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. Tamika Perry and award winning veteran broadcaster Ron Aaron will share information to improve your health and well-being. And now here are Ron Aaron and Dr. Tamika Perry.

RON AARON
Hello everybody, and welcome to the award winning Docs in a Pod. I'm Ron Aaron. Our podcast is available wherever you get your podcast. We're on the radio in a number of cities in Florida and Texas as well. We've got a great opportunity today because our guest is also our co-host, and it is a delight to welcome back again, pinch-hitting for Dr. Tamika Perry is Brooke Mobley. Dr. Mobley is the medical director of post-acute care for Optum and WellMed across the states of Florida. She earned her Doctor of Osteopathy degree from Philadelphia College of Osteopathic Medicine and a Master of Business Administration from Saint Joseph's Haub School of Business. She completed her internal medicine residency and chief fellowship at Christiana Care Health Services in Newark, Delaware. She's been with Legacy Dividend, Optum Florida and WellMed since 2013. She's an author, and wrote about her own personal experiences with domestic violence, and started the nonprofit Purple Tears. We'll be talking about all of that in an upcoming show right here on Docs in a Pod. First off, Dr. Mobley, thanks for being with us.

DR. BROOKE MOBLEY
No problem. Thank you very much. I always appreciate the opportunity to educate and to learn.

RON AARON
Well, we love having you on. You picked a great topic because as we celebrate Black History Month across this country, we still face incredible health care disparities for minority populations.

DR. BROOKE MOBLEY
We do. While this is Black History Month, I want to make sure that people know that when we talk about health care disparities, it doesn't just affect the major minority, which are African American people, but any minority group or organization. You could be a minority based on your religious beliefs in a particular area. You can be a minority based on your sexual preference. You can be a minority based on your race. Hispanic, Native American. So, health care disparities affect anybody who is outnumbered by the majority population, be it race, sex, religious beliefs, things of that nature. ItÕs important that we discuss all of it in its totality in order for us to truly make a change.

RON AARON
Now, when you say health care disparities, are you talking about both access and quality of care?

DR. BROOKE MOBLEY
Access, quality of care, research and development for medications and treatment options, especially in things like cancer. There's health care disparities and diagnosis. Studies have shown that minority racial groups, African American, Hispanic and Latino are less likely to be diagnosed with mental health issues. Unfortunately, that truly impacts the community because a lot of times there are certain crimes that are committed and it's based on people's undiagnosed and untreated mental health issues. And if they're not being diagnosed and treated, it also causes for there to be an increase of that particular race in jails and prisons because they're not being properly diagnosed. They're not being properly treated. They're unfortunately having different mental health breakdowns causing them to do illegal things, which causes for them to be incarcerated.

RON AARON
Wow. There's an amazing statistic in the city of San Antonio. It looks at a division between the city north and south. Those living south of a street called Hildebrand will live 20 years less than people living north. And the majority population in the south is Latino. When you look at that, that's just an amazing statistic. You will live 20 years less than mostly Anglos living north.

DR. BROOKE MOBLEY
Yep. There's no research to say that these minority races are genetically inefficient. So, you would think if an entire race or group of people have a lower mortality rate, have higher incidence of certain cancers and chronic conditions, that there should be some research to show that there is something going on in their genetic uptake, chromosomes that would make them genetically defunct. But the truth is they're not finding that. And they're not finding that because the reasons why we have increased mortality or less diagnosis and less treatment is because unfortunately as a whole, there are certain populations who don't get treated the same. They don't get the same access to certain diagnostic models and treatment models, and they are unfortunately unable to pay for or properly be insured in order to truly take care of their chronic conditions, fatal conditions like different cancers or even diagnostic things to prevent things like breast cancer or colon cancer, or making sure that those things are addressed earlier rather than later.

RON AARON
We'll pick up the conversation in a moment, but I want to let folks know who may have just joined us, you're listening to the award winning Docs and a Pod. Our podcast is available wherever you get your podcast. I'm Ron Aaron, along with our co-host and guest today, Dr. Brooke Mobley. She is an osteopath medical director for the post acute care for Florida and across that state for Optum and WellMed. So, Dr. Mobley, is this disparity intentional? How does it happen?

