78. Uncovering Inequality in Healthcare with Brianna Cardenas, DMSC, PA-C

Episodes have been transcribed to improve the accessibility of this information. Our best attempts have been made to ensure accuracy,  however, if you discover a possible error please notify us at info@bendybodies.org You may notice that the timestamps are not 100% accurate, especially as it gets closer to the end of an episode. We apologize for the inconvenience; however, this is a problem with the recording software. Thank you for understanding.

Linda Bluestein, MD (00:03.874)

 Welcome back, every bendy body. This is the bendy bodies podcast and I'm your host and founder, Dr. Linda Blustein, the hypermobility MD. This is going to be a great episode. Be sure to stick around until the very end so you don't miss any of our hypermobility hacks. As always, this information is for educational purposes only and it's not a substitute for personalized medical advice.

Linda Bluestein, MD (00:33.762)

Today, I am so excited to have Dr. Brianna Cardenas with me, a physician's assistant and certified athletic trainer with an additional doctorate in medical science. On her website, she shares that she has EDS, upper cervical instability, spinal CSF leak, and dysautonomia, and has a lifetime of experience with chronic pain. She believes education is the key to becoming healed and empowered, which of course is also in perfect alignment with the mission of this podcast.

Brianna, hello and welcome to Vendy Bodies.

Brianna Cardenas (01:04.601)

Hello, thank you so much for having me. I'm happy to be here.

Linda Bluestein, MD (01:07.334)

I am so excited to chat with you. You and I have communicated a little bit from time to time on social media and things. And so I'm super excited to finally get to sit down and have a real conversation. Can you start out by telling us a little bit about yourself and then we'll start digging into some of the topics that are super near and dear to your heart.

Brianna Cardenas (01:26.769)

Absolutely, and thank you for the kind introduction with my educational background and so forth. I started my career as a PA in 2013 and the majority of my career was in pain management, so I loved working with people in pain because I think that a lot of times people in pain don't have their pain taken seriously and don't have...

you know, maybe the compassionate care that all of us deserve when we're dealing with difficult circumstances in our life. And I actually knew that I had EDS while I was in PA school and it wasn't until about seven years into my career that I actually became really debilitated from having a CSF leak.

And I took a little bit of time off of clinical practice. They took about a year off of just work to recover. And during that time, I had this crazy idea that I was gonna start my own practice and really be able to work with EDS people so that no one else had to go through the level of diagnostic odyssey that I had to go through to just be believed with some of the conditions that I had to deal with.

And lo and behold, here I am on the other side of recovery and having the practice. And so I'm really so fortunate that I'm in this position now. And before I started my practice, once I got back into work, I had the opportunity to work in PA education, so teaching future physician assistants. And I had the.

unfortunate experience of being one of two women of color in the entire college of Arts and Sciences at the institution that I worked at.

Brianna Cardenas (03:15.685)

and got really into diversity, equity, inclusion work or DEI work. At that time, I got the opportunity to serve on state and national committees to help diversify the PA profession. As of 2021, our profession was 86% white people, which is very disproportionate to what our population looks like in the United States. And I had such a great opportunity to

Brianna Cardenas (03:46.299)

I've been able to bring some of those concepts around diversity, equity, and inclusion work, and some people are now referring to it as justice, equity, diversion, and inclusion work or JEDI work, which feels fitting into my practice. And now I get to share it with some of my colleagues, which I'm so grateful to be getting to talk about this with you today.

Linda Bluestein, MD (04:07.946)

Well, it's such an important topic, and I'm sure a lot of people are thinking, wow, I can't wait to learn about this, depending on, of course, this all impacts everyone differently. So I'm super excited to hear more about your incredible work and how people can help move the needle and help everyone get better care, because so many people are struggling to get good care. So why should someone care about medical racism when they already have so much to worry about?

trying to manage EDS and if they're not affected by it, why is that something that all of us should care about?

Brianna Cardenas (04:45.333)

No, that's an excellent question. And I think that, you know, it's a valid point, right? Like so many of us are struggling with just trying to manage our health. And it feels like sometimes taking on this additional work of unlearning some of our internalized biases that maybe we're just brought up with, or that we see in the media examples of that are like Disney movies where like the villains typically have like.

essentially like southern or black sounding accents as early as some of the movies that we see with like Dumbo where like the darker characters are considered like the vilified ones or the dumb ones historically in media. So all of us have some level of work to do to start unlearning some of these internalized pieces that are just kind of inherent with growing up in the U.S. But why it

Brianna Cardenas (05:42.435)

is kind of the same reasons that representation of all types, not just people of different ethnicities, really affects us in positive ways. So for example, I'm sure you've had the experience in your practice as well, Dr. Bleestein, where patients are like, oh my gosh, it's so nice to go to somebody who understands what it's like to deal with this condition.

They don't have to tell you what EDS is like. They don't have to tell you what it's like to fight with insurance. You just get it, right? And I think that having the opportunity for everyone, regardless of their skin color, regardless of who they love, regardless of what gender they identify with or what socioeconomic status that they currently exist in, has the same opportunity to feel seen and safe in the health care setting. And

It takes all of us, or the collective of us, I should say, to push for that collectively because it benefits all of us.

There's a really cool thing that says we all benefit when we center the marginalized. And a good example of that is, for example, cutting curbs in the sidewalk corners, which originally, you know, was thought to be a helpful ADA inclusivity piece where people in wheelchairs could navigate on sidewalks with more ease. But then we found out, wow, like that actually helped moms with strollers or people, you know, who are pushing strollers or shopkeepers loading

Linda Bluestein, MD (06:47.172)

Mm.

Linda Bluestein, MD (07:07.788)

Yeah.

Brianna Cardenas (07:11.947)

So we find that when we focus our attention to the areas most in need societally that we tend to lift everyone else up as a result. So I think that regardless of somebody's identities caring about diversity, equity, and inclusion just makes things better for us as a collective society.

