23 I Reflection Series—The Power of Cultural Humility and Cultural Safety to Transform Healthcare (Maha Razzaki)

• Timespan: 42 minutes & 04seconds
• Transcription Type: Cleaned Verbatim
• Speakers: ( Maha Razzaki & Raj Sundar)

00:00

Dr. Raj Sundar: Hi, I'm Dr. Raj Sundar, a family physician, and a community organizer. You're listening to Healthcare for Humans, the show dedicated to educating you on how to care for culturally diverse communities, so you can be a better healer. This is about everything that you wish you knew, to really care for the person in front of you, not just a body system. Let's learn together. Welcome back, everyone. You'll hear a lot from me in this episode. So this intro will be brief. Today I'm joined by Mahatma Zaki, a colleague, a friend, and an essential part of our podcast team. She's the program manager in quality for member equity, inclusion and diversity program. Together, we'll explore topics that have talked about a lot in other settings, but haven't had a chance to on this platform. If you've been listening along since the beginning, or just joined us, we've touched on a wide range of subjects on this podcast so far, exploring ethnicities like Ethiopia, and combined, as well as specific topics like model minority, and Afro Latinx. What makes this podcast special as learning medium is the continuous ongoing nature of us learning together. As I evolve, I want to occasionally share my thoughts with you on this platform for a whole episode. Today will be one of them. Where I talk a lot more than usual, we'll dive into the differences between cultural competence, cultural humility, cultural safety, and the dizzying number of terms to define culturally responsive care. And then talk about the layers of identity we all hold. We will unpack these concepts and redefine them to better serve our needs. Thanks again to Maha for keeping our conversation grounded with our insightful questions, particularly when it comes to caring for individuals in the healthcare system. You won't know this by now, sometimes I get caught up in abstract ideas, technical terms, and kinda like to just get nerdy and Maha helps me stay focused in this episode on the real world impact and what it actually means. Let's get started. Welcome to the show, Mahara Zaki.

2:16

Maha Razzaki: Thans for having me.

2:17

Raj Sundar: Tell me about yourself and how you ended up doing the work you're doing.

2:21

Maha Razzaki: It's interesting because I feel like what I'm doing today is something I was always meant to do. So I was born in Pakistan, and I was about five when we moved to Singapore. And I remember that being a very transitional period for me. Even though I was that young, I really fell in love with diversity and equity because I was part of such a diverse community in Singapore, it was really this hub for folks from all over the world being there to work. And I went to international schools. And every time I'd go back to Boston, I was really struck by the intense poverty that I saw. And just similarly to other developing countries, huge contrast between folks that were really struggling as well as folks that had resources. And I knew that was my calling back then, that I wanted to make an impact in the equity space. And so since then, I've been seeking out a formal role in the health equity space, and I joined my civic role in 2019.

3:18

Raj Sundar: what’s your role?

3:18

Maha Razzaki: My role is a program manager in quality for a member equity inclusion diversity program. So that includes language access, ADEA, civil rights and health equity initiatives.

3:30

Raj Sundar: Okay, thanks, Maha. I think I get your story. But not everybody, when they're surrounded by diverse people, you know, in Singapore decides, I want to dedicate my life to equity. Give me a moment in that story, where you're like, wow, like, this is what I want to do. Because I'm curious on how it led to that choice for you. Was there any specific moment or experiences that made it feel like the right work for you?

3:56

Maha Razzaki: Yeah, that's a great question. I think even though I was so young, I had a string of several moments that I grouped together. And a lot of the classes were intentionally focusing on issues from around the world. And that was just the way the curriculum was set up. And the students in my class attending all were aware of their own cultural background, whether they were European, American, Asian, or had, you know, African backgrounds. And I just remember feeling this level of connectedness to not just communities that I identify with, but really communities that banned the various continents. And I had several of those moments sitting in that classroom. I hadn't really experienced anything else. And then when I moved to Ohio, it was such a stark difference, because most of my classmates hadn't traveled outside of Ohio and our curriculum was really homogenous. So we didn't really study in a constructive way, I would say about other communities in the way that history was told. I remember feeling really uncomfortable in my classrooms. And then reflecting back to my experiences in Singapore and thinking, how can I contribute? How can I bring some of that same sense of not just belonging but conversations and efforts around equity and centering all the communities that are involved.

