1. < Message from the Chair

In commemoration of Martin Luther King, Jr. Day, last week’s Grand Rounds was dedicated to our annual Grand Rounds Health Equity Story Slam. Our faculty’s stories shed light on the many ways communication, cultural competency, advocacy and decisions regarding prevention and treatment, when viewed through the lens of equity, can be leveraged to improve racial and socioeconomic gaps in care outcomes. In this week's newsletter we also share highlights from important work presented by UCLA Department of Medicine (DoM) faculty at the inaugural LA Wildfires Research Conference.

A Tale of Two Options: Felix W. Leung, MD

It is well-established that colonoscopy rates for Black men in the U.S. are lower than for white men, despite the fact that both the incidence and mortality rates of colon cancer are higher. There are many potential reasons for this, including a lack of awareness about or access to screening options that do not require anesthesia — a protocol that requires a family member or another escort to drive the patient home, downtime from work and other inconveniences that many people from historically marginalized populations simply cannot afford.

A study in 2013 involving patients at the West Los Angeles VA Medical Center (WLAVAMC) showed that offering unsedated colonoscopies to Veterans improved procedure uptake and reduced the number of no-shows from 5% to 0.5%. Thirty percent of the study group was Black. Subsequent retrospective analysis revealed that having the option to undergo a colonoscopy without sedation dramatically improved screening rates for Black Veterans,

In total, Dr. Leung now possesses more than 25 years of data that show that unsedated colonoscopy can make it possible for people without escorts to get the screening test, and that Black patients account for 20 to 30 percent of those who take this option.

“It was an excellent example of patient-centered care and likely had an impact on the disparity in Black patient colonoscopy participation,” Dr. Leung said.

He also has plenty of anecdotes about the usefulness of unsedated colonoscopies to back up the data, as well as many that illustrate the myriad reasons why a Veteran might choose to undergo the procedure without anesthesia. One wanted to avoid grogginess after the procedure so he could spend quality time at his wife’s birthday party. Another suffered from PTSD and wished to avoid unpleasant flashbacks he experienced when he was on narcotic medication. Yet another wanted to be fully awake for his daughter’s cheerleading performance that afternoon.

Dr. Leung noted that it is not just people outside healthcare who prefer unsedated colonoscopies.

“Over the years, when I was doing site visits to talk about my work, I found it amazing that many of my colleagues had elected that option for their personal screening!"

Dr. Leung wants attendees who are involved in colonoscopies to leave with the message that unsedated screenings are not second-rate.

“The humanistic approach sometimes deviates from the standard of practice,” Dr. Leung said. “I hope this story will motivate some of you to consider thinking outside of the box.”

Advocating for Warriors: Linda Kaye Czypinski, MD

Sickle cell disease is an inherited blood condition that requires careful lifelong management. It is more common in Black populations — and thus, many patients with sickle cell may encounter systemic racism, a limited amount of provider knowledge and other health inequities that can make it difficult to find consistent, trustworthy care.

“In attempting to obtain additional information from Eric, including psychosocial history, he was hesitant to reveal much information,” Dr. Cyzpinski said. “When offered a social work consult to assist with evaluating for additional resources, he declined.” 

Eric was admitted to the RR Observation team several more times over the next two months. But by the time Dr. Cyzpinski saw him next, things had changed. A cohorting guideline implemented earlier in the year had established that patients who present with sickle cell disease are always admitted to the RR Observation team — a standard designed to ensure they receive consistent, high-quality care. Eric had grown to build trust and rapport with the RR Observation team, eventually revealing that he was homeless and did not have a phone. With their encouragement, he eventually agreed to be seen by a social worker who helped him obtain long-term assistance. Furthermore, he had gone from refusing to take his medications to taking all of them consistently. 

“This was also likely due to Eric entrusting his care in the team he had come to know and trust,” Dr. Czypinski said. Although he has continued to present in the emergency room frequently, he has since established outpatient care with the hematology division. 

“Although ongoing optimization of Eric’s care is essential, I am confident this can be achieved with ongoing collaboration, advocacy, and coordination of care by the multidisciplinary providers to provide Eric with consistent, standardized, compassionate care,” she said. 

DoM providers’ commitment to serving our patients with sickle cell disease in an environment that is free from stigma and bias has made it an invaluable hub for their care — and in turn, for advancing health equity. A multidisciplinary team of DoM providers within hospital medicine, hematology-oncology, primary care, addiction medicine and palliative care have worked with the UCLA Department of Emergency Medicine to develop a standard operating procedure for patients with sickle cell disease who present with pain. We are also developing patient-centered innovative care models and advancing provider education to improve patients' access to care.

Dr. Czypinski hopes that listeners to her story will be inspired and motivated to be active participants in advocating for and making a difference in the UCLA DoM’s mission of advancing health equity for our patients.