Linda Bluestein, MD (07:35.318)

that definitely seems to resonate with me. And I love that quote. I think that's really brilliant. And I never thought about that, about the curbs. I think it's really helpful whether you're older and you just can't see the curb as well. Or like you're saying, there's so many other cases in which that's really helpful. So that's really, really interesting.

And what can someone do if they suspect that they're being mistreated by a healthcare professional due to bias of some sort, whether it's racism, transphobia, or anything like that?

Brianna Cardenas (08:09.617)

Absolutely. So one thing that I think is really important for all patients to know is that you have the right as a patient to bring a patient advocate with you. And you also have the right to leave, right? Like, except for in rare cases, right? Like if you're inpatient or if you're in the ER and things like that, right? If we're talking about just like an outpatient visit.

There's a couple of things that can be done, and we have to understand that one of the difficult things about navigating a situation like that when you're experiencing bias in a healthcare provider's office, for example, is that there's a power dynamic where this healthcare provider holds the power to potentially help you in your healthcare or hinder you in your ability to get the care that you need. So I think...

making sure that we're doing our own inner work as people who have unfortunately been dealt not a great hand when we deal with a lot of health care providers. Sometimes they know that most of the audiences no stranger to like medical gas lighting for example. But I think understanding that

the more regulated that we can stay and giving people kind of the benefit of the doubt, unless it's just totally blatant, right? Like if someone says like a racial or homophobic slur, like, of course, like, there's no room for ambiguity there, right? Like that's just a, you know, KO, like, let's leave the visit. Let's not continue here. But if someone suspects that their pain isn't being taken seriously, for example, I think

having the understanding that you're allowed to ask why your pain isn't being taken seriously. You're allowed to essentially ask in, in my experience, it's best to do it in a tactful manner, if possible, but asking somebody if they say, oh, let me think of an example. For example, I've been asked several times how many kids I have, rather than if I,

Linda Bluestein, MD (10:15.128)

Mm.

Brianna Cardenas (10:17.413)

have kids, which I don't have bio kids, because it's like a trope in like, medical education, unfortunately, that like women of color have lots of kids, which is not true and has racist, racist origins and undertones, right. So one of the things that I learned in how to combat questionable types of assertions like that, is just simply asking like, what, what do you mean by that? Or like,

you know, why is that pertinent to what we're talking about? And then I think that does two things. It allows a pause in the conversation for the person to stop and think about why they did that. It creates an opportunity to call in the person rather than calling out the person, which allows kind of an invitation to maybe.

have an opportunity for growth rather than calling out somebody and saying, hey, that's racist, right? Can really cause somebody to recoil and then unfortunately turn around and weaponize it onto that person as, hey, that person's just anxious and therefore they're not in pain. And it just turns into this snowball effect, right? So I think unfortunately understanding that in some cases the onus is on us to kind of recognize, hey, this could be...

a microaggression that I'm experiencing it, ask in a kind way, like, hey, what did you mean by that? Or can you tell me more about why you asked that question? It's certainly a fair thing to ask. And then if it crosses the line into just outright discrimination, of course.

understanding that you as a patient you have the right to file a grievance against a health care provider if something egregious happened. You have the right to speak with a patient advocate who works for example in the hospital especially if you're inpatient and you don't have the opportunity to leave for example.

Brianna Cardenas (12:14.309)

Let's say you have a hospitalist who's overseeing your care who you suspect is mistreating you based on, you know, having different pronouns from your birth gender or having, you know, a same-sex partner or whatever the case may be. You're allowed to speak with a patient advocate that works on staff at most institutions and express your concerns and just request that you're assigned a different...

person to oversee your care because when bias exists, it does create a safety issue. So I definitely think that knowing your rights as a patient and not being afraid to advocate for yourself are a couple of steps that can be taken.

Linda Bluestein, MD (12:58.194)

I like the, of course knowing your rights is so important, but I also think if we can influence other people and help them make changes in future encounters, I think that's really, really powerful. So I like the idea of asking the question, why did you ask it that way, or what did you mean by that question? Because I think anytime we can get people to really think, they, it puts in a pause.

and rather than just them getting defensive and reacting. And so I really liked that approach.

Brianna Cardenas (13:30.757)

Absolutely, I mean, I have experienced racism, of course, going through like my PA schooling and being a patient.

And I would say that the vast majority of times has been like kind of those accidental like, oh, I didn't realize that was like a racist thing to do or say. There's only been a couple of times that I can think of that were just outright like discriminatory with, you know, malicious intent, essentially. And I think for the most part, people who maybe have missteps here and there don't mean to do it. I really have not encountered very many people who want to be discriminatory. And instead they're just kind of on autopilot at the end of a

long shift or what have you. And so I think it may just be an educational gap, right? Like when you think about the things that we were exposed to in school, like I was just talking with a colleague of mine where we were talking about how the only time like LGBTQIA plus case studies are brought up in like our testing, for example, for boards and so forth is when it has to do with like a sexually transmitted infection and like the kind of

stereotypical question is like, oh, this is like a male who has sex with men and, you know, blah, blah. And the answer turns out that it's like some type of STI or HIV or something like that. And that type of like exposure in medical training for years and years and years just creates that internalized bias that, you know, sometimes people are just kind of reacting based on what they've seen and what's been drilled into their head from medical textbooks or what have you. And

I don't think it's meant with malicious intent, but it does, it doesn't excuse, you know, behaving in that way. And also at the same time, we as patients can do the work and when we have the bandwidth and we have the capacity to do so, to invite people to do that work with us instead of being, you know, abrasive when we aren't 100% sure that a person meant something with malicious intent.

Linda Bluestein, MD (15:38.338)

Well, that's really, really helpful. And what if it's a colleague? So what if you have a colleague who says something racist, ableist, homophobic, sexist, classist. What if that person is a colleague that is on the same playing field with you or maybe they're even a boss or an attending? Do you have suggestions for how to handle those kind of situations?