5:07

Raj Sundar: Yeah, that's a good transition to the topic of this episode, which will be parsing out this idea of cultural competence. I sent you some articles we talked about a little bit, but I want our audience to have more context in the episodes that we've covered in this podcast so far. Because at first hate, I think it's easy to get stuck in this idea of competence, like, what we're doing here is listening to these community voices. So I can hear how different they are. And then we can check it off our list. Okay, we got the Vietnamese community down, we've got the Cambodian community down. And now we can go and do the same things that we're doing before, but at least I know a little bit. We know that they're different. But it's so problematic. I want it to first talk about the idea of cultural competence and humility and safety. If you had to explain it to somebody, cultural competence, what has it meant to you? And how does it fall short?

6:06

Maha Razzaki: Yeah, I think that's a really important question that you're asking, because cultural competency, I became really familiar with that term. In grad school, it was the term that was the most frequently used. And at that time, it was really defined as interpersonal skills that you have as an individual to understand the norms, the values and behaviors of a variety of other community groups. So being able to interact with anybody, regardless of their racial socio-economic background, and then using the word competency to me, there was a strong suggestion of once you've developed those skills, you're set. I know, that was probably not the intent. But I always found that a little bit of an area, which seemed problematic. So I think from that point on, I did see the term evolve and be used at an organizational level to convey how scaled as an organization in terms of meeting the needs of diverse communities and populations. What's really missing, there is any discussion of what are the forces at play here. So what are things in our society, both socially and historically, such as racism, colonial history, slavery, all those different factors that have happened in history and continue to happen and how they've impacted where we are today? So for example, you brought up patient stories, a question that often comes up is how do we get various communities to trust us various communities of color to trust our system? When we ask that question, and we're just looking at it from that cultural competency lens, we might just think about touching the surface. When it comes to historical context, when you go into this space of some of the other concepts we're going to talk about, I think we start to open up our minds a little bit to think about what are the power dynamics at play.

7:53

Raj Sundar: Yeah, that's a good way to encompass it. I've been trying to distill where it all falls short it and and for me, it, I think falls into three categories. One is this idea of othering. Two it sometimes oversimplifies a whole culture. And three, there supposed to be this clear endpoint of competency. So this othering I think of, as you mentioned, there's a standard norm that were comparing every other culture to which is the dominant culture, which is offered the white American culture in the US, and everybody else is something we need to study. They're like exotic animals in the zoo. That's what we're trying to do look at them and talk about how like different they are, and maybe strange in some ways, but it's kind of interesting. But that's all there is to it. Right? The second part is the oversimplification. Because you end up sometimes putting people into stereotypes, or these boxes of who they're supposed to be like, you may have listened to the episodes on India. And then you look at me, and you come to me talking about your eating rice all the time. And then you might find out that I don't eat that much rice, because mostly, in our house, we eat like quinoa and barley, right? You're stereotyping me, because you thought you understood Indians after listening to the episode or researching about the Indian community. And now I don't feel really listened to. And third is this checkpoint aspect of it, which I brought up, it's that you somehow can get competency about a whole culture, which is very dynamic. So there's so many aspects of culture, I think that time sometimes can be reductive. You said it evolved? What does this evolution look like in what you've studied?

9:33

Maha  Razzaki: I think we move from a space of more cultural competency to cultural humility, giving that same understanding that you're discussing where everything really is on a continuum. So the example you're using I think, is perfect. When we break down culture and you think about diet, behavior, activities, preferences, the list goes on and on. It's really endless. And if you really think about every single one of those things on a continuum, because I've heard that a lot of times to where people are like you're not Bakasana, you don't like spicy food. I'm like, That's doesn't boil down to just one thing. And here are all the reasons why I can't eat spicy food.

I have to tell you, my dad only eats food when he's profusely sweating. That's what like good food. I think I could never do that.

