I think that by putting people in boxes, it's a shortcut. It's a safe, quick way to try to come to a diagnosis and move that person along. And it's not always right. And it can very much leave patients feeling dissatisfied or rushed. But the more dangerous side of it is the misdiagnosis or missed diagnosis. And again, ultimately, the patient suffers from it.
health care access remains a big issue across all populations. But even if patients can afford and attain health care, there are still barriers based upon background experience, gender, identity, race, and many other factors. This is random acts of knowledge presented by Heartland Community College. I'm your host, Steve fast. Today we are discussing new conversations for how healthcare providers can avoid a one size fits all approach to their patients. In particular, how can practitioners be more aware of the vulnerabilities of marginalized populations and more aware of people that may have been victimized in the past?
I'm Susan Carl, I am an advanced practice nurse and interim director of nursing education at Heartland Community College, and I have been organizing a conference that will be held here at Heartland on Tuesday, September 27, focusing on trauma informed care for vulnerable populations, more specifically LGBTQ plus populations.
Alexandre Merton, my pronouns are they and she are an artist, performer and educated. I will be talking about barriers to accessing care and intersectionalities. How Being from various communities and underrepresented populations can prevent access to health care.
Well, thank you both for being here to talk about this conference in this topic, trauma informed care. Susan, could you give a brief description of what trauma informed care is,
honestly, it's something that has been I'm almost embarrassed to admit, but I've been a nurse for a while, and not really understanding what trauma informed care was up until very recently. So it is taking into account a person's life experiences and things that they bring with them to any encounter that you have with them. And those experiences very much play into responses that they will have. And it's very eye opening to consider that of people because in healthcare, it's very much about rush, rush, rush, see as many people as you can get the information that you need, and then deal with the absolute presenting problem. And you don't really go any deeper than that. And there are so many other levels to things that are going on that you have to think about all of that, when you're dealing with people, I mean, not just necessarily in healthcare, but that is that's my wheelhouse. That's where I live my life. So I think it's very important for the nursing students that we are educating for them to be aware of that. Because again, I've been a nurse for a very long time. And it's only recently that I have found this aspect of being a nurse and providing care for people.
So Alexander, I know you'll be speaking at this event. Can you talk a little bit about some of the more vulnerable populations that might be in need of trauma informed care,
so many different kinds of people and barriers. And so we hear a lot talk about advocating for specific communities. But since the pandemic has had, I think people are understanding how many barriers are out there, whether it's race, institutionalized racism has prevented people from accessing care, Miss trusted medical institutions amongst those populations, people of color have been victimized by medical institutions, and it's especially our parents or grandparents. So there's generational trauma, there are people not trusting medical institutions, it's creating a barrier to care. There's also stigma, stigma towards folks with lack of resources, which more often than not our vulnerable populations, someone doesn't have transportation, they have to take the bus, they have to take off work. They missed the bus, because they couldn't find a sitter. They don't get their appointment, they get written up. And people don't think about that or like the LGBTQ plus community. Half the time we have to convince doctors that we even exist, I am a real person. My identity is real. The things I'm facing are real. That Can we please get to the medical part of this people from lower socioeconomic statuses and the areas no access to care. There may be a clinic that they can maybe access but there's no access to care there. resources to help them get that care, lack of insurance, all of these different factors play into people not being able to access care. And the medical institution has done damage to these populations over time, and writing them up was not compliant, experimenting on vulnerable populations, doing unethical things. And so we're still trying to do that some people get really frustrated, it's like, Why aren't this group of people coming in and getting tested for like an HIV prevention and care, the most vulnerable population is HIV are gay and bisexual black men and black trans women, that population has been some of the most damaged by health, our health care system. So you can hear people your doctors offices within like, well, if they need access to care of aren't these people coming in? Why are they accessing these resources? Not at all questioning that offices or that medical institutions role in keeping people out. They just assume that everyone's going to think like them and think that they need to go to the doctor and access health care, without thinking of where folks are coming from their history of medical institutions, and the resources they may or may not have.
So Susan, is there a risk that the way that processes work in, you know, in health care situations, some of these populations might be re traumatized from a past experience or string of experience? What are the things that commonly could happen in healthcare situations that healthcare providers just do as a as a course of action that might cause further trauma and distrust?
Very basic things that we teach about asking questions, starting off with? Are you male or female? That question is one of the first things that we ask people on any forms any interaction, or we don't ask, we just assume an identity or a gender. And that I think sets the tone. If someone does not identify on a binary, or they are transgender or gender non conforming, you have let them know that you don't understand that you're not going to welcome that you're not going to affirm that. So then they automatically just shut down. And that prevents them from receiving the type of care that they need. Or someone perhaps has experienced sexual assault or abuse in their past. And part of a physical exam includes them getting undressed, and being in a gown and being very vulnerable. And having a stranger, approach them and touch them without maybe asking permission or explaining what they're doing and why they're doing it and saying is that, okay? Those types of things. And it's just in the education process, we don't think about that. And we just further that traumatic process for those patients that are out there. And then they end up, you know, potentially not seeking out care because of that retraumatization. And then they don't get the health care that they need.