Brianna Cardenas (16:05.325)

Yes, absolutely. So I think it's another one of those things where it's like a little bit.

frustrating slash unfortunate to be a person who's on the receiving ends of those microaggressions and needing to do extra work to like insulate ourselves and prepare ourselves for when we are exposed to these kinds of Microaggressions so one thing that I let people know especially if they're a student because I think that there is really not quite a position of powerlessness in the medical journey as there is

while you're in medical training. I know that essentially if you upset you know your attending or your preceptor or what have you they can like literally end your medical career if they feel like it right. So in those cases

having the understanding that power dynamics exist, but arming yourself with the information that's available to you in a student handbook or an employee handbook, again, kind of knowing what your rights are as an employee. So if you have a situation where you have an HR department, if it's something that keeps repetitively happening and the person doesn't really have any inkling of...

what they're doing is wrong, you have a couple of options. So for example, I had a boss who every time I wore my hair curly, she made a comment about my professionalism. And it was only when I wore my wore my hair curly and I even of course, I'm like such a scientist about it. I made sure to go to work with a button up shirt, a blazer and a bow tie.

Brianna Cardenas (17:43.025)

and dressed as professionally as I possibly could and made sure to wear my hair curly. And I still got that comment. So I knew at that point, hey, this is some internalized racism around what we deem professional because a lot of professionalism standards are inherently racist when it talks about having your hair unkempt and things like that. We have kind of fuzzy lines to walk there, but understanding what's in the student handbook

in that case, I was able to take that concern to HR and say, hey, you know what, this keeps happening. I don't know that this person realizes that they're doing it. I already kind of had a tenuous relationship with that boss. So understanding that our relationship was not one of, you know, collegiality to the point where I could just bring that to her in private.

I made the decision to go to my HR department about that. And she was assigned like diversity, equity, and inclusion training, right? But if it's a colleague, let's say you have a great relationship with a colleague and the colleague says something that you're like, wow, that was out of left field, right? Like one of my peers said something about building a wall one time when I was still in clinic and that was...

previous administration ago. And we had to, my colleague and I, who were both Latina, asked like, oh, hey, what did you mean by that? Are you aware that some people might take that kind of offensively? And he was like, oh, I was just joking. And the thing that's actually been really powerful to me is when people use humor or say that they're joking to kind of hide a racist microaggression, asking the person to explain why it's funny.

has been like a really powerful tool. Like, oh, tell me why that's funny, I don't get it. Because then they're forced to be like, oh wow, like as I am saying this and as it's coming out of my mouth, like I realize how big it is or how inflammatory that is. And a lot of, in that case, our colleague self corrected and he was like, wow, like I did not realize that. Like it's stuff that I had just heard on the radio and just kind of repeated it, like his family.

Linda Bluestein, MD (19:29.271)

Mmm.

Brianna Cardenas (19:57.221)

felt the same way. So just kind of stuff that he was exposed to and bringing it into a clinical environment and having the opportunity to just be like, hey, what did you mean by that? And why do you think that's funny? Was this opportunity to kind of course correct and be like, oh wow, like that was totally inappropriate. So I guess to kind of sum that up, if you're in a...

low power position, right? If it's with your boss making these comments or what have you, talking to HR, talking to the appropriate channels to potentially remediate that behavior. And as one of my good friends and colleagues, Dr. Williams says, keep your receipts. So document the, document the encounter.

keep it for you to be able to reference back to because if you go to your HR department and say, hey, like, I think this person's being racist to me, or I think this person's being ableist to me, and you don't have like clear examples to refer back to, it's going to be really hard for HR to take those concerns and bring tangible things to remediate or tangible behavior to remediate to that individual. So having documentation and kind of keeping record of it and saying, hey,

when I wore my hair curly, I had this, and on this date, blah, and so and so was in a t-shirt and didn't get a comment about their professionalism, right? So keeping really solid documentation. And then, again, I think if just generally, if we assume the best in people and assume that people are not out there trying to be malicious or be classist or ableist or what have you, just kind of asking them to explain what they mean and give them the opportunity to...

educate themselves and realize as they're having to retrace their steps or recount what they've said can be a really powerful tool, I think, to allow people who you have that type of rapport with to do that work without necessarily getting in trouble with HR or what have you.

Linda Bluestein, MD (21:59.706)

And I'm curious to ask, because I was asked to speak to a group of medical students not long ago. And a lot of them have EDS. It wasn't specific to one medical school. It was kind of a national group. And they met periodically. And they asked me to come in and talk about it was during Disability Pride Month. And a lot of them were asking me questions about, should I disclose when I'm applying for residency?

how much should I disclose about my health problems? And they asked me how much I disclosed. I was like, I actually, I had problems, but I didn't know what any of them were really caused by at that point in time. So I was just curious if you could comment on that, what kind of advice you would give to somebody who is in that kind of situation, because we know there's what's ideal or what should happen, and then there's the reality.

Brianna Cardenas (22:52.065)

Absolutely. I'm so glad you brought up that point. And I do want to definitely hold space for anyone who's going through medical training and residency to acknowledge how high stakes that application process is with the understanding that there are not enough seats for all graduating medical students to match into residency the first time, which adds an additional layer of like, oh my gosh, I can't afford to be discriminated against and I have concerns about XYZ.

in like PA school, like our rotations are built in for us. So like, you're gonna have a rotation, like it's part of the school being able to maintain accreditation, right? So definitely a different scenario. But generally what I...

would advise because I was in a similar boat as you were. I had my EDS diagnosis, but I was still in that mindset of my internalized ableism where I was like, I'll just push through this and I'll just show up and I'll pay for it later on the couch, whatever the case may be. I think that it needs to be an individual decision. If it's something where there's a visible disability that...

not that we should ever have to hide our disabilities, of course, but something like a visible disability where you use a mobility aid on a daily basis or whatever. It's a good idea to disclose that, in my opinion. Having more visibility of outwards disabilities or even invisible disabilities in the medical training arena, I think will begin to culturally shift norms over time. But for the people that are dealing with that now, having...

