Year 4. January 21. The Timeliness of Our Focus on Equity.
In the spirit of Martin Luther King, Jr.’s legacy, the UCLA Department of Medicine (DoM) devoted its Jan. 16 Grand Rounds to the seventh annual “On Equity Story Slam,” an hour-long introspective of reflections from seven members of our faculty about their experiences with issues around equity in medicine. The focus on equity is especially timely in light of the wildfires that have ravaged our beautiful city and impacted thousands of lives. In one sense, this horrific disaster was a great and terrible equalizer; after all, the fires did not care if you lived in a multi-million-dollar mansion or a humble apartment. But in another, there is no question that the impact will be felt more strongly by those who were already on the disadvantaged end of an unequal playing field — particularly the poor and those from historically marginalized racial and ethnic backgrounds.
We should keep these inequalities top of mind as we move forward with our duty to provide care to our Los Angeles community. So too should we remember that this has been a tremendously traumatic experience for all of those who lost homes and possessions. On top of our ongoing commitment to Advance Health for All by addressing issues of equity and going above and beyond for all our patients, we must be cognizant that many of them will now be dealing with a new form of trauma — as are many of us. I encourage all of you to continue to take care of each other, and please know that department’s commitment to support you in any way we can is ongoing; more details on initiatives to assist those who need help are available at the bottom of this post.
Let me recap three of the stories shared by our faculty during this year’s On Equity Story Slam Grand Rounds.
The Power of the MD
None of us who treat patients in Los Angeles are strangers to the overwhelming multitude of challenges faced by those experiencing poverty and housing insecurity. Katie Hu, MD, associate director of the UCLA Center for East-West Medicine, program director of the UCLA East West Integrative Medicine Fellowship and associate clinical professor, shared the experience that taught her how physicians can be part of the solution. She told us of her time treating “Anna”, a 55-year-old patient with chronic housing insecurity, PTSD, chronic pain, and, per the warning of those who had treated her before, a temper. Dr. Hu approached her with gentleness and caution, leaning on her experience working with individuals with trauma.
“It was clear that chronic stress was fueling her chronic pain. We started there,” Dr. Hu recalled. “I referred her to behavioral health associates and therapists, but none were a good fit. They tried, but Anna felt drained by having to educate them about her reality, and she was tired of explaining herself. Tired of being misunderstood.”
The “standard” remedies that were supposed to ameliorate Anna’s challenges — from medication for her mental health conditions to getting food stamps— sometimes made her already-difficult life even harder. Her reality “was a web of systemic failures, a cycle where the very structures meant to protect her became the source of her suffering,” said Dr. Hu. That changed when Dr. Hu decided to go beyond her classic duties as a physician and advocate for Anna to housing program authorities by writing letters to remove a hold on her application and improve the conditions of her home.
“Since then, I've written countless letters to housing offices, social services, and beyond,” Dr. Hu said. “Between listening and advocating, I've become her social worker and her therapist.”
While this may be a departure from the conventional role of a physician, the change that it has created in Anna is undeniable. Anna now trusts Dr. Hu, is warm with the clinic staff and no longer feels she has to “fight to be heard and helped.”
“The MD signature carries a lot of weight, and sometimes it's the difference between shelter and eviction between having enough to eat and going hungry,” Dr. Hu said. “I urge my fellow clinicians don't underestimate the power of a simple letter. Sometimes it's the most effective medicine that we can offer.”
As the director of a fellowship program, Dr. Hu was compelled to share her experience, so her fellows might be better equipped to help patients address the social determinants of health.
“Achieving Dr. Martin Luther King Jr.'s dream of true equity remains a distant goal, particularly in the realm of health equity,” Dr. Hu said. “When a patient is struggling to secure basic needs like food or a safe and stable home, conversations about medications or lifestyle changes, such as exercising more, are futile. To truly make a difference, we must prioritize addressing the social determinants of health that serve as the foundation for well-being.”
Seeing Our Patients
So too must we be willing to look beyond our patients diagnoses — or disabilities — and remember their humanity, as endocrinologist Rashmi Mullur, MD, chief of telehealth at the VA Greater Los Angeles and education lead for the UCLA Integrative Medicine Collaborative, reflected during her presentation at the story slam. Dr. Mullur recalled the many lessons she learned about ableism as the longtime physician for “Megan,” a young woman with severe disabilities who used a wheelchair that was highly decorated with sports decals. During their first appointment, Dr. Mullur commented that Megan would need to watch her diet because “exercise would be tough.”
“As my attending walked out of the room, I could feel the tone in the room change. Megan was suddenly distant,” Dr. Mullur said, and her father Rob stroked her back to comfort her. Megan’s mother, Pat, laid it out for her: Megan was, in fact, a championship bowler who worked for hours on her muscle control.
