46 – Insights Into Health Equity with Dr. Medell Briggs-Malonson

Vic: [00:00:00] Thanks everyone for joining Health Further. We have today. Madele Briggs Malanson to talk to us about health equity. Madele, thanks for doing this. We really appreciate it.

Dr. Medell Briggs-Malonson: Well, thank you so much for inviting me today.

Vic: So as you know, we talked about before the show, I’m really trying to, uh, learn myself about health equity.

Vic: What does it mean? How does it fit into our healthcare system? How can we bring better, more innovative solutions? As a part of health equity, and we are doing guest shows like this with real experts in the field, which you certainly are so can you give the audience just a little bit of your background, where you practice now and what you’ve been involved, especially as it relates to health equity.

Dr. Medell Briggs-Malonson: Absolutely. So, um, my journey and my career in health equity [00:01:00] runs over decades. And so currently I am the chief for health equity, diversity, inclusion for UCLA health. Um, in that position, I am responsible for all health services. system wide initiatives to promote overall equity and justice for our workforce, our patients and our community.

Dr. Medell Briggs-Malonson: Um, in addition to that, I’m an associate professor of emergency medicine, so I still practice in the E. R. Every Friday, um, in order to see patients and then plus, of course, continue to serve. So those are my two primary roles at U. C. L. A. Health. However, I’m also one of the leads of health equity for the University of California Health System.

Dr. Medell Briggs-Malonson: Um, do a lot of various things, such as Different things in technology. And currently I serve as the co chair for HITAC, um, through ONC.

Vic: Oh, wow. Okay. So you have, uh, around UCLA city ish, statewide and then federal.

Dr. Medell Briggs-Malonson: I feel that if we’re really going to make sure that we’re promoting health equity and justice, we need to make sure that we’re doing it at every single level.

Vic: Yeah, yeah, [00:02:00] definitely. Um, okay. Let, let me, um, I want to get a little bit of your personal experience. So. What brought you to medicine and then particularly, how did you start getting really passionate about health equity as a part of your practice?

Dr. Medell Briggs-Malonson: That’s a great question. So I’m incredibly just privileged and grateful to be born into the family that I was born into.

Dr. Medell Briggs-Malonson: So my parents are both educators. Um, they grew up in the Jim Crow South, and so that was back in the time, and what’s there was whites only and blacks only. So they grew up in a very segregated area, um, but they have always been just incredibly brilliant people. And they always instilled in me of number one, they’re smart.

Dr. Medell Briggs-Malonson: You are no better than anyone else and no one else is better than you. And that also with any type of success or responsibility that you achieve, it is your responsibility to give back to others. And so the blessings that we receive, we have to make sure that we provide those blessings to other [00:03:00] people as well as to uplift our community in particular.

Dr. Medell Briggs-Malonson: So given who they were, um, and All that they kind of instilled in myself, as well as in my brother, um, social justice has always been at the core of who I am. And I really didn’t realize that not everyone had access to healthcare until I was in about high school. So again, since my parents were educators as well as administrators, if I was sick, I would just go to the doctor.

Dr. Medell Briggs-Malonson: It was not a big deal whatsoever. Um, and so that was, again, part of my privilege, um, due to the fact of where I was raised and who I was raised by. But once I got into high school, of course, with me having friends of all different backgrounds, Um, I had a, one of my good friends at that time, she wasn’t feeling well.

Dr. Medell Briggs-Malonson: And I was like, well, why don’t you just go to the doctor if you’re not feeling well? Right. And she looked at me like I had five heads, and she was like, well, if I try to go to the doctor, we have to get there at eight o’clock in the morning. Then we have to wait for a doctor to even be available. My mom’s going to have to take off [00:04:00] of work.

Dr. Medell Briggs-Malonson: And it’s just not that easy for us. Yeah,

Vic: right.

Dr. Medell Briggs-Malonson: And that, for me, opened my eyes because it never occurred to me that everyone just doesn’t have direct access to go see a physician. And now this is, as you know, many decades ago, I won’t, I won’t date myself, but we still have the same issues. Um, and even though we have things such as healthcare insurance now with a lot of the various different federal legislation that passed, that does not necessarily equate to true access, um, to not only physicians, but other healthcare services.

Dr. Medell Briggs-Malonson: So as I continued in my own kind of individual journey as. Especially through college here at UCLA and just seeing the levels of inequities between communities and between people. And

Vic: it could be blocks away from each other, like right next door.

Dr. Medell Briggs-Malonson: I mean, literally across the street, truly. Um, and it was just like, this is unacceptable.

Dr. Medell Briggs-Malonson: Like, why, why would one group of people have something and another group does not? And so that actually then started to bubble up the whole idea of not [00:05:00] only social justice, but what can I actually do with. In health in order to promote just greater outcomes, greater access for everyone. So my interest in medicine started when I was very, very young.

Dr. Medell Briggs-Malonson: Um, in fact, the very first time I even thought about being a doctor was when I was five years old.

Vic: Oh, wow. Yeah. So

Dr. Medell Briggs-Malonson: I am the first doctor in my family and unfortunately still the only doctor, so I’m trying to get more of the next generation, but I have. I’ve had a lot of nurses in my family. And I’ll never forget when I was five years old, I was actually at my aunt’s house.

Dr. Medell Briggs-Malonson: And of course she had her stethoscope. I put her stethoscope in my ears and was just starting to listen to my heart. And she came over to me and she said, Hey baby, do you want to be a doctor? And I was like, Oh, I don’t know. I was like, sure. That sounds like a fantastic. thing to do when I grow up. But what I so appreciate my aunt in doing is that she didn’t say, do you want to be a nurse?

Vic: Yeah.

Dr. Medell Briggs-Malonson: She literally planted into me the seed of being a [00:06:00] doctor because one, she knew that we do not have enough black doctors in this country. And in fact, we’re, we still only make up 5 percent of all doctors, but then two, She also recognized we didn’t have enough Black women doctors in this country either.

Dr. Medell Briggs-Malonson: And still to this day, Black women doctors, we only make up about 2. 5 percent at the most 3%. Yeah,

Vic: and to tell a five year old, you can be a doctor. Do you want, like, do you want to? It’s your choice, is really empowering.

Dr. Medell Briggs-Malonson: Absolutely. And that’s something that I hold very near and dear to my heart with, especially all the work that I do with young people and with community, because it is about planting those seeds because we never know the impact of our words, both good and bad, right.

Dr. Medell Briggs-Malonson: But it’s best for us to use our words for good. And that’s what she did to me. And I continue to try to inspire so many others. So,

Vic: and so medical school and residency. is quite challenging. When did you start to bring the [00:07:00] two interests together? Social justice and medicine, was it always one of the same?

Vic: It was always

Dr. Medell Briggs-Malonson: there. So what’s interesting is that my the idea of merging together although I was pre med, but in my mind I was already You were on

Vic: your track. I was on my track, right?

Dr. Medell Briggs-Malonson: So during, even in college, um, many of us that were pre med, we would go, for instance, to a lot of the predominantly Black communities or the predominantly Latino communities, set up community health fairs and do whatever we even could as undergrads in order to promote greater health and wellbeing.