“Eric and other patients I have cared for with sickle cell disease have had a significant impact on my professional growth as a clinician. UCLA Health and the UCLA Department of Medicine are committed to improving health equity and outcomes for patients with sickle cell disease,” she said. “I have been fortunate enough to be actively involved with initiatives to put this commitment into action, and Eric's story is a testament to these initiatives having a positive impact on the care of our patients.” 

Let Me Do My Job: Max Jordan Nguemeni Taiko, MD, MS

All of us who have graduated from medical school will recall the proud moment when we took the Hippocratic Oath. Though there are many different versions used today, all of them promise to practice the art of medicine only for the benefit of our patients and never to cause harm, suffering or injustice. We also promise to preserve the dignity of our patients. Sometimes, standing up for a patient means we must stand alone.

Dr. Nguemeni learned that she was in treatment for opioid use disorder; she also used cocaine, she told him voluntarily. While he was sharing resources for people with stimulant use disorder, Dr. Nguemeni noticed the patient turn fearful.

“I turned around, and there was a security officer, ostensibly waiting for me to finish, to introduce himself,” Dr. Nguemeni recalled. Confused, he asked the officer to come outside to discuss why he had barged into the room unannounced. Someone had reported that the patient had a crack pipe on her when she was admitted, he learned, and had called security for a room search. 

“’Is that necessary? Right now?’” he asked the on-call nurse administrator. The patient was far too sick to be at risk of doing any drugs she possessed, and Dr. Nguemeni feared that a drug search would antagonize the patient and prompt her to leave the hospital without the treatment she badly needed. Though the legal team insisted that an immediate search was required, he begged the staff to wait until her condition had improved enough that she would not be in immediate danger if she left. He was met with overwhelming pushback, even from people he normally considered to be quite reasonable. His intern pleaded with them to compromise; another security guard joined the fray as they argued.

Then, a nurse received the patient’s labs. Her anion gap — a metric that explains at the balance of electrolytes in the blood and is used to detect diabetic acidosis — came back within a safe range, indicating that she no longer at high risk for acute worsening now.

“I had stalled things long enough to make sure she was out of the woods, first and foremost,” Dr. Nguemeni said. The drug search commenced, turning up a small bag filled with white powder. The security officer who found it waved it in his face triumphantly, “as if it justified everything that had just happened,” he recalled. 

“But I never had a position on whether she could or could not possess drugs — just that she was unlikely to use them in her sickly state,” Dr. Nguemeni said. “I knew I didn't make any new friends that night, but the idea of putting what felt like security theater ahead of respecting this patient’s dignity was nauseating.”

Dr. Nguemeni was reported to his attending and to the program director for standing up for the patient. His conversations with both of them led to the same agreement.

“Institutions work in their own idiosyncratic ways. But policies and rules are created by people, enforced by people, and unevenly applied by people,” he said. “And if we cannot push back when those policies ask us to trade dignity for liability, or care for control, then what are we here for?”

When Dr. Nguemni looks back at that night, he recognizes that his job and the apparent job of the institution where he was a resident had become incompatible.

“But by the end, my patient knew that my intern and I cared about her,” he said.

Beyond Hearing, Towards Understanding: Kenechukwu Ojukwu, MD, MS, MPP

Pathology reports and medical records can be challenging to understand even for those with some degree of medical literacy. But for the many patients who have limited healthcare access, even terms that providers may assume are common knowledge can stand in the way of understanding — and proper care.

“Mentioning something is not the same as communicating it,” she said. “And communicating something is not the same thing as ensuring someone understands it.” 

The patient did not lack motivation to take care of himself, Dr. Ojukwu explained. He simply did not understand the information that was presented to him, and no one along the way had checked to see if he did. 

The encounter left her forever changed. Suddenly, she could see the problem all around her — especially when she changed fields from surgery to pathology. 

“Pathology reports — the documents that defines a person’s cancer diagnosis — are written for doctors. Dense terminology, Latin roots, long compound words, paragraphs of microscopic descriptions,” Dr. Ojukwu said. “It’s a language we literally spend years learning.” 

Patients do not have those years of learning, nor the necessary time or resources to dedicate toward decoding their pathology reports. As a result, they may miss life-or-death details in their pathology reports that could alter the trajectory of their lives. As Dr. Ojukwu explained in her story, research has shown that many patients cannot correctly state their diagnosis after reading a pathology report. The problem is even more profound in safety net settings, where patients are often navigating multiple stressors and systems, sometimes with limited English proficiency. 

These experiences motivated Dr. Ojukwu to action. She views pathology as a critical point for patient communication, the place where their entire journey could be transformed. She entered the field with a clear goal in mind: to reshape the system. 

