A doctor’s role in a community: reflections from a yale med student

I found Michael sitting in a café on Yale’s campus early on a Saturday morning. I arrived to write up my questions before my last interview on my revisit for the Ph.D. program at the Yale School of Management and was surprised to see someone else here. The café had only been open for 20 minutes and the campus was mostly empty while most of the students were on spring break. There was room at the table beside him, so I sat down and asked him, “what are you reading?”

“A book about eye examinations and diagnosis. It’s for an Ophthalmology class I’m taking at the medical school.” He was holding a highlighter in his right hand, and had been flipping back and forth between pages with a very serious expression on his face when I interrupted him.

“Do you like the class?”
“Yes. The faculty who teach it are trying to convince us to join their specialization.” And after a pause where he looked off into the room behind me absently, he added, “It has instilled a joy of medicine in me that my other courses haven’t.” There was weariness to his tone. Maybe medical school wasn’t what he expected it to be.

“What kind of patients do you want to work with?”
Like he was apologizing to me, he said, “I want to support a patient population that doesn’t trust physicians and who has been under-served by the medical system, like undocumented workers, low-income people, people of color…”

“Does your medical school do a good job reaching out to them?”
He thought for a minute, looking down at his lap as he responded. “Yes, it’s part of our curriculum. We talk about how to take care of them.” Though, it seemed, maybe not as well as he hoped.

“What are the biggest barriers for them?”
He looked up again. “Lack of access — I mean physical and financial access. Distrust of the medical system.”

Overcome with my own curiosity, I asked, “How do people rebuild that trust?”
“Well, you have to be there and follow-up, and be there for a long time. It’s about building long-term relationships. It’s about outreach: going to people’s homes and providing care there, not forcing them to go to a clinic full of people who don’t look like them, not force them into filling out overly complicated forms and navigating payment systems. The offices are gross, they’re covered in Pharma ads, with Pharma pens and Pharma shit everywhere.” I felt a similar frustration towards Pharma, especially with the ACA on the chop block earlier that week.

Michael, trying to convince himself he was a happy med student.

“What kinds of doctors do a good job serving them?”
“Right now, Primary care and family medicine do this well. But we also want other kinds of doctors to do better. Ophthalmology could do better … you need your vision to help your family, lots of space for impact here. People go into poverty because they have vision issues. There are so many easy, low-cost interventions that could fix their vision issues.” Maybe he really was interested in reading about eyes!

“What made you decide to become a med student?”
He crossed his legs, then his arms and leaned back in his chair. He looked down again when he said, faintly, “I want to help people. I want to be a doctor who serves these communities.”

“Do you still believe that you can do that as a doctor?”
He tilted his head and raised an eyebrow at me. “I do. I don’t know what it looks like in practice, what with all the logistical issues of being a physician. I like the idea of providing free care to people who need it. But this is a logistical nightmare… but who has time for it? And all the ethical things that go along with that… so much paperwork…” He was avoiding my eyes now. He had put his book and highlighter down on the table and was now very focused on gathering the crumbs on the table in front of him into a pile.

“Who creates all this extra paperwork?” I couldn’t help but keep poking.
“Insurance. Medicare and Medicaid do. HHS do.” He seemed to be less interested in answering my questions now, so I changed the subject.

“I don’t quite know how to ask this,” I said, “but what do you think about the physician’s God Complex? Do you notice one?”
He looked at me very seriously. “Some do go into medicine for this reason: OBGYN and Surgeons do see themselves as super humans. It exists. But I find this very off-putting. I went into medicine to build relationships with patients, to help them in the long-term. I think having a God Complex means building an inherent distance from the patient. This is off-putting to me. I believe medicine is about empowering patients, not just doing things to them that makes their lives better. It’s a collaboration, I’m not just a service provider.” He looked at me expectantly.,

I found myself without a good response, so I asked quietly, “Is it sometimes hard to remember why you are there?”
“Yes. Especially when you’re memorizing the umpteenth fact about cranial nerve 10 or whatever, it’s hard to remember why I’m doing what I do every day and what it will ultimately lead towards.”
“So then, how do you re-center yourself?”
“I try to go have experiences in hospitals as much as I can, I shadow as much as I can because that reminds me why I am here.”