Dr. Medell Briggs-Malonson: And then once I actually went to medical school at Harvard, I mean, Harvard is all about. Your job is to change the world.

Vic: Yeah, right. And

Dr. Medell Briggs-Malonson: so, you know, both at medical school and When

Vic: you have the public policy at Harvard, too, yeah, right. Absolutely.

Dr. Medell Briggs-Malonson: So I did the combined program Oh, you did.

Vic: Okay, yeah. of

Dr. Medell Briggs-Malonson: both my MD, as well as my Master’s of Public Health, plus also took public policy classes.

Dr. Medell Briggs-Malonson: And that’s when everything chilled, in which it was like, well, I love taking care. of one person, where my focus is, is [00:08:00] how do I help to transform our most under resourced and marginalized communities that we have within this country and also globally?

Vic: Yeah, that, it’s that, uh, at every level of focus, like, one person coming into the ED on Friday night you’re caring for, but then also the system of UCLA And then the state of California and the whole country and then globally.

Vic: Absolutely. Absolutely.

Dr. Medell Briggs-Malonson: And there’s so much work that we have to do. And, and so that’s where my love and my passions came from it. How can we think about this in a way that we can truly. transform lives, transform communities, and also break down some of those systems that have historically prevented people from being as successful, as healthy as they can be.

Dr. Medell Briggs-Malonson: Because none of this happened by chance. Um, and so that’s part of the work that we have to do in order to think about what does it really mean to achieve health equity? What does it really mean to achieve health justice? And what’s the work that’s required to actually get there?

Vic: Yeah. So that’s [00:09:00] a good segue to, um, can you give me an easy to remember definition of how, how do you think about health equity?

Dr. Medell Briggs-Malonson: Yeah. So I think about health equity. I actually think about three different layers. Again, I, I, my brain works in pyramids just know. I have no clue why, but everything’s layered. Yeah. So

Vic: what’s the foundational layer? Yeah. So the

Dr. Medell Briggs-Malonson: foundational layer, or at least I will say, what does the term health equity mean?

Vic: Yeah.

Dr. Medell Briggs-Malonson: Because that’s the term that most people are actually kind of embracing and trying to get to know more. And I, I say that the definition of health equity is when everyone has a And just ability to be as healthy as possible. Now, in order for that to happen, to have that opportunity, to be as healthy as possible is not just the care that you receive in the four walls of a hospital or of a clinic or of an emergency department, it’s every single thing around you as well.

Dr. Medell Briggs-Malonson: So it’s how the environment that you’re in, is it free of toxins? It’s the educational level that you’re able to [00:10:00] achieve. It’s all of those things that actually make up one’s overall wellness. So that’s what health equity is, when everyone has a fair and just opportunity to be as healthy as possible. Now, there’s a difference between health equity and health care equity.

Dr. Medell Briggs-Malonson: So health care equity is when everyone has a fair and a just opportunity to access health services and to have the best outcomes possible.

Vic: So now we’re moving up the pyramid to, Interacting with doctors, health systems, maybe payer systems, all of the health care industry, health care equity is an equal opportunity to access and receive care in that.

Dr. Medell Briggs-Malonson: Absolutely. And to have the best outcomes.

Vic: Okay. Yes.

Dr. Medell Briggs-Malonson: Because what happens sometimes is that we think about just access, like, okay, well, you can get into a clinic or you may be able to see a doctor, but are you receiving the right treatments? Are you being treated with respect and kindness so that [00:11:00] you actually want to listen to that doctor or those nurses?

Dr. Medell Briggs-Malonson: Um, or do they

Vic: listen to

Dr. Medell Briggs-Malonson: you and do they, and that’s exactly, do they listen to you? And especially when you’re saying, this is what’s really bothering me. So it’s that whole entire. All those aspects of terms of that respect, um, that cultural humility and having the best outcomes and experience. But the ultimate level, which is really at the top of the pyramid, right?

Dr. Medell Briggs-Malonson: Because it’s really, it’s really healthcare equity and then health equity and then health justice. But I started up, um, with the health equity just because that’s the most common term, but the real top of the pyramid is health justice. And so many people say, okay, what is health justice? Well, I describe it as health justice is when all of the various different systems of power and of oppression and of barriers that cause the inequities to begin with.

Dr. Medell Briggs-Malonson: are eliminated so that everyone truly can achieve their optimal [00:12:00] level of health and wellness.

Vic: And we probably never attain the end of health justice, but that’s the goal we’re striving for. That is the goal that we’re striving for. But we can get a lot better.

Dr. Medell Briggs-Malonson: But we can get a lot better. So what I tend to say is that while achieving health equity is fantastic, it is just an important stepping stone to get to health justice.

Dr. Medell Briggs-Malonson: So health equity is when we’re still in a box. With all of the different systems that cause the inequities to begin with, but everyone’s just kind of in this box, whatever we can do in order to get everybody as healthy as possible in this box, health justice is when that box no longer exists.

Vic: Yeah.

Dr. Medell Briggs-Malonson: And that truly all those different infrastructures and systems and practices and beliefs.

Dr. Medell Briggs-Malonson: have been removed so that you, me, everyone else within. Yeah, we don’t need

Vic: to focus on health equity as much because we have attained nirvana. And that’s

Dr. Medell Briggs-Malonson: exactly it. So I always, people always say, like, how do you know that the work is successful? And [00:13:00] what I’ve said is that at some point in time, I hope my position never exists.

Vic: Yeah. Yeah. Because

Dr. Medell Briggs-Malonson: it’s already truly, you know, truly intertwined, like thinking about health equity and justice is truly intertwined in all that we do in terms of health and health care.

Vic: Yeah. Yeah. Excellent. Um, talk to me about the data and evidence. I mean, I think, um, the stories really move people’s heart and move their kind of belief systems, but then we need to go to data to see where can we Make the most impact the quickest.

Dr. Medell Briggs-Malonson: Yeah. So I’m a data nerd. Yeah. I’m, I’m a former health services researcher and I’m lane six sigma trained. So every single thing I do in my world is data. And that’s actually been, I think, some of the problems that we’ve had. Historically in the past of this type of work is because everything’s been kind of fuzzy and kind of philosophical.

Dr. Medell Briggs-Malonson: No, no, no, no data in the space is real. And how we actually, as you said, moved the needle is actually by looking [00:14:00] at data. So when I started my career, um, there really was no health equity. Uh, we had conversations about health disparities and by the way, health is different from from health inequities, by the way, but So there was a lot of that of just maybe talking about health disparities, but one of the reasons why I started my career in quality and patient safety was because I felt that no matter who you are, no matter where you live, you deserve the right to high quality, safe care.

Dr. Medell Briggs-Malonson: And so a lot of the work in quality and patient safety is all database. And so with health equity, it’s no different. And so by using data, and this is something that we really kind of grab onto at UCLA Health, um, and even throughout the entire University of California Health System, is that every single thing we do is rooted in data.

Dr. Medell Briggs-Malonson: Every single thing we do is actually informed by data in terms of where’s our areas that need to be improved upon, what are the interventions we need to [00:15:00] develop in order to address those inequities? And how do we know that we’re actually hitting those metrics of success?