“I wanted to build a system where patients are not passive recipients of medical decisions but informed partners in their care,” she said. Her work today includes the development of tools, curricula and systems that ensure patients — particularly those who are historically marginalized or under-resourced — can understand their condition, ask the right questions, and make informed, value-aligned treatment decisions. 

Dr. Ojukwu hopes that her story illustrates that transforming care often requires looking beyond typical silos.

“Patient care does not happen in isolation, and meaningful change emerges when we are willing to work across disciplines, roles, and perspectives,” she said. “Even small shifts in how we communicate and collaborate can meaningfully shape how patients experience their care.”

She added that she is grateful for the breadth of her training and for the support of her mentors.

“At the end of the day, our patients are our greatest teachers,” Dr. Ojukwu said. “If we want to prepare the next generation of clinicians well, we need to create opportunities for trainees to engage with patients’ needs early and often and to understand how their work fits into the larger story of care.”

One Umeboshi at a Time: Misa Tanaka, MD

The late UCLA linguist and literary scholar Vyacheslav Ivanov once estimated that there are more than 224 languages spoken in Greater Los Angeles. Yet despite our community’s diversity, many patients lack access to health care providers who speak their language.

Dr. Tanaka’s story about working with Mrs. Y demonstrated that language and cultural competency can unlock insights to improve patient care in creative ways. For instance, when Dr. Tanaka asked Mrs. Y about the sodium chloride tablets she was supposed to take three times a day, Mrs. Y confessed that she had been taking them once a day — or even less. Her sodium levels thus remained as low as they had been during her hospitalization. 

Thanks to her time practicing medicine in Japan, “I knew the trick,” Dr. Tanaka recalled. She “prescribed” Mrs. Y one umeboshi — a type of intensely salty and sour pickled plum that typically contains about two grams of salt — every day for one week. After rechecking Mrs. Y’s sodium levels, Dr. Tanaka tapered her dose down to one umeboshi every other day, then to “as needed” but no more than twice a week. Mrs. Y has remained stable on this regimen since then.

“This was one of many encounters that reinforced how profoundly language and culture shape patient care — particularly for older adults,” Dr. Tanaka said. She noted that Mrs. Y had once had greater proficiency in English, but her ability to speak it declined with age, as it does for many people who learn languages later in life. 

“Beyond linguistic challenges, Japanese cultural values such as ‘和 (wa)’ — harmony and respect for others — can lead to reluctance in expressing needs directly or questioning authority,” Dr. Tanaka said. “This tendency is often more pronounced in the older generation.”

Cultural and linguistic concordance in patient care is at the core of inclusive, patient-centered care, Dr. Tanaka noted, as it fosters connection, trust and better health outcomes. She is proud to be one of the few providers who are able to offer care in Japanese and encouraged her fellow providers who speak other languages to take the Language Proficiency Exam so they can reach more patients, with whom they share their native language. She hopes that her story will encourage reflection on how to best provide care to adults from diverse backgrounds. 

“When I think back to Mrs. Y — speaking freely in her native language, in the center of our attention, appreciative and smiling as we tailored her care together — I’m reminded that small, culturally attuned choices can make a profound difference,” Dr. Tanaka said. “As we continue to build inclusive systems that serve our diverse aging population, let us not overlook the quiet power of one shared word, one trusted moment — or even, one umeboshi plum.”

Death by Zip Code: Jennifer Plotkin, MD

The COVID-19 pandemic exacerbated many of the health equity disparities we witness every day throughout our health care system. In few places, were they brought into sharper relief than in the ICU; a patient’s likelihood of dying — and how much pain they went through in the process — might depend on where they lived and what resources were available at their local hospital.

All of her co-residents had their own stories of grief, she said. Some endured the pain of telling families that their loved one would die alone of cirrhosis unless they agreed to remove lifesaving measures so they could obtain visitor access. Others witnessed deaths as they were transferring patients between ventilators because the wall oxygen wasn’t functioning. Dr. Plotkin recalled an intern asking if she was to blame for so many patients dying. 

Healing comes from talking and connecting, she said — something she had learned from the Veterans she works with at the VA. 

“They light up chit-chatting in the waiting room with their fellow Vets, knowing that they all shared in the same thing,” Dr. Plotkin said. “We do the same. Our bond comes from being soldiers in the same war against COVID-19.”

She added that the trauma is collective. 

“It is first the patient’s, and then their loved ones, and then it is ours,” she said. “And just like we tell Veterans, the way to share that grief, that burden, to unload, to process the tiredness deep set in our hearts is to share it.”

Dr. Plotkin noted that she is grateful to her cohort of fellow residents at the time and to Daniel M. Karlin, MD in the palliative care division at UCLA Santa Monica Hospital. She hopes that the audience at Grand Rounds will recognize that health equity is not an abstract concept. 

“Patients died because of their zip code,” Dr. Plotkin said. “We must dismantle the structures that restrict our ability to give quality care to all.”