very clear understanding of what the like match or entrance criteria is and being certain that hey like I've crossed all of my Tees and dotted all of my eyes and I'm an excellent candidate here Is a good opportunity to you know decide hey, do I want to disclose? Do I not want to disclose? Once you're admitted into residency like it's against the law obviously to like admit or excuse me to dismiss someone

Brianna Cardenas (24:58.249)

based on a physical trait or characteristic or disability. So for some people they may want to join and then bring accommodations with them once they've matched, because that's a legal requirement and that gives a little bit more insulation than potentially disclosing on an application before you've had the opportunity to enter that residency training. Things that I let people know.

when they were students going into, for example, PA school rotations and we knew that there were certain preceptors who maybe have had complaints of a similar nature. I think I would tell students to find a faculty advisor or someone in the program and voice those concerns before you enter that externship or residency or

outside of the campus type of training area, because then it's already on record that, hey, I have concerns about XYZ identifier that I have. I've been mistreated in the past and I just want to let you know, Professor So-and-so or Dr. So-and-so, that I have concerns about this. What would you advise that I do? What are the appropriate channels that I should follow? Because if a student were to backtalk a preceptor, for example,

not only does that student jeopardize their ability to move forward in their medical education and potentially lose that rotation, so to speak, but it can compromise the rotation site for the school and the rest of the students and that can potentially compromise everyone's ability to graduate, right, which like makes it just really an unfortunate and difficult situation to navigate. So I think having allies within your program, understanding what you can do should you experience something like that and asking in advance, like

Hey, I just have a feeling that I might experience some type of microaggression based on my various identifiers. What should I do when that happens? And just phrasing it as like a when rather than an if because then...

Brianna Cardenas (27:05.901)

your advisor doesn't get to say, oh, no, don't worry about that. Like, that's not going to happen, right? Just like, what should I do when that happens? Because then that forces them to give you an explanation of like, hey, first, you would come and talk to me as your advisor. Next, we would escalate it to the program director. Following that, we would have a discussion faculty to preceptor and have that, you know.

discussion without naming you as the student so as not to have you further targeted, right? And I would ask for that in an email so that you have it in writing and you keep your receipts. So just knowing that you have a clear policy to follow and if you open your student handbook or your HR handbook and that's not delineated, asking about that in advance would be really, really powerful and helpful.

Linda Bluestein, MD (27:51.438)

How often do you think that is in handbooks? And Abby, do you have any data on that?

Brianna Cardenas (27:57.781)

I don't have any data on that, but I know that for PA education in particular is part of our accreditation criteria. So we need to have policies in the student handbook that reference essentially how we make accommodations or what would be done in the event of a student grievance, regardless of if it was based on discrimination or harassment or what have you. So that's part of like our accreditation.

criteria in physician-assisted education. I'm not sure about medical education. And then I know that in California, we definitely have, you know, I think more protections around employment discrimination than other states in the nation.

Linda Bluestein, MD (28:45.898)

That would not surprise me. OK, well, what about if someone is outside of academia, they're not involved at all in medical education, but they say, wow, this is really important. And I think it would be really smart to help diversify medical training and really have more inclusion within the medical field. Is there anything that they can do to help with that?

Brianna Cardenas (29:10.533)

Yeah, I think there's a couple things. So number one, I think.

it helps people from underrepresented or historically marginalized identity groups to know that we're supported. So as a queer person myself, I am married to a man, so as my friends drove me, I'm straight passing. So people don't know that I'm queer unless I choose to disclose. But when I walk into a space that has an LGBTQIA+, safe space sticker or a rainbow

Bye.

or I see a store that has those things, I automatically feel safer just knowing like, hey, this is something that if I choose to disclose this, my safety is not gonna be compromised. My way that I'm perceived isn't gonna be changed by this individual. So I think if you know that you have healthcare providers already who are welcoming to you regardless of what your identifiers are, ask them to make that clear in some way, shape or form. So for me, I have like a Jedi statement

the About Me page of my website where I talk about the fact that like I run my business on unceded Tongva land and like that I offer LGBTQ plus and BIPOC sliding PL rates. So just having like very outward visible signs of hey like you are welcome here you are safe here regardless of how you identify or what your background is. Asking your healthcare professionals who have

Brianna Cardenas (30:45.287)

that and to share with their colleagues like hey this really was important to me as your patient to see that you have like a pronouns pin or to see that you have like a rainbow flag on your laptop or whatever and letting the office staff know or the office manager know like hey this really went a long way for me like how can you be more visible about this so that's like one thing that you can do kind of like to your colleagues who are already or to your providers who are already out and practicing.

Also just voicing support for people who are going through medical training or in academia because it doesn't just start in college or in grad school or medical school where some of those feelings of othering and discrimination occur. Like we know that SATs, for example, are essentially racist IQ scores were built around the idea of eugenics. Like there are a lot of early, early interventions.

roadblocks in the way for people of various identifiers. And so I think being involved in whatever way, shape, or form you can, whether it's if you have children in grade school, if you have the opportunity to vote in a way that supports like trans people being able to have access to the health care that they need, any way that you can essentially go out of your way to show support to

Brianna Cardenas (32:15.159)

like an upstream or I should say a downstream effect into medical education. So everything that you do at the community level if you own a coffee shop or you are a baker or whatever right like if you can show those signs of support.

in your storefronts or in any public platform that you have, right? Even just displaying your pronouns like on your social media profile, like shows people that are trans or transitioning or gender non-conforming that they're accepted and that they're welcome and that there are people who like see them as people, not just...

identity group. So anyway, I guess in short that you can be more visible and more supportive will ultimately translate into the academic arena and into the medical field because it's a cultural phenomenon that needs to shift gradually.

Linda Bluestein, MD (33:09.434)

That's really helpful because I think for at least I would not have necessarily expected that those things would be that meaningful because you know like I know what I feel in my heart and I don't. But that really makes sense what you're saying that people can assume.

that you're not supportive unless you have those kind of demonstrable things that are either on your website or at your clinic space and that kind of thing. So that's really good to know about.

