Are you tired of feeling powerless in the doctor’s office? Discover how to be your own advocate and champion health equity to overcome cultural bias in your medical records.
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Show Notes | Transcript“When the person is referred to as non-compliant, what it tells you is that the person is not following directions… And if you write non-compliant in the medical records two or three times, that person is not going to help us.” – Dr. Mauvareen Beverley
In this raw and insightful conversation, Dr. Mauvareen Beverley, patient engagement expert and author of “Nine Simple Solutions to Achieve Health Equity,” pulls back the curtain on the unconscious biases and systemic barriers impacting care for women and minority communities. Through eye-opening anecdotes spanning her 20-year tenure as an executive-level physician, you’ll bear witness to the transformative impact of asking “why” instead of making assumptions.
You’ll emerge with the tools to:
- Advocate for a comprehensive social history in your medical records beyond reductive labels like “non-drinker, non-smoker”
- Understand the deep-rooted fears that can fuel “non-compliance” and learn the “SPOT Methodology” for addressing these concerns
- Reframe your perspective to recognize the “common thread” uniting all human experiences with illness, transcending societal divides
- Discover powerful strategies for communicating your needs without feeling dismissed or judged during medical appointments
Resources:
Join the Soulful Women’s Network
Connect with Dr. Mauvareen Beverley:
Website: drbeverley.com
Book: 9 Simple Solutions to Achieve Health Equity: A Guide for Healthcare Professionals and Patients
Email: mbeverleymd(at)gmail.com
Phone: (914) 409-2767
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TRANSCRIPT
Gloria “Grace” Rand
Namaste. Did you know that unconscious and unconscious bias, I should say, and non compliance can have a life or death impact in a healthcare environment, especially for women and minority communities? So the author of nine simple Solutions to achieve Health Equity, a guide for physicians and patients, is going to be joining us today to talk about how to advocate for yourself and loved ones in patient care. But before I bring her on, I would like to welcome those of you who are new to live, love, engage, and introduce myself. I am Gloria Grace. I help female entrepreneurs attract more clients with calm, clarity and confidence by releasing negative thought patterns like self doubt and poor self worth. And I am really looking forward to this conversation today with Doctor Mauvareen Beverley as my guest. And I apologize if I pronounced her name wrong because I was going over it before we started, but hopefully I got it right. But I’m going to bring her on shortly. But in addition to being an author, she is a patient engagement and cultural competence specialist with 20 years of experience as an executive level physician. So I’m going to, without further ado, welcome, doctor Beverley, to live love, engagement. Welcome.
Dr. Mauvareen Beverley
Thank you so much, Gloria. I’m honored to be here with you. And you did pronounce my name correctly.
Gloria “Grace” Rand
I’m good. Thank goodness. Okay. I wasn’t sure. It looks easy, and yet somehow my mind is wanting to trip over it. But I’m going to get right into talking about bias and health disparities that show up for women and minorities. And I’m wondering if you could share with our listeners and our audience on YouTube, what does that look like in practical terms? Maybe you can give some examples of that.
