March 11, 2024 • 31 mins
Dr. Ruby Skinner, the Chief Medical Officer for Dignity Health’s Community Hospital of San Bernardino, joins host Evelyn Erives for an important conversation about racial disparities in health care and how are health care agencies are addressing this issue.
For more information on this show's topic visit IEHP.org and Dignity Health.
Reach out to Evelyn via Instagram @evelynerives or email her at EvelynErives@iHeartMedia.com
For more information on this show's topic visit IEHP.org and Dignity Health.
Reach out to Evelyn via Instagram @evelynerives or email her at EvelynErives@iHeartMedia.com
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Episode Transcript
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(00:01):
Welcome to Covering Your Health, awellness podcast dedicated to covering all areas of
living a healthy and happy lifestyle,from healthy hearts to understanding health plans and
everything in between. Each episode willprovide you with a better understanding of managing
your health, preventative care, andstaying on the right path for your family's
wellness journey. The Covering Your Healthpodcast is presented by i EhP. Now
(00:26):
your host Evelina Revez. Well,let's do it again, shall we?
Hi there, Yes, it's EvaldiErivez. I am very happy to be
here with you today, and todaywe're going to dive into a very critical
topic. So before I get intowhat we are going to discuss, I
wanted to give you a little bitof an update on my own personal wellness
(00:50):
journey. I know in the beginningof the podcast, if you listened from
the very first one, you knowI am on my own personal wellness journey
and I've been trying to find ways, with these resources that we now have
with this podcast to inspire my ownself to get out there to do more
from my own health. And onething I'm very excited about is I've given
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myself a big goal at the endof the summer, I have signed up
for a half marathon. I'm goingto be doing the inaugural Disneyland Halloween half
Marathon, and this is really cool. It's with Run Disney and I I've
done Run Disney half marathons in thepast. But here is what is different
(01:33):
about me now. I am eightyears older and that is a big deal.
I haven't done a half marathon inyears. Since then, I've had
some health issues and also was ina car accident and you know, things
set me back. I had somesetbacks. I am ready to get back
out there, and I'm actually goingto be doing it through charity work,
(01:53):
so that's really cool. I'm gonnabe fundraising for Run Third Alliance, which
is really cool because they are empowered, bring you through after school running programs
to get out there, discover theirgrit, build meaningful relationships, and my
favorite part, inspire healthy communities.And if that's not what this podcast is
all about, I don't know whatit is. So I'm very excited about
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it. I hope you'll give mea follow at EVELYNI Reva's on Instagram and
and see me through this goal.I have about six months to get myself
in shape and ready through training forthis half marathon. And I'm a little
bit crazy. I didn't just signup for the half marathon. I also
signed up for the Chills and ThrillsChallenge, which is a funny name to
(02:36):
call the ten k plus half marathon. So it's a nineteen point three mile
weekend. I know I've done itbefore. I've done it before, so
I feel in my bones I cando it again. But let me just
tell you, this body is older, and I know it's going to be
a challenge. Okay, let's getoff the topic of me and on to
the topic for today's show. Stillon the topic of wellness, of course,
(03:00):
racial disparities in healthcare. Inequities persistwoven into the very fabric of our
health system. But there's hope andthere are dedicated professionals working tirelessly to bridge
these gaps and heal the wounds ofinjustice. Today we're joined by doctor Ruby
Skinner, chief medical officer for DignityHealth's Community Hospital of San Bernardino, to
(03:22):
speak about the racial disparities in healthcareand health professionals in the field are working
to address this very important issue.Thank you so much for joining me today,
doctor Skinner, thank you, thankyou for having me. Absolutely it's
a joy. I want to talka little about you first. I've been
kind of making this a habit withevery episode. I you know what it
(03:44):
is. I love I'm fascinated bypeople, and I'm fascinated by how people
found their calling right and how didthat happen for you? What made you
go into this line of work?You know, it's interesting. I I'm
a surgeon, a trauma surgeon,and I practiced a general surgery and trauma
(04:05):
surgery for about twenty years and thentransition to the executive side of healthcare.
What attracted me to surgery? Youknow, it's really hard to say.
I was always, as a kidvery interested in science. I grew up
in California. My parents encouraged meto pursue whatever I wanted to do,
(04:29):
and you know, through that,I ended up going to medical school and
kind of the rest with history.I was really attracted to surgery. I
like the fact that as a surgeonI could fix things. I could diagnose
you know, processes really quick andtake patients to the operating room and generally
(04:50):
impact outcomes right away. That fitmy personality, and trauma was you know,
even more of that. I reallyliked the adrenal and rush of you
know, managing patients coming in bleedingand with you know, severe injuries.
So that really was the focus ofmy career. But as a result of
that, especially with being a traumasurgeon, you know, the global issue
(05:16):
of health care and how to providethe best healthcare to all patients became a
big passion of mine. And soyeah, I started to train and you
know, towards health care management andleadership, and then my career took a
turn in that direction. So currentlyI'm the chief medical officer on the executive
(05:38):
team at Community Hospital San Bernardino forDignity Health Common Spirit, and I've been
doing this for about three years.Wonderful, Okaith, That tells me a
lot about you. You sound likea very passionate person. I can tell
like this is this is your thing, and I love that, right,
I love hearing that. Well.To get into the topic for today,
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I mean, are you as healthcaresystem is complicated to say the very least.
I think the layman like myself,I am no expert in any of
these things, gets a little overwhelmedwith it thinks about it, wonders about
other ways to do things, butknows nothing about the topic. So what
strides are we making to implement betterpractices and be on part with healthcare services
(06:19):
in like other countries? Right?You know, the US healthcare system is
very complicated. You know, weare a very diverse and complex country,
very large country. You know,we have fifty states. You know,
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we've got a large rural population,urban population, you know, a number
of things like other countries. Butwhen you compare you know, the US
to other similar high income countries,parts of Europe, you know, another
parts of the world. You know, we spend a lot of health a
lot of money on healthcare, butyou know, our health overall compared to
(07:00):
similar countries is not that great acrossthe board. You know, we don't
we're the only country that doesn't haveuniversal healthcare coverage. You know, we
have compared to other countries similar toUS, we have the lowest life expectancy
at birth, the highest death ratesfor avoidable and treatable conditions like diabetes and
things like that, high maternal andinfant mortality rates, and high suicide rates.
