welcome back to my Channel today we have a treat for you I'm here with Dr. Rachel
Rubin she is a urologist and
fellowship-trained expert in female and
male sexual dysfunction so I'm so happy
to have her here today and to be here so
we are going to react to last week
tonight episode of John Oliver where he
talks about bias in medicine so let's
get started doctors rated number one by
reasons there's a finger in your a**
magazine I tell patients my finger is
just as smart as my male colleagues but
much skinnier but what medicine maybe
the most respected of all professions it
is important to know that not everyone
has the same experience when they visit
a doctor I think I would have been
treated completely differently if I had
been male you'll hurt doctors and nurses
like oh they're just exaggerating you
know and not really listening to them
because it's a black person but it's
just like a white person it's just like
oh my god like this is serious it's true
if you are a woman and or a person of
color in the u.s. you may well have a
very different relationship to our
healthcare system than a white man I see
a lot of patients America and Hispanic
all sorts of nationalities and races and
I think that they definitely have a
different experience and I know you see
a lot of women in your practice I'm
actually thinking of doing a coffee
table book that is titled dumb sh*t doctor
say to women it's get your latest
copy it's rampant it is people say some
really stupid things to women who
complain of pain and sexual dysfunction
women's bodies have always been fault
with judgments and misconceptions mom
can I go swimming with Peggy tomorrow
after school no it's not a good idea the
first two or three days of your period
you might get chilled and catch cold
oh that's right Peggy of course I can't
go swimming you know I've got the curse
that was only 1953 so there wasn't that
long ago that this is what people see in
movies and television my mother was born
in 1953 so how do we teach our daughters
about how to view their bodies it starts
from birth and it's how their mothers
taught them and how you're raised it's
very deep
yeah didn't you guys know we're cursed I
mean we basically walk around with a hat
on our head with a big scarlet M
once a month never trust anything
that  bleeds for five days and doesn't
die things have clearly improved since
then but women can still face an uphill
battle to get quality health care there
are many many studies showing this for
instance they found that women were less
likely to be referred for knee
replacements than men if they're over 50
and critically ill they were less likely
to receive life-saving interventions and
when going to the ER with urgent
abdominal pain women were less likely to
receive any pain medicine just listen to
one doctor sum up how too many in her
profession treat female patients I think
that a lot of times women's symptoms
especially pain are you attributed to
emotional imbalance or you know women
being hysterical or crying wolf about
their pain and that's absolutely wrong
Hysteria is alive and well in this
country not just our country but around
the world did that pelvic pain you get
lumped into this category of whiny woman
disease it takes patients 10-20 doctors
before eventually they get to me and
they realize that all of the pain in
their vulva the pain in their pelvic
floor the pain in their vagina it's all
from their back pain or from their tight
muscles from their back problems and
nobody believes them and it's pretty
crazy I see so many women all the time
and I asked everyone if they have pain
with sex and they look at me like they
can't believe I'm even asking them kind
of an ass and it's it's really a shame
because these women are you know I'm
struggling are suffering and they have
no one to talk to they can't even tell
their doctors about it
heart attacks your condition to think of
them looking like they do on TV all the
time you know people grabbing their
chest and then falling over
but for many women that is not what they
look like instead their heart attacks
present with subtler symptoms like pain
in the back or jaw nausea and unusual
fatigue and lots of doctors miss that
just look what happened to Katherine
Leon who went to the ER with serious
heart problems and was told this the
young doctor came in very condescending
thought I was just a drama queen and he
said it's not my job to tell you what's
wrong with you it's my job to tell you
what it's not and it's not your heart
and that was it I was like well what do
I do next
and he's like you go home we actually
see misdiagnosis and women too in urology
for example bladder cancer diagnosis
for women is delayed because very often
they present and blood in the urine with
usually problems they workup but a lot
of women are misdiagnosed with urinary
tract infections they are then delayed
to get the appropriate workup and
subsequently when they are diagnosed
they're diagnosed at a later stage and
then have worse outcomes there is a huge
disparity in life expectancy between
black and white Americans particularly
for black men in fact when one study
tried to quantify what is called the
mortality gap they found some shocking
numbers which this documentary chose to
illustrate in the most jarring possible
way we found over 83,000 excess deaths
per year in the african-american
community alone clearly there are
systemic factors contributing to that
number but even just when it comes to
contact with the healthcare system there
can be appalling disparities there are
again many studies showing
african-americans have a lower
likelihood of receiving recommended care
for everything from pneumonia hip
fractures to multiple cancers prostate
cancer thing is very well known in
urologic literature essentially black
men are more likely to be diagnosed or
died of prostate cancer when compared to
a white man and that can be for a number
of reasons most cancer is genetically
different in black men there's also some
different risk factors like diet
lifestyle that may contribute to having
higher risk of prostate cancer and then
ultimately access to care can be
different because of different
socioeconomic factors we also know
treatment for prostate cancer it's going
to affect people's quality of life I'd
see men and women for sexual dysfunction
