April 26, 2023
Doctors Making a Difference: Raj Sundar, MD
Through its first 15 episodes, guests on the podcast "Healthcare for Humans" cover topics ranging from the concept of food as medicine to the model minority myth to the meaning of "aloha." In the series, creator and host Raj Sundar, MD, a family physician at Kaiser Permanente's Burien Medical Center and community organizer, speaks with physicians and others from a wide range of backgrounds about how physicians can weave patients' cultural values into the care they provide. Dr. Sundar talks to WSMA Reports about the genesis of the podcast what he hopes physicians take away from these conversations.
WSMA Reports: Where did the idea for the "Healthcare for Humans" podcast come from?
Dr. Sundar: The idea was born out of my personal experience of feeling stuck in caring for culturally diverse communities. This was particularly noticeable in immigrant and refugee communities, where there was a vast difference between my worldview and that of my patients. I tried to find ways to be a better caregiver but found that existing resources were focused on cultural competence, which was stereotypical and "othering." It conveyed the belief that my way of life was normal, while the patient's way was abnormal and needed to be studied.
As I have two kids (a 2 1/2-year-old and a 12-month-old), I listen to a lot of podcasts while doing chores. I found that the podcast was an excellent medium to capture voices and stories better and convey the nuances of culture by elevating community voices. After realizing this, I started the "Healthcare for Humans" podcast to give community members a voice and answer the question, "What does it mean to care for your community?" The podcast focuses on highlighting the diversity of cultures and values in the community and bridging the gap between caregivers and patients.
In the podcast intro, you say one of the goals is to help physicians learn to "care for the person in front of you, not just a body system." What does that mean to you?
Caring for the person, not just their body system, means treating patients like individuals with unique needs rather than just a collection of organs and symptoms. It's about recognizing that health care is more than treating diseases and conditions. It involves healing the person in front of you. Although the [biomedical] model is effective in many situations, we all witness daily how this can be inadequate in healing our patients and communities. We can lose sight of the person behind the illness, their needs, values, and preferences. To be healers, we need to be well versed in the history and culture of our communities as we are about diagnosis and treatment plans.
Why is it important to include that historical context?
Understanding the historical context of a patient's community can provide insight into the cultural, social, and economic factors that may impact their health outcomes. Historical events such as immigration patterns, discriminatory policies, and social movements can shape a community's experiences and contribute to current health inequities.
One important point is that cultural competence, the idea that health care professionals should learn about and master cultural practices and beliefs, is not the most effective paradigm for promoting health equity. Instead, we need to focus on cultural safety. Cultural safety is about creating an environment where patients feel safe, respected, and understood, regardless of their background or cultural identity. It's not just about learning specific cultural practices but also recognizing the historical and social contexts that have shaped a patient's experiences and tailoring care accordingly.
Lastly, understanding the historical context of a patient's community can help clinicians identify systemic issues and advocate for policy changes that address health disparities. This is critical to creating more equitable and just health care systems that better serve all communities.
What are some of the most surprising or meaningful things you've learned from guests on the podcast?
Each episode has many learnings I have not learned about in my medical education. Let's take the Pacific Islander community, for example. The foundation of our health care system is on one-on-one consultations. This traditional approach of educating individuals with diabetes may not work in Pacific Islander families where someone else prepares the food. Making dietary changes must involve the entire family to be effective. The respect and togetherness of the family are essential in making these changes. This value is not exclusive to Pacific Islander communities, but it's amplified in a culture that values family and community over individuality. How often do we see health systems make "family" visits a priority?
Another example is from the Native Hawaiian episode. We often focus on morbidity and mortality to "motivate" individuals and patients. "Hey, you should do this so you can live longer and healthier." But this idea of living longer as a selling point for health care doesn't resonate with families who face hardship and poverty. However, passing down knowledge and legacy to younger family members is a value that is important to many. Again, what does it mean to focus our care on families and how we care for each other because we have generational knowledge that we want to pass on and a legacy that we want to create? Do we talk about that at all in our conversations?
Lastly, in almost all episodes, there is a focus on bringing back practices that ancestors had to integrate into daily lives, shifting away from the toxic stress of capitalism to nurture relationships and recreate the village or town of health.
What do you hope physicians, or other listeners, take away from the podcast?
I want listeners to contemplate these questions: What does it take to build a healing relationship? What do you need to know about the person to care for them? What does it mean for you to learn about them and their community so you don't place the burden on the patient to educate you? I hope the podcast is one resource to help clinicians on this journey.
What topics would you like to cover that you haven't, yet?
I am currently working on a series of interviews that aim to amplify the voices of underrepresented communities, particularly the Latinx community, and their intersectional experiences. This series includes interviews with the Afro-Latinx community and DACA recipients. Additionally, I am collaborating with Safe Place International to shed light on the often-overlooked experiences of LGBTQ individuals in refugee populations. Lots more ideas and I'm happy to hear more from listeners at healthcareforhumans.org.
This article was featured in the May/June 2023 issue of WSMA Reports, WSMA's print magazine.