(07:27):
So there's a lot of challenges thatwe face and you know in this
country across the board. You know, certainly those challenges impact communities of color
and you know, certain social economicgroups, et cetera. You know,
but overall we have we have bigchallenges in this country, despite you know,
(07:47):
being you know, a very productiveand powerful country. What are we
doing to try to change that toget on par with those other countries?
Right? You know, that's it'syou know, it's it's a lot of
it has to do with you know, access to care, preventative measures,
lifestyle things like that. I thinkthat that's been a big focus in healthcare
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and different health care systems. Youknow. Certainly, uh, you know,
there there is a need to toaddress getting doctors trained in primary care
and getting them to certain parts ofthe country, and that's being addressed in
different populations. Education is important.There's a lot of educational resources and things
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like that, and you know,I think all of those activities have been
going on for years and years.But yet again, you know, our
country is just very complex and youknow, they're different. Different regions of
the country have different challenges, youknow, so really the goal is to
try to in many ways standardize uhhealth care practices and be able to you
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know, provide the same level anywhereanywhere you live in the country. And
that's very difficult here, very difficult. Yeah, I can imagine. I
mean, just if you just lookat it state by state, you can
see the differences if you've ever traveledacross the country or did a road trip.
Lucky that my family has been ableto do that. We had these
discussions about how different it is justin a one state over and then so
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you think about, well, ofcourse, then their health is going to
be different than our health because wehave different climate, different you know,
a different style of living, differentfoods that we eat, those kinds of
things as well. Right exactly,I'm just saying in our country is so
big, every state could be acountry. Yeah, that's exactly right.
Right, you know, California,you know, we we could fit you
know, three or four you knowEuropean countries within our state. And you
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know, different regions of California arevery you know, are very so you
know, again, we're a big, complex country. So let's talk about
health disparities. And for those whodon't understand what that even means, can
you tell me a little bit aboutwhat health disparity are sure. You know,
health disparities overall are preventable differences inthe in the burden of disease,
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injury, violence, or any anyopportunities that impact optimal health. And typically
these disparities when when we talk aboutthat, typically, uh, these disparities
refer to socially disadvantaged populations and thatand that is the part of the I
guess our conversation just a couple ofmoments ago, with the different areas and
(10:35):
the different some maybe even rural areasthat have you know, lack of healthcare
or lack of facilities. So whyare people of color more at risk for
disease or for chronic conditions? Right? You know, I think again,
you know, it is people ofcolor. It's it's quite complex. And
before I get into that, youknow, just to put it into perspective.
(10:58):
You know, for example, youknow, the rural population in this
country is very large. They're aboutforty six million US residents that live in
rural parts of the country, youknow, in the South, Midwest,
different parts of the country, andand the majority of those you know,
uh, those those people are arewhite Americans. And you know, many
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of the disparities that exist for peoplethat live in more urban settings if you
will, you know, people ofcolor, things like that. Those same
disparities exist for for rural Americans aswell. So you know, a lot
of it has to do with accessto care. Uh, you know,
lifestyle, you know, education,things like that. That that overall impact
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care and you know, not havingnecessarily the services, the facilities, the
physicians, the complexity the diversity ofphysicians read available to provide care, you
know, for for patients, forpeople. Yeah. So let's talk locally
then, right here in the InlandEmpire. You you work with San in
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San Bornandino. So what strides arebeing made at San Marnidino Community Hospital to
decrease these numbers? Right? Yeah, you know San Bernardino, the Inland
Empire. I actually went to highschool back in the eighties here at San
Bernardino High School. Amazing for acouple of years. Yeah, so local,
you know, I I'm I'm Ilove the Inland Empire. This is
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you know, San Bernardino County isone of the largest counties in the country.
Uh, an area that is growing. But there is a you know,
a diverse population, a large populationof people of color. There's some
social economics challenges as we know inthis San Bernardino County and other parts of
the state. And community hospital youknow has been here for over one hundred
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years and is very dedicated to servingthe community, to serving this population.
And you know, there have beenmany strides recently but over the years UH
to provide care for patients here.One thing I do want to mention is
that you know, the Joint Commission, which is a national regulatory organization that
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oversees quality for you know, hospitals, big healthcare organizations recently a year ago,
put out a requirement to reduce healthcare disparities and as requiring hospitals healthcare
systems to focus on UH socially disadvantagedpopulations UH, to look at the data,
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to look at to do extensive assessmentsof the community needs and to provide
you know, optimal care. Andyou know, these hospitals will be will
be will be graded. Oh,that's interesting, different different grade. We
have diferent grading systems that hospitals.There's leap Frog, there's Star ratings that
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impact you know, hospitals. Everyhospital has UH, you know, focuses
on quality and outcomes and this willbe a part of that overall arching grading
system. So this is a bigmove. This is a big deal.
And at community, you know,we've always focused on providing the best care,
but we are looking specifically at,you know, some of our high
(14:26):
risk population features and we're going tofocus on the management of heart failure,
which is a very common diagnosis whenpatients come into the hospital, they're admitted
to the hospital. We're going tofocus on providing the most current evidence based
care to those patients and ensuring thatthey have close follow up with primary care
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physicians or in you know, clinicsthat you know can evaluate their medications and
things like that. Yeah, itsounds like I'm loving the fact that there
is going to be I guess accountabilityso to speak, yes, for these
hospitals. Right. So that makesme really happy because that sounds like we're
going in the right direction and thenright now putting it in the hands of
(15:13):
the people to make sure that theyare getting there right now, they have
to get in and actually be takingright care of themselves. How can we
help people of color learn about managingtheir health a little bit more on that
level, right? You know,a lot of it has to do with
education and you know, and there'sa lot out there. I mean,
certainly there's a there are a lotof resources in different communities. For example,
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a community hospital, we have avery busy, very active healthcare education
center that can provide resources, accessto resources, not you know, on
lifestyle, healthy living resources for youknow, primary care, for clinics,
things like that, and so there, you know, there there's certain a
(16:00):
lot of resources in the community.Certainly, you know, on the individual
level, you know, we allall of us have to you know,
ensure that we follow up with ourprimary care physicians and you know, use
the resources available to get access tomedications and things like that, you know,
and personally, you know, focuson you know, healthy routines.