Vic: So like, uh, let’s try to find an example.

Vic: So can you take, um, Multiple emergency departments in UCLA and pull data out of them and then compare based on the population.

Dr. Medell Briggs-Malonson: 100%. Yeah. So that is exactly what we have. We have dashboards over every different facility, all the different patient populations within that facility, the various different medical conditions.

Dr. Medell Briggs-Malonson: Like for instance, here’s a perfect example of a current project that I’m very passionate about because I’ve been working on readmissions. for again, a very long time and thinking about what drives readmissions. Because as an emergency doctor, when I see people come into the emergency room, when they just, for instance, were discharged seven days ago, 14 days ago, it’s like, what happened?

Dr. Medell Briggs-Malonson: What happened when you went home?

Vic: Yeah. And they don’t want to come back. I mean, they’re not, no one wants to come back seven days later.

Dr. Medell Briggs-Malonson: And so in a way that’s a. Failure on our [00:16:00] system, meaning the overall healthcare system when we have re admissions. And so I started a lot of my initial health services research really looking specifically at, uh, those who identify as black who also have heart failure coming from lower income communities.

Dr. Medell Briggs-Malonson: And they’re being coming back into the ER after they’ve been discharged. I’m trying to understand from the patient’s voice, like what happened? And so even right now, one of the things that we’re doing is we are looking at readmissions, but we’re looking at readmissions based off of the community. That are discharged patients live in.

Dr. Medell Briggs-Malonson: So there’s something called the social vulnerability index score, which was originally developed by the CDC to map out the entire country in terms of emergency preparedness and the level of resiliency during a natural or a bioterrorism type emergency event of trying to understand

Vic: pre pandemic.

Dr. Medell Briggs-Malonson: Oh, this is pre pandemic, but I’m happy you asked that because we really started to use it in [00:17:00] healthcare.

Dr. Medell Briggs-Malonson: Once the pandemic hit us, right? Where’s that, where’s that

Vic: study? We got to see. Yeah, exactly.

Dr. Medell Briggs-Malonson: And so what it actually does, it takes a look at communities and it says, well, gosh, like what’s up, is it public transportation base or do people have private cars? Um, what is the overall socioeconomic status of that community education level?

Dr. Medell Briggs-Malonson: Are there multi generational homes? Hints like COVID. Um, so it, it literally maps out a community and says, Which communities are highest at risk, and which communities are not. And so we started to And so in the

Vic: UCL footprint, do you have, uh, a vari I assume you have a variety of those communities.

Dr. Medell Briggs-Malonson: Oh, yes.

Dr. Medell Briggs-Malonson: You’re talking about in my health system? In your health system, yeah. So we are UCLA is very unique in which, and especially sitting here in Los Angeles, Los Angeles is so incredibly diverse. I mean Anything and everything is here in Los Angeles. Yeah,

Vic: all different nationalities and races and economic status and everything.

Vic: Everything.

Dr. Medell Briggs-Malonson: Everything. We have it all, which is why, you know, so many of us love Los Angeles. [00:18:00] And so with the patients that we serve are also highly diverse. Um, so for instance, UCLA Health, the medical center itself, the mothership, we call it, it actually sits in one of the most affluent areas of Los Angeles.

Dr. Medell Briggs-Malonson: I mean, it sits right, you know, by Bel Air, Beverly Hills, Brentwood, you know, like you can’t get more affluent, right? But then also we still serve. All in Los Angeles County. And, and as she said, sometimes even crossing over a street can actually make a difference in terms of social economic status. Here’s a little Angeleno, um, nuance here in Los Angeles, everybody knows about Rodeo drive.

Vic: Yeah, sure.

Dr. Medell Briggs-Malonson: Right. And everyone

Vic: makes me go to every day of drive.

Dr. Medell Briggs-Malonson: Yes. Well, there is a part of Rodeo drive that after you cross over a specific street, It becomes rodeo drive. Same street, same

Vic: street, same street. Just pronounced differently. Exactly. And maybe not as fancy stores.

Dr. Medell Briggs-Malonson: And that’s [00:19:00] exactly it. The, the drop and change in social economic status is so incredibly significant.

Dr. Medell Briggs-Malonson: You’re going from multiple millions of dollars, all this, all of a sudden down to maybe 200 percent of the poverty level. And so, and even the name changes rodeo. Rodeo. After you cross one street. So, so that is part of our ecosystem here in Los Angeles. So one of the things we’re doing in terms of data and thinking about our outcomes is that we specifically have identified the readmission rates in our patient populations that live in our more socially vulnerable communities.

Dr. Medell Briggs-Malonson: And what we’re doing is that we’re looking at. All the data, meaning what are they coming in for? When are they being discharged? What resources are we giving to them as well as capturing their voice when they are re admitted and bringing that data together and developing various different targeted interventions for them so that they do not have unnecessary re admissions.

Vic: So [00:20:00] let me try to unpack that. So when you say listen to their voice, what do they needing help with? What are their, where did they run into trouble? And then maybe that can feed back into how you discharge a patient. And that’s,

Dr. Medell Briggs-Malonson: that’s, you’re already on track on what we’re doing. So when I say the patient’s voice, we have been conducting interviews when patients come directly into the emergency department that live in these most socially vulnerable communities and saying, What happened?

Dr. Medell Briggs-Malonson: Tell us. And oftentimes the patients say like, yeah, you know, I thought I understood what my instructions were, but when I got home, I actually started to worsen. And then I was trying to figure out who do I call. And then I had some challenges getting my medications. Um, I mean, the list, um, there’s so many different items.

Dr. Medell Briggs-Malonson: And then when I did call, it was after hours,

Vic: but there, there may be categories that you can, And

Dr. Medell Briggs-Malonson: that’s what we actually did. We, again, because I’m Lean Six Sigma, um, we actually did a full Kaizen event. So a rapid improvement event, we identify all of the different root causes in which not only our patients [00:21:00] said brought them into the ED, but we even as the, as the leadership of UCLA went through and said, okay, what is driving these higher rates of readmissions?

Dr. Medell Briggs-Malonson: And now we’ve developed interventions. In order to address each one of those drivers, and we’ve already started to see an improvement in our readmissions rate. And by the time you get to six months and nine months, I’m confident that we’re going to definitely decrease that inequity that we saw between more of our more affluent communities and those that live in less affluent communities.

Vic: And then one, it’s better, it’s better outcomes for the patient.

Dr. Medell Briggs-Malonson: Absolutely.

Vic: Two, it, there’s penalties for re admission, so it’s financial benefit. There’s

Dr. Medell Briggs-Malonson: financial benefit, 100%.

Vic: And three, it brings the equity more together.

Dr. Medell Briggs-Malonson: And the other thing I would say too is that, and that’s an important piece that she brought up.

Dr. Medell Briggs-Malonson: This work, all equity work, is actually beneficial for those that provide the care for the institutions as well. It’s [00:22:00] always beneficial. And, and so even when thinking about, um, just addressing those different pieces and, and saying, we’re going to put, do focus interventions on this population. Well, guess what?

