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

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

An idea exploring Government vs. Civil Society

I am exploring this idea:

If government represents who we are and what we value now, then civil society and institutions are responsible for exploring and articulating visions for what we could be, who we might become as a community.

I would love to hear other people’s reactions to this, especially as I explore it further through specific case studies.

Fall 2016: Salon Schedule

I’ve been running a salon for women interested in reflecting together for the last four years. We hoped this experiment could lead to a cool network of women interested in answering difficult questions, continuing with their research after college, and supporting each other through life transitions. It has been all of that for me for years, I am very grateful for this community we’ve built together.

To make this easier for new salon leaders, I am posting our fall/winter schedule and topics, maybe to inspire some of their own discussions. I will update it with our readings in case you want to follow along on your own.

SEPTEMBER:
Sunday Sept 25: Family and Community

Questions we’ve been playing with:
– if we’re moving past the mom+dad+2 kids+dog in a white picket fence home, how has the definition of “family” shifted for you? Who do you consider to be your “family?”
– can your community become part of your “family?”
– who do you seek out when you need support?
Some thoughts on community:
Courtney Martin’s the New American Dream
And a really honest essay about one writer’s anxiety and the support system she built with her friends

OCTOBER

Sunday Oct. 9: Death

Kaela’s Intro Email: I had originally been inspired to add this as a salon topic because of IDEO’s event series about death back in May. I realized that I had never really had any long conversation about death with anyone in my life.
There are many ways we could go on this, but we thought we could spring board off of with the idea of ‘what does it mean to be alive versus dead?’ and ‘how do the dead in our lives “live” on once they’ve passed?’
A few things to get your brain moving:
From Diana herself (On Day of the Dead, Memory, and living profiles)
A TED talk about how other communities engage with the dead/death
This group and this other group who are also trying to open conversations on death
And a great insta post shared to use by Connie (who also gave us a few of the links above!)

Sunday Oct 23: Grief

Our questions (brought together by Kaela and Connie)
Thinking about before and after — how do you change before and after you grieve? What does grief bring and how do you build through it?
And how do we deal with the timeline of grief? We have heard of all the stages – but what about the days you feel like you “should feel better” but don’t?
A few readings: 

NOVEMBER

Sunday Nov 6th: Transformation

“Human beings,” Harvard psychologist Daniel Gilbert observed…, “are works in progress that mistakenly think they’re finished.”
Let’s talk about Transformation. There are two questions that we’ve been playing with her that we’d love to hear your reactions to:
1) How do we know when we’ve “transformed” from someone we were or thought we were into a different version of ourselves?
2) And is this transformation really just a chance in perspective? Or is it like shedding a layer of armor and taking up something different?
Some Media:
Maybe change is like the Tower in Tarot (it’s meant to show the destruction at the end before a significant change. You can see it as “doom” and “disaster” like this image depicts, or it can be an opportunity for something new and exciting)
If it is about our perspective, maybe we can rewire towards optimism… I always seems to come back to Carol Dweck’s “Growth Mindset” too
And finally, sometimes relationships transform when we are able to ask questions. In light of this election, I related to this and it helped me feel better, like we can heal after Tuesday.

Sunday Nov 20th: Gratitude (Family style thanksgiving) Dinner

DECEMBER

Sunday December 4th: This Is Water: Ta-Nehisi Coates’ Book Discussion
Dec 18th: Holiday Party

JANUARY

Sunday January 8th: Men Explain Things to Me
Sunday January 22nd: Anger

More to come! Please send me questions/readings/thoughts, as they occur to you.

Header photo credit: Pedro Ribeiro Simões on Flickr, http://bit.ly/2d9A8QQ

Collecting beautiful little things from the TED Community.

Many darks things in the news these last few weeks (perhaps months, at this point). While it was hard to block it out and re-center for a while, I found my peace in my communities. We cannot let the darkness win, so instead, let us celebrate the good we create together and the beautiful, little things. These are a few things from my community within TED that brought some light and healing into the week.