10:10

Raj Sundar: I have to tell you, my dad only eats food when he's profusely sweating. That's what like good food. I think I could never do that.

10:18

Maha Razzaki: So exactly what you're saying. It's like how can we just take one understanding of a particular culture and assume from that baseline, we know someone else's story. So from cultural humility, I think about that as taking some of the strengths of the cultural competency model, but then going into a space of active listening, and centering the voices and lived experiences of other folks and communities that you are not a part of, even when you're within your own community. I think cultural humility is a really important practice. Because I can say, almost four decades, I'm still learning my cultural community, there's just so much incredible diversity. But anytime we think, yes, we have the answer. Yes, I'm an expert in an area, I think that's the best time to pause, and reflect on why we're feeling that way. Because that space, can then lead to making a lot of assumptions. And that's what we hear from patients, a lot of the time I went in for an interaction, this is what I thought I was going to be receiving. But the end of the day, it didn't sit right with me. And the complaint will come in three weeks, several months later, because it takes time to process what was unsettling about that interaction. And when we go back to look at those complaints clinically, when you don't find something that happened, which was a deviation from a standard care practice, you were just thinking, was it the care experience, those are the times when we have so much opportunity to do better. And I you know, again, cultural human Humility is a step forward, where rather than us getting defensive and being like, I didn't intend that My intentions were to really make us feel seen and heard and really make this all about you. But Raj, I think what it boils down to, and I was just actually reflecting on this today was so often we're treating people like we want to be treated, right? It's like, No, I would want my provider clinician explain it to me this way. And I think that's where we make a mistake, we really have to treat people the way they want to be treated. And how do we do that? If we don't ask them the questions upfront at the very beginning to ask them about their preferences, like what do they need? And then again, coming from a space of cultural humility, it teaches you just can't make those assumptions.

12:16

Raj Sundar: Yeah, I think about misdiagnosis a lot. You probably hear about this, where, let's say there's a blood clot or DVT. And we miss the diagnosis, because it presented in a typical way. In the patient's mind, oftentimes I see it because of my identity, that the clinician didn't listen to me, or didn't take me seriously. And when we hear those complaints, I think clinicians sometimes are like, it looks like the standard of care. Maybe there are some misdiagnosis, but it's unclear. But it sounds like we can improve on that clinical part of it. And then we never step back to look at what did the patient actually hear that now they're questioning everything, right? Did anybody take me seriously. And that's where there's a slippery slope, because you mentioned this, where cultural competency can lead to stereotyping, racism sometimes, right?

13:19

Maha Razzaki: I'll give you a few themes that I hear. So when you think about patients that are Asian, that category, first of all, is way too broad. And you've had an episode or two that's talked about some of the historical issues that have come up with that category. But then you further break it down and talking about South Asian patients, even. You're contending with the model minority myth, which I think about from a broader perspective, even outside of healthcare, academia workforce, this is where Asian Americans are not getting services. I remember being very involved in college worked with a lot of different student groups. And I remember we continually got denied services, because the thought process from the administrators was Wait, you guys are performing really well, you must not have issues that other students are experiencing. And that itself was false, right? You had a lot of variation and academic performance, you had a lot of similar types of struggles with college students. And the reason why I bring up that example, is I think looking at other settings outside of healthcare is really helpful to know what type of experiences you're seeing within the clinical setting. Because if a patient's coming in and you have this thought process in your mind of Oh, yes, this is the model minority myth, which is just so false. It's such a false construct. And it really does a lot of erasure and creates invisibility around struggles that Asian Americans have, then there might be a tendency to not dig deeper or ask questions to really get to the root of the issue. And there might also be some internalized struggles patients are experiencing to where they feel like Oh, I'm supposed to be at a particular standard, or I'm not supposed to have these issues or challenges and you think about mental health issues. Do you think about substance abuse or any other category where topics that are really difficult to talk about, so that I would say is an example from the Asian American community. And when you dig down to the granular level with ethnicities, there's just so much rich and diverse experience that's happening across the board.