(16:22):
That's very important as well. Butthere are resources you know to drive that,
to guide healthy lifestyles you know,in most communities, and certainly we
we have that here at our hospital. Yeah. Yeah, you know,
that got me to think about somedifferent reasons that maybe somebody wouldn't have gone
into a doctor or something like that. I think about how many people I
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know that don't even have a primarycare physician, right, just somebody that
is their advocate, right, justthat one first step into taking care of
your health. And another thing thatcomes to mind for me is trust.
Yes, do you feel like thereare people of color? I mean,
I'm a Latina, so I meanI feel like this is in my community
right, that lack of trust withthe healthcare system because of things that have
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happened in the past. Yeah,you know, that's a really a really
good point. I'm glad you broughtthat up. You know. Yeah,
trust, you know, trustism isa big factor. You know. I'm
African American. I understand the issuesrelated to trust as it relates to healthcare.
And you know, I think alot of those barriers are being are
(17:33):
being broken down, you know,because of information you know that's available because
of communities, and you know,because of you know, the fact that
you know, there's a growing populationfor example, of you know, physicians
of color. You know, yousee Riverside for example, which is you
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know, in Riverside County and theInland Empire. They are met medical school
has received you know, the highestrating for diversity for medical students. They're
training the physicians of the future tostay in this community and to provide care,
you know, and linking you knowwith hospitals such as Saint Bernadine's Medical
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Center, which is another big Nativefacility and community hospital to you know,
ensure that we all participate in focusingon the diversities of the community. And
so I think there are a lotof strides that are being made in that
regard. Yeah, yeah, itis true and I hate to even say
(18:38):
it, but it is true thatwhen you go to see a doctor and
you feel like that doctor understands youbetter, maybe they look like you,
you know, yeh, feel likeyou can have that trust with them.
So, right, how very coolto hear that that is happening right here
in Riverside at uc Riverside. That'scool, That's very nice. Yes,
So let's go back to the tothe patient part of this, right,
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what type of questions should should patientsask their primary care physicians when maybe even
or even when they're searching for anew provider, sure, you know,
searching for a new provider, certainly, I think, you know, uh,
transparency, Transparency is important, andyou know, I think patients should
(19:21):
feel comfortable with their provider and theyshould ask any questions that they see fit.
You know, certainly, if youknow they're concerned about, you know,
the provider being able to you know, manage their particular needs. You
know, uh if they have Forexample, if a patient is given the
(19:42):
diagnosis of nuancet adult diabetes, youknow, then they should ask anything.
They should completely understand what the diseaseprocess is, how it impacts their body,
how it impacts their future. Ifthey're given medications, understanding what the
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medications do, how, what arethe side effects? You know, what
is the plan? You know,how they can impact the need for medication.
You know they may be on multiplemedications. How do these medications interact?
Things like that, And I thinkyou know, patients have the right
to really understand their care and theyhave the right to have an environment that
(20:29):
still support is you know, tomeet their needs. And you know,
their physicians and the physician extenders thatwork with them need to take the time
to ensure that the patients understand andlearn, you know, about their bodies
and what they can do, youknow, working with their physician team if
you will, to improve their care. So what I'm taking away from that
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is there are no dumb questions,no, absolutely right not when it comes
to your health. You need toknow the answer. You need to know
the answers. There's a lot youcan look up, and sometimes it's confusing.
You know, if you google youknow something, there's a lot of
information there. But you know,and that can be very powerful too,
you know, to understand. ButI think there is a human connection with
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the physician. You know, thatis important. And you know, sometimes
you may have a physician that justyou don't connect with, and so there
you know, are resources to youknow, find the right primary physician that
you connect with. You know,my mother who's ninety will be ninety two,
will be ninety one in March.You know, she has a primary
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care physician that she's been with foryears at Kaiser Fontana and they just have
a special connection and that's who shedressed and so you know, but it's
been years, it's been years.But you know sometimes those relationships take time,
Yeah, they do. They taketime to build that trust. I
felt like I had the most amazingprimary care physician and she just retired.
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And now I'm looking at it going, oh, I don't feel the same
with this next person as they didwith the last person. And it's okay.
It's okay to find somebody else,right, It's okay if you're not
having that good feeling when you're withyour doctor, you don't feel like you're
being heard. It's okay to moveon. I have an example for you
that literally happened yesterday. My goodfriend is a nurse. She's she's an
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RN and she's and she's a littleshe's a little heavier, and she said
that there was a person who cameinto her urgent care and said to her,
can I ask you a question?You're you know, you're just you're
a little bigger, and I wantto ask you something? Does your doctor
tell you that you're fat? Andyou know, my my friend was taken
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back kind of like what what doyou what do you mean? Like you
know, and she goes, well, because my doctor constantly calls me fat
and it hurts. And then myfriend and I think she gave the best
advice. She said, you needto find a new doctor. Yes,
yes, because there is a thingcalled tact and it's one thing to tell
someone that they're overweight, right,and especially in with people of color,
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because I will say that specifically becauseof my demographic as well. You know,
of course, if we know,we know we're overweight, right,
if like you go in you knowyou already that that is a battle that
you are fight fighting. In thefact that you even went into your doctor
and you went in to say,you know, I need to I'm feeling
this way, I'm feeling that way. To have someone just blatantly call you
fat or rather say well, let'sget let's work on this part so that
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we can solve all these other partsthat are happening right right right, it
blew me away and it made methink, yeah, you know what,
not all doctors are for you foreverybody. No, they're not. And
you know, there's a everyone deservesto be treated with respect and to be
in an environment that fits them.And every you know that that same doctor,
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you know that that said that tothat patient, that's horrible. But
there may be someone else that's okaywith that. But that's not great.