He looked at his watch, purposefully. I got the message.
“Ok I have one last question and then I’ll leave you alone. What is something you wished people would ask you?”
“I wish people would ask me why my beard is red but my hair is not red. The answer is that it’s a mutation of one gene. I discovered this in med school, when my med school friend told me.” I let out a laugh from deep in my stomach in surprise.

Header image credit: mararie / flickr

Anger, a February Salon

[Sharing our Anger Salon email to our salon for this weekend. because I would love to hear what others would add to the readings or how they’d answer some of the questions.]

Hello lovelies,

I don’t know about you, but I am really excited about this topic because it’s hard to figure out what to do with all my anger right now. Even limiting my news consumption is only doing so much…
Some questions: 
1 //  you let yourself be angry? When? Are there other times you try to “turn it off” or hide it?
2 // In your view, are there more acceptable forms of displaying anger? Where did those “rules” come from?
3 // Can anger be productive?
4 // What is making you mad right now? (I think we’ll start with this answer in the intros, feel free to bring a list… I definitely have one right now haha)
Some readings…
Kaela and I talk about Anger a lot because it seems to be an emotion that society has a lot of rules about, particularly in, as Roxane Gay puts it, who is allowed to be angry.
And finally, if you’re at work and like me occasionally need to find some things to channel the anger into, at least until you can go home and use it for something more productive, lifehacker has some ideas.
(Header image credit: Rob Howard / Flickr)

A Sociologist’s Guide to Spanish

TED spends the last two hours of Wednesday afternoons in what we call “Learning Wednesday.” This time is reserved for a lecture, company wide meeting, or a series of workshops created and hosted by the staff.

For this month, I volunteered to host a workshop called “A Sociologist’s Guide to Spanish,” where we explore the Latino/Hispanic communities that coexist in New York City and the differences in the Spanish each of these groups speak. We have a number of native Spanish speakers from different countries on our teams, so we’ll host and discuss language differences together with some of our coworkers who are new to the language. It’s also a neat opportunity to compare pronunciation, slang, and expressions between our communities.

This seemed like a good time to host this workshop as the city comes together to support all of its communities in light of the executive order on immigration and the proposal for the border wall going through the government.

We have many different immigrant communities in our city, all coexisting peacefully, and language is one wonderful way to connect to our neighbors. I would love to be able to teach my coworkers enough Spanish that they could ask for directions or specific groceries in some of the predominantly Spanish-speaking areas of the city. Practicing a language that is foreign to you is humbling. It is good to see what it’s like to stumble through someone else’s words and sentence structures to fully appreciate what it means to learn English as a second language. It’s also about recognizing how cool it is that you can visit a neighborhood like Corona in Queens and practice your Spanish with a short trip on the train.

The guidebook I created includes some basic conversations in Spanish with relevant vocabulary lists, demographic information about different neighborhoods and communities within Queens, Brooklyn, and the Bronx, and our favorite recipes from the different countries represented within our staff.

This was a tiny way I can be a bridge between two of my communities, but it was also a nice way to introduce a broader conversation about the diversity that exists within Spanish speakers in New York and across our hemisphere.

Header Image credit: Chris Goldberg / Flickr

A case for helping your coworkers negotiate their contracts

I believe that one of the best ways to close to wage gap is for each of us to commit to mentoring and supporting our teammates as they negotiate their contracts. I have been really lucky to have great mentors who helped me think through my projects and contracts, so I try to pay it forward with my coworkers friends too.

I advocate for other workers, because I think being honest and supportive upfront reduces turnover and builds a better team.