15:17

Raj Sundar: Yeah, that's actually a fantastic example, that you see somebody that's high performing, and an Asian, and you may walk into that room, and this person is doing great. They seem to not share anything with me, but seems like they're doing well just normal well visit. And then you can just check off a box. And then you don't know all the biases that you carry it in with you and didn't do what you'd maybe did for other patients talking about substance use and how their mental health is, and ways that we all as humans can struggle, whether it's a pandemic or not, because we're falling back on these biases, and the stereotypes that we hold in our head, we talked about all the problems with competency and you brought up this idea of humility. That's why that can be helpful, because now you're reflecting on your own values and beliefs, and what you're bringing to the table and where you could be holding biases. I wanted to bring in also this idea of cultural safety that we talked about, what do you think the concept of cultural safety adds to cultural humility?

16:18

Maha Razzaki: Cultural safety is a concept that you introduced me to, and it's something that I've always thought about, I just didn't really even know that the term existed. And the reason being is I got so engrossed in really looking at best practices nationally. And you shared this with me that this research had been done in New Zealand a couple of decades ago, by Maori nurses looking at their indigenous population, really asking the questions about the disparities in care, and the struggles that the indigenous population, the Maoris we're having in New Zealand. And so from that, I became familiar with the fact that we're taking the cultural competency and humility model and looking at the power dynamics within that. So as a clinician, or as a part of a clinical staff, what are the power dynamics between me and the patient? What is the social and historical context that has led us to where we are today. So I think a lot of the times, we're in the present moment, which is great, but then we all carry these histories with us, these stories of our own individual experiences, but also this larger communal experience that we've had. And they think that opens up the door for a really important conversation when it comes to safety. because safety is really truly the first thing right as kids, that's what we're always taught prioritize your safety. And somewhere along the line, especially in healthcare, we're talking about care experience where we're missing the first step, if we can't make our patients from diverse backgrounds, from communities of color, or from marginalized communities really feel like they're centered, and they're saved from the very beginning of their interaction. And in fact, it happens before even communicating with their doctor. It happens when they're calling to make the appointment or scheduling the appointment. And there's that entire patient journey. But if something those inherently wrong in that exam room, it's really going to overpower even if everything else felt safe prior to that clinical experience.

18:22

Raj Sundar: I agree. Okay, let's bring in the final concept that I shared with you, I can't find where this came from somebody said who is Asian proverb, which is the worst sourcing of something. Probably, but that pyramid that I shared with you, where it talks about how every person in certain respects, is like, no other person, individual, like some other persons a group, and like all other persons, the collective. So that we each hold individual identity, we each hold a group identity, and that we all share something collectively as humanity. So for me, that could mean collectively, I have the same need for safety, experience joy, I struggle with death of family members, these are all universal human experiences that we all contend with. And we need support with from our family or caregivers. And then there's the group identity, which is I have my background as a Indian American. And my parents grew up in Tamil Nadu. And then my grandfather was from a small village there, so a lot of identities back there. And there's a lot of cultural elements to that incorporated into my identity. And then there's the individual identity because I really am different from any Indian or any Indian American because I'm also a doctor that grew up mostly in North Carolina, and then I came to Seattle, Washington do residency, and I haven't found another person with that same trajectory. Actually, but do you think that helps? Or am I missing something?

