Dr. Reyblat discusses what it means to build an inclusive urology practice

At the 2022 Society of Women in Urology Annual Clinical Mentoring Conference, Polina X. Reyblat, MD, delivered a presentation called “Building an Inclusive Medical Practice for Patients.” In this talk, she discusses the ways in which urologists can make their practices a more comfortable and open environment for patients of all different backgrounds to receive care. She expands upon these themes in the following interview. Reyblat is a reconstructive urologist and the chief of the department of urology at the Kaiser Permanente Los Angeles Medical Center in Los Angeles, California.

What does inclusion mean to you?

Inclusion is a very broad concept, especially when we talk about health care. Inclusion, to me, means fairness. Inclusion, to me, means deliver[ing] or provid[ing] care in a way that you [would] want that care be given to you or your family. Because we all come from different backgrounds and have different histories, we perceive and understand health care in different ways. t's important to build our practice in a way that can be suitable or comfortable for people coming from all different backgrounds.

Please summarize the main points of the talk.

I started my [presentation] by talking about [how] before we can fix the problem, we need to really look at the source. What are we trying to accomplish and where [is] our current baseline? So, I started my talk by examining where we stand in terms of care for patients from different racial backgrounds, different socioeconomic [statuses], different immigrant [statuses], health care literacy, as well as looking at elderly [communities], LGBT communities, and other marginalized groups. We then looked at what immediate and long-term policy changes we can establish to improve care and make our practices more inclusive.

What are some of the specific changes related to inclusion that you'd like to see in medical practices within the next few years?

There are certain things that we can do immediately in everyday practice, but a lot of work that needs to be done [is] at the system level and an organizational level. Things we talked about [are] hiring culturally diverse staff, ongoing staff training in terms of cultural and racial sensitivity, investing into forms and materials in different languages— [We should] have it reviewed by a native speaker and look for things that can be lost in translation. We spend some time talking about medically competent interpreters. Features like language line solutions and professional medical interpretation are a gold standard. Additionally, your internal staff can be trained properly to interpret some common care pathways for diagnosis and treatment. I would like to encourage [urologists] not to rely on children and grandchildren of our patients because we don't know the true medical and language competency of these translators. We also talked about the extended hours of operation for a weekend—early evenings and late-night clinics. In no way [do] I encourage people to work longer hours than we do already. We know about physician burnout. But adjusting the schedule and having flexible schedules will allow patients to see us at a time where they don't have to take time off work or have their kids [take] off work to provide care. So, in our experience, Saturday [is a] success. Patients [are] satisfied and it also increases our ability to give care to the patients that really need it.

What can urologists do to be advocates for an inclusive medical practice?

I think urologists [have] always been on the forefront of innovation and changes [in] care. Urologists can do a lot of things, [like] adjusting their practice internally, looking at your own practices [to] see [how] your offerings and your treatment pathways affect patients, based on your racial and socioeconomic breakdown of your own practice. Urologists can reach out to [communities] outside of your practice. [For example,] use patient ambassadors [and] include a concept like promotores de salud, or community health care workers. [LGBTQ] centers are [also] strong centers where medical trust is built. We also can be promoters of trust, and that's another part that we talked about during the talk. Medical distrust has seen an increased prevalence throughout our community, and some of it lies in [the] historical experiences of the patients. But some of it is more contemporary. B building trust in the day-to-day interactions [and] acknowledging and respecting patients' decisions on [a] daily basis can make a huge difference in our delivery of health care.

In addition, I'd like to bring up some more specific, concrete steps that we can do to build an LGBTQA-inclusive space. We can start small, and every practice can start internally, whether you're a small private practice or a large institution. I would start with terminology and cultural competency. There are a lot of online resources for that, and having it brought [in]to the open space and for discussion opens doors. You can be the best physician and clinician out there, but if the patient who walks in at your check-in gets misgendered and disrespected before they even see you, that encounter and that relationship with the patient is already broken. So, I would highly recommend us to educate ourselves and our staff in terminology and make our urologic offices a comfortable place for our LGBTQA patients.

Is there anything else you feel our audience should know about this topic?

I think what's important to know about this topic [is] that change is not easy. So, we need to be okay being uncomfortable and accept the fact that what we've always done is not always the best. The intent is there. I know everyone in our urologic community can deliver [the] most excellent care to patients [of a] background different from theirs. I want people to take advantage of the opportunity to learn about a culture or life experience different from their own and seek feedback from the community. In conclusion, I want to say we're all students on this journey, and things change and evolve. [I] want us to stay open minded.

Reference

1. Reyblat PX. Building an inclusive medical practice for patients. Presented at: 2022 Society of Women in Urology Annual Clinical Mentoring Conference; February 7-9, 2022; New Orleans, Louisiana.