Dr. Medell Briggs-Malonson: While you’re focusing on the most vulnerable population, those same tactics. tend to help all the other populations. So everyone actually improves together.

Vic: So let’s talk about, um, what was, what’s the easiest to explain intervention that you realized from this work that now happens on discharge that was different?

Dr. Medell Briggs-Malonson: Yeah, what I would say, gosh, let me think about Or is it,

Vic: is it possible even to break it out like that?

Dr. Medell Briggs-Malonson: No, well, well, I, I’m happy that you said that. Um, we are, are launching just big bundles, like where we know that there’s certain aspects of their care that has not been addressed. As optimized, um, one of the things that we know for sure tends to help significantly is making sure that medications are available at discharge.

Dr. Medell Briggs-Malonson: Now there’s been a lot of work around this on making sure [00:23:00] medications are in hand at discharge, but the reason why it is so incredibly important and by the way, California is a very complex situ place with a lot of our managed Medicaid, um, and some of the way that all of the various different health plans engage with the provider systems.

Vic: Yeah. Not everything that would work here. would work in other parts of the country. Correct. And vice versa. Right. And vice versa. And some things are harder here.

Dr. Medell Briggs-Malonson: Exactly. So one of the, one of the things about medications, which is a really important piece, is that at least here in the Los Angeles area, in our more socially vulnerable communities, it’s actually hard to find a pharmacy.

Vic: Yeah. There’s pharmacy deserts, or it’s difficult to get to a pharmacy. A hundred percent. And

Dr. Medell Briggs-Malonson: so, so there’s pharmacy deserts. And unfortunately,

Vic: the Rite Aid bankruptcy, A lot of those stores that are closing are in those communities.

Dr. Medell Briggs-Malonson: And that’s exactly it. So, so therefore, you can have, give all the education and you can say, here’s your prescriptions.

Dr. Medell Briggs-Malonson: We’re going to, we’re going to send it electronically to the pharmacy near you. Right. But then it’s like, okay, which pharmacy are you going to? And then if you [00:24:00] somebody that has heart failure, COPD, or may have transportation challenges, you know, them getting their medications, yeah,

Vic: they may be relying on a daughter or a neighbor or someone else.

Vic: Yeah. And it’s

Dr. Medell Briggs-Malonson: unreliable or either they weren’t able to get the medications in time. So even just making sure, listen, you have two to two weeks to a month supply of all your meds right now in hand when you’re discharged, we’re doing the medication planning right now. It makes a big difference.

Vic: And you can show them the actual.

Vic: Pills. That’s

Dr. Medell Briggs-Malonson: exactly

Vic: it. Because it’s, uh, I don’t know. I’m visual. So like, I need to know, like, okay, I take the blue one or the red one, as opposed to a name that I might forget.

Dr. Medell Briggs-Malonson: And that is it. And then also just saying, do you have any questions? Repeat back to me. So those are all the different things. I mean, there’s so many different things we’re doing.

Dr. Medell Briggs-Malonson: That one just came to mind. But really, it’s the methodology Which I think is is so incredibly important of using data constantly looking at how all the various populations are performing and really identifying [00:25:00] where’s our areas of vulnerability, which patients are not having the best outcomes or the best experiences and let’s dive into the and I can tell you this from having all my dashboards and all my data.

Dr. Medell Briggs-Malonson: It’s hardly ever the same populations. One condition may be one group of patients. Another condition is another group of patients, which shows that you cannot generalize and make assumptions about any group. You actually have to go to the data.

Vic: And what is the, um, like iterative cycle? So you collect data for how long, how long does it take to To understand it and decide on the interventions.

Vic: And when do you start seeing results?

Dr. Medell Briggs-Malonson: Yeah. So I’m super impatient. So again, that’s just my nature. So what we use is that we use what the six sigma domain cycle, which is define, measure, analyze, improve control. But what we do is that we have a super special system at UCLA Health called the Just Excellence System, where we overlay principles of equity and justice on top of that.

Dr. Medell Briggs-Malonson: So as we’re looking at various [00:26:00] different data and problems, while we are looking at it from a strictly a performance improvement standpoint, we also say, gosh, did bias Contribute to these outcomes. Did racism contribute to these outcomes? Did other forms of discrimination contribute to these outcomes?

Dr. Medell Briggs-Malonson: And that also allows us to take a look at the kind of like what I like to call the traditional healthcare performance improvement model while also adding in some of these other aspects of health equity. And is it

Vic: fair, I may be bringing my own biases to this, but is it fair to say that workers in the emergency department or on discharge or anywhere in the process, they may have.

Vic: Racist biases that they’re unaware of and so it’s not necessarily to catch them as it is to try to intervene and make it better. So that fair or mischaracterizing? No,

Dr. Medell Briggs-Malonson: no, no, you are. You’re absolutely on track. So. When it comes to all healthcare providers, just like when it comes to our general society, and that’s what I was going to say, our general society, we know that racism exists.

Dr. Medell Briggs-Malonson: We know that sexism exists. We [00:27:00] know that homophobia exists. We know that, you know, anti Semitism exists, Islamophobia. We know these isms. We’re not going to wish it away. Correct. But especially what my role is, number one, we can raise awareness of the existence because some of these isms actually are part of our implicit cognition.

Dr. Medell Briggs-Malonson: And so without being aware that A, you may have racist beliefs or sexist beliefs or other types of discriminatory beliefs because of how you were raised or because of the school that you went to or whomever trained you to be a doctor. Yeah. We see that a lot. I call that vertical transmission. Okay.

Vic: Interesting. Yeah. You may

Dr. Medell Briggs-Malonson: not, you may not even be aware of it. And so part of what my role is, is to say, listen, these exist and everyone has implicit biases. Our job is to identify those implicit biases and make sure that it does not exist. impact our patients. And then the second main way of doing it is to ensure, and this comes back to quality and patient safety, that we are following evidence based guidelines.

Dr. Medell Briggs-Malonson: And we have [00:28:00] standard protocols so that it decreases the variation of care between one person and another.

Vic: checklist or this procedure when any person comes in the ED. Right,

Dr. Medell Briggs-Malonson: or in the hospital because I’m all over the system. But yes, exactly. So if you’re coming in with chest pain, this is our standard checklist and our standard protocol.

Dr. Medell Briggs-Malonson: If you’re coming in with, you know, shortness of breath because you have asthma, this is how we’re going to treat you. And we do not change based off of, of course, we have to adapt sometimes based off of other conditions, but we have standard guidelines.

Vic: Yeah. So that makes me think about a topic I wanted to bring up, which is you’re in health equity in, in the health, in the practice of health care, but you’re existing in the U S society.

Vic: And there’s a lot of societal kind of systematic issues that you’ve, you’ve brought up discrimination, racism, sexism, but also poverty,

Dr. Medell Briggs-Malonson: ableism. Yes. Yes. Yes. [00:29:00] How

Vic: do those things intertwine and. Can you separate the health equity? Or, uh, how do you think about that?

Dr. Medell Briggs-Malonson: Well, it’s all connected. And so there’s something called social drivers of health.