20:03

Maha Razzaki: I think it is really powerful. When you sent me the image, I feel like it was triangulated, Right? And it had those three components broken down and you explain those beautifully, really, it is all three. And they are really fluid. Each of those components as like you're describing your story in North Carolina, who you were 10 years ago, who you are in medical school and residency, right? But I think when you were describing the differences between the three, I went back to my seat to new medical education, professional development days. And I think so much of that curriculum across the board in different organizations focuses on the universal experience. So it's really supporting clinicians, and how are we connecting to our patients at an emotional level showing empathy, but not getting burned out? asking permission? So creating this conversation, that's more in terms of partnership than being overly prescriptive, even though as a provider, you have to be times? Right. So when I think about coursework, like that, I feel our clinicians get a lot of content when it comes to the universal experience. And to your point, you have to have knowledge about the communities that you're serving. So you have to have at least a baseline in understanding and commit to growing that thing is somebody whose understanding of India was just limited to the diet, right? What are they committing to not just for that, but really learning about your history, and all the communities understanding African American history, Native American history, and Native Americans are so often left out of a conversation, right? There's so much erasure, and all the communities that they're serving. And then going that one step further, where you said, there's that group identity and the individual identity, I'm thinking about a project I did, it was an ongoing initiative, and it was serving the Latine community, and we're looking at diabetes outcome for a population. And the reason why this is coming to mind for me is so often we go into these spaces saying, we want to co-design, we really don't want to design a solution for you without you. But when you think about all the constraints, we have, like the challenges and really getting community-based participation, depending on where you are, where you work, you start out maybe with a more idealistic vision. And as time goes on, a lot of people are just like, Well, I tried my best, this is all I could do. And I'm thinking I'm designing for you with you. But I'm really designing for you. And so that's where I think the model that you're describing, is giving us a permission to pause along the way and ask that question all the time. So even if you're a clinician doing primarily individual care, or if you're a clinician at the administrative level, thinking about who am I designing with right now? Or am I equally partnering with community members that I'm trying to serve? And then I think at the individual level, Raj, I'm really curious to hear your perspective on how you go into the exam room and make patients feel safe. Because just conversing with you, I know, it's such a strong priority of yours. Have there been instances where you felt that a patient has given you the opportunity to ask them from the get go? What kind of communication would make you feel like you're understanding the directions I'm giving you? or What do you need to feel really engaged?

23:22

Raj Sundar: Yeah, that's a good question too Maha. And I'll bring in one more concept, because I think it's helped me, which is thinking of it as patterns and power. And that aligns with the cultural safety model, right? Patterns being worldviews, values, beliefs that a community or a person of this background could hold, can that could as important because they don't have to, but it's a possibility. And then second is the power. What is the power dynamic between me and this patient? And we could just use an example that's come up in our past episodes, Dr. Miley Tao li talked about building rapport, right? It's such a common thing that we all do. We walk into a patient room, and we're like, looking for that one thing that I can connect with this person with that I don't know. And if you see a patient from Hawaii, like a lot of clinicians, unfortunately, they bring up going to vacation in Hawaii, because, hey, like, that's what we do. We're in the West Coast, and that's the cheapest flight. So you bring up I was just in Hawaii in blank island. But then Dr. Miley brought up specifically how that can be traumatizing. And that in itself is not providing an environment that's safe for the patient because you have to understand why men were dismissing this bigger concept of land trauma, and colonialism that's happened where people from Hawaii ended up here because they've been kicked out of Hawaii because of tourism, and were part of that and then they can't go back or visit their family because they can't afford to. So what you went in there to do which is build rapport, you've actually done the very opposite and made it feel really unsafe. Because here's this person galavanting talking about taking vacation in my country, or my state in which I can't even go back to. And now I have to be super vulnerable with them about something that is really hard for me. Now, can I trust this person who already did this to me to listen fully? And I can I trust them enough to follow what they say, and that they will be here on this journey with me. Right, that's just small instant that can actually affect the entire relationship. This is where I ask people to be cautious because the patterns and worldviews and values and beliefs I talked about lantra. And people want to like immediately make it black and white. And sometimes people are like, oh, man, I can never bring up Hawaii to another patient again. And that may not be true, right? This is the collective identity, the person you may talk into may go to Hawaii every other month and see their family. But now you know that knowledge because you've done that work. So you actually ask the patient, where do you call home? Have you been home recently? Is that important to you? And you may find out that they haven't. And they really miss it. And it's hard for them, or you may hear it go back all the time. If they're going back all the time, you could bring them Hawaii and say yeah, I was there. That's a different way of connecting. So you understand the patterns of the collective identity, but your early approach each one as an individual, but you have this understanding to make it more nuanced. And you don't really let's be honest, like effort up for the whole entire visit. And they're not going to trust you nor the system, who doesn't get them at all. So I talked about power. And the power is important because all of the history that's affected their community comes down to this power dynamic. Because the patient won't say, hey, stop talking about Hawaii, I haven't been there in a while. That's right, because then they got to actually talk about the problem that came in for so there's that power that's there. So you won't actually hear the truth from them, probably unless you do the work. And historically, the colonialism also made them so like forbade them feel that they don't have a voice. So there's a broader community level and individual level power dynamic. So you're acknowledging all that. And that's why the cultural safety part becomes really important, I feel.