Brianna Cardenas (33:39.697)

Yeah, absolutely. And I mean, that's part of what I mean about like, assuming the best in people, right? Like I don't ever walk into spaces and be like, these people are gonna be like ableist or racist to me, right? But having...

the ability to kind of the same way our patients can walk in and be like, oh, okay, like I don't have to like, pretend that I'm not in pain because this person isn't gonna think I'm like a hypochondriac if I like lay down on the table or the couch or whatever. Just that kind of ability to like let one's hair down, so to speak, goes such a long way to create a feeling of safety. And we know that there are measurable cardiovascular effects of the stress of microaggressions,

us, hematinics, et cetera, microaggressions that affect our health. So almost I like to think of it as having an overt sign of like, I am safe here, is like the inverse of that. It's like the exhale that allows us to activate our parasympathetic nervous system a little bit and have one less thing to be on guard about as people with marginalized identities.

Linda Bluestein, MD (34:34.636)

Mm-hmm.

Mm-hmm.

Linda Bluestein, MD (34:48.986)

And most of us could definitely use that. So yeah, but especially people who have even more other concerns when they're entering into the healthcare space. So what about people who might be listening to this conversation and they're feeling guilty or they're feeling like this is really important work, I wanna be a better ally, but I.

Brianna Cardenas (34:51.642)

Yes.

Linda Bluestein, MD (35:10.41)

don't really know how to do that. Do you have some suggestions for that? And can you talk a little bit about white guilt and our white fragility?

Brianna Cardenas (35:22.061)

Absolutely. So thank you for asking that question because, and thank you for listeners who are feeling that way and have the desire to want to learn.

new ways to approach these topics and unlearn some of the ways that we've been shown these topics. I think that just first and foremost I want to express gratitude and thank you for being willing to endeavor into this work. One of the things to not do is to go and ask your Black friend or your queer friend or your disabled friend to have the additional burden of educating you on those topics as it may be upsetting or retraumatizing to have to explain.

like, hey, here's ways in which I experience racism or ableism, et cetera. So understanding that there's a myriad of resources out there that are incredibly helpful. So specific to kind of the medical field and how it overlaps with racism and ableism. The book Enflamed, Deep Medicine and the Anatomy of Injustice by Raj Patel and Rupa Mara is a fantastic book. Like it literally talks about, you know, from the inception.

of the medical industrial complex to now how this overlap occurs. So that's a phenomenal book. The other thing that I recommend depending on your specific identity groups that you're trying to do more work around, finding books that are helpful specific for those points. So another great book is called How to Be Anti-Racist by Ibram X. Kendi. That is a phenomenal book and it helps

between being not racist and anti-racist. So somebody who you know knows in their heart for example like I am not racist right that is fantastic and the next step of being anti-racist is going forward and being visible about you know hey I acknowledge that these injustices exist and I'm taking steps to right them whether that's in my business or in my practice or in my day-to-day life

Brianna Cardenas (37:34.107)

donate to XYZ charities, right, like taking tangible steps and actions to move forward. So there's some great examples in that book.

If you're on social media, another great one is Smarter in Seconds. I believe that's the name of her handle. Let me just double check. But Smarter in Seconds with Blair Imani is a really great social media channel that has just little reels about, hey, here's what intersectionality means or here's ways that you can avoid being somebody who...

like, displace toxic positivity to the disabled community, or here's ways that you can be more feminist, right? So that's another really solid resource. And then there is another Instagram handle that I think is really great for like the trans and gender nonconforming education space. The Instagram handle is PinkMantere, and it's Skylar Baylor,

is pink manta ray, like the sea creature, but really, really great info on using pronouns correctly, how certain things, whether it's like new laws that are being discussed at the state and national levels, or certain policies as they pertain to athletics, like are actually, you know, very harmful to people who are trans and don't really impact, like the general public. And so certain

you know opportunities for learning exist there. Lastly I would say give yourself compassion. So the guilt is natural because I think that shows that

Brianna Cardenas (39:21.801)

and reinforces that we do not mean harm to other people in general. Like most of us are not out here like really trying to other humans and make them feel discriminated against. So if you're feeling that guilt or you're feeling that concern, give yourself the self-compassion and the grace to not shame yourself. Shame is not productive. Shame doesn't help us move forward and just acknowledge like okay like this is an opportunity for me to do better. Acknowledge that you may

Like I messed up with like spelling, the alternative spelling of women. I used a Y and didn't realize that was like a trans exclusionary way to spell that on a social media post one time. And I apologized and was like, wow, that was like a public misstep. I am sorry. Like I educated myself and learned that was inappropriate. So just understanding that like none of us are perfect. The landscape of this changes over time. Like it's gonna, I'm sure look completely different in 10 years than it looks.

Linda Bluestein, MD (40:02.839)

Hmm.

Brianna Cardenas (40:21.775)

now because even like pre-pandemic I think that it looks very different than it did then. So just understanding that like we're never gonna be perfect but your desire to move forward and do better is really appreciated and means a lot and that there are plenty of

books out there. And then specifically to the topic of white fragility, there's a book called White Fragility by Robin DiAngelo that does a really good job of discussing that and how to undo some of the internalized biases that white culture typically has inherent to some of the upbringing, especially like if you grew up in Western culture or the U.S.

Linda Bluestein, MD (41:04.798)

And those are great resources and we will be sure to have all of those linked in the show notes so people can find them as easily as possible. So thank you so much for sharing all of that. What if somebody wants to be a better ally, but they're afraid of a misstep. You kind of made a quick reference to that. If we could get into that just a little bit more, they don't want to be ridiculed or canceled. Is there, are there certain things that they can do to make sure that does not happen?

Brianna Cardenas (41:30.189)

Absolutely. So, again, just like kudos for wanting to like stand up for a marginalized group. A couple of general things to avoid is number one, like speaking on behalf of a group or assuming that like a certain group of people are like a monolith.