“’Just because she can't walk doesn't mean she can't exercise. Can you see her? She is more than just her medical conditions,’” Dr. Mullur recalled Pat saying. “She is a fighter and has hopes and dreams. She's not just a laundry list of her diagnoses.”
That moment dramatically changed the way she viewed not just Megan, but all of her patients and those who cared for them — even years after Megan died suddenly from an aneurysm. Dr. Mullur carried the lessons she learned from Pat’s fierce devotion to her daughter into her own life a decade later when she gave birth to her son, who was disabled due to intractable epilepsy.
“I made sure that each member of his care team knew that my son was smart and capable, and communicated directly with him, and saw that he used an iPad to communicate back,” Dr. Mullur said. “I wanted the world to see him for the fantastic little boy. He was not just his laundry list of medical conditions.”
Dr. Mullur’s son tragically passed away at nearly 10 years old. She devoted her career to teaching medical students and trainees the practice of whole-person care — about what it means to see “our patients for who they are, despite their disease and disability, learning to focus on what matters most.”
“I hope the next time you see a patient like Megan or my son,” Dr. Mullur said. “I hope that you truly see them as person full of life, hope, and dreams.”
Dr. Mullur was moved to share her experience to highlight the importance of inclusion and acceptance for our disabled communities. She believes Dr. King’s legacy highlights the importance of compassion and humanity in all of our interactions.
“For us to treat each other as equals requires that we see each other as equals—not just looking beyond differences but actually embracing them,” she said. “Recognizing that our diversity is what makes us stronger.”
Equal Access
In addition to embracing our differences, we as physicians must also be willing to break down the barriers that prevent patients from accessing vital tools and technologies, as Estelle Everett, MD, MHS, assistant professor in the UCLA Division of Endocrinology and the Division of GIMHSR, reminded us. Dr. Everett told the story of her sister Connie, who was diagnosed with type 1 diabetes on the first day of third grade. Connie struggled for years to keep her blood sugar in check, her progress hampered by clunky glucometers and the need to inject insulin manually with vials and syringes.
“Though Connie was incredibly brave. I can see the toll that the burden of her diabetes management took on her physically, emotionally, and socially. She lost her normal child almost overnight, and it was heartbreaking,” Dr. Everett recalled. Connie’s experiences with doctors — who warned her in dire tones that she might die before she turned 18 if she didn’t control her blood sugar — left her feeling like a failure.
“She began to believe that maybe this grim future was inevitable,” Dr. Everett said. “At that point Connie just stopped caring, feeling like nothing she did would ever be enough.”
It wasn’t until Dr. Everett was in training to become an endocrinologist that she learned of insulin pumps, devices that deliver insulin to patients’ bodies without the need for injections. These were hardly new technologies at the time; they had been around since the 1990s. So why didn’t Connie have one?
“When I asked her, she told me none of her doctors ever offered her insulin pump, or even mentioned one to her,” Dr. Everett recalled. Connie’s attempt to obtain one was met with a list of requirements, including the need to demonstrate greater control over her blood sugars.
“Why would the very tools designed to help people struggling with diabetes control be held until they achieved better control?” Dr. Everett wondered. “This only deepened Connie’s frustration and discouragement.”
Dr. Everett encouraged Connie to advocate for herself and, eventually, she did receive an insulin pump. But the challenges didn’t stop there. She was met with resistance again when she attempted to get a continuous glucose monitor, or CGM, and had to switch endocrinologists entirely in order to get one.
But when she did, everything changed, Dr. Everett recalled.
“It made it easier for her to manage her blood sugars and took away a lot of the daily burden and the stress associated with living with diabetes,” she said. “She told me that for once in her life she felt like diabetes didn't control her. She was in control.”
Dr. Everett later learned that Connie’s story was one of many. Research has demonstrated that healthcare providers are less likely to discuss CGMs and insulin pumps with type 1 diabetes patients who are racial and ethnic minorities, meaning they may not even know the option for better control exists. They must “prove” that they are worthy of using tools that are essential for their health.
Dr. Everett has devoted her career to eliminating these disparities and promoting equal access to diabetes technology for all patients. In sharing her story at Grand Rounds, she hopes to provoke others to reflect on the systemic barriers that perpetuate inequities in healthcare and galvanize them to take action.
“Dr. King’s vision of a more just and equitable society inspires me to use my platform as an endocrinologist and researcher to address health care disparities. Telling my story during the observance of MLK Jr. Day is my way of honoring his legacy by spotlighting the urgent need to ensure that every individual, regardless of race, background, or socioeconomic status, has equal access to the tools and care that allow them to lead healthier, fuller lives,” she said. “It’s a call to action for all of us to continue the work toward a fairer and more compassionate healthcare system.”