DR. BROOKE MOBLEY
I would like to believe that the foundation of it was not intentional, but unfortunately, it was. Feeling of a certain race being superior than someone else is, unfortunately, how those things happen. The culture of coming out of something like slavery or being immigrants from another country, not necessarily being looked at as equal people in the human race causes for people to be paid less. For people not to have the same opportunities when it came to education, when it came to certain jobs, when it came to different resources, grants, financial aid, things of that nature. Unfortunately, the foundation of it was racism. Because of it, it causes for certain populations to be years behind other populations when it comes to education, finances, how they're paid, how they're looked at, respected or listened to. It's unfortunate because it started off as something based on racism, which then causes for financial disparities. But studies have shown that we've gone beyond financial disparities. The African American woman, despite insurance, despite class, despite education, despite wealthiness, are more likely to die from birth than any other population in this country.

RON AARON
Wow.

DR. BROOKE MOBLEY
Serena Williams, who is one of the most famous, wealthiest people known to mankind.

RON AARON
Incredible tennis star.

DR. BROOKE MOBLEY
Absolutely. Known all across the world, just not the United States, almost lost her life giving birth to her first child because clinical staff was not listening to when she said she had pain. They did not take it seriously. They did not do a very thorough investigation and diagnosis as to why she had pain, and she almost lost her life giving birth to her first child.

RON AARON
What was happening physically?

DR. BROOKE MOBLEY
She was having blood clots.

RON AARON
Wow.

DR. BROOKE MOBLEY
This is across the board for African American women regardless of their education, their insurance access, how much money they make, how many degrees do they have, and this is a problem. It was one of the major topics that were discussed in our last administration from Vice President Kamala Harris. She had a whole task force. Because of it, they created a month for education on maternal fetal concerns, especially in minority populations.

RON AARON
I don't want to turn this into a political show, but we're living in a time when we are, pardon the term, whitewashing differences between races and trying to eliminate national discussions about exactly what you and I are talking about. That has to have a deleterious effect on fixing the problem.

DR. BROOKE MOBLEY
It's going to have a deleterious effect on recognizing and acknowledging the problem, because when we pretend as if it doesn't exist, it can easily be brushed over. So, removing some of the things that were put in place to try to combat as much as possible these disparities, removing these programs are basically telling us that these problems no longer exist, despite statistics telling us otherwise. It is going to cause a further disparity for a lot of different people. It's not just about race, and as an African-American person, I would love for the focus to be only on my people, but it's not. We talk about sexual preference and the fact that our country has been very open and has been very accepting of people identifying into many different things and being allowed the same resources as any other partnership, whether it be a man and a woman, or a woman who identifies as a man and a woman who would prefer to be with the woman. Regardless of what that partnership is, they have been able to have the same resources. Getting married, being able to be dependents on insurance, being able to be beneficiary on different disability insurance claims. And they're taking that away from some of these populations by limiting what people can identify as. Limiting them to, if you were born a man, then you can only identify as a man. If you were born a woman, you can only identify as a woman. And they are going to take away being able to acknowledge any other thing outside of male and female and being birthed into what we call those particular sexes.

RON AARON
You spend a lot of time thinking about, talking about, and writing about these issues. How do we fix it?

DR. BROOKE MOBLEY
First, we have to acknowledge and accept that disparities are based on racism, sexism, and classism. Until we truly are honest with ourselves about that being the basis of the problem, we can never solve the problem. So many times, we want to be so politically correct and pretend as if because things may be better than 40 years ago, that the things no longer exist. So, acknowledgment is going to be the first thing. Education is going to be the second thing. As much as people don't recognize it, minorities can't fix the problem for minorities because we are a minority. We have to have advocates from the majority populations to truly make a change to accept and to give resources to help combat and decrease the chances of any kind of disparities. Health care, class, financial resources. In order to truly improve on those things, we have to first acknowledge, we have to then educate and then we have to have advocacy from our majority advocates and allies.