Dr. Mauvareen Beverley
I think unconscious bias, obviously, is a stereotype about particular groups of individuals, and it does not address the reality of who that person is, necessarily. And what I find the relationship. One of the common relationships in medicine is the word noncompliance. And so now there’s a nice word, non adherent. And when the person is referred to as non compliant, what it tells you is that the person is not following directions and not following any instructions that’s given. And if you write non compliant in the medical records two or three times, that person is not going to help us. And it’s been proven that negativity in the medical records is geared worse towards African Americans, particularly african american male. And when you write non compliant, there’s never a why question that’s included. So we don’t know why a patient didn’t follow directions, but we are going to write non compliant. And I’ll give you an example how the unconscious buyer. And the word non compliant was addressed in a particular patient. And so at Kings County Hospital, I was in charge of the congestive heart failure readmission prevention program. And when Medicare came in and said, if you take, if you. I’m sorry, if you are readmitted in 30 days with only pay for one admission, whereas prior to that they would pay for 24, 68, ten admission. So here’s an example of the non compliant and how we saved a life when we asked the why questions and eliminated the unconscious bias. 60 year old african american male, recenter diagnosed with congestive heart failure, returns. Two weeks later, congestive heart failure decompensated due to non compliance. My team had to ask why, and they referred to me as doctor B. They said, please, we have to ask why? Because doctor B is going to bug out if we don’t x why? So we asked the patient, why didn’t you take your medication? I can’t take the water pill, which is another word for diuretic that flushes out the body so that the heart pump better. And the problem is it makes the person urinate a lot. So we asked him, why can’t you take the water pill? And I’m glad you’re sitting down, glory. Because his answer was, because I drive the number seven train. Oh, so when the train is delayed because the driver has to find a bathroom. Yes. When you see a shift, 11:00 p.m. to 11:00 a.m. what do you do when you get home? I do some chores. I make breakfast. I take some of my medications. But if I’m going on my shift, I don’t take the water pill. We brought this to the attention of the cardiologist, the same cardiologist who was ignoring him. And he said, okay, take the water pill. When you get home, be aware, it may wake you up during the day, but by the time you get to your ship, you’ll have less of a reason to urinate. And to the degree that you do, we’re going to give you a cubicle to use in the private space. You know what the patient’s response was? If I knew I had to choose between peeing and breathing, I was, yeah, I think so. Conversation. So, you know, without the why question, he would have been readmitted multiple times and who’s going to care about him? And if he were to pass at mortality, it would have said died due to non compliance. But the key takeaway from this particular case, the patient. We made it such that the patient didn’t have to choose between his job and his health, but also that we recognize him as a human being, and we needed to know why he couldn’t follow direction. And in my experience, asking the why question resulted in a lot of better health outcomes. Did it solve all the problems? No, but it solved a large percentage of what would have been, could be mortality.
Gloria “Grace” Rand
Yeah, absolutely. I can understand that because I can also understand it from the point of view of the patient and his not wanting to do that. And I guess there’s the. One of the issues is that we really do need to not be afraid of speaking up to healthcare providers and to ask questions. And I suppose he may have thought that, but maybe he didn’t feel comfortable even enough to ask. I’m so glad that you were advocate, but I guess that’s why you kind of wrote the book. Tell me a little bit about that. Is that one of the reasons about that?
Dr. Mauvareen Beverley
And it’s what I refer to in my book as stopping my tracks moments that led to boots on the ground, simple solution. And the stopping my tracks moments came from speaking to patients and recognizing that currently in. In healthcare, and also the topic of health disparity and everything now is nicer word. Now there’s health equity. The patients are not included in the solution. And in my book, the stop in my tracks moments came from patients that actually led to boots on the ground, simple solution. And it was humbling. And what I realized is that obviously, heart failure is age related. Most of the cohort of patients were between 60 and 92. And what I realized is that the english speaking african american population is not included in the cultural competence conversation. The elderly black population had the worst health outcomes in all disease categories. When you consider the atrocities that they endured, it’s unacceptable. And again, one of my stopping my tracks moments went into see a patient in Brooklyn, is what I call the merging of the african diaspora was a large caribbean population. There’s a large African American. And the spanish population were interested. They weren’t from Dominican Republic or Puerto Rico or Mexico. There were Panamanians under colonial rule. The British sent the english speaking population to Panama. To do what? To build a canal. So they have English and spanish name Ronaldo Austin, Antonio Martin. And typically they look black. And the top language was English. And the bulk of the patients that were African American came from the Carolinas. And I’m saying to myself, why is everybody from the Carolinas? Virginia, sort of down the street from us? And what I had to do the research after the emancipation proclamation, when blacks had their first representation in Congress. Their communities did better than their white counterpart. They built churches, they built schools, they built businesses, plantation owned a property, went south because nobody was picking the cotton. And over the course of time, the Ku Klux Klan came in and burned the place down, and they came up the coastline to New York. And so in terms of cultural competence, I told the team, you really have to ask, where’s the patient from? Because what I call the look alike syndrome. And I’ll give you an example what I mean by that. We went in to see a patient when I was at Queen’s Hospital, and he was Indian. And the team said, oh, where in India are you from? He said, I’m not from India, Guyanese. I’m Caribbean. So it’s what I call the look alike syndrome. Go tell a British person they’re Irish and see how far you get. Go tell the Chinese they’re Japanese. Go tell a Jamaican they’re Trinidadian. Tell a Nigerian that they’re Ghanaian. And most important, go to tell a New Yorker they’re from New Jersey.
