"Geography Should Not Be Destiny"

This week, I wrote about why I'm leaving the ER (for now) for public health: 

Why I Left the ER to Run Baltimore's Health Department

I also lay out my goals and vision in the Baltimore Sun:

Geography Should Not Be Destiny

I will be on this Blog infrequently from now on. Please follow us on our website and new blog, B'Healthy in B'More! And on Twitter @BMore_Healthy.

A New Year & New Adventures—A Farewell Message

Dear Readers,

I am writing to share some exciting news: this Thursday, January 15^th 2015, I will be joining the administration of Mayor Stephanie Rawlings-Blake as the Commissioner of Health in Baltimore City. In this role, I will be overseeing our agency of 1,100 strong to lead the activities of the Health Department, which include health promotion and disease prevention, aging and care services, environmental health, animal control, and food safety.

This is an amazing opportunity to serve and to combine my passion for community engagement, public health, and patient-centered care to help those who were most vulnerable. Baltimore faces many health disparities that are rooted in poverty, violence, and substance abuse—but it’s also a city with extremely committed civic and faith leaders, engaged community organizations, strong foundation presence, and the longest continuous-serving health department in the country that has an outstanding history of service and innovation.

My last couple of years at George Washington University have been fantastic. I’ve loved teaching residents and students and providing care in our ER; serving as Founding Director of Patient-Centered Care Research; leading a new collaboration between GW and Kaiser Permanente on social mission and health policy with my mentor Dr. Fitzhugh Mullan; and researching and speaking about paradigm changes in healthcare reform (including a talk on Who’s My Doctor and our transparency campaign that is now on TED.com). While I’m sad to leave my inspiring students and extraordinary colleagues, I am honored and humbled to be selected to this new role to fight for health equity and social justice.

Thank you for following this blog for the last two years and advancing our common vision that patients, families, and providers can work together to be empowered to better health. I will be continuing to comment on public health and healthcare transformation on my Twitter account @DrLeanaWen and Facebook site. We will also be featuring announcements and guest posts at the official Baltimore City Health Department Twitter @BMore_Healthy and BCHD Facebook page.

Ten years ago, I wrote an essay for The New York Times that began with a quote by the Reverend Dr. Martin Luther King, Jr., that injustice anywhere is a threat to justice everywhere. I end this blog (for now) with another quote by Dr. King, as it explains my core vision and drive: “Of all the forms of inequality, injustice in healthcare is the most shocking and most inhumane.”

Thank you for all that you have done and continue to do. Please join me in this next chapter to fight against injustice and to improve health and well-being.

Sincerely,

Leana Wen, M.D. M.Sc.

Listen to Who's My Doctor on NPR's TED Radio Hour

Since my TEDMED talk on the importance of transparency in medicine was featured on TED.com last month, I have had an overwhelming number of responses. The majority were very positive. Hundreds of people encouraged us to keep going, and a lot wanted to know how they could participate: as transparent doctors and as patients. 

Many asked about how they could find a transparent doctor in their area. Our website is not robust enough for a geographical search function, and it contains a small fraction of the doctors who have signed the Total Transparency Manifesto. We are open to working with nonprofits and developers on improving Who’s My Doctor to make it more user-friendly.

In the meantime, Who’s My Doctor is fortunate to have captured the attention of someone who I’ve secretly admired for a long time: NPR radio host Guy Raz. You may have heard of Guy’s work as host of All Things Considered. Since March 2014, he has been the host of NPR’s TED Radio Hour. As a TED nerd and NPR faithful, I download these excellent podcasts every week. Some of my recent favorites have been the Source of Creativity featuring (among others) Sting and Overcoming.

I had the privilege of meeting Guy at TEDMED; he is as energetic and charismatic in person as he is on air. I was flattered when he invited me to be interviewed on TED Radio hour—but quite astounded and not a little bit embarrassed when he revealed that the topic of this session was “courage”. The other people interviewed in this episode are war journalist Janine Di Giovanni, human rights litigator Kimberley Motley, former CEO Margaret Heffernan.