Dr. Medell Briggs-Malonson: Most people call them social determinants of health. Um, I call them drivers because they’re dynamic.

Vic: And

Dr. Medell Briggs-Malonson: what I mean by dynamic is that based off, I mean, you’re just mentioning poverty and we can talk about education. Um, all of these different factors, except for a few of them. Can be changed.

Vic: Yeah,

Dr. Medell Briggs-Malonson: so just because you were drivers is much

Vic: better because determinants feels like locked in exactly you’re locked in

Dr. Medell Briggs-Malonson: fatalistic.

Dr. Medell Briggs-Malonson: There’s no way you can change. And yeah, and you can

Vic: still call it SDH. Exactly. I know that. See, you already picked up on

Dr. Medell Briggs-Malonson: why we call it drivers. But yeah, drivers are dynamic. And for the most part, it can change during one’s lifetime. So even for instance, you were born in poverty. That doesn’t mean that you’re always going to stay in poverty.

Dr. Medell Briggs-Malonson: Um, And we know that when you’re not in poverty, you’re going to likely have much better health outcomes. Same thing when it comes to education. [00:30:00] We have clear connections with education, that higher level of education you obtain, the longer life expectancy you’re going to have. The healthier you’re most likely going to be.

Dr. Medell Briggs-Malonson: I mean, it is so clear. Yeah, the

Vic: disparities of health span by different population and by Income bracket and education is really sad. It is. It

Dr. Medell Briggs-Malonson: is. But then there’s other social drivers, which are racism. And the truth is our country has been rooted in a lot of racism from the very beginning. And so how do we address that when it comes to healthcare, right?

Dr. Medell Briggs-Malonson: Well, part of that, how we address it is a, we monitor the data

Vic: and

Dr. Medell Briggs-Malonson: B, we have those standardized protocols, but I also love to bring in that technology is a significant source of racism. Um, and the reason we’ve talked so much, especially even during the pandemic about the digital divide, but it’s more than just having Internet or not having Internet is actually, yes, having access to Internet, but it’s also your overall digital literacy, because so [00:31:00] much of what we do in health care nowadays are digital literacy.

Dr. Medell Briggs-Malonson: through our phones or through portals or through computers. So if you don’t have reliable devices, or if you’re unable to navigate that portal, and I’m thinking about even those individuals that are older or those individuals that are non English speaker, it’s automatically causing those barriers. So we can’t separate out these, what we call health related social factors.

Dr. Medell Briggs-Malonson: From achieving health and health equity because they directly play a role. It’s all intertwined. It’s all intertwined. So that’s the new age of healthcare now. And I think that’s the new age of health technology is that we have to lean into this space and say, if we’re really in the business of making people feel better and making sure they’re as healthy as they can be, we have to be in the business of ensuring there’s economic opportunity, ensuring there’s access to high quality education, ensuring that we don’t have food deserts and.

Dr. Medell Briggs-Malonson: Everyone has access to nutritious food, ensuring that we think outside the box and really drive [00:32:00] connectivity in all communities, especially our rural communities that we know have been really, really suffering in terms of connectivity. That’s how we have to think about health and healthcare. It

Vic: strikes me that.

Vic: Health technology can be used to, especially if it has a good UI and very intuitive, it can be, uh, it can be used to improve people’s access and understanding, but also it can be used as a way to help the clinicians. go through their checklist and follow the procedures. They don’t have to remember everything.

Vic: They can sort of follow along with, uh, with the

Dr. Medell Briggs-Malonson: workflow. That’s correct. That’s correct.

Vic: So we’re, we both were at the Vive conference earlier today, and there’s a lot of, a lot of new technology, a lot of innovation, pretty exciting, and also a little bit of a carnival kind of atmosphere. But give, give me your impressions.

Dr. Medell Briggs-Malonson: You know, I’ve definitely enjoyed the VIVE conference. Um, it’s always great to see just so many different innovators and so many different sectors of health technology all come together. You know, everything [00:33:00] from, of course, the big buzz right now of AI and all the different forms of AI. Yeah, AI is going to change the world.

Dr. Medell Briggs-Malonson: Yeah, right. But then also just even just some of the staples like interoperability, as well as, you know, I even had a meeting the other day about just even policy mapping. So a lot of different things at Vive. I think one of the things that I have loved to see is that we’re getting a lot more patient centered when we’re thinking about technology and patient centered in terms of how do we, even similar to what you’re saying, how do we, how do we really advance patient engagement?

Dr. Medell Briggs-Malonson: With our various different forms of technology, how does health equity play into inclusive designs? That’s one of my passions is let’s develop technology inclusively, like meaning that we are thinking about all sectors of our, our population in order to ensure that it’s helping to lift up everyone.

Vic: Yeah.

Vic: I mean, it’s patient just centered design. With all the different patient populations that are going to be affected.

Dr. Medell Briggs-Malonson: Correct. [00:34:00] And too often for too long, we have, um, only focus on a certain sector, which is probably maybe about 20 to 40 percent maybe, and instead of all 100 percent or even 80%. Um, and so I think five was really good of just.

Dr. Medell Briggs-Malonson: People are starting to get into those spaces of how do we really add more value to the technology while still, we have some that are, you know, still the standard technologies that we’ve seen.

Vic: I mean, I felt like it is, um, I’m hopeful that we’re at kind of a turning point where maybe some of the. Some of the death by a thousand pilots can go away.

Vic: I know health systems have, kind of, vendor fatigue. I know all the growth companies have pilot fatigue. And it, it feels like we’re getting some actual Results back from the trials and tests and beginning to see some rollouts, [00:35:00] not with generative AI particularly, because that’s more new, but some of the more workforce automation empowerment efficiency tools and that that was pretty sweet.

Vic: Exciting to see, like, actually, can we make a difference? Cause the, the people, the caregivers, the clinicians, the doctors, the nurses, even the non licensed staff, they’ve dedicated their life to really helping people. And unfortunately we’ve loaded onto them lots of data entry, lots of bureaucracy. And I’m hopeful.

Vic: It seems like we’re beginning to peel some of that away and letting them again focus on holding the patient’s hand and talking about what they’re experiencing.

Dr. Medell Briggs-Malonson: Yes. And it’s needed because I can tell you that we are in a very different phase in health care right now. Uh, all of us that have been practicing for years have never seen it this way.

Dr. Medell Briggs-Malonson: I mean, the pandemic was one thing that shocked us on, especially as an emergency doctor, I can tell you, there was no other scarier time ever, um, than practicing during the [00:36:00] pandemic, but now we’re seeing this huge volume of patients throughout the country in our emergency departments, in our hospitals, and much higher acuity, and so anything that helps to take away all of the administrative tasks.

Dr. Medell Briggs-Malonson: And anything, even from an administrative standpoint, me as an executive, that I can do to make the lives of my overall clinicians better, that’s what we need. Right. We don’t need extras at this point. We need to actually scale it back.

Vic: Yeah, we don’t need another tool for the tool belt that’s already loading you down.