There are a few ways that I do this to support my communities. I hope by sharing my process, we can all do a better job supporting each other.

1. Help them navigate market wage rates and your own company’s salary scale as best you can.

I was an economics student who was obsessed with pricing and how prices are determined by the market. This made it very easy for me to know where to go to learn about competitive market rates for different skill sets, but many of the workers I’m coached through the years feel like they’re left in the dark about what they can ask for when they negotiate their salaries. Companies have a lot of incentives to keep these numbers quiet. You can help improve transparency here and provide immediate relief for your teammates by helping them gather information through your own experiences and network.

There are plenty of reasons why the secrecy around wages can hurt workers and trust within teams. For now, the best way you can help a coworker may be improving transparency in your own corner or sharing resources you’ve found to describe salaries in your field. Sometimes Glassdoor has some useful information here too.

I realize this can be complicated when you are hiring someone for your team. I think there are roles we can each play in this process, and I encourage you to find one that is comfortable for you.

2. Help them think through what they could ask for (both financially and in terms of other responsibilities and benefits in their jobs)

Once you have some background research together on salary and a benefits package, you can design a “wish list” contract together. I always assume there will be some price negotiation, so I encourage people to ask for a little more than they their ideal salary. Then we talk through the benefits they would like, which could be things like a learning stipend for classes, flexible vacation days or working from home sometimes, getting to shadow someone in the company whose job you’d like to learn more about, etc..

Then, we write up their dream document carefully and talk through which items are absolute priorities that would cause them to keep or reject the opportunity, things that they would be very excited to have at their new job, and things that would be nice to include.

3. Help them practice asking clearly and confidently for what they want.

Negotiating contracts is a terrifying experience for most people, especially for people who have been socialized to be agreeable as a priority. This is an important time to learn to advocate for yourself and your projects down the road. Role playing this conversation out a few times and imagining different scenes playing out can be a really helpful way to build confidence.

I usually start by helping my friend make very clear statements about what they want and what they are willing to negotiate on. Then we work on making them confident and calm while they ask for those things. We talk about when to ask for more time to think about something or ask for a counter offer, when to accept different terms, and how to create space in your head to weigh your options clearly within losing focus to pressure.

4. Talk them through the worst case scenarios.

There is a possibility that this negotiation will not work out as you planned. Sometimes it’s helpful to work through a pre-mortem of the worse case scenarios, such as the company wont negotiate, they tell you you’re asking for too much, they pressure you for an immediate answer. Sometimes going through these scenarios in advance makes it less painful if the negotiation doesn’t go well.

I always finish this part by reminding my friend that this experience, negotiating and being confident asking for what you need and want, is important for every corner of life. It never hurts to have a little more practice. And learning to manage failure is an enormous strength to develop.

5. Celebrate with them if it goes well. Be a warm figure in the office they can turn to when they get nervous or bad news.

I always check in after a negotiation to see how it went. If it went well, we celebrate together! Some victories come from unexpected places, and you may end up with something completely different from where you started, but if the friend is happy with their results, you should be too.

If it’s hard and didn’t go well, I will take the person for a walk and remind them why I believe in them. I remind them that their salary and job description does not define them, but their growth in this moment and similarly challenging ones does. I tell them I am proud of them for asking because this is the only way that it gets better (f*ck the wage gap). AND I remind them that it will be even easier to ask in the future.

Special thanks to my mentors and peer-mentors who helped me gain my confidence in negotiating for myself.

Originally posted on Code Like A Girl.

Header Photo Credit: Melanie

Spring 2017 Salon Syllabus

I am excited to introduce the Spring 2017 salon calendar! As I did with the fall calendar, I will update this with our readings and questions as we move through the Spring.  Think of this as a Work-in-Progress Syllabus.

1/22 2017: what’s your next jump?