Gloria “Grace” Rand
As my mother said, you can’t assume. You just can’t assume.
Dr. Mauvareen Beverley
You miss some if the unique cultural differences. It could impact the health outcome, because, again, it’s perception about people versus the reality. So I went in to see the patient, and she was 80 years old, and I thought of the stop in my tracks moment, and I said, where are you from? She said, South Carolina. And what I was thinking in my, put on my clinical hat, I was going to ask the next, are you visiting New York, or do you live here? Because if you visited and you got sick, it’s a different situation than if you live here. And Gloria, Monday morning, 09:00. You know what she said? The next statement before I even asked that question? My parents were a step away from slavery, and my grandparents were slaves.
Gloria Grace Rand
Oh wow.
Dr. Mauvareen Beverley
Was that expecting that Monday morning, 09:00?
Gloria Grace Rand
No.
Dr. Mauvareen Beverley
And I said, tell me about it. And some of them spoke in codes. My family picked cotton on a plantation that was not ours, and we had to get up at the crack of dawn and pick 300 to 500 pounds of cotton. And then I had to walk 10 miles to a segregated school. And I’m saying, 10 miles? We can’t even go five blocks without calling the Uber, you know, had to walk 10 miles. And the body language and her tone changed. She said, if you want an education, you had to. Like what part of this don’t you get stupid? And I said, did you have to walk back? She said, no. The principal in the horse drawn carriage, and they had to. They had to get that before dark, before the Ku Klux Klan. I said, how old were you? She said, ten years old. Imagine. So she continued her education. She went to Voorhees College. It’s a two-year black college in South Carolina. She came to New York, the migration was in the thirties and forties. And she continued her education, became a dietitian. I don’t know if you’re familiar with Stuyvesant High school. It’s a top of the tier school in New York. It outshadows the private and public school. And her two children were two of five black children to integrate Stuyvesant high school. And it was humbling. And I said to her, you know, you’re going to need home care services. And her response was, I don’t want anything that’s not mine. She thought I was giving her a handout. And I told my team, whether. If the patient is upset about what you may have said, whether you meant it or not, apologize. I said, I’m so sorry. Maybe I could have explained it a little bit different. I said, everyone that has Medicare. I didn’t use the word entitled. Everyone that has Medicare has home care. She says, everyone? I said, yes. Do you mind telling me when you retired? She said, in 2000. I said, do you mind me telling how much you made? She said, $200 a week. But others made more. Read between the lines.
Gloria Grace Rand
Yeah.
Dr. Mauvareen Beverley
It was learning from the culture, you know? And that’s when I realized they are not included. And cultural competence has to be part of the conversation. Yes. The American born physicians to foreign born patients, but also foreign born physicians to American born patients. American born physicians to American born patients who are different than themselves. And the role of religion in these populations was pivotal to their survivors. And I’ve done presentation and I made the point. I said, when a Holocaust survivor comes in the hospital, we roll out the red carpet. The chief medical officer, the board of directors, the CEO, the rabbi would go and see that patient. And so they should, because of the horrific circumstances that they endured. But when an elderly black person who fled the south because of Ku Klux Klan lynching and Jim Crow, how come we don’t roll out the red carpet? It’s an opportunity to recognize all atrocity survivors the same. And to recognize the role of religion in these two populations were pivotal to their survival.
Gloria Grace Rand
Yeah.
Dr. Mauvareen Beverley
And we were able. It’s a lot of things that we put in place, but we were able to decrease readmission from 30% to 18.7 in just about two years. The population didn’t change. The critical care, the so called social determinants of health didn’t change. You know, it’s not like a whole bunch of people came in on the 18.7. What changed was the heightened human value. Never used the word non-compliant without asking why. Collaborate with patients and eliminate the perception versus the reality of who that individual in that bed is. And I think we, and the team was amazing. Teamwork from all races. We had black, we had black team, we had whites, we had Hassidic, amazing Jewish pharmacists, and, you know, we all got together and we all collaborated in a very positive. And, you know, and people said that, oh, wow, that was a lot where you guys must have been stretched out. And it seems that, no, we weren’t stretched out, we were having fun.
