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

TED@250: Sights UnSeen

Back in summer 2013, I was an intern with the TED Content team… and I had an amazing manager who let me help him curate a TED@250 event. I recommended a professor I had worked with on my thesis and really admired for his research and cross disciplinary approach to answering hard questions about cartels and organized crime.

This was the talk that came out of it. I’m still so proud to have supported him as he produced this fascinating talk:

If Our Worst Fears Really Are Public Speaking, Heights, & Insects*…

…then the least I can do is offer some advice for people who are working on presentations/talks.

I think about this a lot for the work I do every day now at TED, but it was a more direct concern to me while I was preparing for my talks at TEDUniversity at TEDGlobal 2014 and TEDxMunich last fall. The following are some of the lessons I’ve learned through

Ok, so it’s terrifying. Where do we start?

1) Find someone who respects you enough to give you real time feedback. Ideally, they will tell you the points when you are eating your words, stumbling through an explanation, skipping important points in your argument, gesticulating too much, etc. They need to be confident, authoritative, and clear with their feedback. Don’t look for someone who will be too nice and give you unclear comments.

2) Have your selected speaker coach go through multiple trials with you. You should pick something to work on in each round, ideally finding a way to fit all of your performance edits into a routine. Maybe the first time you run through something, you work on being loud. The second time, you work on speaking very clearly and enunciating. The third time, you get comfortable enough with the language to relax your body and develop a stage presence. Each round requires feedback and an eye for detail. Get comfortable with your coach, it’s going to take a while.

3) Don’t memorize to the point that you can’t go off script when something goes wrong. Once you’ve run through the talk enough times, you should have a loose roadmap in your head of where you need to go, where there are some tough, tight turns you need to nail so you don’t free fall, and parts that are more relaxed where you can be more creative. Be gentle with your talk, it will go better that way.

4) You can prepare yourself to weather the tides of failed technology and missing slides. As a speaker, being able to roll with the punches makes you seem more confident and authoritative. Lifehacker published an article recently about mental rehearsals, and there is a particular section about all the various things that could go wrong with technology and audiences etc. when you are giving a talk. It recommends thinking through each of those scenarios and having a back up reaction ready for the impending problem. This is excellent advice. It will not only make you feel more at ease, but when something goes wrong, as it inevitably might, you will shrug if off because you’ll think “I’ve been here before. No sweat!”

5) Remember why you are doing this talk. Remember why you enjoy the work/research you are presenting. Then have fun! At some point in your rehearsals, you will have gone through enough rounds of practice with your talk that you could go through it on autopilot. Now, learn to have fun with it. Your audience will read your expression and body language. If you have fun, they’ll have fun.

*According to the 1977 Book of Lists, the Top 10 things the audience polled feared were (in order of frequency): death, heights, insects, financial problems, deep water, sickness, death, flying, and loneliness.

Happy New Year!

Happy New Year, everyone!

2014 was a really fantastic year full of adventure for me.

I switched jobs, started studying a new continent (!!), worked with a series of different researchers that I really admire and find myself learning a lot from, gave a talk at the TEDUniversity session at TEDGlobal in Rio, gave a different version of the talk at TEDxMunich in November, started learning to program in Python, returned to some of the data I was working with from international remittances transfers… and used my python codes to do cool things with it, returned to Mexico purely for fun instead of work (it has been a while), and started to be able to answer the question: What do you want from this one precious life?

I have a lot of things I want to work on and learn this year, but 2014 was a great start to this chapter of life. Thank you to everyone who offered me their time, thoughts, feedback and patience. Really excited to cross paths with all of you again soon.

Find the Numbers!

This is a story about hunting for the numbers, the origins of those numbers, and the full story of the Ebola crisis in Western Africa.

Disclaimer: I do not have the full story of the crisis, but I am trying to track down the numbers I need to explain what is going on a little better and how we can mitigate risk through automated contact tracing. This is part of measuring impact of the start up I started working for in October.

For now, the narrative around ebola is constantly changing. With each article, you see a new layer. The UNFPA offers information about the children and women at risk during pregnancy and childbirth from the crisis and crumbling health systems.

NPR digs into some of the trust issues and limited access to healthcare facilities that are a reality for many people in Sierra Leone and Liberia.

We hear about new outbreaks in Mali when sick patients go untested for ebola and cross borders…

We hear the numbers of the death toll with each article that goes up, hoping to provide the reader with context in a situation more complicated than any of us can begin to image from afar.

From the floods of articles and coverage and organizations presenting their side of the story, their role in recovery and crisis management, and the climbing death tolls… it’s hard to understand the full network of people interacting and offering support on the ground.

This is partially why I am spending some time this week digging through numbers. How many contact tracers are there? Where are they concentrated? How many doctors do we see in the field and who are they answering to? What organizations have their hands in different processes, etc.

It’s a map of social networks, resources, and… the limits of communication between them.

[Hopefully] more to come!

 

October Interrupted

Sometimes, opportunities throw open the door, turn over the furniture and still manage to get you to come running after them.

I left my full time job at a Think Tank to come work for a start up in possibly the most chaotic field possible. We are working on technical and data support products for the Ebola crisis in West Africa. I am spending my days simultaneously figuring out how to build a business, work through organizational steps, networking, learning everything I can about Ebola, technology for contact tracing, medical procedures for an epidemic, public health, information mapping… and just about everything else you could imagine. And I love it.

It’s been a juggling act to get through the homework for my UX design course, learn this job and produce good work on the job, figure out when/how I would like to return to school, talk to mentors, attend all the lectures and things I enjoy going to… and have friends… but I like it. I’m also trying to get through the final rounds of edits for my TEDxMunich talk this fall. But this is where I am supposed to be right now.

I hope to be able to share more success stories from this end soon, but just wanted to leave a brief update for now.