I don't, I don't, Idon't. I can't imagine that happening to
anyone. But you have to findyour person. There are, you know,
physicians out there, and I thinkthat can be the person for for
(24:23):
everyone. And and and so ittakes time, it takes trust, and
it's a it's a long relationship.It takes investment on both sides, and
you know, sometimes you know,and there's ups there, they're ups up,
ups and downs to you know,to that relationship. But certainly your
physician needs to be your friend,your advisor, your friend and vice versa.
(24:47):
And physicians are human too, sophysicians have medical issues as well and
struggles, and I think if youcan connect on that level, that's very
very helpful. Yeah, absolutely,thank you. Well on a person level,
what health connections have you made alongthe way to you know, get
better health and to stay on agood solid routine for you right, Yeah,
(25:08):
you know it's been it's challenging inhealthcare. You know, I was
a trauma surgeon for twenty years,so you know, I spent I spent
a lot of time, you know, doing twenty four thirty hour shifts,
being up operating, very stressful andso it's important, you know, in
that setting to figure out a medium, a happy medium. You know.
(25:32):
I really I like yoga, Ilike exercise, I like the outdoors.
I like beakroum yoga or hot yogathat it's referred to. So that's been
very helpful for me. It's beenreally helpful both mentally and physically, you
know, to keep myself healthy,to keep myself focused and relaxed, and
you know, I try to toto eat healthy as well. Yeah,
(25:56):
that's the hard part for me.It's hard. It's so I love food.
I just love food. I havea relationship with it. It likes
me back exactly. We have alot of options in America. In this
country, it's very difficult. That'salso another good point. There's a lot
of options do We have a lotof options, So it's just a balance.
(26:18):
I don't think anything has to bevery extreme. I think it's important
to find, you know, away to you know, deal with stress.
Certainly, exercise and movement is important, and and there are ways to
do that, you know for people. Not everyone's gonna want to be do
hot yoga and be in a roomthat's one hundred and five degrees, right,
(26:38):
you know, that's pretty extreme.But you know, certainly walking,
you know, other forms of exercise, you know, doing exercise in the
home, you know, with weightsand things like that, and certain classes,
walking groups and things like that arevery useful. Yeah, it's fun
(26:59):
when you have that a little bitof accountability when you have like a walking
group or something, Hey we missedyou today, Why weren't you out there
with us. It does make yougo, oh no, I got to
get back out there again, thingslike that kind of thing. Yeah,
oh yeah, Okay, So beforeI let you go, you've been so
informative and just such a pleasure.What are the three biggest takeaways you hope
our listeners can take from this conversation? Sure? Number one, you know,
(27:25):
overall, I think our healthcare systemis very complex and disparities exist in
multiple populations. But as it relatesto communities of color, there are big
disparities, but they're resources number one. Number two, there is a national
focus on these healthcare disparities, andhospitals, health care facilities are being required
(27:53):
to focus on those disparities and toperform and address us and less in most
disparities as it relates to communities ofcolor primarily. And then you know,
number three, Community Hospital. We'rehere. This hospital has been here for
years, for over one hundred years, and we are dedicated to provide quality
(28:18):
care to this community. We haveso many new programs. In addition,
you know, to our primary care, We've added the Da Vinci robot.
We're doing complex robotic surgery, We'redoing surgical oncology to address the cancer disparities
in our community. We have intensivistsICU physicians on site to manage the most
(28:40):
critical patients. We're here for thecommunity, and we're providing a level of
care that allows patients to stay inthis community and not have to be transferred
to other places. That is key, stay home, be able to stay
right here, stay right here.Yes, thank you, doctor Skinner.
You have been so wonderful. You'llhave to come back on because you know,
(29:03):
I really think that there's so muchmore to dive into with this topic,
specifically something that hits close to homefor me. You know, the
way that people of color are treatedwhen when they are having babies. That's
that's that's such a big topic andI would love to talk to you about
that down the road. It isa big topic. Yeah, I would
love to address that absolutely. Yes, well I will have you back for
(29:26):
sure. I'll make sure my peoplecall your people and will make it happen.
Yes, okay, great, Sonice to meet you. Always so
wonderful to meet you. Thank you, doctor Skinner. I I just you
know, and now I'm in aweof you, so I appreciate you.
Oh, thank you, thank you. Likewise, well as we conclude this
I opening episode of Covering Your Health, I want to express my gratitude for
(29:49):
our remarkable guest, doctor Ruby Skinner. She's just so so wonderful. Her
dedication to well being a part ofdismantling health disparities. Really it inspires me.
It really does, and I hopeit inspired you as well. What
we all need to remember is thatchange begins with awareness. So we're amplifying
(30:10):
these conversations advocating for equity and demandingjustice. I am really I have to
tell you, I'm feeling very positivetoday with knowing that there is a national
focus on this issue happening right now, and these hospitals will be graded,
and I think that that is sucha massive step in the right direction.
(30:30):
So stay informed, stay compassionate.Remember healthcare is a human right. I
am so grateful that you joined mefor another episode of Covering Your Health with
Evely and Ereva's presented by IEHP,who's been such a wonderful partner on this
podcast. Remember all of the resources, I will be listing them in the
description. If you want to getin touch with you know, doctor Skinner,
or of course i EhP. Besure to subscribe on your favorite podcast
(30:55):
platform and reach out to me ifyou have any questions or concerns or just
comments. Love it at Evelina Reva'son all social media platforms. Very easy
to get a hold of. Untilnext time, this is Evelyn Reva is
wishing you a lifetime of happiness andhealth
Welcome to Covering Your Health, awellness podcast dedicated to covering all areas of
living a healthy and happy lifestyle,from healthy hearts to understanding health plans and
everything in between. Each episode willprovide you with a better understanding of managing
your health, preventative care, andstaying on the right path for your family's
wellness journey. The Covering Your Healthpodcast is presented by i EhP. Now
(00:26):
your host Evelina Revez. Well,let's do it again, shall we?