It was nice to meet with everyone right after the women’s march in NYC. This was a more simple salon and question, since we know it’s been a strange time for many people and we hoped offering some reflective space here would be helpful.

We asked the group, “what will your next big jump or risk be for 2017?” Each person offered their reflections on the end of the year and where they wanted to grow this year. Especially in a year where political participation mattered in new ways to some of our salon members.

Our upcoming topics include:
2/19: Anger
3/5: Men explain things to me

Rebecca Solnit’s Hope in the Dark kept me sane during the 2016 election. We thought this was a good time for her collection of essays, Men Explain Things To Me.


3/19: Strangers in their own land reading group

Our reading group from the fall (Ta-Nehisi Coates’ Between the World and Men) decided this was a good way to follow up on our really interesting discussion on race and America from the fall. 


4/2: Feeling worthy: what does it mean to observe without judgment


4/23: Resistance and Relaxation (how do we find balance?)


5/7: Mental health and our monsters

Inspired by my friend here, drawn by TED Animator Franz Palomares

Work by Franz Palomares

 

Franz Palomares

I will continue updating as we move through the spring!

Header Image credit: gabriella szekely / Flickr

Defining your own terms on Love

I love the challenge: what would it be like to love without rules, so you have to define how and who you love on your own without “guidance.”

Then we’d have to decide what we want and we’d have to build relationships out loud with our partners. We wouldn’t be allowed to be lazy and accept things as “they are” because we’d have to define it and grow in all of those uncomfortable, exploratory and necessary moments of love.

I can’t wait to discuss this with our salon group.

What does “winning” a political discussion in 2016 look like?

I’ll tell you now, it doesn’t have a grand ending.

What does it look like?

It looks like a conversation where you are uncomfortable because you need to state your values and your “truths” in ways you’ve taken for granted for a long time. You are uncomfortable because while these truths have guided your life and run in parallel to your decisions forever, you now have to say WHY and HOW they are true… possibly encountering that moment where you might have been wrong, or even just a little off, for a long time.

You are uncomfortable because you have to grapple with the externalities of decisions and systems that we all have to ignore from time to time to continue being optimistic about the future and to argue things will improve because we’re learning as we go. But there are externalities to every decision and we have to take responsibility for our decisions, right?

It looks like watching someone else grapple with this discomfort, both of you constantly fighting moments where you can see that switch that allows you to listen and be uncomfortable, or turn it off and stop listening, congratulate yourself for “being right.”

The uncomfortable is an important place for you both to play, and here you can empathize with each other. Maybe it’s a moment where you can both be wrong in different ways and come out with a better formulated argument and a backbone to your decisions that mean you are willing to acknowledge the externalities of your decisions head on.

What did it feel like for me last week?

I think I “won.” I say this because I had a goal: address the fake news problem with someone close to me. The conversation went terribly at first. I introduced the Washington Post piece investigating a fake news site. The response was: I try to read both sides of every argument. This completely deflected from the central issue, which was that this person was arguing with citations from fake news websites regularly. I had to explain why some news sources were “good” and others were “bad.” I also had to grapple with my daily philosophical meltdown of “what is truth?” The other person had to grapple with the fact that maybe their well intended research was faulty and they had been caught doing bad research. It was uncomfortable for both of us.

I was trying to do my job as a professional fact checker to right my corner of the universe and be helpful, but it seemed like it backfired and the gulf between us grew.

I left this conversation feeling defeated, but a few days later I noticed this person fact checking and tagging fake news sites in the comments on their friends’ Facebook pages… the same sites they’d been citing in arguments against me the week before. Maybe this was a quiet moment of “victory.” I smiled to myself, acknowledged what was taking place, and kept scrolling. I think we both grew from it.

Maybe then this mission into the “uncomfortable” was worth it. And now it’s time to try it again… maybe with harder issues. But I acknowledge that if I want to go there, I also need to be better prepared to be wrong and uncomfortable.

(Image credit: Barry Silver)