Dr. Medell Briggs-Malonson: Yeah. And which we can barely stand up because not only all the tools, but then all the, the challenges of even taking care of these high volume of sick patients. So, so I agree. I hope we are moving in that direction of thinking about the patient and also thinking about the clinician and knowing that.

Dr. Medell Briggs-Malonson: We’re not in a space right now to be super innovative. We are in a space of do something to help us so that we can provide better care to our patients. Right. [00:37:00]

Vic: And it has to be like today.

Dr. Medell Briggs-Malonson: Yes, absolutely. There’s lots

Vic: of cool stuff that will work, uh, you know, in four years, but yeah. But

Dr. Medell Briggs-Malonson: we need it today for sure.

Vic: Let’s shift to the policy side of things. You’re involved across the country. Thinking about these issues, what, what is working on the policy front and what needs to be modified?

Dr. Medell Briggs-Malonson: Yeah. Well, I think we’re doing a lot of great things in terms of health IT policy and really thinking about the standards and thinking about our next steps.

Dr. Medell Briggs-Malonson: Um, you know, the office of the national coordinator published the HTI one rule officially in December, and that is something that That high tech that we provided a large amount of recommendations, and I think the role is a very, very important role for increasing transparency and health technology, and especially when it comes to, you know, machine learning and all of the other forms of artificial intelligence in which we’re now starting to interface with our certified electronic health record systems and other technology.

Dr. Medell Briggs-Malonson: [00:38:00] So On a national level, and especially in a policy level, it’s very clear our agencies know we have to really provide some guidance, but I also respect the fact that they’re saying, while we want to provide guidance, increase transparency, increase safety, we also need the industry to To help to also guide where we’re going in the future too.

Dr. Medell Briggs-Malonson: Cause it’s almost, I mean, truly almost like the wild, wild West right now. And so it’s a, it’s a, it’s a very fascinating dance of this. public private partnership in order to ensure that our future, and when I say our future meaning like even a year from now, is much more fair, much more just, much more transparent, much safer, and most importantly, are not perpetuating all the health inequities that we have today and hopefully decreasing those inequities.

Vic: Yeah, because technology and powerful systems can be used. You know, for good or evil, even [00:39:00] unintentionally, I mean, and I honestly think

Dr. Medell Briggs-Malonson: it’s unintentional. Yes. So

Vic: people might put in place a machine learning apparatus, maybe that doesn’t have, uh, diverse training data in it for it’s an easy one to say. And then it’s not going to have, the same outcomes in the field if it doesn’t have the appropriate diversity of training data.

Dr. Medell Briggs-Malonson: And I actually say that that that’s one of the most important pieces as we’re selecting the data sets to train these models is that it does not have any of those critical data errors. And those critical data errors that I always say is number one, how was the data collected? Was the data very representative of all the populations that this tool is going to be used on.

Dr. Medell Briggs-Malonson: Um, but the second thing is, was there bias interpretation of that data, right? Because sometimes the data can be collected, but then the models, the non AI models, have said, Oh, well, gosh, I’m interpreting the data this way. And so, therefore, that data goes to train a certain model that is based, once again, on bias, and it’s just going to [00:40:00] replicate it over and over again.

Dr. Medell Briggs-Malonson: Yeah,

Vic: it’s just going to reinforce

Dr. Medell Briggs-Malonson: the problem. Exactly. And then the just overall interpretation of like, well, since we see this. Then we think this about a certain population. So really making sure that data has integrity is, is incredibly representative and that it’s not rooted in bias assumptions is incredibly important.

Dr. Medell Briggs-Malonson: That source data, because if not, if we train our models on it, It’s just going to make things worse. And so the good thing is that we’re all having these conversations right now. And I honestly do not, I can tell you as being in the space with, especially the intersection between health equity and data and health technology, these conversations were not taking place two years ago

Vic: or

Dr. Medell Briggs-Malonson: three years ago.

Dr. Medell Briggs-Malonson: So I’m very happy that people are all discussing the importance of data, integrity, representative data, and how we’re using the data most importantly. How do we test these models once they are in, you know, go live, whether it’s in a pilot population, and then definitely when it goes live to real world situations.

Vic: And so [00:41:00] talk to me about how you think about community engagement and empowerment at all, but also around this, because a lot of the data. for diverse communities is not out there. So we’ll need to collect it. And that means engagement and showing them that contributing is actually empowering to get the models better.

Vic: If we can make that case, I don’t know. How do you think about engagement and empowerment in the community?

Dr. Medell Briggs-Malonson: Yeah, well, I think about it all in partnering. And so I, I always call it community service and partnering. And as an academician, I can tell you. For too long, for too often, academic medical centers across the country went into lower income communities of color and just took, took, took, took, took, and did not give anything back to the community at all.

Dr. Medell Briggs-Malonson: We’re going

Vic: to write a paper, but we don’t actually help. Yeah, right. Exactly. We’re

Dr. Medell Briggs-Malonson: just going to bring people together. We’re going to take all your ideas. Take some other data, take blood samples and we’ll never give it back to you and you’ll never, it’s not going to improve your community. Um, [00:42:00] in addition, of course, we know about all of the historic medical experiments that were written in racism as well as sexism and other forms of isms before.

Dr. Medell Briggs-Malonson: So what we have to do now in this modern day is that we have to partner and we have to actually find out who the leaders are in the community and say, this is what we’re thinking about. We want your ideas. Because one of the fatal flaws that I think many people have done, whether it’s innovators, whether it’s academic centers, is that they come in and to various different communities to say, we’re the experts.

Dr. Medell Briggs-Malonson: Yeah.

Vic: So listen to us. Or they hold a half hour meeting and then they have all the information they need.

Dr. Medell Briggs-Malonson: And then never come back. The

Vic: community’s been there for a hundred years. Right. Yeah.

Dr. Medell Briggs-Malonson: And so there’s no one that knows better that of what’s going to work for a community than the community, period.

Dr. Medell Briggs-Malonson: And even when it comes to thinking about the development of technology and what’s going to work or enrollment in clinical trials so that we can have highly diverse populations, Then you have to go and capture the [00:43:00] voice of the community and partner with community so that in a community there’s clear expectations.

Dr. Medell Briggs-Malonson: Like when I work with my community partners, we always set up, this is the expectation that you can receive from us as the institution and tell us what your expectations are. Right. Because it’s full partnership in every single way. And

Vic: then it. It, I would think it should be many touch points over a long period of time.

Vic: I

Dr. Medell Briggs-Malonson: mean, it’s, it’s a partnership. I mean, not only just many touch points, but it should be a relationship that it continues. Because if you think about it, and especially when it comes to data, I say that that is another principle of data justice. The data of the people belongs to the people.

Vic: Yeah. Period.

Vic: Right.

Dr. Medell Briggs-Malonson: And so if you’re going to data. Yeah. We need

Vic: to give them the benefit.

Dr. Medell Briggs-Malonson: And, and not only that, not, yes, the benefit, but then also the say of how that data is used. Mm hmm. Also helping out with the interpretation. Because. Yeah. Oftentimes we have blinders on whether we are, again, [00:44:00] innovators, or we’re researchers, or we’re even healthcare professionals, we have blinders because we come in with our own assumptions, of course, I mean, we can’t, and we’re trying to move

Vic: fast, and we have good intentions, but we maybe don’t.