Um, so, um, what I mean by that is saying like, you know, uh, all Mexican people are this and they don't like this. Like, well, you know, like we can't speak on behalf of an entire group, right? So like before we make sweeping statements, um, just kind of reviewing our language. Um, also if it's going to be something like, there's a difference between like a premeditated social media post.

and reacting in a moment's notice, right? So if you see something happening in a public space to a person of color, you see discrimination happening. Using the privileges that you may have as a person who is not experiencing that same type of prejudice.

using that privilege to call that act out, like if it's an actual like aggressive type of thing, is like one of the most powerful things that can be done. Like seeing, for example, like a racist or race-based crime occur or you know even just an altercation occur, if it's safe being able to be like, hey like we don't need to go there, you know, sir are you okay, ma'am are you okay, like is there anything I can do to help you, I'm sorry that happened, right? So just like understanding that

when it's safe to intervene, like intervening goes such a long way. Like it really makes a huge difference. Like honestly, I had a very, very healing experience with.

Brianna Cardenas (43:09.481)

a blonde haired blue eyed woman who stood up for me when someone was starting to condescend to me and I had been used to that treatment for so long in my life that it literally didn't even flag for me that person was behaving in a way that could have been construed as racist. And it was really huge to me to be like, wow, that person stood up for me and thank you. You know what I mean? So standing up for somebody when it's appropriate.

There's a fine line of the hero complex. I know in the disabled community we talk about, don't just go and push a disabled person's chair without asking them or talking to them if they need help. So don't infantilize people. Don't look at a group of people as a monolith. But also asking permission and doing a quick Google. My misstep that I shared earlier, literally I could have.

Linda Bluestein, MD (43:41.197)

Yeah.

Brianna Cardenas (44:00.825)

Googled it and I would have saved myself some embarrassment, but it also was like a good learning opportunity for me. And then also just acknowledging that when we do have missteps, like one of the things that took me a little while was learning to use they, them pronouns more fluidly, like in a patient encounter or on documentation and just acknowledging like, oh, I'm so sorry, like.

I didn't mean to misgender you. I'm going to correct that in your chart, like apologies. Right. So just like acknowledging, hey, I'm sorry, I made a misstep. I'm going to move forward and correct it. So understanding that it may not be possible to be perfect in this work, giving yourself the compassion and really just having the spirit of wanting to try is.

just a really important piece. And if you're not sure, there's some of the resources that we discussed and also like checking on Google is like a good quick way to look into that. And I would just add a caveat of curating the media that you consume and expose yourself to because we are all creatures that are influenced by our surroundings and our habits. Like, I'm not sure if you've heard the term, like we become like the five people that we're.

Linda Bluestein, MD (45:04.403)

Mm-hmm.

Brianna Cardenas (45:16.465)

around most frequently. And so if you're constantly consuming media that has hateful or bigoted messaging as part of the undertones of that, maybe considering switching your media.

Linda Bluestein, MD (45:17.954)

Mmm.

Brianna Cardenas (45:30.053)

consumption or if you are in a family that you know freely uses words that are like not okay to use anymore. Just having a conversation like hey grandma like it's not okay to refer to that group that way and being the person in your family that potentially could make the change for everyone that you're exposed to in that type of group so kind of changing the environment that you expose yourself to can also be a really helpful thing.

Linda Bluestein, MD (45:56.914)

I had not heard that saying before you become the five people you spend the most time with, but that is really fascinating.

Brianna Cardenas (46:04.301)

Yes, I don't know who said it, but it was just like one of those like memorable things that I probably saw while I was scrolling on Instagram, you know, while brushing my teeth or something at one point, but it stuck with me.

Linda Bluestein, MD (46:14.756)

Right. Yeah, no, I can see that. I mean, we are influenced by the people that we hang out with, and so choosing those people carefully is a very good idea.

Brianna Cardenas (46:26.449)

Absolutely.

Linda Bluestein, MD (46:27.518)

So I am super eager to talk about pseudoscience. Oh my gosh, I feel like this has just become such a huge problem. I am fascinated when I talk to people and they tell me, well, I've been trying this and I've done that. And then you look sometimes at some of these websites and you're like, whoa, this is kind of scary. So there's a lot of this going on right now, I feel like. And I think that...

also can contribute to mistrust in the healthcare community. People don't, makes it hard to know who they can trust, who they can't trust. Is there an interaction between racism, ableism and pseudoscience that we should be aware of?

Brianna Cardenas (47:10.457)

Absolutely. And thank you so much for bringing that up because you're absolutely right. Like the peddling of pseudoscience for like the profit potential off of patients is...

just absolutely harmful in so many ways. And I think it's important to understand that when we look at the process of what is considered science now, meaning what has gone through peer review and what has been evaluated by research and so forth, understanding a couple of key pillars of that is really, really an important step to.

not necessarily being combative to like what is science and what is not, but having a more expansive view of like why people would turn to those types of modalities that are alternative and maybe not evidence-based.

because of some of the interplay of racism and sexism, ableism, etc. So understanding that the institutions of academia and medicine were inherently exclusionary to people of color, disabled folks, and women literally until the 1860s. The medicine has been around since Socrates, right? And probably even before that in cultures that didn't document.

their practices. But when you think about the history of medicine and like, you know, not being able to have people with different backgrounds even allowed in these spaces until the 1860s, like...

Brianna Cardenas (48:44.941)

Literally in the 1860s, teaching an enslaved African American to read or write was a crime that was punishable by law, or punishable with jail time or a fine, even if it was a white person who was a northerner who was trying to help educate an enslaved black person. So understanding that these institutions were inherently exclusionary and that those things don't just go away.