Hi there, Yes, it's EvaldiErivez. I am very happy to be
here with you today, and todaywe're going to dive into a very critical
topic. So before I get intowhat we are going to discuss, I
wanted to give you a little bitof an update on my own personal wellness
(00:50):
journey. I know in the beginningof the podcast, if you listened from
the very first one, you knowI am on my own personal wellness journey
and I've been trying to find ways, with these resources that we now have
with this podcast to inspire my ownself to get out there to do more
from my own health. And onething I'm very excited about is I've given
(01:11):
myself a big goal at the endof the summer, I have signed up
for a half marathon. I'm goingto be doing the inaugural Disneyland Halloween half
Marathon, and this is really cool. It's with Run Disney and I I've
done Run Disney half marathons in thepast. But here is what is different
(01:33):
about me now. I am eightyears older and that is a big deal.
I haven't done a half marathon inyears. Since then, I've had
some health issues and also was ina car accident and you know, things
set me back. I had somesetbacks. I am ready to get back
out there, and I'm actually goingto be doing it through charity work,
(01:53):
so that's really cool. I'm gonnabe fundraising for Run Third Alliance, which
is really cool because they are empowered, bring you through after school running programs
to get out there, discover theirgrit, build meaningful relationships, and my
favorite part, inspire healthy communities.And if that's not what this podcast is
all about, I don't know whatit is. So I'm very excited about
(02:15):
it. I hope you'll give mea follow at EVELYNI Reva's on Instagram and
and see me through this goal.I have about six months to get myself
in shape and ready through training forthis half marathon. And I'm a little
bit crazy. I didn't just signup for the half marathon. I also
signed up for the Chills and ThrillsChallenge, which is a funny name to
(02:36):
call the ten k plus half marathon. So it's a nineteen point three mile
weekend. I know I've done itbefore. I've done it before, so
I feel in my bones I cando it again. But let me just
tell you, this body is older, and I know it's going to be
a challenge. Okay, let's getoff the topic of me and on to
the topic for today's show. Stillon the topic of wellness, of course,
(03:00):
racial disparities in healthcare. Inequities persistwoven into the very fabric of our
health system. But there's hope andthere are dedicated professionals working tirelessly to bridge
these gaps and heal the wounds ofinjustice. Today we're joined by doctor Ruby
Skinner, chief medical officer for DignityHealth's Community Hospital of San Bernardino, to
(03:22):
speak about the racial disparities in healthcareand health professionals in the field are working
to address this very important issue.Thank you so much for joining me today,
doctor Skinner, thank you, thankyou for having me. Absolutely it's
a joy. I want to talka little about you first. I've been
kind of making this a habit withevery episode. I you know what it
(03:44):
is. I love I'm fascinated bypeople, and I'm fascinated by how people
found their calling right and how didthat happen for you? What made you
go into this line of work?You know, it's interesting. I I'm
a surgeon, a trauma surgeon,and I practiced a general surgery and trauma
(04:05):
surgery for about twenty years and thentransition to the executive side of healthcare.
What attracted me to surgery? Youknow, it's really hard to say.
I was always, as a kidvery interested in science. I grew up
in California. My parents encouraged meto pursue whatever I wanted to do,
(04:29):
and you know, through that,I ended up going to medical school and
kind of the rest with history.I was really attracted to surgery. I
like the fact that as a surgeonI could fix things. I could diagnose
you know, processes really quick andtake patients to the operating room and generally
(04:50):
impact outcomes right away. That fitmy personality, and trauma was you know,
even more of that. I reallyliked the adrenal and rush of you
know, managing patients coming in bleedingand with you know, severe injuries.
So that really was the focus ofmy career. But as a result of
that, especially with being a traumasurgeon, you know, the global issue
(05:16):
of health care and how to providethe best healthcare to all patients became a
big passion of mine. And soyeah, I started to train and you
know, towards health care management andleadership, and then my career took a
turn in that direction. So currentlyI'm the chief medical officer on the executive
(05:38):
team at Community Hospital San Bernardino forDignity Health Common Spirit, and I've been
doing this for about three years.Wonderful, Okaith, That tells me a
lot about you. You sound likea very passionate person. I can tell
like this is this is your thing, and I love that, right,
I love hearing that. Well.To get into the topic for today,
(05:58):
I mean, are you as healthcaresystem is complicated to say the very least.
I think the layman like myself,I am no expert in any of
these things, gets a little overwhelmedwith it thinks about it, wonders about
other ways to do things, butknows nothing about the topic. So what
strides are we making to implement betterpractices and be on part with healthcare services
(06:19):
in like other countries? Right?You know, the US healthcare system is
very complicated. You know, weare a very diverse and complex country,
very large country. You know,we have fifty states. You know,
(06:39):
we've got a large rural population,urban population, you know, a number
of things like other countries. Butwhen you compare you know, the US
to other similar high income countries,parts of Europe, you know, another
parts of the world. You know, we spend a lot of health a
lot of money on healthcare, butyou know, our health overall compared to
(07:00):
similar countries is not that great acrossthe board. You know, we don't
we're the only country that doesn't haveuniversal healthcare coverage. You know, we
have compared to other countries similar toUS, we have the lowest life expectancy
at birth, the highest death ratesfor avoidable and treatable conditions like diabetes and
things like that, high maternal andinfant mortality rates, and high suicide rates.