TED Radio Hour: Courage

What we’ve done in Who’s My Doctor is important, but hardly courageous! Having been a patient and caregiver, I know how frightening it is to be in the position of extreme vulnerable, when you or a loved one are ill. Dealing with these stressful situations is what takes real courage; Who’s My Doctor is our attempt to level the playing field.

Whatever your thoughts are on transparency in medicine, I hope you will listen to Guy’s masterful interview, where he created a narrative out of my story and the stories of Janine, Kimberley, and Margaret. I look forward to your comments.

Life in an Urban ER

I wrote a piece for NPR about the patients we see in an urban ER, and how every day is a reminder that health doesn't exist in a vacuum.

 

Even in the time-limited setting of the ER, it's important for providers to understand where our patients live, work and play. It's these conversations that allow us to diagnose and treat the real causes of our patients' ills.

 

Why the ER Doctor Asks Patients What's Happening At Home

Thanks to everyone for reading, and in particular to the many people who pointed out the critical necessity of teamwork--with nurses, physician assistants, technicians, nurse practictioners, case managers, students, social workers, and many more. 

 

Indeed, it takes an entire team to provide true care. As people have commented on NPR's Facebook site, we in the ER rely on social workers--many of whom are overworked yet try so hard to help our patients. Whenever we as docs and nurses refer patients to social workers, they are always fantastic about helping us. It's critical for us frontline providers who see patients first to ask the tough questions and look beyond the "chief complaint" in order to know to involve the other members of our team.

 

I have been fortunate over the course of my training and career to learn from and work with many incredibly caring, highly compassionate, and superbly competent providers. It's also the community leaders and neighborhood organizations who provide care outside the walls of our institution, who are critical to the health of people. 

 

On this Thanksgiving weekend, I give them, and all of you, my unending gratitude and deep respect. Thank you.

Who’s My Doctor on TED.com!

I am thrilled that TED has picked up on Who’s My Doctor and our efforts to improve transparency in medicine. 

Click here for link to TED talk 

TED prohibits “selling from the stage” and apparently my call to action at the end was too much of a “sell”. Here is the intended conclusion of my original TEDMED talk.

"Radical transparency won’t be easy. There will be many critics, some who have ulterior motives and have something to hide, and others who are just scared of changing the status quo. But if it’s anywhere we can unlock our imaginations, any place where we dare to speak up, with anyone who can make the impossible a reality, it’s here at TEDMED, with all of you.

I call upon everyone here—anyone who will ever be a patient or family member of a patient—to sign the total transparency manifesto. I call upon doctors, nurses, physical therapists, nutritionists, and all healthcare providers to take off our white coats and show our patients who we are. 

I’m taking the leap. This, today, is my pledge. Will you join me?"

The talk is here. I'd love to hear what you think.

On Caring for the Neglected 20%: People With Disabilities

In last month’s Health Affairs, I wrote a personal perspective about unequal treatment for patients with disabilities. Nearly 20% of the population in the U.S. have a disability; yet, teaching about care for people with disabilities is not a mandated part of the medical curriculum.

This is a deeply personal issue to me. As someone who grew up with a speech impediment, I am acutely aware of the prejudices and disparities that result from lack of knowledge.

I’m grateful to Health Affairs for publishing this article and producing the associated podcast. This has been nearly10 years in the making—thanks to my mentors and colleagues Dr. Fitzhugh Mullan and Dr. Audrey Young, among others, for encouraging me to write about my experiences. 

And I will be forever indebted to Professor Vivian Sisskin: a friend, mentor, supporter, cheerleader, and best speech therapist ever. This essay is dedicated to all those who are fighting to ensure equitable and accessible healthcare.

Link to Health Affairs article:

Condensed version in the Washington Post:

A Month of Conferences & Inspiration

My blog entries have been light over the last month in large part because of significant travel. In between clinical shifts in the ED and co-leading a fantastic cohort of GWU’s Residency Fellowship in Health Policy, I was fortunate to be invited to speak at several conferences in October. Here are some highlights:

In early October, I was honored to keynote the Centra Health Foundation annual gala in Lynchburg, VA to celebrate the work of several hundred volunteers, all of whom were either breast cancer survivors or family members of survivors. The event was moving and powerful; I thought of how proud my mother would be to hear me share her story with so many courageous and inspiring women.