27:07

Maha Razzaki: Yeah, absolutely. And I feel like a cornerstone of that safety is concern and genuine care, and empathy. So that challenge of having that 20-minute visit with a patient, I know that so tough to create that immediate rapport. But I think those first initial minutes, especially when it's your very first visit with a patient, those will carry onwards. So I think back to the primary care provider I had for many years, and it was literally that first meeting that we had, and her taking like two to three minutes to connect with me. And she was really good at it. I don't even know how she went about it. But it was just finding something or an experience we had in common, she happened to find a point of connection. And I have to say I'm a very conversational, I think I'm semi-extroverted person. But I myself get nervous whenever I'm seeing a clinician, because part of it is my cultural background, too. There's so much deference given to clinicians, right? And so I'm going in there trying to follow what they're telling me. But what most of my doctors don't know is even though I'm trying my best, I may or may not after the fact, given whatever else is going on. And I think what you're really addressing is if you don't create that safe environment immediately, a patient can easily not through the whole appointment, not ask too many questions make it seem like yes, they understand what they're going through, they're going to follow the after visit summary and the directions you're giving them. But it kind of gets lost along the way. And I'm curious to from your perspective, are you able to pick up on that, when you can tell like a patient is agreeing for the sake of not just necessarily the sake of agreement, but also because they feel like it's the right thing to do that. They don't feel like they can really share with you, you know, I do really want to follow your directions. But here's a reason why I can't this is a reason why. Maybe I can't exercise. I don't have access to save spaces, or I would go the gym, but I have too much on my plate with work. How do you create that dialogue with your patients to really have them open up again, given that they're all coming from different cultural contexts?

29:10

Raj Sundar: Yeah, I think there's a few parts of that, right? Like you said that Asian women can be different because of cultural norm. Don't assume that about all Asian women. That's what it's called stereotype and racism. If I go in there, and assume that you're not going to tell me anything, keep asking you the same question. You're like, I already told you, I'm fine. Try to get to this. But you understand that if you've done the work of cultural humility, and some basic understanding of cultures that some cultures don't empower women, not that America does that well, but there's a feeling of deference. So you go into the understanding and you always have in the back of your mind that we came up with a plan. But I'm not confident they're sharing this with me, and I need to keep that always present in my mind. So we'll need to check back in and if they say no, I didn't get a chance to do that. Or they said, Yeah, how did that go? Like? How did that go? Just ask them few more details until they feel safe enough to say, You know what, I actually did it. And then you'd be like, Why that's okay. Like, again, you have to approach it on not scolding them or diminishing their reality. An example of that could be the use of supplements, right? In the Somalia episode, we talked about use of habit, soda when a community uses it a lot. It's one way to approach the question of asking about supplements by saying, Are you taking these other supplements that could affect the medication? They're going to prescribe you in a way of these things that you do on the side that we know don't work, but you're doing it anyway? Versus like, I heard this other supplement can be effective for a lot of illnesses. And some people in the Somali community use that. Do you use that too? Me like, yeah, actually, thanks for asking, I do that. And I think I'm really getting better. So I'm not sure if I really want your medication. I was just curious if you were going to prescribe something else for me. And maybe if it's not better in a week, we'll talk and I'll take the antibiotic. And I've just noticed, that's how the conversations go, depending on how I knowledge what they're already doing, or have a knowledge about what the nuance where again, I didn't go in saying you've probably taken the supplements that everybody else is taking. I just say, that's what I've heard. Are you doing it too, because I heard it works. I think those all helped me build that safe relationship.