Gloria Grace Rand
Well, that’s good. Well, let’s, let’s get into how we can be our advocates. So your book has nine simple solutions. We’re not going to go over all nine of them in the podcast, because you need to get the book. But if you could pick two of those solutions that people could use, which ones would you choose? At my, that are the most important?
Dr. Mauvareen Beverley
I think the two that I would select, again, it’s a focus, and I may be repetitive, but if you didn’t follow directions, and the doctor asked whether you’re in the hospital or in the private practice, did you take your medications? And you say no. Or did you follow directions, whatever those directions are, and you say no, wait a couple of seconds and say to the doctor, do you want to know why I didn’t do something? Do you want to know why I didn’t take my medication? And the public needs to be aware of the negativity in the medical records, and it could be related to everyone. And so please don’t write the word non-compliant in my medical records without asking me why. Because if could have a negative impact on my health outcomes. The other thing that I would recommend, currently in the social history, it just says non-drinker, non-smoker, no toxic substance. When I trained in medical school and when I completed my internship and residency, the social history has to be more comprehensive because it gives you a sense of who that individual is. We had to say the age of the person, the gender, the race, whether the person was employed or unemployed, the family in who does the family, who does the patient live with? And then asked whether the person was a smoker or a drinker or addicted to narcotics. But it wasn’t just limited to non drink and non smoke or non, no toxic substance. So how does that would help could you imagine an 80-year-old African American woman or any elderly patient who has been in church since birth, regardless of what the religion is and that’s how that person is being described in the medical records. Non drink and non smoker, no toxic substance. What does that tell you about the system? Is that information going to let the physician and nurse or the care, or the care case manager more receptive to understanding who you are? You know?
Gloria Grace Rand
Not necessarily. Yeah.
Dr. Mauvareen Beverley
And, and I think for everyone, and it’s irrespective of age, gender, race, make sure. Ask about. So what’s included in my social history?
Gloria Grace Rand
Yeah, that’s good. Yeah, that’s true. That’s. And that seems like an easy question to ask. It’s not, you know.. You’re not being argumentative or anything. You’re just inquiring. You know, you’re just, you’re just saying, just, you know, hey, I’m curious. What do you. What’s in there?
Dr. Mauvareen Beverley
Yes. Because if that’s what they come up with and then the response could be, well, that’s not who I am. Let me tell you who I am.
Gloria Grace Rand
Yeah.
Dr. Mauvareen Beverley
I am married. I’m not married. I’m in Florida. I’m not employed. Level of education. I live at home with family members or I live alone and I do smoke, but I don’t drink and I don’t take toxic substance or I do smoke and I drink. And then, you know, they could have a different conversation.
Gloria Grace Rand
Yeah. And I would think, and maybe you can, you can address this better as a physician yourself. Would. Are physicians happy to hear that? To be able to get feedback from their patient, to be able to advocate for themselves? Are they open to that? Are you finding that? Or maybe not. And maybe it still needs to educate our physicians as well.
Dr. Mauvareen Beverley
I think. And that’s why I do patient engagement and cultural competence training. And it’s not, it’s about expanding the conversation. And as I said, we’re trained to do no harm. And I think once you put that in the minds of the clinical team and say, this is what the circumstances, and you have to make these changes and to recognize and to be honest, that, and I show the literature, what I’m saying is not something I think about or I think, you know, I think that the, it’s in the medical literature, negativity in the medical records are geared more towards African Americans, particularly African American males. So we have to fix that. But the conversation could extend to everyone, and so everyone needs to know what’s in my medical record, because when you have this medical record where you could go online, but it doesn’t show you what, just those history and the negativity. And it’s important to understand that. I really do think it can make a change patients. I don’t care who that person is, what age, what disease, what entity. And ask me, do you want to know why I did do something? So what is the doctor going to say? No, I don’t want to know why.
Gloria Grace Rand
Yeah. Hopefully, not.
Dr. Mauvareen Beverley
And it’s an opportunity to get to know who you are and also for the patient to get to know who the doctor is at that point.
Gloria Grace Rand
Yeah.