DoM Faculty Share Insights at LA Fires Research Conference

In the year since the Palisades and Eaton fires, scientists across Southern California and beyond have been hard at work studying the disasters’ medical, environmental and public health effects. While it will be many years before researchers can draw any conclusions about the fires’ long-term impact, already there have been many meaningful findings that will inform future studies and preparedness plans. 

On Jan. 14, more than 250 scientists studying the fires came together at UCLA to discuss what they’ve learned so far at the inaugural LA Fires Research Conference. The turnout was fantastic — there were over 100 abstract submissions, many from early-career scientists, and a waitlist for attendance. Many of the studies utilized the UCLA Wildfire Impacted Communities Research Registry, which connects community members directly to research.

Seventy posters were presented at the conference, which also featured panels on environmental contaminants, wildfire exposure modeling, data capture, social impacts, and much more. The UCLA DoM was well-represented at the conference: Dr. Eisenman gave a talk on the adverse health effects of home defense during the fires; National Clinician Scholars Program post-doctoral fellow Patrick Smith, RN, PhD spoke about the health impacts of housing and home disruption caused by the fires; Joshua N. Khalili, MD presented a poster on the DoM Office of Wellness’s efforts to maintain faculty and staff wellbeing during the crisis; Evan M. Shannon, MD shared a poster on the impact of the wildfires on people experiencing homelessness; and Maryum H. Merchant, MD presented a poster on the strategic placement of fire-resistant native plants to protect structures from wildfires.

Dr. Khalili’s poster detailed the wellness office’s action plan in supporting the DoM. He believes this work is important to protecting the well-being of faculty and staff, as wildfires may compromise their well-being.

“Many disaster response models focus on infrastructure and clinical operations, but our people and finding ways to help them were at the heart of our response,” Dr. Khalili said. The data he and Sun M. Yoo, MD, MPH collected through surveys helped them identify and provide help for short- and long-term housing needs, financial assistance and policy-based support for leave options. Their survey also revealed that many of those who were impacted by the fires were interested in learning from individuals who had previously lost their homes to wildfires, resulting in a panel discussion in April 2025.

The research Dr. Shannon presented at the conference centered on a cohort of about 600 people experiencing homelessness (PEH) that he and his collaborators had been following through PATHS, an ongoing longitudinal study that aims to improve gaps in homelessness research and rapidly evaluate emerging policies and issues. They had three main questions: 1) What percentage of the cohort reported disruptions from the fires? 2) How well did self-measured disruption correlate with remote-sensed air quality and wind speed data; and 3) were there changes in self-reported health measures before and after the fires among those exposed and not exposed to fire disruptions? 

Dr. Shannon’s team found that about 75% of the cohort experienced some degree of disruption following the fires, even as there was not a strong correlation between self-reported health and meteorological data and little change in health trajectory. Moving forward, they plan to write up their findings for publication and to add a “natural hazard” module to the PATHS survey so they can analyze the effects of extreme heat, flooding and other exposures on PEH.

The work Dr. Merchant highlighted in her poster presentation detailed a review of literature that suggests fire-resistant plants combined with structured defensible space could reduce wildfire spread and lower the risk of structural fires in areas prone to wildfires. She and her team identified specific plant characteristics — including high water content, low resin or sap levels, open growth structure and minimal dead material — that are associated with lower flammability. Their review also demonstrated the efficacy of a three-zone defensible space model for the area around structures.

“I would like to use this platform to advocate for dedicated funding to support burn care research, with a particular emphasis on inhalational injury,” she said. “Expanded funding would allow us to better characterize pulmonary outcomes, identify high-risk populations, and develop targeted prevention and treatment strategies for patients affected by wildfire-related inhalation injuries.”

Dr. Eisenman hopes the conference draws attention to all of the remarkable science being done in service of our patients and our wider greater LA community.

“I hope it illuminates how important scientists are to our communities during and after disasters like this fire,” he said. “UCLA scientists are conducting so much research for our community and that research shines in its excellence and relevance. We are truly a mission-driven research institution.” 

One final note: Much has been said about the support you all gave each other and to our greater community during the fires. Reflecting on the DoM’s response, Dr. Khalili expressed gratitude for Dr. Yoo’s leadership and recalled with awe what it was like to see you come together. 

“We had countless individuals reach out to us to see how they could support. I truly had never seen anything like it,” Dr. Khalili said. “It made me so proud to be part of this team in the Office of Wellness and in the DoM.”

I hope that you are as inspired by these accounts as I am by our faculty’s commitment to their colleagues and the diverse communities that they serve.

Dale

P.S.

I took the photograph (left) from my home last week, one year after I took the photograph on the right. What a difference a year makes. Please continue to be cognizant that there remain many faculty who were displaced by the fires, who are still working through recovery and navigating long-term options for their families.

---