Also understanding that specifically for communities of color.

there has been a long history of mistreatment. And when you look at like Henrietta Lacks and HeLa cells, which were taken from her without her consent and then used to profit and of course, develop like drugs that have helped people tremendously and make breakthroughs. But again, it's an area where like this was a black woman who had her cells taken without her consent. There are, you know, again, content warnings. Some of these are hard to hear, but you know, there's been cases of like this Tuskegee.

experiments for sterilization of women in Cuba. And there's been so many scenarios like that, whether it's eugenics-based practices or what have you, or the whole practice of phrenology, which was measuring people's head sizes to determine their intelligence when the Native American people were first being colonized. So that was considered the science of the day and was considered the accurate science.

when you take into account that obviously we know better now, but at the time there were real harms done to communities of color, disabled communities, women. It was still legal to lobotomize people until 50 years ago for hypochondria. So I think that understanding that those harms exist and that they don't go away, those

Linda Bluestein, MD (50:33.386)

Mm.

Brianna Cardenas (50:44.153)

those wounds cut really deep into communities. And when we still have policies in place that enforce racism and.

disparate access to care, whether it's like the war on drugs, being very different. For example, the treatment that we offer for opioid use disorder and crack cocaine addiction back in the 80s, right? Very, very different policy approaches based on the demographics of people. So understanding that those harms exist, those mistrust and the mistrust and misguided feelings about like, hey, this person may not be in my...

acting in my best interest, right, are very real things that contribute to that. So when we look at like the institution of research, the things that have occurred to people or have happened to people and whole groups of people just based on some of their identifiers.

I think that it leaves an opportunity for us to invite some of those communities in to be able to have more participation in these processes so that we can have, you know.

an opportunity to begin to mend some of those bridges. Also, I think it's important to note that research is not free. So it is not lucrative or profitable for a company to say, hey, regulating your nervous system helps you heal your body. But it is really profitable to say, hey, this new drug that you can take for the rest of your life is gonna be really helpful. And in many cases it is, right? Not to discount those things, but people aren't...

Brianna Cardenas (52:24.289)

lining up to fund research about like the systemic inequities that exist in health care or like, you know, how we can improve health outcomes for underrepresented groups, right? So, understanding that the research is not always inclusive of certain communities is also a really important factor to consider. And I think understanding that the way that we approach these conversations plays a big role in that too.

So what I mean by that is as healthcare professionals, like not shaming people for seeking that alternative advice, understanding why that mistrust exists in the first place, and doing what we can and asking our patients, right? Like, why is this something that's appealing to you? Or tell me more about like why you feel that.

like this remedy was a better fit for you versus saying, why aren't you vaccinating your child? Don't you know how dangerous that is? Having a more nuanced conversation, asking the person rather than telling the person and inquiring as to like, is there anything that I can do as somebody who's in a position to help you with your healthcare that would help you trust me more? That would help you trust.

our office more that would, you know, help you feel more comfortable in my care because acknowledging that elephant in the room and acknowledging like, hey, I know that, you know, your community has been harmed by people like me in a white coat, right, really, really goes a long way because it shows again, kind of like how we talked about like having a pride flag in your office or whatever the case may be. It shows that

you're aware of these things, you're not going to have to, again, like one of those let your hair down moments, especially as like a woman of color, knowing that like, hey, this person understands that there's wrongs that need to be righted, and at least I can trust that they're going to try. That's a really key piece of that, in my opinion.

Linda Bluestein, MD (54:25.722)

And so many people that I have seen, and I'm sure it's true for you as well, like you said, they've sought out traditional healthcare, but they've had gaslighting experiences, and they've had such terrible, terrible encounters, and they're not getting any better, and so they do start to explore other alternatives, and so it can be really, really tricky to navigate all of that for sure.

Brianna Cardenas (54:54.105)

Absolutely. And I think, you know, as patients, you know, writing down and kind of being prepared and just saying like, hey, here's the medicines that I'm taking and knowing as a patient, like, hey, these are things that I'm not willing to do, right? Like I have patients that are like, I'm not gonna take medication. And I'm just like, okay, cool. Can you tell me more about that? And sometimes it's based in some of the concerns that we shared today. Sometimes it's a personal preference and just having the, you know, mutual respect to be like, okay, like.

I trust you, I'll work with you. There are some alternatives that we could discuss at a later time. But I look at it as like when I'm seeing a patient, my goal is not to like impose my will on them. Right. Like and I think that's generally speaking, something that our community of health care providers could do a better job at is like not being so paternalistic. But I think first.

having the goal of like, hey, this is a human being that I'm establishing a relationship with and making sure that our rapport is there before I just start pushing someone out of their comfort zone. It's just like a really, I think, kind of different approach to at least how I was taught medicine and how I think a lot of medicine operates. Like I think taking that collaborative approach and asking patients, because some of the stuff could potentially inform research later on.

Right? Just because it's not in the literature doesn't mean that it has zero validity. And having the opportunity to like invite those conversations potentially allows us to make safe and meaningful recommendations to our patients. If we're talking about things that are like not going to harm people, like breathing exercises and things like that, right? That can potentially inform areas of future research later. Like.

Linda Bluestein, MD (56:33.972)

Yeah.

Brianna Cardenas (56:39.609)

That's kind of the whole point of research is we acknowledge that there are gaps that we need to fill. So it's kind of like impossible for everything to start evidence based. And for some people, like you said, they're just desperate to get help. So making sure that they trust us enough to come to us with experimental things to try and so forth, so that we can advise them as their health care providers who they know, like we have their best interests in mind is like probably one of the most reparative things that we can do as people who.

have the privilege of helping other humans.

Linda Bluestein, MD (57:11.338)

Yes, yes, totally agree. And before we get to my favorite section, hypermobility hacks, I just want to ask first, was there anything that I should have asked you, or if you have any final thoughts before we get to your favorite hypermobility hack?

Brianna Cardenas (57:28.313)

Hmm gosh, there's so much that we could talk about. I feel like we would fill up like five more episodes, but No, I mean I just want to say thank you for having me on and more importantly Thank you for being willing. Dr. Blavestein to have this conversation. Thank you listeners for being willing to you know Want to learn about these topics because I know they are hard They're hard on the receiving end. They're hard on you know

Linda Bluestein, MD (57:32.138)

Ah!

