Words matter: Definitions ground us in our profession and in our world [PODCAST]

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“Definitions ground us in our profession and in our world. Definitions matter because they help us pause, give our body a moment to settle, and our breath time to move in and out. Our racist actions, inactions, and comments are invasive throughout our waking hours, but we can change them if we can define them.

Racist. Anti-racist. Microaggression. Institutional racism. Don’t let the words keep you tense. Let’s move forward together and breathe.”

Joy Eberhardt De Master is a pediatrician.

She shares her story and discusses her KevinMD article, “Racist. Anti-racist. Microaggression. Institutional racism. The power of a definition.”

The opinions in this podcast are those of the guest and not of her employer, Kaiser Permanente.

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Joy Eberhardt De Master. She is a pediatrician, and she wrote the KevinMD article “Racist. Anti-racist. Microaggression. Institutional racism. The power of a definition.” Joy, welcome to the show.

Joy Eberhardt De Master: Thank you, Kevin. It’s wonderful to be here.

Kevin Pho: So we’ll get into your article in a little bit, but first off, can you share your story and your journey to where you are today?

Joy Eberhardt De Master: I grew up between the U.S. and Mexico, and so I feel like I moved in between different cultures. I grew up financially disadvantaged. I was the first of anyone in my family to go on and get my doctorate. I’ve always looked at ways where I want to look at greater system focuses, and so when I completed my pediatric residency, I worked at a community health center and got to experience and work with people from all around the world, many different backgrounds.

And then I moved, and I work now with Kaiser Permanente. I do well-child treatment assessments and work in the eating disorder clinic, and I get to use my Spanish regularly, and I’m always looking for ways of preventative focus, as well as ways of improving systems.

Kevin Pho: Now, from your lens as a pediatrician and through your lens in your practice, what would you say are some of the biggest challenges that you see?

Joy Eberhardt De Master: I think the biggest challenge is that sometimes we focus in on the smaller actions that a patient does, and we don’t understand the context around it. I think one of the other challenges we have as clinicians is that we don’t see what we bring or how we can positively or adversely affect a situation.

Kevin Pho: Give an example of that challenge, say, in the exam room, and tell me how you and your experience can help address that particular challenge.

Joy Eberhardt De Master: So an example would be, and I could pull from my article, I used an example of talking with a teen in regards to their interest in going into health care and becoming a doctor, and seeing their disadvantaged background, seeing that they were a person of color, seeing that they didn’t have financial privilege, and my worries about promoting their ability to go on and pursue being a doctor. And then my realization of how I was propagating institutional racism. And just the recognition of that, and the importance of how, as health care providers, as physicians, nurse practitioners, whatever our expertise is, we really need to be aware of that.

Kevin Pho: All right, so let’s transition into your KevinMD article. It was written back in December, and it’s titled “Racist. Anti-racist. Microaggression. Institutional racism. The power of a definition.” Now, for those who didn’t read the article, can you just walk my audience through it and share the story of why you decided to write it?

Joy Eberhardt De Master: So I am a Doximity fellow this year, and I just want to thank Doximity for the ability to do this, and my editor, Haley Smith. Without it, it just wouldn’t be possible. I really wanted to talk about where we’re at as a country, and as a health care system, working with the BIPOC population, the Black, Indigenous, people of color, and realizing how they’ve been disproportionately affected by COVID-19. But then also recognizing our own suffering as health care providers: How do we incorporate that and those pieces?

So I wanted to give some very concrete examples in the beginning. I talked about El Terremoto of 1985 in Mexico City. I talked about an Indigenous woman whose baby was dying. And then I moved into some very clinical examples, as well as then acknowledging our suffering in our training. It’s horrendous training we go through in health care, and then how can we be present with others? And then interweaving with it the piece of awareness of our bodies, which is something that we so often neglect, our own well-being.

Kevin Pho: Take us through one of the examples that you wrote in the article, the challenge it presents, and what are some of the ways that we can overcome it?

Joy Eberhardt De Master: One of the examples that’s very salient, especially with the snowfall, the ice, the power outages: I remember as a child in Mexico City El Terremoto, which means a huge earthquake, in 1985. And there was just so much destruction, hospitals falling. I can’t speak about it without getting slightly teary-eyed. But the fact that these babies survived that were without care for, I believe it was, a week, that people partnered together, coming from other countries, and public hospitals, private hospitals partnering together: There’s the beauty of taking a crisis and using it to unite all people.