RON AARON
All right, stick with me and let's turn to the medical side in just a moment. What can and should the patient do if they happen to be a minority, to get not only equal access, but the same kind of treatment that ought to be given to everybody? We'll talk about that in a moment. For those of you who are listening to us, this is Docs in a Pod. I'm Ron Aaron, along with our special guest and co-host, Dr. Brooke Mobley. Thank you for being with us on the award winning Docs in a Pod.

AD
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RON AARON
Thank you so much for sticking with us right here on the award winning Docs in a Pod. I'm Ron Aaron, along with our very special guest and co-host, Dr. Brooke Mobley. Dr. Mobley is the medical director of post-acute care for Optum and WellMed in Florida. She earned her Doctor of Osteopathy degree from Philadelphia College of Osteopathic Medicine and is an author and distinguished writer. We will talk more about that on an upcoming show right here on Docs in a Pod. Meanwhile, we are talking about health care disparities. And this being Black History Month, we're trying to focus on what that means and what can be done really to protect individuals. So, Dr. Mobley, understanding this, what should the individual do as a patient or is an advocate for that patient when they seek and access medical care?

DR. BROOKE MOBLEY
I'll tell you studies have shown that Asian American people live longer when their physicians are Asian American. African American patients live longer when their clinical provider is African American. As much as integration is important, there are certain cultural trusts that are hard to break through based on historical traumas that a lot of minority populations have. So, first and foremost, if you can find a provider who looks like you, who has a similar background from you, or comes from a similar area than you do, that's going to be the first thing and that's going to take research. And it's not possible for everybody. The same way there are health care disparities, there are disparities in clinicians who are minority. While African American people make up 12 to 14% of the population, depending on what census you're looking at, we only make up 2 to 4% of health care providers. And when I say health care providers, I don't just mean physicians. I mean nurses and nurse practitioners, CNAs, MAs. So, the population who are actually physicians is even smaller. And you look at the population who are women is even smaller than that. So, trying to find someone who looks like you and who can understand you may not be feasible for everybody. If you have to go to a physician who you may not be able to relate to on a personal basis, the first thing you need to do is be honest. A lot of times we don't trust people who don't look like us, so we may not be as honest as we would have been if it was somebody who we knew understood us. Whether it is our diet or taking our medications regularly, it's going to be important that the clinical provider can present the information in a way that the patient can understand. All medical literature needs to be at a fourth grade reading level or less. If it is an area that is highly populated by a different language, resources should be available for translators and for fliers in the majority language in that community, and it's going to be important for the clinical provider to do their research as well. If you are somebody not from an urban community and you want to be a physician in an urban community, it's going to be important that you go into that community. You find out what resources they have. You can tell somebody until you're blue in the face that you want them to eat healthy and have fresh vegetables, but if you haven't walked around that neighborhood and understood, it's what we call it a food desert, meaning they could be 20 to 30 miles away from a grocery store where they can get fresh vegetables, you are requiring them to do something that is not feasible for them. Because a lot of times they don't have cars and carrying large grocery bags on public transportation 20 to 30 miles is not feasible. So, it takes effort on both sides. The patient has to be an advocate for themselves and research and find providers who they feel the most comfortable with. They have to be honest with the providers as far as what they're doing at home, what symptoms they have, their compliance with their medication.

RON AARON
That's interesting when you're talking about access to food. I have a friend who is a pediatrician in a rather low-income neighborhood in San Antonio, and he was doing what you're saying. Talking to the moms and dads. You've got to give your kids a balanced diet. They need fruits and vegetables. And finally, one of the patients said, hey, doctor, you can't get that here. What do you think he did? He opened a food bank in his own office and made fresh fruits and vegetables available for his patients.