This week, I briefly caught up with a friend (and previous co-worker) who went to Baton Rouge a week ago to join the protests when we ran into each other in the Strand, unplanned. I was standing over a shelf of books, looking for Andrew Soloman’s newly published collection of essays, but also taking my quiet moment of solace in my favorite of sacred spaces (bookstores). She was taking a break from her office, trying to digest everything that she had seen and experienced, while trying to integrate back into New York. We bought sought that moment of peace over a table of books. I looked up to see her beaming, even through her complicated thoughts and reflections. While it took me a moment to process who I was seeing in front of me, her warmth made my face involuntarily break into an easy smile. That was a moment I needed and celebrate, even while so much else was brewing in the background. Andrew’s TED2014 talk offers some moments of his own healing:

This talk from Adam Savage at TED2016 is a series of beautiful little moments in a very creative community. It was amazing to watch coworkers post this talk this week alongside pictures of their children creating their own costumes, memories from their own adventures in make-believe worlds, and artists sharing stories from their own creative communities.

I went to see Finding Dory this week in a movie theatre with my partner. I forgot how magical Pixar’s movies are. There are characters we’re joking about a week later and scenes I described to my mother, hoping she would go see it too so we could talk about them. It reminds me of the talk from TEDTalks Live this past fall where lighting designer Danielle Feinberg talked about the effect of color and light in animated stories.

I appreciate them even more than I used to, because we work so closely to the amazing animators behind TED-Ed’s Lessons.

This team puts so much love into their work. It’s visible in their work and their willingness to teach others about their craft. They regularly volunteer to do workshops in the rest of our community (and get extremely positive feedback, because they are amazing teachers!) and one animator even teaches art classes regularly in a school in her community!

A friend asked me to send her a talk that gave me hope, and I was grateful to return to this talk by May El-Khalil. Peace is a marathon… we have to build our endurance because in the long run, love will win.

I was also deeply inspired by our community this week. The TED residents gave talks about the projects they are working on, and my friend Sheryl, who is a TEDx organizer and immigration attorney, talked about the value of immigration and immigrant stories in the US. It was the perfect antidote to the waves of far right backlash in politics right now.

Sheryl Winareck, TED Residents talks, July 2016
Sheryl Winareck, TED Residents talks, July 2016

I am grateful to be part of this community today and every day. The optimism is infectious and the common belief holding us together is a share love for ideas, experiments, creative growth, and hope for a better future. We see the good, here and now, but we also see what we could become and we celebrate it.

I want to end with an essay written by TED’s CEO, Chris Anderson on the value of ideas. It was the hope in the dark we needed, just after the Brexit vote… Ideas matter, more than ever.

Why ideas matter … now more than ever

Celebrating the creators.

I stayed up late to read the Brexit results and commentary last night. In the last few weeks, the media has been filled with heart break after heart break, and our politics seem to be filled with people who only want to destroy and move backwards. But we cannot let them win. We may grieve, but we must give our attention, love and joy to those who create.

The real leaders, the brave ones, are those that create, not destroy. Let’s celebrate the creators. 

I got up early and went to creative mornings in Gowanus. The theme was appropriately “Broken,” and the speaker Michaela Angela Davis was the perfect person to speak this morning. She talked about race in the United States, and the terrorism of Jim Crow, but she ended on an important high note. There was time for us to heal together.

She said her grandmother, who grew up during a time when lynchings were common and she had to survive. “This was life.” Davis explained, her grandmother did not have time to process her feelings because survival meant defying what was expecting and fighting the power.

Her mother was part of the civil rights movement, fighting the power. “This was liberty.” Each generation building on the next. They were creating a new world together.

“And I am pursuing happiness like it is a revolution.” Davis is creating the world she wants to live in, and creating a world for her daughter to survive, be free, and thrive in. This is what it means to create.

Most importantly, Davis reminded us all that we cannot take on the grief and sadness of our ancestors. They suffered to create a better world, if we take on their suffering we have not fully accepted and lived the world they fought to create. We can take on their pride, but we must keep fighting and celebrating growth to move forward.

I needed to hear all of this this morning. The room was filled with laughter and sorrow but most importantly people who came together because we want to create, not destroy. I want to celebrate these kindnesses and give them my love and attention so we can grow.

Because it’s always easy to leave, but harder and more rewarding to stay and grow together. So let’s grow. Let’s love.

Why it’s hard to record beautiful, hidden moments in labor organizing

Recording history as it happens is much more complicated than it seems. Victories are often celebrated privately and hope grows from these shared experiences with other organizers. I wonder now, how and why are these stories about successful labor organizer harder to find?