Kevin Pho: So you also talk about the challenges that Black, Indigenous, and people of color face, especially during the pandemic. Can you articulate some of those challenges and maybe share a story or an example of what you’ve seen through your practice?

Joy Eberhardt De Master: So in February of 2020, there was a law that passed that made it basically criminal if you didn’t have papers, legal papers, to pursue public assistance. So here we’re heading into the pandemic. There are a lot of people who lack documentation. There’s a large Latino population. They’re not the only ones, but documentation is really a struggle there. And there’s the fact of, do you get food assistance? Do you get food stamps? Do you get housing assistance? Do you get health care assistance? And so even being able to go to a doctor when you worry that you have COVID is a very big struggle.

There’s the fact of having enough food, having enough money. I spoke with people who did not want to take any of the monthly funds from the federal government due to the fear of, “OK, wait, will I be able to get my residency in the future? Because this is being looked at as a criminal offense if I take assistance now with my lack of documentation.”

Kevin Pho: And when you see these patients and families in your clinic, what do you say to them, and what kind of advice can you share?

Joy Eberhardt De Master: One is, I like to acknowledge it. I think that’s huge, and to have these conversations, so that’s a big reason I’m having this conversation with you today. And the other piece is advocacy. Ideally, if you can partner with medical-legal partnerships and make systemic changes, and then with the advice of lawyers, they can really help advise families on what supports would be best for them to utilize or not.

Kevin Pho: And for those individual clinicians who are listening to this podcast, what are some resources that they could turn to, and what are some of the things that they could do to help address the issues that you’re describing?

Joy Eberhardt De Master: So there are some specific medical-legal partnerships that I don’t have on me at this very moment, but just be aware that that is a very important presence and that it makes a really big difference. Be aware that it can be a reason why you have what’s been termed in the past a noncompliant patient. What are the barriers to their ability to access care for themselves or a family member?

And look at the terminology and how we use it. I don’t talk about it in my article, but, you know, just “noncompliant.” I talk a lot in my article in regards to definitions. How we talk about people, what we say, is so important, and so is being very aware of that.

Kevin Pho: All right, go into more detail in terms of some of the terms that we use. What are some of the things that we say that can adversely affect a relationship?

Joy Eberhardt De Master: So one of the examples I use in my article is in regards to acknowledging someone by saying, “Oh, they speak such good English.” I have this mother who comes in who does not want to use an interpreter, and we’ve all been there with the stress of navigating languages. How does that work? And she did not want to use an interpreter. I was struggling. I was afraid I wasn’t going to understand her appropriately, and then I was feeling the guilt of, here I am judging her before I even had a chance.

And then she speaks, and then I’m acknowledging, “Oh, you have very good English.” Those are microaggressions. It’s me assuaging myself, putting that person down, and recognizing that. So I think that’s really important in our clinical practice.

Kevin Pho: We’re talking to Joy Eberhardt De Master. She is a pediatrician, and she wrote the KevinMD article “Racist. Anti-racist. Microaggression. Institutional racism. The power of a definition.” You mentioned that one of the things that’s lacking in our medical education system is really addressing these issues head-on. So what are some recommendations that you can make so that physicians can be more aware of some of the issues that you’re describing in this article, and what can they do about it?

Joy Eberhardt De Master: I always thought it was a disadvantage coming from such a different background than my colleagues. I felt that in medical school and in residency, and I really look at it as an advantage. Working in other settings, maybe getting out of your comfort zone, doing something that you just wouldn’t do otherwise: I think those can really be key.

So what does that mean for medical school? I would leave those details for medical schools. I know when I was in medical school, I did it in Chicago, and we went into Chicago and the cities. There was a group where some of us volunteered in clinics, and some of us went and served food. Some of us really got to know some of the different neighborhoods within Chicago. And so I think that would be one piece: knowing where you’re practicing, knowing the different neighborhoods. And then realizing you don’t know, I think, is a really, really big piece as well. There’s always so much we don’t know in life, and it’s about carrying that with us.

Kevin Pho: And my final question: What’s your take-home message that you want to leave with the KevinMD audience?

Joy Eberhardt De Master: I would say the words we use matter. It cannot be said strongly enough. What you say, how you say it, matters, and the struggle, what you bring to an encounter, can create issues.

Kevin Pho: Joy, thank you so much for sharing your time and insight, and thanks again for being on the show.

Joy Eberhardt De Master: Thank you, Kevin. I appreciate it.

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