Dr. Mauvareen Beverley
Everybody said the doctors are stressed out. It’s too many. But if you. What we realized was that once we saw good results, the stress level was low. Could you imagine if patients were being readmitted multiple times? That was what’s causing the stress. But if you do reduce the readmission, then the stress level for that particular circumstance, and if she would come in and said, oh, Doctor B, can you help us with John Brown? You know, so you get a different culture, what you want to change the culture in the institution. And I think it can be doable because I experienced it.
Gloria Grace Rand
Absolutely. And it’s just occurring to me as you’re saying that, because I can put myself in the shoes of a doctor saying, oh, no, this guy’s coming in again. Again. What’s his problem now? But if he just, if they’d taken the time at the beginning to really have this discussion, to really see who they are as you’re talking about, then, yeah, then he wouldn’t have to see that person as often because they’d be taking better care of themselves and following directions.
Dr. Mauvareen Beverley
And I’ll give you one example, which was education for me, because it came about the relationship between patient fears and non-compliance. So there’s the patient whose kidney functions were failing and he refused dialysis. And every time he went to the ambulatory care appointment with the nephrologist, all the doctor wrote was, patient refused, patient refused. So the patient was admitted. And I said to the team, does anybody speak to his wife? Does his wife come to visit him? She said, yes, she comes every evening after 05:00 after work. So I said, let me wait and let’s speak to her, because if anybody’s going to convince him, his wife is going to convince him. That was my thought process. I waited. I saw her after five and I told her, I know you love your husband, you know, but his kidney functions are worsening. And if you don’t convince him, to have dialysis. He may not be here with you, you know, much longer. And she said, a statement just blew my mind. She says, I don’t think I want to do that. And I’m saying, what? Again, the why question. Tell me why. And she said, another powerful statement. I don’t think I could live with myself. That statement resonated with me. And I said, tell me why. And she said, our neighbor down the hall went and dialysis, and two weeks later, he died. Could you imagine the trauma, mental, emotional trauma, if that happened to her husband and she was considered herself responsible, how much would I put our family members on dialysis and brought again the change in mindset. I brought in an apology. I told him this story, and I said, they’re going to need hand holding. So he went to see them and he said, I don’t know why your neighbor passed. He could have had a stroke, could have had a heart attack. His kidneys could have failed. But here is the change that I think is so positive. He said, if you agree to dialysis, I will be there with you for the first week. Nephrologists don’t go to dialysis for patients. They refer patients to dialysis cervix. And he did, and the patient did better, you know, and I. From a relationship between people who talk about noncompliance. Now, in my mind, I wonder, what does the fear factor play into this? And so I developed what I call the SPOT methodology. Speak to patients and family. O. Outline what’s important to the individual. I mean, I’m sorry. S sorry. Speak to patients and family. P – pacify fears. O. Outline what’s important to the individual and T – take into account the time it takes for someone to accept the disease, because if I’m going on vacation with my family, I become, I got my mammogram, and it’s positive. I may not know who I am at that point.
Gloria Grace Rand
Right. Yeah.
Dr. Mauvareen Beverley
So that’s also part of the solution. One of the solutions. Adopt the spot methodology. And, you know, it’s, it’s, it was a really humbling and, and informative and educational experience.
Gloria Grace Rand
Oh, yeah.
Dr. Mauvareen Beverley
Yeah. And that’s why I wrote the book. The solution is to achieve health equity, a guide for healthcare professionals and patients. And it’s available right now on Amazon. Very number one bestseller for new releases. And what? Yes. And the book came out on Juneteenth, which is a federal holiday, and it’s my birthday.
Gloria Grace Rand
Oh, well, very good. Doubly good day then. I love that. Yes. I like that works.