and prostate cancer treatments all of
them have effects on quality of life
whether it's sexual dysfunction or
urinary incontinence or urinary
frequency and urgency and we're you know
we often don't focus on explaining those
side effects to people if we have only
10 minutes with them and there's a bias
in how we talk to people or what we
think if a person is over the age of 70
don't ask them if they're sexually
active you don't ask them if they're gay
and have anal sex right until this year
we didn't have guidelines for gay men
and prostate cancer talk about bias in
medicine it took till this year to have
guidelines for if someone has anal sex
how soon can they have sex after a
prostate biopsy what are the rules after
prostatectomy what are the rules after
radiation we don't have those
conversations because nobody likes to
talk about sex or ask people what kind
of sex they're having absolutely so
we'll link to those guidelines below and
can save anyone because of racism
black people we don't even get our hands
on opioids
they don't even get them to us white
people get opioids like they tic-tacs
it amazes me how many opiods you
motherfu**** have Ihad a double mastectomy you know what they sent my black a** home with ibu fu*** profen
just shocks me and I'll pain management
is so mismanaged in this country I get
the opiate crisis is real it's important
it needs to be talked about but how
about the fact now that gabapentin is
going on the you know naughty list of
things that you can't prescribe or
you're going to be dinged every time you
prescribe how about the idea of getting
people in to see pain management doctors
they get put in this box of crazy people
if you have pain everyone has pain back
pain I had a kidney stone myself two
weeks ago
pain is real okay that opioids have
their role and it's really amazing how
we don't do a good job talking about
pain management and really working with
people who have different levels of pain
so actually there is some data that
black people who use opioids long term
when compared to their white
counterparts
are more likely to get tested for
illicit drugs and their urine and also
are more likely to have their opioid
stop for pain control so there
definitely is a disparity and some of
this is because of obviously implicit or
explicit bias and providers but there's
also the way that media portrays pain
control when there are crime stories or
news investigations with Caucasian
people they're often giving you a whole
narrative as to why they use the drugs
giving you a story that you can relate
to and think that it's not really
inherently a problem with their morality
whereas when it's a person of color
they're often talking about the just
their name the offense and with the drug
one and that's it they're not really
going into detail about it yeah what
about any physical therapy we talked to
we see a ton of patients with pelvic
pain and back pain but physical therapy
isn't an automatic thing a lot of
insurance companies won't cover physical
therapists or out-of-network physical
therapists with a specialist who focus
on pelvic health so you have this
problem where only rich people can
afford to get the physical therapy that
they need and the pain management that
they need those things that are actually
helped their pain instead
recently showed we only need 10 minutes
with people right if you do 10 minute
office visits so later the doctor is in
their schedule the more opioids they
hand out
oh I didn't see that one
we'll link that one down below too
actually want to tell you guys a story
so I had a patient the other day who was
waiting for me and I was talking to this
other patient and her daughter or niece
was sitting in the in the hallway and I
walked out and she's talking to my other
patient and like outside their room and
I asked and there's a car they friend
then she's like no Dr. Malik they're not
friends like that woman just paid her to
give a urine sample
on her behalf literally she's like don't
test her urine that is that other
woman's urine because she was scared she
was scared that we're gonna drug test
her and I was like this is the urologist
office we don't do that but you know
from her perspective I was she's scared
of being labeled in a certain way and
that's that's really sad and that's your
point on physical therapy it also is
very time consuming to go to physical
therapy and to be honest a lot of people
who people of lower socioeconomic
status cannot afford to take a day off
of work once a week for 8 to 12 weeks
that's a huge time commitment and the
danger is if you consistently have bad
experiences with healthcare you might be
less inclined to seek help that you need
in the future just listen to this woman
who was diagnosed with lupus describe
how she was impacted by the response
from doctors when she sought pain
treatment it was just this belief that I
was making things up that what I was
saying wasn't real that I must be
seeking drugs or selling the drugs or
some such thing is that really what
people with that's that's what you were
getting oh absolutely and so what
happens is you start to develop a ton of
fear around going to the doctor come in
as a patient and you have all these
issues all these things you want to talk
about but the doctor doesn't have the
time to attend to all those things so
you feel brushed off you feel rushed and
and then of course you're not going to
want to go back or hyper feel nervous
about going again because he feel
vulnerable and you feel scared
gonna miss things if you only have ten
minutes with the patients somethings gonna get missed the way you know
insurance reimbursement works in the way
the current health care system works and
getting so many people in so quickly
it's so frustrating for doctors of course it's
frustrating for patients they don't want
to pay their co-pays and they're huge
out of network deductibles to get a 10
minute visit where you're not going to
tell them anything that they don't
already know and so it's just easier to
not come to the doctor patients are
having to choose do I want to go to the
ER with my sick kid I know they're gonna
just tell me you know it's viral do I
want to pay all that money people have
biases and doctors are people and they
may have come up in a system that
intentionally or not as often discounted