(07:27):
So there's a lot of challenges thatwe face and you know in this
country across the board. You know, certainly those challenges impact communities of color
and you know, certain social economicgroups, et cetera. You know,
but overall we have we have bigchallenges in this country, despite you know,
(07:47):
being you know, a very productiveand powerful country. What are we
doing to try to change that toget on par with those other countries?
Right? You know, that's it'syou know, it's it's a lot of
it has to do with you know, access to care, preventative measures,
lifestyle things like that. I thinkthat that's been a big focus in healthcare
(08:11):
and different health care systems. Youknow. Certainly, uh, you know,
there there is a need to toaddress getting doctors trained in primary care
and getting them to certain parts ofthe country, and that's being addressed in
different populations. Education is important.There's a lot of educational resources and things
(08:33):
like that, and you know,I think all of those activities have been
going on for years and years.But yet again, you know, our
country is just very complex and youknow, they're different. Different regions of
the country have different challenges, youknow, so really the goal is to
try to in many ways standardize uhhealth care practices and be able to you
(08:56):
know, provide the same level anywhereanywhere you live in the country. And
that's very difficult here, very difficult. Yeah, I can imagine. I
mean, just if you just lookat it state by state, you can
see the differences if you've ever traveledacross the country or did a road trip.
Lucky that my family has been ableto do that. We had these
discussions about how different it is justin a one state over and then so
(09:20):
you think about, well, ofcourse, then their health is going to
be different than our health because wehave different climate, different you know,
a different style of living, differentfoods that we eat, those kinds of
things as well. Right exactly,I'm just saying in our country is so
big, every state could be acountry. Yeah, that's exactly right.
Right, you know, California,you know, we we could fit you
know, three or four you knowEuropean countries within our state. And you
(09:43):
know, different regions of California arevery you know, are very so you
know, again, we're a big, complex country. So let's talk about
health disparities. And for those whodon't understand what that even means, can
you tell me a little bit aboutwhat health disparity are sure. You know,
health disparities overall are preventable differences inthe in the burden of disease,
(10:11):
injury, violence, or any anyopportunities that impact optimal health. And typically
these disparities when when we talk aboutthat, typically, uh, these disparities
refer to socially disadvantaged populations and thatand that is the part of the I
guess our conversation just a couple ofmoments ago, with the different areas and
(10:35):
the different some maybe even rural areasthat have you know, lack of healthcare
or lack of facilities. So whyare people of color more at risk for
disease or for chronic conditions? Right? You know, I think again,
you know, it is people ofcolor. It's it's quite complex. And
before I get into that, youknow, just to put it into perspective.
(10:58):
You know, for example, youknow, the rural population in this
country is very large. They're aboutforty six million US residents that live in
rural parts of the country, youknow, in the South, Midwest,
different parts of the country, andand the majority of those you know,
uh, those those people are arewhite Americans. And you know, many
(11:20):
of the disparities that exist for peoplethat live in more urban settings if you
will, you know, people ofcolor, things like that. Those same
disparities exist for for rural Americans aswell. So you know, a lot
of it has to do with accessto care. Uh, you know,
lifestyle, you know, education,things like that. That that overall impact
(11:48):
care and you know, not havingnecessarily the services, the facilities, the
physicians, the complexity the diversity ofphysicians read available to provide care, you
know, for for patients, forpeople. Yeah. So let's talk locally
then, right here in the InlandEmpire. You you work with San in
(12:11):
San Bornandino. So what strides arebeing made at San Marnidino Community Hospital to
decrease these numbers? Right? Yeah, you know San Bernardino, the Inland
Empire. I actually went to highschool back in the eighties here at San
Bernardino High School. Amazing for acouple of years. Yeah, so local,
you know, I I'm I'm Ilove the Inland Empire. This is
(12:33):
you know, San Bernardino County isone of the largest counties in the country.
Uh, an area that is growing. But there is a you know,
a diverse population, a large populationof people of color. There's some
social economics challenges as we know inthis San Bernardino County and other parts of
the state. And community hospital youknow has been here for over one hundred
(12:58):
years and is very dedicated to servingthe community, to serving this population.
And you know, there have beenmany strides recently but over the years UH
to provide care for patients here.One thing I do want to mention is
that you know, the Joint Commission, which is a national regulatory organization that
(13:20):
oversees quality for you know, hospitals, big healthcare organizations recently a year ago,
put out a requirement to reduce healthcare disparities and as requiring hospitals healthcare
systems to focus on UH socially disadvantagedpopulations UH, to look at the data,
(13:41):
to look at to do extensive assessmentsof the community needs and to provide
you know, optimal care. Andyou know, these hospitals will be will
be will be graded. Oh,that's interesting, different different grade. We
have diferent grading systems that hospitals.There's leap Frog, there's Star ratings that
(14:03):
impact you know, hospitals. Everyhospital has UH, you know, focuses
on quality and outcomes and this willbe a part of that overall arching grading
system. So this is a bigmove. This is a big deal.
And at community, you know,we've always focused on providing the best care,
but we are looking specifically at,you know, some of our high
(14:26):
risk population features and we're going tofocus on the management of heart failure,
which is a very common diagnosis whenpatients come into the hospital, they're admitted
to the hospital. We're going tofocus on providing the most current evidence based
care to those patients and ensuring thatthey have close follow up with primary care
(14:48):
physicians or in you know, clinicsthat you know can evaluate their medications and
things like that. Yeah, itsounds like I'm loving the fact that there
is going to be I guess accountabilityso to speak, yes, for these
hospitals. Right. So that makesme really happy because that sounds like we're
going in the right direction and thenright now putting it in the hands of
(15:13):
the people to make sure that theyare getting there right now, they have
to get in and actually be takingright care of themselves. How can we
help people of color learn about managingtheir health a little bit more on that
level, right? You know,a lot of it has to do with
education and you know, and there'sa lot out there. I mean,
certainly there's a there are a lotof resources in different communities. For example,
(15:37):
a community hospital, we have avery busy, very active healthcare education
center that can provide resources, accessto resources, not you know, on
lifestyle, healthy living resources for youknow, primary care, for clinics,
things like that, and so there, you know, there there's certain a
(16:00):
lot of resources in the community.Certainly, you know, on the individual
level, you know, we allall of us have to you know,
ensure that we follow up with ourprimary care physicians and you know, use
the resources available to get access tomedications and things like that, you know,
and personally, you know, focuson you know, healthy routines.