Next was the 12^th Annual UC Davis Pre-Health Professions Conference in Davis, CA. Ten years ago, when I was the national president of the American Medical Student Association, I was approached by a student from a community college named Joubin Afshar who told me that he had started a conference for community college students who wanted information about the health professions. I attended the conference then, and was blown away by the drive and passion of these students. Nearly all were first generation college students, and for many, this was their first and only exposure to medical professionals.

Having been such a student myself, I vowed to return whenever possible. Last year and this year, I gave a keynote and led four workshops on leadership in medicine. Nearly 8,000 students attended the conference—many took overnight buses across California and even from the East Coast. It’s remarkable to see the work done by a small group of committed students. I wonder how many health professionals are where they are now because of the work of Joubin and his colleagues. (I also had the opportunity to see a friend and colleague, Dr. Davis Liu: an exceptional leader, thinker, and physician.)

My former Rhodes colleague who is now Chief Resident at Einstein Hospital in Philadelphia, Dr. Gary Huang, invited me to give Grand Rounds to the Departments of Internal Medicine and Emergency Medicine (pictured here with fellow Chief Resident and very kind physician Dr. Carlos Davila). I received many questions on what physician trainees can do to avoid burnout and deliver true patient-centered care. 

No answer I gave could have been as telling as the actions of Dr. Huang. As we were coming down the elevator, a woman in her fifties stopped us to ask directions to a particular surgeon’s office. I watched as Gary helped her figure out the name of the surgeon, led her to identify his location, then navigate her there. So many other people would have simply said, “I don’t know” and implied that it’s not their job to know, but not Gary. He took the time to help this woman in need, going far out of his way to do so. He didn’t do it to impress her or me (and I suspect he and his equally humble and caring wife Sherry would both be embarrassed by this blog post), but because it was the right thing to do. This action speaks volumes about the type of doctor he is, and answers the question that the residents asked: there may be many factors that make us disconnected from our patients, but it is within our abilities to treat patients as people, to value each person’s humanity, and to exemplify basic dignity and respect.

At the Urgent Matters Conference during the American College of Emergency Physicians meeting in Chicago, Dr. Jesse Pines expanded upon these themes. The other presenters (including my former attending at Brigham and now MGH Vice Chair, Dr. Ali Raja) and I spoke about how patient-centeredness and better communication can reduce overtreatment, improve patient safety, and transform care. The response was much better than expected, in no little part due to the amazing tweeting capabilities of one Dr. Seth Trueger (aka @MDAware).

Then it was on to Nijmegen, the Netherlands, where Corine Jansen (pictured), Jennie Grau, and their team organized the first-ever listening conference in healthcare. Initially, when my husband heard that I was speaking at listening conference, he laughed—isn’t it an oxymoron? And I have to say that I didn’t initially understand what a listening conference was really about (though the International Listening Association has a long history of hosting these conferences, and cosponsored this one).

The moment I showed up, though, I got it. Patients, family members, doctors, nurses—they shared their stories. They were powerful and unforgettable; indeed, as one participant commented, “the shortest distance between people is a story.” I heard a doctor speak about how he and his fellow neurologists assumed that their patients with Parkinson’s disease cared most about memory and managing their tremors. But when they listened—really listened—to their patients, they heard that what mattered most to them was sleep and sex. So they changed the entire medical encounter so that it wasn’t just about medication management, but also hired a sex and sleep therapist. Corine, Jennie, your team at REShape (where I took the photo with the best message ever): hats off to you for a fantastic conference and to the tremendous individuals I had the pleasure of meeting there.

This week, it is off to Grantmakers in Health Conference in DC then American Cancer Society in San Jose, CA. I hope to contribute more substantive blog posts soon; please write if there are particular topics you would like to see.