Brianna Cardenas (57:58.085)

the acknowledgement of like, hey, like at some point I may have participated in being on the giving end of some of these microaggressions, right? And I think, you know, just wanted to express my gratitude because it's so important that we continue to try and better ourselves just like as humans, period, but then also having the

you know, the space to just acknowledge like the work and the difficulty that can sometimes come with these topics. I just wanted to say thank you.

Linda Bluestein, MD (58:29.938)

And I'm so grateful to you because this is such an important conversation to have. It's so important to have it with the right people who understand these matters on a deeper level. And so I just really appreciate you sharing your wisdom and your expertise and your perspective on everything because it's super, super helpful. Okay. So I know we're going to have another conversation for sure.

When it comes to this particular topic, do you have a favorite hypermobility hack? Now understanding that not all hacks are really hacks. Like they're just kind of some favorite tips, some things that we think are helpful for people that they can turn around and implement the next day. They don't need to wait till they go see their doctor in six months.

Brianna Cardenas (59:22.485)

Absolutely. So generally speaking, like, I'll try and keep it like related to the topic of today's conversation. So I would say like, my ultimate like hyper mobility slash life hack that has not only helped me in like many other areas of my life, but has helped me do this work is self compassion. So implementing self compassion, I know can be really hard to do.

A great resource on that is a book called Self-Compassion by Kristin Neff because it's kind of like the how-to book of like how to talk nicer to yourself or like give yourself a break, right? So I think that giving yourself compassion as you are a growing human being and understanding that it's okay to change your mind. It's a good thing to grow if you look back at your life and you're like, oh my gosh like

Linda Bluestein, MD (59:54.254)

Mm-hmm. Love her.

Brianna Cardenas (01:00:16.397)

I'm a completely different person than I was five years ago, ten years ago, maybe because of having EDS or hypermobility or because of some hard kind of truths and truth bombs that I've had to swallow type there, to have medicine so to speak. That's a good thing. So knowing that we have a great big community who I think is very willing to help one another, giving ourselves that compassion that we're...

pretty quick to show other people is probably one of the best hacks that I think could help take you far in allyship work, in Jedi work, and just like in life period. So, self-compassion would be my hack.

Linda Bluestein, MD (01:00:57.814)

I love that. I absolutely love that. I love Kristin and Nath, love the book. I've definitely read that numerous times and I think it is such an important thing because I think what happens with so many of us who have experienced chronic pain.

and we've gone in for appointments and we have been dismissed and then we start gaslighting ourselves. So I think that this is applicable to so many different scenarios. So I think that's really, really important. Can you tell people where they can find you online?

Brianna Cardenas (01:01:17.617)

Mm-hmm.

Brianna Cardenas (01:01:27.993)

Yes, absolutely. So my website is healedandempowered.com. You can find me on Instagram at healedandempowered or facebook.com forward slash healedandempowered. You can find my phone number and email address on my website and I let people know that I am very cognizant of some of the structural barriers that we've discussed today. So I like to let people know that I offer.

free 15 minute calls either to see if they're a good fit to work with me or if they just need information on where they can find resources. Like I had a person call yesterday who was like there's no way I could afford to pay out of pocket for any type of services but I'm just wondering if you can give me some starting points and I was like absolutely like that's what this call is here for. Online pretty much everywhere healed and empowered.

Linda Bluestein, MD (01:02:17.463)

Mm-hmm.

Linda Bluestein, MD (01:02:21.698)

That's so wonderful that you do that. And you're on Twitter too. Haven't we connected over there or you're not really very active?

Brianna Cardenas (01:02:28.65)

Oh, a long time ago when I first started, and then I realized that my ambition to keep up with multiple social media was delusional. So my Instagram is where I'm most active. Stuff shows up on Facebook because I can auto-post to Facebook. So I don't even know if I remember my Twitter handle, honestly.

Linda Bluestein, MD (01:02:35.842)

Ah!

Linda Bluestein, MD (01:02:42.135)

Okay.

Linda Bluestein, MD (01:02:45.611)

Right.

Linda Bluestein, MD (01:02:51.742)

Okay, that's super good to know. Super, super good to know. Okay, so people can find you most easily through your website, healedandempowered.com, right? And at that same handle on Instagram and Facebook. Those are the best places. Okay, great, great. Well, Dr. Cardenas, it has been so fabulous to chat with you today. I'm so grateful to you for coming on Bed the Bendy Bodies with Hypermobility MD podcast and talking about

Brianna Cardenas (01:02:54.139)

Ha ha ha.

Brianna Cardenas (01:03:05.689)

That's it. Yes.

Linda Bluestein, MD (01:03:21.234)

such an important topic, but one that can be difficult to navigate and so important to have people who, like yourself, are compassionate and approach it from a standpoint of, you know, we can all be compassionate towards one another and let's figure out how to help each other. Let's figure out how to try to become better humans one day at a time.

Brianna Cardenas (01:03:46.201)

Thank you for having me.

Linda Bluestein, MD (01:03:47.806)

Absolutely. You have been listening to this week's episode of the Bendy Bodies with the Hypermobility MD podcast. Help us spread the word about joint hypermobility and related disorders by leaving a review and sharing the podcast. This helps raise awareness about these complex conditions. Visit bendybodyspodcast.com and follow us on Instagram at bendy underscore bodies. We love seeing your posts and stories, so be a buddy and engage our community by using the hashtag

Bendy Buddy, that's hashtag B-E-N-D-Y, B-U-D-D-Y. You can also find me, Dr. Linda Blustein, on Instagram, Facebook, Twitter, or LinkedIn at hypermobilityMD. This podcast is for general informational purposes only and does not constitute the practice of medicine or other professional healthcare services, including the giving of medical advice. No doctor-patient relationship is formed. This is not intended to be a substitute for professional medical advisor diagnosis. Do not.

disregard or delay obtaining medical advice for any medical condition you have. The opinions shared are that of the guest and do not necessarily represent the views of the host or any particular organization. Sponsorship of the podcast does not necessarily mean an endorsement. Thank you for being a part of our community and we will catch you next time on the Bendy Bodies podcast.