Dr. Miguel Ruiz
speaker
84 appearances
1 recordings
1 series
first heard Jul 2024
last heard Jul 2024
Dr. Miguel Ruiz’s voice in public audio — every appearance, attributed to the second.
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You name it, you know, issues with drug use disorders, discrimination, poverty, poor quality of environment and so forth. That in utero, in development human, is already being affected by higher levels of stress hormones, cortisol, adrenaline, norepinephrine, and so forth.
that baby comes into the world into a situation of, again, maybe homelessness, maybe incarceration of one of the parents, maybe emotional and sexual abuse of one of the parents and so forth. So this is leading to a situation in which by the teenage years,
they're already having to cope with that added, as they call it, allostatic load of stress that has been affecting this individual that may have already caused some, through epigenetic mechanisms, some disturbances in their nervous system. And that ultimately we know it leads to premature ageing. and to higher mortality and to shorter life expectancy. So it's there, it's in the society, really.
So how do the diseases of our days, to your question of diabetes, cardiovascular diseases, how are they impacted by these disparities greatly?
Because if really to be able to eat healthier food, you have to pay more, or you have to have a car so you can buy the food in certain places, or you are living with a food scarcity type of situation because you are in a food desert in a bigger city, in a larger city. Those issues are going to make you more prone to fast food, intermittent food.
That is going to make you more prone to poor control of diabetes, of hypertension, and other diseases that lead to cardiovascular death. So that's why, for example, in our hospital today, we are starting to measure food safety on any patient who is discharged from the hospital. Special workers, case managers are assessing these patients' access to food before they leave the hospital.
And the safety of it. And guess what? We are finding people who don't have food security. here in St. Paul, okay? And guess what?
Well, we have a partnership with Second Harvest or whatever nonprofit organization that can provide and we can do a follow-up and we can, how can we pretend that this patient is going to be worried about getting those medications that have been recommended following their heart attack or following their stroke or whatever else when they are most primarily worried about what they're going to be eating or how they're going to be feeding their children.
I mean, we need to start building the house from the foundation, not from the roof.
And what we are doing sometimes with our traditional medical approach is trying to patch a sinking boat, and there's bigger holes than the medical problem. And I think basic needs need to be addressed, just to give you an example.
Thank you, Sheridan. This is so important. And you are absolutely right. And I think I should have clarified this from the get-go that it's not just about skin color. There are so many other categories of disparity. So thank you for bringing those up. Yeah, it is black. It's a woman. It's poor. is with a family member in jail. I mean, the intersectionality there is just huge.
And the result of systemic racism through centuries and generations and generations. So complex. I think something that we, the data you present is based on, back to the point I was making before about the cultural humility, seeking to understand. we need to listen to this community and really hear their perspective on the care they are receiving. So if LGBTQ individuals are perceiving
poor care and discrimination, we need to say, yeah, I want to hear you because you're right. Your perception, we cannot say, oh, we treat everybody the same, which is, you know, we have the same standard, the same protocol, the same algorithms. No, we don't. Because even when we do the same things, there is a human essence and there is still the issue of unconscious biases.
And there is the issue of discrimination that happens and that is there and is proven and is present. What do we do about it? Number one is we need to listen to these communities. And to be able to listen to them, we need to give them a place at the table. We need to reach out and say, tell us, how are you being cared for? How are you perceiving your care is being?
Tell us what do you see the problems are? Tell us how we can help you. Again, a humble approach to, no, I do have developed these solutions to your problem, and this is what we're going to do. No, I go to you and you tell me, how do you think you could be helped better and doing something about what we hear. At the hospital, we have these equity rounds.
We have them for a while where leadership, senior leadership, will go to rooms of patients who were in one of those categories, not just people of color, but a veteran or somebody who is, you know,
different gender or different sexual orientation or whatever else and try to sit down with them and have a one-on-one conversation and take some notes and apologize on the spot for whatever perception they already in that hospitalization were perceiving as being treated unequally. So I think that's the start.
And then obviously at the level of policy, we need to advocate for those policies that are all about equity. And I just, let me remind all of us that equity really is that everyone has the best chance to get the best outcomes possible or be as healthy as possible. Equity is not about we do give everybody the same treatment. Equity is about outcomes.
It's how can we have everybody achieve the best health possible. Some people will need this to achieve that. Other people will need something very different to achieve that goal. And that's where we need to customize our care based on what we learn from these communities. So community engagement is very key.
And then having those individuals being in patient board meetings and having individuals from those communities who are disadvantaged or have been made disadvantaged be at the table. But not only be at the table, talkerism, but be at the table and have a say at the table, inclusivity.
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