31:22

Maha Razzaki: Yeah, in your example, you shared something that brought to mind a very interesting experience I had I remember in a therapeutic setting, one thing I was told, and I think it was intended as a compliment. But it really landed board with was like, Oh, you're not like women from your background. And I think what she was trying to convey to me was I seemed more modern, because I had a job at the time. And I just stood there. And so much of my thinking is process-oriented. So if you say something, to me, that's really surprising. I wish I had those comebacks. And a lot of people, I realized don't have that. And so for her, she probably felt like I didn't do anything wrong, because I never said that back to her as feedback like, hey, what you just shared just made me feel really uncomfortable. But after that, I had to think do I want to keep going back. And ultimately, the reason why I did for me was I just know that's a really wide held belief. That women from my cultural background, they're seen as being submissive, oppressed, not having agency. And I was just thinking that whole time, like, I know so many other friends, relatives, that are so much further along the line than I am. So I was like, if you're surprised by me, I'm just an ordinary person. And it's so problematic. But that's ultimately what made me go back was that I know that I'm contending with this stereotype. She happened to voice it out loud. And throughout that conversation about future appointments, I tried to convey to her exactly what I was saying to you that I'm not necessarily out of the ordinary, but I feel like I have to do a lot of this teaching, whether it was during my school years, college years in the work setting. And I think that takes a toll on a lot of people. And I know for patients especially they feel like they have to teach in the moments. And then they're sitting with these feelings that make them uncomfortable. And this is why I was saying that sometimes I see complaints come to me a month or several months afterward. And how do we create that environment? Raj? Do you think of having folks from clinical teams really think about it through the lens of opportunity? And not that fear of defensiveness because I think what happens oftentimes, we miss that growth opportunity at an individual level. So if I said something, and if I'm a clinician, I said something that really hindered my patient's ability to feel comfortable and feel safe, and they have the courage to later voice that and that alone is really difficult, right? Because we know that there's so many communities we rarely hear from. For example, patients that have limited English proficiency, because systems are so challenging to navigate. And I would say, patients of color as well, because oftentimes, they're like this is going to keep happening. So why would I call in? Why would I submit a complaint? So I know you've done really great work in this space to create awareness to create a culture that really shifts the perspective of the mindset. And I'm just curious to learn from you, like what do you think the next steps are? Where do you think there's continued opportunity to grow to have clinicians really be open to this type of feedback, and not be afraid of canceled-culture. Everybody fears that this these days, we're all worried about saying the wrong thing and getting canceled, but it's really not about that.

34:41

Raj Sundar: There's that defensiveness that you talked about? That's probably one thing. And then you said the fear of being canceled or saying the wrong thing. So they're not actually making an effort. That's probably a little more complicated. So this is why I've been thinking about a lot. One is like Why am I doing this work? And so much of that has been because of my self-reflection on what am I contributing to this? What am I actually doing here? And what's my purpose, I am an Episcopalian, which is like diet catalysis. And then I am really deep into understanding the Buddhist philosophy too. And I bring up two things that resonate with me that I tried to reorient towards when I do something wrong, or I'm not good at something, which is there's this concept of love. One is mudita. And one is Karuna. And the idea behind that is that the joy that you experience is not about you, it's about the other person. So sympathetic joy is one of them, which means that I'm really happy because you're happy. And then second part of it is compassion, which is relieving the suffering of another person. Not in this paternalistic, condescending way of saviors, though, I'm going to come and save you. But I'm in this together with you. And I'll feel better. And I'm going to join you in this journey when you do, because we're all connected in that way as humanity. I digressed to that, because we all struggle with this idea of perfectionism in medicine. And there's other factors like fear of litigation and messing up that our first reaction is always defensiveness. But we are in this work, caring for others, and for striving to be better in loving this person in relieving their suffering, then it's okay to make a mistake. And the goal is to get better, and not to put the burden on the patient to teach you. That's a lot to put on them every time to keep telling you about the history of their community, or their food, or what they've experienced. So you doing some of that work. And a fear of being canceled. I mean, there's this, like bigger trend of that. But I don't think people are going to cancel people in health care and the work that we're doing, I could be wrong. But if you approach it with authenticity, and you're like genuinely trying to be better, because people understand that people are trying to be better and care for people that are different than them. I don't know, that's my first step. Does that make sense?