the experiences of a major portion of
the population and thereby sees explicit
or implicit have life or death
consequences female relatives we know
it's important to know that there are
baises in medicine and absolutely
there's biases everywhere right whether
they're explicit being there they're you
can obviously notice that they're having
a bias or their inputs that are
unconscious which happens a lot of the
time because people have different life
experiences right people have different
walks of life until they carry those
biases with them but I think there's a
lot of factors here that are in play
that you know John Oliver doesn't really
get into that affect the way people are
taking care of and one that we've talked
about a lot today is how little time we
have any most people agenda trying to do
the best they can
people are not malicious or have bad
intent and taking care of patients I
think we can definitely do a better job
as soon as we stop trying to be better
what's the point where you always have
to try to be better learn more in
medicine do more research help more
people the system is broken in so many
ways and we have to keep when things
aren't right stand up and speak out and
it's complicated art sometimes no
stalking expression of where sex and
race can negatively impact healthcare
outcomes than maternal mortality conely
the United States has the highest rate
of maternal mortality in the developed
world which is already terrible but it
gets even worse for black women you're a
woman of color in this country
especially if you're black your odds of
dying in childbirth are three to four
times higher on average in our country
why cuz you're not talking about access
to health care you're not talking about
money or education no and this is gonna
be hard to hear we believe black women
less when they express concerns about
the symptoms they're having particularly
around pain Serena Williams almost died
giving birth if Serena Williams one of
the richest people in the United States
almost dies we are doing something wrong
it's an implicit bias this these ideas
that we're not choosing to treat people
differently but it's happening the data
shows it but how do we care about women
how do we talk to women we were talking
about physical therapy earlier again if
you have a knee replacement you
automatically go to physical therapy
twice a week hip replacement same thing
if a bowling ball comes out of your
vagina or out of your stomach you have
to beg to understand why you have pain I
just saw a woman this week two years she
has had horrible pain and nobody has
even said the word physical therapy to
her two years after her kid it shouldn't
take that long to get women heard women
need to be listened I'm so so glad that
you're here bet you are yeah it's just
because I was worried I might be a bit
too white to give advice on this subject
well that's because you are oh yeah
you're real white yeah yeah yeah I bet
you clap on the 1 and the 3 don't you I
obviously wouldn't know how else to do
it so you just gonna have me stay in
here Oh would you rather huh yeah I
would oh okay sure
should not should I just if you're a
woman or a person of color going to the
doctor can be rough been there done that
got the Ibu fu***** profen  but
there's some things we can do first
doctors and med students should get bias
training I know that doesn't sound like
fun but it's one of those things that's
not fun but you should do it anyway
second we need more diversity in the
medical field
we need more non-white doctors in actual
hospitals not just the ones made up by
Shonda Rhimes
and finally until we do those first two
things you've got to advocate for
yourself and if that doesn't work don't
worry I've got a back-up plan
it's called bring a white man she brings
up some great points I think one implicit
bias training so I've actually had that in my
institution and I think it's helpful it
does go through it does kind of help you
uncover some of your implicit biases
there's also a tool online and that can
help you look at your implicit biases so
if you're curious I'll put it in the
link below so you can try and take the
quiz and see what comes up
and that's extremely valuable because
they're implicit for a reason they're
unconscious and people don't know they
have them including minority than
medicine or diversify medicine is
extremely extremely important so in
urology there are about 9% of women who
are practicing in urology but in
training there's almost 26% right now so
you know it's definitely increasing and
the potential minority there's about 2%
African Americans and about 4% Hispanic
population in urology but we definitely
could use more and then lastly
advocating yourself is very important
but it's actually really hard to do so I
know she jokes about bringing a white
man with but you can bring anybody with
you your family your friend your
neighbor or just someone who's another
set of ears too
hear what you have to say or what the
doctors saying and help ask questions
that maybe you don't think maybe take
notes so you can remember you have to
ask questions you have to speak up if
something's not right and you're not
being heard find people who will listen
who will take the time and work with you
and know that this is not in your head
and even if it is in your head your
heads a part of your body and it needs
to be addressed in so you the whole you
needs to be taken care of
absolutely and get a second opinion if
you're not happy with your doctor or
what they said there's never harm and
getting another opinion because it's
important to make sure you feel
comfortable with whoever is treating you
whether it's for pain a good doctor will
always support you getting a second
opinion
and if they give you a hard time for
reaching out to someone else then you
did a smart thing by going to get that
second opinion anyway well thank you so
much Dr. Rubin for joining us today and
I hope you guys enjoyed our episode of
reacting to John Oliver please make sure
to comment below let us know what you
thought it does anything else you want
us to discuss or if you'd like to see
Dr. Rubin again talking about sexual
dysfunction issues let me it on yeah let
me know as well we'll arrange news again
thank you and always remember to take
care of yourself because you're worth