I would like to thank Drs. Hu, Mullur and Everett as well as all of our physicians who so generously shared their stories, including Katherine Chen, MD, PhD; Naomi Duncan, MD; Lucinda Leung, MD, PhD and Jarod DuVall, MD. I would also like to thank our host Keith Norris, MD, PhD, for introducing them.
Watch the entire event on DoM TV.
Support for DoM Community Affected by the Los Angeles Wildfires
As the fires have come under greater control and containment, we now begin to move from the emergency response to the no less challenging recovery phase. For the 27 members of our DoM community who completely lost their homes and others where it will take considerable time to return their devastated neighborhoods, we will continue to support them in various ways as they re-build. During the wildfire emergency, the DoM community quickly mobilized to provide essential support and resources to our community members affected by the crisis. Within the first day, we launched a webpage on DoM Connect dedicated to sharing resources and support services as they became available.
We witnessed generous acts of kindness from our faculty, trainees, and staff offering to help our colleagues impacted. Members of our community donated rooms in their homes, essential supplies such as clothing and personal hygiene products, contributed monetary donations, and donated hours to the Catastrophic Leave Program. The department also used internal housing resources to assist with providing temporary shelter to those who have been displaced. Under the leadership of Chief Wellness Officer Dr. Sun Yoo, our department led a herculean effort to support members of our department during the emergency. We also learned that there were some gaps in communication regarding aspects of hospital operations that lead to anxiety among many of you who were on duty in the early days of the disaster. There is a robust internal disaster preparedness process that was activated within the health system with clear plans for all contingencies. We have conveyed these concerns to health system leadership and are working on enhanced communication strategies and relevant disaster preparedness information that will be deployed in the future.
I am proud of the effort and compassion demonstrated by all but recognize that we still have a long road to recovery ahead of us. Many have asked how they can help DoM members as we work towards recovery and rebuilding. Here are two ways to help in addition to other University-wide initiatives that have been recently announced.
Donate to the Catastrophic Leave Program
The program allows all UCLA employees including staff and faculty** to donate vacation hours to the Catastrophic Leave Program which is available to those who do not have sufficient accumulated paid leave accruals to meet a verifiable, catastrophic circumstance. To donate hours, please complete the form below and return to your division administrator. I would encourage many of our faculty who have maximized their vacation accruals to donate 80 hours to this program. I made my donation on Friday. This is an easy decision to make, as the hours you donate will be accrued again over the next few months. Your colleagues and other members of the community who have exhausted their vacation time will be eternally grateful for the gift of paid time off under this catastrophic leave program, so they can attend to the many tasks that they have to deal with in the weeks and months ahead.
**In recognition of the extraordinary circumstances caused by the LA wildfires, academic personnel who accrue vacation leave may temporarily participate in the program, either by donating or receiving catastrophic leave hours. Get details HERE. Additional information about participating in the program as a donor or recipient will be shared by your division administrator.
Other Ways to Donate
The department is committed to supporting impacted faculty in various ways, including offering temporary housing, expanding administrative support for employee assistance, supporting faculty compensation if productivity is limited during the recovery period, and supporting faculty research if directly impacted by the emergency. We continue to identify new opportunities to support our department with initiatives that are consistent with University policies. If you would like to support the cost of these efforts by making a donation to the Department of Medicine Unrestricted Funds, please contact DoMWellness@mednet.ucla.edu for additional information. I want to thank those members of our department who have already made generous contributions.
Our most impacted faculty members need time, shelter and financial resources as they begin the long journey to rebuild. Thank you for your consideration in supporting them during this time of need.
Many of you may not know that members of the senior leadership team of the department were evacuated from their homes during the early parts of this disaster, and some have still not returned to their homes. Others were under evacuation warnings for over a week. Yet they all came together to ensure that needs of faculty in our department were met. On behalf of the department, let me thank you for your leadership and the tremendous example of selflessness that you have exhibited even while under duress. It is clear to me that we are a special community in the DoM, and the way that everyone rallied around to support our colleagues and mobilized to ensure that disruptions to patient care were minimized is nothing short of impressive.
Dale
P.S.
I share with you two pictures that I took over the holidays and weekends during my runs in the mountains. The first is from the top of San Vicente State Park, at the geophysical instrumentation station (monitoring earth processes and hazards such as earthquakes, volcanic activity, subsidence and severe weather). Little did I know when I took this that this would be epicenter of the Palisades fire three days later.
The second picture is a sunrise over LA, which reminds me of our resilience to rebuild for a stronger future.
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