day. So, of course, that changes everything. You're doing the right thing, but it's not healthy. ItÕs not something that you want to do. Even if you think about fruits and vegetables, there's a list of fruits that contain a lot of sugar.

GINA GALAVIZ EISENBERG
Right.

DR. KRISTEL FERNANDEZ-LOPEZ
It's probably not the best food of the day if you have already finished a good meal, and then on top of that, you eat a banana. So, I feel that we are lucky because here at WellMed, we do have dieticians, and they have diabetes educators. We do have classes in English and Spanish. They come every Thursday. and they see a group of patients and they give them classes. Because sometimes, I understand we do not have the time to go into detail about the diet that the patient needs to follow. And when I say diet it's the meals that they have.

GINA GALAVIZ EISENBERG
Not to lose weight, but this is the diet. This is what you should be putting in your body.

DR. KRISTEL FERNANDEZ-LOPEZ
Exactly.

GINA GALAVIZ EISENBERG
I always say you wouldn't be putting sugar into your vehicle because that's just going to destroy it. But you can always get a new engine. You can't really replace what's inside you. A little more difficult. A lot more difficult. How do they react? How are the classes? Are people coming? Is it catching on?

DR. KRISTEL FERNANDEZ-LOPEZ
We do have a good response. Imelda, who who helps us here in the Valley, at least in San Benito, she's really good at giving them resources as well. It's not only about diabetes. It's also for obesity. As you guys were mentioning, sometimes what we have available, it's probably not what we decide. More if there's a patient that's homeless or whatnot. But as I tell them, it always comes down to the decisions that you make. Maybe you can start by choosing a different food that what you're eating currently. Or maybe you can choose to avoid some other foods or replace them.

GINA GALAVIZ EISENBERG
I think people think when they hear the word diet, they're like, I want to lose weight so I can look better. Maybe think differently and say, it's going to extend my life. I'm going to be able to breathe and that could affect my breath. My breathing can affect my heart and so on and so forth. It's difficult. I mean, I know. You want to go out to eat with your family every day, right? And you just canÕt.

DR. RAJAY SEUDATH
Yes.

DR. KRISTEL FERNANDEZ-LOPEZ
Right.

DR. RAJAYSEUDATH
One of the things when it comes to wellness, when it comes to health care literacy, specifically for diabetes, for diet, for any of the diseases where we're trying to make a change in the way a person is eating or behaving, is sometimes you tie that back to, what are your goals? Are your goals that you want to keep being active? Would you want to see your granddaughter get married or graduate from high school? Tell me the things that you want to do. What do you what's your goal five years from now? What would you like to be able to do in five years that you can't do now? And after you hear that and patients listen to you and you listen to them, they're far more receptive to whatever you're going to say after that. That's kind of the why. If I can get to the why. If I get to, why do you want to do something, or they get to why do I want them to do something, they're almost always better prepared to listen to the information I have. We usually talk what, how and we rarely talk about the why. But if I start with the why, I really feel like I want to protect you. I see that you said your dad lost his foot to diabetes and that you've got fungus on your toes. I really want to protect your feet, and I want you to be able to walk and be as healthy as possible. How can we do that? We can do that by making sure we're taking your medicines and making sure we're cutting back on carbs. What do I want you to do? I want you to stop eating four bowls of rice in the day. When you hear that progression, they're usually a little bit better. Okay, I can eat more beans instead of rice. I can cut back on the pineapple. I'll have some more peaches, those kinds of things.

DR. KRISTEL FERNANDEZ-LOPEZ
Motivation is a huge part. As you you're mentioning, if they have a family member or a friend that has a complication secondary to diabetes, they are more likely to have that insight. What I always try to do is follow up. The follow-up is so important. If I start discussing and we sat together and we had a SMART goal, again, something specific, measurable, achievable, relevant and time based, and I tell you, okay, next time we need to make sure you lose three pounds. That's the goal. That's something measurable. We're going to change the diet. We're going to talk about this and that. We're going to start walking 30 minutes at least three times per day. Then, when I see you in our three-month follow up for diabetes, we need to see a change in the hemoglobin A1C. I educate them a little bit more about what is A1C. It is your average in the blood of your sugars for three months. Some wording that they understand. Then we can start setting our goals. Same thing for patients that smoke, patients that drink alcohol, patients that have a sedentary life. SMART goals. Something achievable that they can follow up. When they succeed, of course they feel good, and we need to praise them. They also find that encouraging and that helps them to continue investing on their health.

GINA GALAVIZ EISENBERG
One thing that was interesting to me. I have three children, a 13-year-old and 11-year-old twins, and a therapist was talking to the PTO about when you celebrate, change on what you're using, your children are watching. So, instead of having your Margarita Friday and margaritas and all this, change it out. Do something nonalcoholic. Something that's not high in calories. The kids will learn. They will pick up on that. I remember one time sitting talking to my doctor and he's like, you got to do this, this and this, and this was 100 pounds ago. Now I'm where I'm supposed to be, so I can't wait to see him to show him. But it's overwhelming. It's overwhelming because you're like, I don't know what to do. Even though you have classes. So, what do you suggest to your patients? Ask us. We will point you in the right direction. I mean, they can do that, right? Please help. I need help on exercise and how to cook better. I know how to cook, but I need to know how to cook better for my family. They can do that, right? I guess you encourage, please ask for help.

DR. KRISTEL FERNANDEZ-LOPEZ
Of course. At the end of the encounter, I always ask them, is there anything, is there any question, anything that we can help you with? But I strongly recommend to patients to ask your doctors about health-related questions and education and resources. It's hard. I understand. Sometimes we feel like it's something that everybody talks about, but the how, right? Just as I mentioned, how we deploy that information. How do we communicate?

GINA GALAVIZ EISENBERG
I think we body shame ourselves or we're embarrassed. I think that's one of the barriers. It's like we should know better. But it's hard, and it's okay to ask for help.

DR. RAJAY SEUDATH
Yeah. I think, when it comes to wellness eating, sometimes it's nice to do it as a group. People get together. You're having your Sunday lunch. Sometimes starting a conversation with people, even if you're not in the clinical setting talking about that, having wellness as part of your regular conversations is another thing that you can encourage people to do and have as part of their life.

GINA GALAVIZ EISENBERG
We're running out of time. Dr. Fernandez-Lopez, what advice do you give to patients listening right now about education and their health?

DR. KRISTEL FERNANDEZ-LOPEZ
Start today. It's never late. I have my 90-year-old patients that we still discuss this. Education is for everybody. And it starts with having that insight and setting one goal a day. One goal that you're going to work with the whole month. So, do not hesitate to ask your physician about wellness and what can you do to improve. Call it exercise or diet or changes in your medications, or maybe something more specific. But start with an inquiry and you'll be surprised of all the information that it's nowadays available for us and the resources that we have.

GINA GALAVIZ EISENBERG
That's great advice. You guys are our friends, so don't be embarrassed to ask for help. Well, thanks for everyone joining in and listening to us today on the award winning Docs in a Pod. I'm Gina Galaviz Eisenberg, along with Dr. Rajay Seudath. Thank you so much to our special guest, Dr. Fernandez-Lopez. In the words of the late Charles Osgood, I'll see you on the radio.

OUTRO
Executive producer for Docs in a Pod is Dan Calderon. The producer is Cherese Pendleton. Thank you for listening to Doc's in a pod presented by WellMed. Be sure and listen next week to Docs in a Pod presented by WellMed.

DISCLAIMER
This transcript is generated using a podcast editing tool; there may be small differences between this transcript and the recorded audio content.

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