(16:22):
That's very important as well. Butthere are resources you know to drive that,
to guide healthy lifestyles you know,in most communities, and certainly we
we have that here at our hospital. Yeah. Yeah, you know,
that got me to think about somedifferent reasons that maybe somebody wouldn't have gone
into a doctor or something like that. I think about how many people I
(16:45):
know that don't even have a primarycare physician, right, just somebody that
is their advocate, right, justthat one first step into taking care of
your health. And another thing thatcomes to mind for me is trust.
Yes, do you feel like thereare people of color? I mean,
I'm a Latina, so I meanI feel like this is in my community
right, that lack of trust withthe healthcare system because of things that have
(17:07):
happened in the past. Yeah,you know, that's a really a really
good point. I'm glad you broughtthat up. You know. Yeah,
trust, you know, trustism isa big factor. You know. I'm
African American. I understand the issuesrelated to trust as it relates to healthcare.
And you know, I think alot of those barriers are being are
(17:33):
being broken down, you know,because of information you know that's available because
of communities, and you know,because of you know, the fact that
you know, there's a growing populationfor example, of you know, physicians
of color. You know, yousee Riverside for example, which is you
(17:56):
know, in Riverside County and theInland Empire. They are met medical school
has received you know, the highestrating for diversity for medical students. They're
training the physicians of the future tostay in this community and to provide care,
you know, and linking you knowwith hospitals such as Saint Bernadine's Medical
(18:18):
Center, which is another big Nativefacility and community hospital to you know,
ensure that we all participate in focusingon the diversities of the community. And
so I think there are a lotof strides that are being made in that
regard. Yeah, yeah, itis true and I hate to even say
(18:38):
it, but it is true thatwhen you go to see a doctor and
you feel like that doctor understands youbetter, maybe they look like you,
you know, yeh, feel likeyou can have that trust with them.
So, right, how very coolto hear that that is happening right here
in Riverside at uc Riverside. That'scool, That's very nice. Yes,
So let's go back to the tothe patient part of this, right,
(19:00):
what type of questions should should patientsask their primary care physicians when maybe even
or even when they're searching for anew provider, sure, you know,
searching for a new provider, certainly, I think, you know, uh,
transparency, Transparency is important, andyou know, I think patients should
(19:21):
feel comfortable with their provider and theyshould ask any questions that they see fit.
You know, certainly, if youknow they're concerned about, you know,
the provider being able to you know, manage their particular needs. You
know, uh if they have Forexample, if a patient is given the
(19:42):
diagnosis of nuancet adult diabetes, youknow, then they should ask anything.
They should completely understand what the diseaseprocess is, how it impacts their body,
how it impacts their future. Ifthey're given medications, understanding what the
(20:02):
medications do, how, what arethe side effects? You know, what
is the plan? You know,how they can impact the need for medication.
You know they may be on multiplemedications. How do these medications interact?
Things like that, And I thinkyou know, patients have the right
to really understand their care and theyhave the right to have an environment that
(20:29):
still support is you know, tomeet their needs. And you know,
their physicians and the physician extenders thatwork with them need to take the time
to ensure that the patients understand andlearn, you know, about their bodies
and what they can do, youknow, working with their physician team if
you will, to improve their care. So what I'm taking away from that
(20:52):
is there are no dumb questions,no, absolutely right not when it comes
to your health. You need toknow the answer. You need to know
the answers. There's a lot youcan look up, and sometimes it's confusing.
You know, if you google youknow something, there's a lot of
information there. But you know,and that can be very powerful too,
you know, to understand. ButI think there is a human connection with
(21:15):
the physician. You know, thatis important. And you know, sometimes
you may have a physician that justyou don't connect with, and so there
you know, are resources to youknow, find the right primary physician that
you connect with. You know,my mother who's ninety will be ninety two,
will be ninety one in March.You know, she has a primary
(21:40):
care physician that she's been with foryears at Kaiser Fontana and they just have
a special connection and that's who shedressed and so you know, but it's
been years, it's been years.But you know sometimes those relationships take time,
Yeah, they do. They taketime to build that trust. I
felt like I had the most amazingprimary care physician and she just retired.
(22:03):
And now I'm looking at it going, oh, I don't feel the same
with this next person as they didwith the last person. And it's okay.
It's okay to find somebody else,right, It's okay if you're not
having that good feeling when you're withyour doctor, you don't feel like you're
being heard. It's okay to moveon. I have an example for you
that literally happened yesterday. My goodfriend is a nurse. She's she's an
(22:29):
RN and she's and she's a littleshe's a little heavier, and she said
that there was a person who cameinto her urgent care and said to her,
can I ask you a question?You're you know, you're just you're
a little bigger, and I wantto ask you something? Does your doctor
tell you that you're fat? Andyou know, my my friend was taken
(22:51):
back kind of like what what doyou what do you mean? Like you
know, and she goes, well, because my doctor constantly calls me fat
and it hurts. And then myfriend and I think she gave the best
advice. She said, you needto find a new doctor. Yes,
yes, because there is a thingcalled tact and it's one thing to tell
someone that they're overweight, right,and especially in with people of color,
(23:14):
because I will say that specifically becauseof my demographic as well. You know,
of course, if we know,we know we're overweight, right,
if like you go in you knowyou already that that is a battle that
you are fight fighting. In thefact that you even went into your doctor
and you went in to say,you know, I need to I'm feeling
this way, I'm feeling that way. To have someone just blatantly call you
fat or rather say well, let'sget let's work on this part so that
(23:37):
we can solve all these other partsthat are happening right right right, it
blew me away and it made methink, yeah, you know what,
not all doctors are for you foreverybody. No, they're not. And
you know, there's a everyone deservesto be treated with respect and to be
in an environment that fits them.And every you know that that same doctor,
(24:02):
you know that that said that tothat patient, that's horrible. But
there may be someone else that's okaywith that. But that's not great.