So Alexander, do you think that there's all these assumptions, and the idea is somehow that it's the patient's duty to go way above and beyond to provide more information even then, then, that the healthcare providers might normally ask for deliver?
Yeah, it happens in these institutions, and also happens in day to day life. Wonderful populations are the ones who have to advocate for themselves, and are always the ones that have to answer all the questions. So you have to have a PhD in gender studies, to go to the doctor's office to make the nurse at the front station believe that you're a real person. And it's, it gets perpetuated in the fact that like doctors and other folks always assume that they are right, like I don't know, they've had a lot of experience with they're like, Well, I went to school for 12 years, I am always correct. And like they just assume that and they think anything that a person brings to them that a patient has another homebody may do that a patient doesn't have themselves. So they're going to categorize and overanalyze people without giving them any genuine, unique individual feedback, or actually looking at the person as a whole, they're going to make the case that you see it happen all the time, when they understand there's high flow, like a lot of people have to go to the doctor, a lot of people coming in and out and it can be a little bit chaotic, but people need to take the time. Or they're going to re traumatize populations, like or people are going to die, not access care, or get misdiagnosed. They see most of the people even like, like I'm a plus size person. Large people in America get misdiagnosed all the time. They're like, Oh, well, this is just deficient fat. And it's like no, like, this is an issue that's never happened before been fat for a long time. This isn't related to that. And then, like I've seen that happen here. I've seen it happen in my city and I've had to see people not being able to access health care or have to get five different opinions to get the treatment doesn't think they know that it's wrong. Because no one will believe them because doctors are assuming they're right. Like I'm a professor. I never assume anything. So I'd like this is what we've researched so far. But let me see if there's something else I can talk about. Or let me see, what do you all think. So if they want to be correct, and then they also don't want to listen, even though the patient is the one that has to sit there and educate them, and it's exhausting. And everyone always talks about advocating for yourself. But like, that's a disproportionate request, you're asking some people to like, not only advocate and educate every single time they go to the doctor when like, they just need a checkup.
So Susan, what Alexander was talking about there kind of sounds very believable, of course, with everyone seems to have gone to the doctor. And there are a set amount of things is that sort of like a frequency bias that you think that some health care providers have, where they're not considering all the options, just because as you say, the health care field is a busy environment, there are a lot of patients, every single patient needs care. But there might be maybe a tendency to fit people into boxes, not only for what you might see as cisgender boxes, but also a lot of other boxes, too. You know, this person's this old, this person's this way this person is in some other category that they might see certain things frequently.
Absolutely. You said frequency bias. And I don't think I've ever heard that phrase, but I like it, because it does absolutely explain or describe the whole medical system right now. And I mean, that's a whole nother issue that we could spend probably a whole lot of time discussing. But I think that in defense of clinicians, not to make excuses, but you know, they have pressures to meet these demands. And again, that's a whole nother issue. But I think that by putting people in boxes or categorizing, it's a shortcut. It's a safe, quick way to try to come to a diagnosis and move that person along. And it's not always right. And it can very much leave patients feeling dissatisfied, or rushed, obviously rushed. But the more dangerous side of it is the misdiagnosis or missed diagnosis. And again, ultimately, the patient suffers from it. I don't know what the answer is. But we need to think of these things as clinicians and try to find a way to find the happy medium.
Well, I don't think it's the ultimate answer. But I think certainly a part of it is education. Because medicine, like a lot of fields is an ongoing continuing education field, you always have to learn more. I don't think that a lot of our medical professionals knew a whole lot about Coronavirus five, six years ago, to the extent that they might know it now.
Equality Illinois is trying to get a bill passed to require medical professionals to have a certain number of hours of continuing education. It's not specific to LGBTQ plus populations. But it is I think they're calling it cultural sensitivity type training. And the American Medical Association if they're resistant to mandating that type of continuing education, which there again, is a signal of the whole overall problem. And I don't see why it should be an issue with having this type of Continuing Education mandating as an advanced practice nurse, I have to have a certain number of pharmacology, continuing education hours, and a certain number of other continuing education hours, I'm not resistant to that. That's what I have to do to keep my license. So I don't see where the problem lies. As far as the conference overall, I'm excited to have all the speakers with the exception of two of them. They're all people that I have encountered through what I do. And I'm just very happy to be able to share them with our nursing students, and hopefully, give them at least a different view on patients that they encounter. Because they may not have ever encountered anyone different than them. Or they
maybe have and just haven't thought about it or noticed it and realized you know, what was happening in a situation. You mentioned something interesting, Susan, you talked about how the AMA or other organizations, I mean, organizations are often really resistant to change. There's one thing on an organizational level and another thing on a personal level. So what would you say, moves the needle to create an overall better environment that is more welcoming and more mindful of the need for trauma informed care doesn't just start with individuals as well as organizations and leadership candidate exist, one without the other. I don't think
I mean, this is just my knee jerk answer. I don't think you can have organizational change. If you don't have individual change. So it starts on the individual level. And that, okay, this is gonna sound completely corny. But my email signature includes a quote that says, you know, do your little bit of good where you are. And it's those little bits of good that change the world. And that's kind of where I'm coming from with this, are we going to change things overnight? Absolutely not. But if I didn't get this education, while I was in nursing school, and even through advanced practice, education, there was very little focus on trauma informed care, and or LGBTQ plus populations, it has to start somewhere. And this is the beginning of that legislation, I guess, is another way to force change on an organizational level or larger level. So I mean, it's, it's on different fronts, but it's absolutely needed, wherever it's happening individually, or organizationally.