The voices of workers provide important feedback on the type of community we want to live in and the type of economy we can sustain together. When it is omitted or skimmed over, we lose a crucial piece of how economies are negotiated and built together. Most importantly,  there is a lot of creativity that goes into successful campaigns for change. Especially when the side arguing to “stay the same” can play to the same “fears of loss” factors that are so powerful.

I appreciate the creativity that goes into successful labor negotiations and the complexity, what it takes to get to the negotiation table and win important victories for workers. But the power dynamics of the work place and the economy makes recording stories from our workers and our organizers challenging. Sometimes part of the negotiation is keeping information, and how things play out, a secret.

While I was researching leads for a story, I ran into a case where the story was so important and inspiring… but the organizer needed to remain in the shadows to organize successfully. I was caught in a tension of wanting to celebrate this story that made me more optimistic about the future of labor… but it’s success depended on keeping private, between negotiating parties.

It made me stop to think about the role journalism plays in recording history, but also the complex partnerships and conditions that have to form to make long term change possible.

Labor is an important part of our community and efforts to silence workers and organizers limit our ability to have honest political discussions. If the only people with a voice are the CEOs and stakeholders, we have a very weird and unrealistic image of what it means to work in the company or the current workforce. And long term… creating a working experience that is only pleasant for the C-suite is not sustainable for the fabric of our communities.

Organizers like Saul Alinsky and Dolores Huerta have shaped how we think about organizing people, from political campaigns to voter turn out, workers strikes, negotiation in many different settings, research methods and so much more. Their creativity and strength lead them through some seemingly impossible battles to come out on top. It also gave me hope that “social structures” do change, we can negotiate. That violence and money as two currencies for dictating the rules are not the only options.

As a student, I learned so much from groups like Unidad Latina en Accion (ULA) in New Haven, which is an amazing organization that supports undocumented workers and protects them when their wages are withheld, they suffer sexual harassment in their work places, and they are not protected by the full extent of their rights as guaranteed by the labor laws of Connecticut regardless of their immigration status.

In the last few years, I am also so excited about the work happening through Palak Shah at National Domestic Workers’ Alliance who is thinking about different ways to protect and negotiate for workers rights. The Worker’s Lab is another group working to improve working conditions through negotiations between workers and their employers. Carmen Rojas, from the Worker’s Lab, gave a talk at Personal Democracy Forum last year about some of the work place conditions improved by direct negotiation.

I spent time talking to other students who later became Union Organizers themselves. Some publicly, and others in a system where organizers work covertly, organizing from within the workforce. Both of these methods are important and offer different methods for negotiating work place conditions.

I, naively, wanted to celebrate both methods for organizing, hoping we could use public discussions to support workers and organizers, and maybe inspire a new generation of organizers who see there are people fighting for better. But I also needed to acknowledge that the organizers who are not public in their efforts are private because the secrecy is a necessary condition for their work.

While I want to preserve their present efforts in history to other students can read about it now and later, to add this layer of complexity and creativity to our labor history, but I cannot do so without compromising their work.

The power dynamic of these work places (typically hotels and other service sector businesses where workers are expected to be invisible or close to it) is that the leadership is set on keeping workers disorganized and afraid. The organizer preserves an alternative and devotes time and energy to helping support internal efforts among workers to organize for their negotiation. The organizer is not meant to be a public leader, the silence is also about being part of the team and not calling more attention to themselves than to the negotiation.

As I can relate from my more recent jobs, negotiation is a sensitive and often quiet process. Victories are often private moments, and failure requires quiet moments of recovery.

I frequently wonder if this covert organizing if the future of labor organizing. In an era where Unions have lost some of the favor they once had, my interest in labor issues usually ends up with the typical derogatory “Socialist” comment (because we have a nasty history here of black listing “communists” and anyone who is sympathetic to workers with a label), and where inequality is seems to only be increasing… Is the best way to protect workers completely off-record, hidden, and perhaps forgotten with time?

I wonder, too, about the role of journalists here. If they play an important role in recording history as it happens, are there sections of history we are meant to celebrate more privately and then lose to time? Or does this story sit in a sort of escrow until enough time has passed to record it, before it’s lost?

I am left with my questions to explore and waiting for ways to support organizers, as they need it.