DR. BROOKE MOBLEY
That's what we call an advocate. More people need to be like that. You don't have to go through certain traumas to understand that it's not fair, or that it's detrimental to somebody who looks different than you do. That's why clinical providers need to listen. Don't assume you know why someone is not doing something. Don't assume one population is less compliant because they don't care. You truly have to find out what's the basis behind some of the behaviors people perceive as negative when it comes to their own health care. You have to be open to understanding that someone else's reality may not be your own, and you have to be willing to adjust how you speak to someone, the actions you ask for them to take, and the particular medications you prescribe because you can have an amazing prescription but if someone can't afford it, they'll never take it. You can have the best pill in the world. It could cure everything. But if you don't know how to explain to people how to take it, it is useless. So, it's important to have the education and the understanding, and then have the opportunity to give everybody the same effort, we would truly see a difference in disparities across the board.

RON AARON
When you mentioned health literacy, there are courses that are offered for medical providers, and there was an example, again, in this local community of a mom who had a prescription for her daughter that prescribed the pill once a day. She read it as ÒonceÓ (ohn-say) and literally killed her kid by giving him the medication 11 times a day.

DR. BROOKE MOBLEY
That's horrible. As a nephrologist, I had a patient who had a horrible reputation for being non-compliant until we did research to find out they were illiterate. So, they did not understand the words that were on their medication pills in order for them to take it. And once we realized that they were illiterate, we would have them bring the entire month's supply of prescriptions. We provided them with the trays that divvied up day night, day night. We would have four of them because they were in week a week period, and we would divvy out the medication for the patient. Day night, day night. Instead of the word being day, we would make a sun as they understood that picture. For the night, we made a moon. So, we're not using any words at all. Then you go over and you teach them what each color pill is verbally so that they understand what they're taking and why they're taking it in a way that they understand the communication.

RON AARON
What's interesting is some folks who are illiterate or who speak a language, not English, become active listeners. You think they know what you're saying, where you will talk with them, and they'll shake their head and smile and yes, and they may have no idea what's been said or what's been handed to them on a written piece of paper. As a provider, how do you get behind that? How do you realize in that case of that patient that they were illiterate? How did you get there?

DR. BROOKE MOBLEY
Any time you do any instruction to a patient; I don't care if they are a Doctor of Education or someone who you don't know if they went to the eighth grade, I treat them all the same and I talk to them all the same. If someone thinks I am speaking to immature leads to them, they have the right to say, hey, I'm a physician too. You can talk to me in clinical terms, and then I change my approach. But I start off talking to everybody the same level, and I require that they paraphrase what I just said back to me so that I know that they understand.

RON AARON
It's very important.

DR. BROOKE MOBLEY
If they cannot paraphrase what you said, then they didn't understand it. And now that's the time they have a true conversation as to why don't you understand it? If someone trusts you, they will say, my English is too small. I don't know enough of it. Then you know, hey, it's time for me to get a translator. They may say I can't read, or I don't know a lot of these words. Then you know that literacy is an issue. There are times when you have people who have hearing problems, and you don't know for a long time because they've learned to mask it. Sometimes just having these conversations or making people paraphrase Betsy, you can find out if somebody has been having hearing issues and may have just been uncomfortable with telling somebody that they just can't hear. It's important to know if somebody understands, and the only way you truly know if they understand is having them paraphrase what you explained or what you have shown them on a piece of paper. If you show them a piece of paper and say, hey, read that. Just tell me, what did you get out of that? What did you understand from that? You know whether or not they read it or not. You know whether they understood your instructions or not.

RON AARON
We have less than a minute left before I let you go. How optimistic or pessimistic are you about addressing health disparities?

DR. BROOKE MOBLEY
I'm optimistic from a humanity standpoint and that there are a lot of people like myself, like you, like your colleague who was a pediatrician who knows the importance of acknowledging differences and making up for the disparity. I don't necessarily have that same optimism for our government.

RON AARON
We'll leave it there. Thank you so much. Appreciate you being here both as guest and our co-host today, Dr. Brooke Mobley. I'm Ron Aaron. Thank you so much for joining us today on the award winning Docs in a Pod.

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