Vic: Right. Even listen to the community as much as we need to.

Dr. Medell Briggs-Malonson: And then the community comes and we’re like, Oh, look at these findings. And the community is like, what are you talking about? Like that’s been that way and that’s no different. And this is what will actually help. So, so really partnering with community is going to do nothing except for make things better, make things more accurate and really engage in that trusting relationship that we still really need to build.

Vic: Can you give an example to help me understand and the audience understand what that looks like, what that feels like? So when you have in the last couple of years engaged with the community around Los Angeles, maybe what were some takeaways that were surprising and then how does the partnership evolve?

Vic: What is UCLA providing? What are they providing?

Dr. Medell Briggs-Malonson: So I position my group because we are, let me take a step back. We [00:45:00] are, UCLA Health is an anchor institution. And what that means is that we have committed our resources in order to directly improve racial and socioeconomic inequities. And so that means leveraging our workforce, our, our knowledge, leveraging our partnerships, finances, you name it.

Dr. Medell Briggs-Malonson: But one of the key aspects of this is service. And so. We do not go into any community or start with any community based organization and say, hey, we have an idea. Let us tell you about the idea. We actually go and say, we want to be here to serve and we have lots of resources. What are the problems that you see?

Vic: Yeah.

Dr. Medell Briggs-Malonson: Where would you like to see or how would you like to see that problem solved? And you’re trying to get a broad

Vic: cross section of the community, people in Maybe religious organizations or another charity group or whoever. So you can find as much as you want.

Dr. Medell Briggs-Malonson: Yes. And that’s what we do. I mean, we have community partners from all various different [00:46:00] sectors.

Dr. Medell Briggs-Malonson: Um, whether it’s those that are truly rooted in environmental justice. And which they’re looking specifically at increasing the number of urban farms or, um, you know, really decreasing various different toxins within the community all the way to those that provide services for food insecurity, um, or shelters for those that are experiencing home.

Dr. Medell Briggs-Malonson: We, I mean, there’s so many partners that we have, but what we tend to do is. Tell us what the problems are and how can we help you?

Vic: Yeah,

Dr. Medell Briggs-Malonson: it’s just that simple.

Vic: And is it fair that sometimes the the community service charity Advocacy program already exists for the community in need but they haven’t connected So so you can you can sort of do a lot of good by connecting existing services to the people that need it

Dr. Medell Briggs-Malonson: Yes And so that’s where all the leveraging of partnerships.

Dr. Medell Briggs-Malonson: Um, I’ve done a lot of that during all of my years partnering with community where, um, and the other thing is [00:47:00] part of our work is also rooted in a large amount of philanthropy. Um, there’s a lot of people out there that care about social impact. And so I may have a, you know, handful of donors that are very interested And making a significant social impact in a certain area, but they don’t know where and they don’t know if it’s like a credible organization, is this a good cause?

Dr. Medell Briggs-Malonson: I also, you know, have a lot of others that are, for instance, in sports and entertainment and which they’re like, we really want to do something really important in this community or that community. You have an idea. We just connect them.

Vic: Yeah.

Dr. Medell Briggs-Malonson: And that is what true service is. Like true service is not about, we’re going to tell you what to do.

Dr. Medell Briggs-Malonson: This is our idea is saying, how can we help you? Because a lot of these groups have existed in our community and have been doing work for decades, but they just haven’t had all the resources to make the large impact that they want to. So by matching resources directly with the brilliant ideas that have already existed, it’s a win win.

Vic: Yeah. And UCLA medical center is an anchor organization in lots of ways where. [00:48:00] It’s a trusted organization. You have lots of resources and and relationships and lots of relationships and you can bring things to bear that Maybe don’t cost money for UCLA or time, but but you can really have an impact that way.

Vic: Absolutely. Give me your sense of What’s your aspirations for health equity in different time horizons? Like what do you aspire to see happen in the next maybe year in the next? Five years, 10 years, where are we headed?

Dr. Medell Briggs-Malonson: So I would say my aspiration within the next year, and I can tell you within my organization, I’m very proud of the work that we’ve done and the full embrace of health equity principles within my organization.

Dr. Medell Briggs-Malonson: There’s, there’s nothing better than when I’m sitting in a meeting and something comes up and it’s one of my other co executives or a director, or even one of our, for instance, frontline staff members are like, wait a second, we’re Is that equitable? Let’s think about this in a different way. There’s [00:49:00] nothing better.

Dr. Medell Briggs-Malonson: And I’m not bringing it up. Like, I’m, and I’m just sitting there just smiling. You’re just like, yeah, like cheering along. Right. And then all I have to say is like, yes, I support that idea. Plus one on that. Um, but, but that shows that it’s a cultural transformation. And so what I would say across the country, um, we still have a lot of work to do and, you know, there is also right now, this.

Dr. Medell Briggs-Malonson: Misunderstanding, I feel, of, and, you know, there’s a lot of various different attacks sent on diversity, equity, inclusion, just in general. And then some of that translates to, well, why do we need to care about health equity, treat everybody the same? And that’s just not the right way of thinking. And the reason why is because we’re not all starting from the same place.

Dr. Medell Briggs-Malonson: And so when we’re not all starting from the same place, that means we have to do what’s needed to get everyone to where we all end up in the same place. And so that’s where that importance is. So I would love to see that movement in our healthcare industry across, [00:50:00] across, um, the entire country and where it comes to health equity.

Dr. Medell Briggs-Malonson: But I would say 10 years from now, in terms of health equity and healthcare, um, I will be over the moon and ecstatic if we say health equity in the same domain that we say quality and patient safety,

Vic: where it is

Dr. Medell Briggs-Malonson: so built within what we do. Everyone agrees

Vic: that we need to work on that. Exactly. Yeah.

Dr. Medell Briggs-Malonson: Absolutely have to go. But in order to get there, we have to have increased awareness. We have to have intentionality of making sure we’re creating the systems to support this. It’s the same revolution that we went through when quality and patient safety came about. Not everybody cared about it. People, doctors did not believe in washing their hands.

Dr. Medell Briggs-Malonson: Nowadays, if a doctor didn’t wash their hands, it’s like, Oh my goodness, you should no longer be a doctor. So I, this is the revolution we’re going through right now too, when it comes to health equity of really transforming minds and practices and structures in order to support it.

Vic: Yeah. And one of the reasons I wanted to dig into it on the podcast is I think [00:51:00] that, um, health equity can almost lead the DEI conversation.

Vic: Right. Because, um. I’m going to butcher it probably, but the core, the foundational level was giving every person an equal chance to have better health outcomes or similar to that.

Dr. Medell Briggs-Malonson: You didn’t butcher that at all, by the

Vic: way. Everyone has a mom and a dad and community members, family members that they want to see get taken care of.

Vic: Have the best health care. I don’t care what race or background you are. You want that for yourself and for your loved ones. And so that feels like a common thing that we can use as a bridge. Every person in this country should have the best. health equity, best opportunity for health. Sure, they all won’t live to the same age, but that doesn’t mean that we shouldn’t give them the opportunity to [00:52:00] have the best health.