I don't, I don't, Idon't. I can't imagine that happening to
anyone. But you have to findyour person. There are, you know,
physicians out there, and I thinkthat can be the person for for
(24:23):
everyone. And and and so ittakes time, it takes trust, and
it's a it's a long relationship.It takes investment on both sides, and
you know, sometimes you know,and there's ups there, they're ups up,
ups and downs to you know,to that relationship. But certainly your
physician needs to be your friend,your advisor, your friend and vice versa.
(24:47):
And physicians are human too, sophysicians have medical issues as well and
struggles, and I think if youcan connect on that level, that's very
very helpful. Yeah, absolutely,thank you. Well on a person level,
what health connections have you made alongthe way to you know, get
better health and to stay on agood solid routine for you right, Yeah,
(25:08):
you know it's been it's challenging inhealthcare. You know, I was
a trauma surgeon for twenty years,so you know, I spent I spent
a lot of time, you know, doing twenty four thirty hour shifts,
being up operating, very stressful andso it's important, you know, in
that setting to figure out a medium, a happy medium. You know.
(25:32):
I really I like yoga, Ilike exercise, I like the outdoors.
I like beakroum yoga or hot yogathat it's referred to. So that's been
very helpful for me. It's beenreally helpful both mentally and physically, you
know, to keep myself healthy,to keep myself focused and relaxed, and
you know, I try to toto eat healthy as well. Yeah,
(25:56):
that's the hard part for me.It's hard. It's so I love food.
I just love food. I havea relationship with it. It likes
me back exactly. We have alot of options in America. In this
country, it's very difficult. That'salso another good point. There's a lot
of options do We have a lotof options, So it's just a balance.
(26:18):
I don't think anything has to bevery extreme. I think it's important
to find, you know, away to you know, deal with stress.
Certainly, exercise and movement is important, and and there are ways to
do that, you know for people. Not everyone's gonna want to be do
hot yoga and be in a roomthat's one hundred and five degrees, right,
(26:38):
you know, that's pretty extreme.But you know, certainly walking,
you know, other forms of exercise, you know, doing exercise in the
home, you know, with weightsand things like that, and certain classes,
walking groups and things like that arevery useful. Yeah, it's fun
(26:59):
when you have that a little bitof accountability when you have like a walking
group or something, Hey we missedyou today, Why weren't you out there
with us. It does make yougo, oh no, I got to
get back out there again, thingslike that kind of thing. Yeah,
oh yeah, Okay, So beforeI let you go, you've been so
informative and just such a pleasure.What are the three biggest takeaways you hope
our listeners can take from this conversation? Sure? Number one, you know,
(27:25):
overall, I think our healthcare systemis very complex and disparities exist in
multiple populations. But as it relatesto communities of color, there are big
disparities, but they're resources number one. Number two, there is a national
focus on these healthcare disparities, andhospitals, health care facilities are being required
(27:53):
to focus on those disparities and toperform and address us and less in most
disparities as it relates to communities ofcolor primarily. And then you know,
number three, Community Hospital. We'rehere. This hospital has been here for
years, for over one hundred years, and we are dedicated to provide quality
(28:18):
care to this community. We haveso many new programs. In addition,
you know, to our primary care, We've added the Da Vinci robot.
We're doing complex robotic surgery, We'redoing surgical oncology to address the cancer disparities
in our community. We have intensivistsICU physicians on site to manage the most
(28:40):
critical patients. We're here for thecommunity, and we're providing a level of
care that allows patients to stay inthis community and not have to be transferred
to other places. That is key, stay home, be able to stay
right here, stay right here.Yes, thank you, doctor Skinner.
You have been so wonderful. You'llhave to come back on because you know,
(29:03):
I really think that there's so muchmore to dive into with this topic,
specifically something that hits close to homefor me. You know, the
way that people of color are treatedwhen when they are having babies. That's
that's that's such a big topic andI would love to talk to you about
that down the road. It isa big topic. Yeah, I would
love to address that absolutely. Yes, well I will have you back for
(29:26):
sure. I'll make sure my peoplecall your people and will make it happen.
Yes, okay, great, Sonice to meet you. Always so
wonderful to meet you. Thank you, doctor Skinner. I I just you
know, and now I'm in aweof you, so I appreciate you.
Oh, thank you, thank you. Likewise, well as we conclude this
I opening episode of Covering Your Health, I want to express my gratitude for
(29:49):
our remarkable guest, doctor Ruby Skinner. She's just so so wonderful. Her
dedication to well being a part ofdismantling health disparities. Really it inspires me.
It really does, and I hopeit inspired you as well. What
we all need to remember is thatchange begins with awareness. So we're amplifying
(30:10):
these conversations advocating for equity and demandingjustice. I am really I have to
tell you, I'm feeling very positivetoday with knowing that there is a national
focus on this issue happening right now, and these hospitals will be graded,
and I think that that is sucha massive step in the right direction.
(30:30):
So stay informed, stay compassionate.Remember healthcare is a human right. I
am so grateful that you joined mefor another episode of Covering Your Health with
Evely and Ereva's presented by IEHP,who's been such a wonderful partner on this
podcast. Remember all of the resources, I will be listing them in the
description. If you want to getin touch with you know, doctor Skinner,
or of course i EhP. Besure to subscribe on your favorite podcast
(30:55):
platform and reach out to me ifyou have any questions or concerns or just
comments. Love it at Evelina Reva'son all social media platforms. Very easy
to get a hold of. Untilnext time, this is Evelyn Reva is
wishing you a lifetime of happiness andhealth
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