Dr. Mauvareen Beverley
Yes. And it’s really, I think informative. And like I said, if we solve it simple, it does not get to the complex. And the last thing I’m going to say, one of the common threads, the human experience. So when I do presentations, which I did at various hospital, and I would say, what is the similarity between a homeless person and, and a millionaire? And the intern and the front row seat said, look on his face, are you kidding me? The only thing I could think about is that they are men. I said, well, there could be females too, but that’s another story. I said, what is the common thread? Once accuracy diagnosed, there is nobody on planet Earth could give it back. Regardless of race, gender, ethnicity, social, economic status, language, whatever the circumstances, the billionaire can say, oh, I’ll give you a million dollars to take the cancer back. Oh, that’s not enough. I’ll give you 5 million. It’s non-negotiable. That’s the only thing in life. And from my experience, that’s the common thread. You know, we have choices in life. You don’t like the school your kids go to, you could change. You don’t like your job, you can leave, you don’t like your family, you can move to another state, once accurately diagnosed, is non-negotiable across the board. And so maybe hospitals could adopt the principle of the common thread and be more empathetic and less judgmental, as I repeated in the past, as I said before, and to recognize the bulk of us taking care of patients never laid in the hospital beds, and those that women deliver in life, and in case patients are trying to prevent it. Now, how you deal with your condition could be your own personal belief system, your culture, and what’s available to you. Yeah, but the underlying factor is the common thread.
Gloria Grace Rand
Yeah, definitely. Oh, this has been very educational for me, and I know that it’s providing a lot of value, and this is definitely something that I encourage everyone to check this out and because even if it’s not necessarily for you, but it could be for a loved one, so you can help them out. As we’re in this day and age, we’ve got baby boomers are getting older all the time, but we’re also living longer. And sometimes they say, no, but whatever, it’s still, you need to take care of yourself, no matter what age you are, and you need to be your own best advocate. So I appreciate that. How can people learn more about what you do? Maybe they want to even have you speak at an organization or something and where they can get their book and what’s the best place for people to reach you.
Dr. Mauvareen Beverley
So my email address is mbeverleymd@Gmail.com and I’ll give, my website is drbeverly.com and my phone number is 914-409-2767 I’m still old school with the phone number. Call me. Can I speak to a human being?
Gloria Grace Rand
That would be wonderful.
Dr. Mauvareen Beverley
And the book is available on Amazon. And you can actually go to the website and there’s a page there that you could just order the book and just show you a picture of the book.
Gloria Grace Rand
All right, there we go. Nine simple solutions to achieve health equity. All right, very good. And the website for those listening, it’s D R Beverley. And Beverley is spelled b e v e r l e y. So we got 3 e’s there.
Dr. Mauvareen Beverley
no dot between D R Beverley. It’s DRBeverley.com
Gloria Grace Rand
Exactly. All right, well, I will have all that. I will have all that in the show notes anyway. So you can go to liveloveengagepodcast.com and you’ll be able to get that. So thank you so much for being with us today. I really appreciate it. And I wish you good luck with the work that you’re doing in the world for educating and healing. And, yeah, I hope that the book continues to do well.
Dr. Mauvareen Beverley
Thank you so much. And I’ll just leave everybody with the note. Even in life, it’s not just in health care, in our personal lives or professional lives, our family lives, if we solve this simple, it doesn’t necessarily have to escalate to the complex. So think about in your own life, things that are simple, that are solvable. Don’t wait till it escalates.
Gloria Grace Rand
That’s true. Yeah, good advice. I like that. Yeah, exactly. Fix it while it’s. Fix it. Well, it’s easy to fix before things get out of hand, for sure. I love that. Thank you.
Dr. Mauvareen Beverley
And thank you, Gloria. This has been really great.
Gloria Grace Rand
And I do want to thank all of you for joining us today, for listening and for watching on YouTube. And I really appreciate it. I have some special news that I want to share, if I can figure out where to put it up here. There we go. So I have been nominated. Well, our live love engage has been nominated for a Women in Podcasting award in the mindset category. So if, voting goes from August 1 through October 1 of 2024 and you can vote for us at womeninpodcasting.net forward slash awards. And then you’ll be able to find it. And I will have that link in the show notes as well. So I hope you will, if you’ve been enjoying the show, I hope you will reach out and give us a vote. There’s no cost for it. So, you know. So it’s easy peasy. And yeah, I think that’s about it. And of course, if you’re not subscribed to the show, I hope you will subscribe to us on your favorite podcast platform or on YouTube. And, yeah, I think that’s going to do it. So until next time, this is Gloria Grace, and I encourage you to go out and live fully, love deeply and engage authentically.