systematic change takes time, like we exist, this system was actively trying to not unto itself. And I think people get disheartened and having to perpetually engage and actually try to shift things. But like Susan was saying, it's an individual one on one thing, like there are people who are happy and who do have community and have somehow and everything that's happening, navigated and found. And so if you can be that for one person that connect them to that, they can do that for someone else. And not only is it making the experience that's good for the patient, that's good for them. But you're also showing them what they deserve. And like I'm very transparent with folks like if I'm either teaching or if I'm doing a test or something, I'm very transparent with folks of like, I wish we could do this better, or I wish this was better, or I wish there were more resources, and there aren't yet. But we're working on that. And I'm going to take what we have, make it the best I can for you, because you deserve more than this. And I think giving them that confidence, giving them that connection, shows them what they deserve. And they aren't going to take less than that. And they're going to be stronger. And it's going to create a movement that already has a movement but can't get too caught up in the big overarching picture, when it's a person to person individual thing, because if you get caught up in the emergent picture, that's how you ignore the individual. So it's about it's about and change and growth. It's painful, but it will, it can't happen. It just takes time. And again, that one is really, really important.
Alexandra, I want to pivot a little bit here to what you might think, to approach some folks that you used examples of in trying to get the quality care or even care at all. You might see people that are reluctant, because they have experienced misunderstandings in health care situations and clinical situations in the past as patients, is there anything you would urge those that are, frankly, maybe a little distrustful of the healthcare system to bring forth to assert it might not be ideal that they have to, but do you suggest that is something that any patient do?
First, I think anyone that has distrust in the medical institution, like should acknowledge that that distrust is based like it is real like that is there is a reason you don't trust medical institutions. And there's nothing wrong with that. And I think another step is finding each other. Advocating is a lot easier as a group sharing resources, like working on nonprofit sphere, you, I refer people to places where I've had a positive experience or other folks had a positive experience. And it's all community based and community referral. And the higher up I think getting those community based folks paid and involved in decision making institutions will be a more systematic change from the folks who have distrust, like you have that distrust for a reason you've been hurt or your family's been hurt or someone has been hurt. But you still need to access care, you just didn't access resources. So finding community, finding each other finding health organizations and nonprofits and other spaces, clinics that are addressing these barriers that are built off of community members that look like you had same experiences to finding those people and then getting referrals from there to build a medical experience that is your own. And it sucks that it takes that much work. But accessing care is important. So finding those resources is crucial. And then also you get to become a more involved member of the community where now you have these resources and you get to share them with people so they don't have to suffer the same way you did. So it's all about community and connection and communication and advocating slash supporting each other.
You mentioned communication and this is for both of you. You Is there something that any of us should be doing not only healthcare professionals but others, when we talk about things, that before anybody even enters a clinic or healthcare environment, and I'm thinking of the long history of how things were covered with HIV and AIDS decades ago, and for many decades, and now we're even seeing a little bit with monkeypox, right? So we see instances of something a healthcare problem emerging, where it gets covered from certain populations. And then it becomes like a stigma. And there's a stigmatization to how we talk about something. And really, it's just a health care problem that is pretty non discriminatory. Anyone can suffer from it. It's just that for whatever reason, it emerged in an area, marginalized population. In some cases, is there anything that we can think about as communicators, but also healthcare educators and just regular people when we talk about situations like this, so we don't try to almost Pat cast blame on somebody because they have gotten sick?
The main thing is doing your own research and looking at as much information as you can. And I know that's a big task, because there's a lot of information, there's a lot of misinformation, and trying to wade through all of the potential misinformation, look at reliable sources, find out what is actually going on, as opposed to what media wants you to see or perhaps wants you to think about any disease process or anything that's happening, being educated. And then when you hear perhaps stigmatizing language or conversations, being an advocate, and speaking up and helping whoever may be having a conversation, understand facts, are you going to be able to change everyone's mind? Absolutely not. But you can always be a voice to try to dispel misinformation. I guess that's the main thing.
Well, thank you, Alexandra. Susan, thank you both for being here today talking about these issues and offering your insight who you really appreciate it. Thanks so much for having us. Thank you.
Susan Carl is Interim Director of Nursing Education and Interim Dean of Health Sciences at Heartland Community College. Alexander Martin is an artist advocate and educator. Both are involved in the trauma informed care conference held at Heartland Community College on September 27 2022. If you are interested in other discussions about health care, inclusion, LGBTQ plus topics, and more, check out our other random acts of knowledge podcasts on Apple podcasts, Spotify, audio boom, or wherever you found this one. Thanks for listening