37:16

Maha Razzaki: It really does. Because I think we all have something driving us. I know, there's just so much work to do in this space. But it's how can we really shift to thinking about these more as gifts, like any time, a patient who has all these barriers from them, giving feedback, the fact that they went through that effort means that they not only want you to do better in terms of your communication with them, but they want you to be better when you serve other patients, too. So for healthcare, it's understanding that before the patient even walks through the door, they've had all kinds of encounters. That week in their workspace, any public space that they've interacted with. So they may have had a traumatic experience. Do you think sometimes that's missing that understanding of what did the patient go through, not just historically in their earlier years, or maybe a few years ago, but maybe just even in that past month? And what trauma is is triggering if we see complaints come in?

38:18

Raj Sundar: Probably right? You have to remind yourself that every time and we're so caught up in our own experience and story that we don't step back to see what could have happened to this other person last month, or this week, or earlier today? Because we are thinking about how this patient's community can answer affecting us. Or we're so time-strapped that we don't take time to think about that, because we were just going from patient to patient, or visit to visit. So I think it's always worth reminding people about that, and having tools to remind yourself about that when you're practicing.

38:51

Maha Razzaki: Yeah, have you found something to be helpful for you in terms of a tool that's helped you grow in this space of creating cultural safety for your patients, and to take it a step further, maybe even for your colleagues. So creating a space for your colleagues where they can share those tough experiences that they've had?

39:11

Raj Sundar: Sounds like we have some homework to do. Let's go to the next episode. How do you create cultural safety? I don't have an answer. Yes, with you. I shared some examples. But I probably have some, I fall short and a lot of ways to self to reflect and see what's been done for it. I think people are clinicians and sometimes non-clinicians are listening to this. The part of that is like our own well being can sometimes be affected. So it feels hard to do that step of where you notice something's falling short and finding ways to solve it in your place like the power you have or advocate for that. And I think people are always trying to find ways to do that, sustainably. Okay, Maha, let's wrap it up. We'll be back. They don't want us to stop talking. So, takeaways, this is not about becoming competent when a culture. You're taking the time to learn the history and context of their community. So it's not on the patient to explain everything to you. And it's just a starting point. Because everybody holds multiple identities within themselves. And you're gonna figure out which identity they want to bring forward. Maha.

40:24

Maha Razzaki: Yes, I would say, for me, one of the key takeaways is to learn how others want to be treated. So going back and reflecting Raj on what you identified, which was, we all have an individual identity, a group identity, and this common humanity, and identity formed through those common human experiences. So how do we take all of that, and at the same time, avoid making assumptions? So what does effective communication look like for them? What does it mean for them to feel safe? And I think the best way to do it is to create a space where you can ask those questions and where they can openly share that feedback with you and get recognized and rewarded for it and really appreciated for that information that they're sharing.,

41:08

Raj Sundar: Yeah, and I think we don't do that enough recognizing and appreciating, because it's hard. Because that power dynamic of speaking up and saying your doctor didn't do something well. Or the healthcare system let you down because you have to go in there again. And there's always that fear, even if it's not true. If it's identified. It's always there. And this is scary. Takes a lot of courage. Yeah. All right. Thanks, Maha. Thank you. Thanks again, everyone, for joining me on another episode of Healthcare for humans. If you liked this episode, as always, I ask you to please share it with one other person, so they can also hear it. I'll see you next time.

This podcast is intended for educational and entertainment purposes only views and opinions expressed in this podcast do not represent any of the participants past current or future employers unless explicitly expressed to so always seek advice of your physician or other qualified healthcare provider with regards to your own personal questions about what medical conditions you may be experiencing this healthcare for humans project is based on Duwamish land and makes a regular commitment to real rental owners.

41:48

Speaker 3: This podcast is intended for educational and entertainment purposes only. Views and opinions expressed in this podcast do not represent any of the participants past, current or future employers unless explicitly expressed so. Always seek advice of your physician or other qualified healthcare provider with regards to your own personal questions about what medical conditions you may be experiencing. This Healthcare for Humans project is based on Duwamish land that makes a regular commitment to Real Rental Duwamish.

The transcript ends here.