Dr. Medell Briggs-Malonson: And that’s the key thing, which you said, while there’s going to be variation, everyone should still have the same opportunity to be as old and grow as old as possible. Yeah,

Vic: and there’s variations that we can’t change. So I, I mean, I’m A white guy with a lot of education and a lot of privilege. And I have, um, genes for cardiac problems.

Vic: Both my grandparents died of. Heart attacks. I have heart disease. That’s a genetic, there’s an aspect to that that’s a genetic. There also is environmental things in your upbringing, in the diet, and so with my heart condition, I need to be really careful of what I can control, but there’s some things that I can’t control, and I think that’s true about every person.

Vic: I use myself just because it’s easiest to out myself, but every person No matter what their race and economic status and situation, they have some things that are genetic. [00:53:00] There’s some things that were environmental and family, family of origin that are in the history, and it’s hard to change. We could change how we interpret it, but You’re bringing is you’re bringing, but then there’s the environment you have now and how we interface with our doctors and how we try to find nutritious food and get some exercise and everyone can make improvements there.

Dr. Medell Briggs-Malonson: And, and even using your story with all that you just said, part of really embracing equity is that I would say. You know what? You have these familiar risk factors. So because of that, we’re going to do something different for you. We’re going to set you on a different program that’s going to benefit you because of these different risk factors or because of this environmental factor that’s contributing.

Dr. Medell Briggs-Malonson: And that is what equity is. We’re taking account.

Vic: Of all of the factors, and then

Dr. Medell Briggs-Malonson: we’re making something that will help [00:54:00] you to thrive and be as healthy as you potentially can. And that’s, that is 100 percent what equity is about. It’s not about giving everybody the same thing because not everyone needs the same thing, but it’s about giving each individual person what they need in order to be as healthy as possible.

Dr. Medell Briggs-Malonson: And

Vic: I think no matter what political party you are going to vote for, which is the main source of all the fighting. You still have loved ones that you want to have healthy, long, fulfilling lives. And so it feels like there’s something of a common ground there that we can all agree with.

Dr. Medell Briggs-Malonson: I agree. And then also when they go and see the doctor, you want your loved one to be taken care of and respected.

Dr. Medell Briggs-Malonson: And that is, That is all that it is, you know, and I even say to every single one of my patients, number one, I like to lean into the good bias, right? And what we call affinity bias in which every one of my patients, I try to find something that we have in common because then once we have identified [00:55:00] what we have in common, it’s like, Oh, you live in Boston.

Dr. Medell Briggs-Malonson: I went to school in Boston. You know, then all of a sudden, guess what? We’re bonded. And now we’re human to human, right? Or if you’re, if I walk into a room and I see, you know, someone wearing a hat, I will just say like, Oh, what is that dress? And then we literally bond. And then guess what happens no matter what?

Dr. Medell Briggs-Malonson: I try to take care of everyone like my family, but even more, I use this as a way to really lean into each one of my patients, but then my patient, no matter what, will lean more into me, because as you say, it’s that human to human bonding.

Vic: They’re seen.

Dr. Medell Briggs-Malonson: Yes, they’re seen, they’re heard, and they feel like they’re that other person.

Dr. Medell Briggs-Malonson: no matter what, I’m going to give them good care because we have commonalities.

Vic: Yeah.

Dr. Medell Briggs-Malonson: Yeah.

Vic: There’s a lot of hope in that. I think there’s a, not every physician takes the time to do that. And they’re, as we talked about earlier, they’re busy. They’re, they’re covering a lot of patients. They’re in hard environments.

Vic: Uh, but sort of bringing more, more opportunity for them to think about that. It doesn’t take that much longer. [00:56:00] Um, and if we can give them a few tools to, you know, Let them take a deep breath. Um, hopefully they can engage with their patient populations.

Dr. Medell Briggs-Malonson: I hope so too, because I can say for my fellow physicians, we’re all in this business because we care.

Vic: Yeah.

Dr. Medell Briggs-Malonson: Um, but. There’s always distractions or other stresses that can take us away from that. So yes, whatever we can do to support the healthcare environment so that we can get back to that level of caring that all of us want to be. And, um, that’s where we need to really strive

Vic: for. And so as individuals, people listening right now, what’s one thing that they should do today to contribute?

Vic: To this,

Dr. Medell Briggs-Malonson: you know, that’s a really good question. Um, what I would say is it’s important to take a step back at times. And say, how do I see the world and not only how do I see the world, [00:57:00] but how can my world be different? And that adds that sense of compassion and empathy, especially if you are thinking about a different person or a different population or even a different region of our world.

Dr. Medell Briggs-Malonson: And I think that’s starting with our own self reflections of, you know, as I mentioned at the very beginning, I come from a privileged background, so I have levels of, or different aspects of myself in which are incredibly marginalized, but I also have identities that are incredibly privileged. But what I tend to tell everyone is, think about your own privilege.

Dr. Medell Briggs-Malonson: And think about the areas that you have more of a marginalized identity and all of us have it, no matter who you are, we all have at least one marginalized identity and then think about how you feel or how you felt when someone pointed out that marginalized identity. And that can add and increase your, your compassion and your empathy for those that [00:58:00] have other marginalized identities.

Dr. Medell Briggs-Malonson: So we all have privilege and marginalization and, but how we use it is incredibly important and key. And making sure that we speak up for those that may not have a voice and we help to serve those that have been ignored. That’s one thing that we can all do starting now and definitely tomorrow.

Vic: So, uh, let me.

Vic: Rephrase make sure I’m following that so I know what to do this afternoon. Sure. Can I use the word gratitude? Like, I should recognize gratitude for all I have, the privilege part of my background, the opportunities that have been given to me. been given the opportunities that I’ve made, where I am today, I get to talk to you on the podcast, and then also recognize where, when I’ve been marginalized, I’ve been criticized, I’ve felt less than, and then try to have empathy for others, kind of appreciate all I have, and have empathy [00:59:00] for others Maybe have been marginalized and then go through the world kind of trying to hold that gratitude and empathy in mind.

Vic: Is that close to what you’re saying?

Dr. Medell Briggs-Malonson: That’s close. I’m going to take you to another level. Yeah, yeah, help me understand differently. I’m going to take you to another step. Yeah, where was I not right? No, no, no. You’re, you’re good. So the idea is we all have privileged identities and experiences. We all have marginalized identities and experiences.

Dr. Medell Briggs-Malonson: Those marginalized identities and experiences can add. And especially how we felt it, we can reflect upon those feelings and especially when it comes to someone else that may have a marginalized identity. But what I really challenge everyone to do is to use your power and your privilege. to help others that may be of a more vulnerable or marginalized identity or experience at that time.

Dr. Medell Briggs-Malonson: So it was kind of like how I started. I was always brought up with, with a large amount of blessings, which with a large amount of privilege, that means you have a responsibility to [01:00:00] help others and also bring others up with you. And so that’s what I would say probably is the, is the, the closing sentence there.

Dr. Medell Briggs-Malonson: Yeah. I have gratitude.