EP. 77: HOW PUBLIC HEALTH SAVED YOUR LIFE

WITH LEANA WEN

Aug 29

WITH LEANA WEN, MD, MS

A former Baltimore City Health Commissioner shares how she went from an immigrant childhood to leading the oldest health department in the US — along with insights on mentorship, the politicization of public health, and crisis leadership.

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Episode Summary

According to emergency physician Leana Wen, MD, MS, "public health saved your life today, you just don't know it." Having been appointed the Baltimore City Health Commissioner at the age of 31, she certainly has the credentials and stories to illustrate this assertion. Prior to the COVID-19 pandemic, public health played a frequently misunderstood and under-appreciated role in our society, ranging from sanitation and immunization to mental health support and pollution control. In addition to her public health work, Dr. Wen is the author of the 2021 memoir Lifelines: A Doctor's Journey in the Fight for Public Health. She is a regular contributor to The Washington Post, a medical analyst for CNN, professor of health policy and management at George Washington University, former president of Planned Parenthood, and in 2019 was named one of TIME magazine's 100 Most Influential People. In this episode, Dr. Wen not only unpacks what public health is, but also shares her challenging upbringing as a child of immigrants, how she became the health commissioner of a city she had not previously worked or lived in, lessons on decision making in a crisis, the importance of finding good mentors, and more.

Dr. Leana Wen is an emergency physician, professor of health policy and management at George Washington University, and a nonresident senior fellow at the Brookings Institution. She is also a contributing columnist for The Washington Post, a CNN medical analyst, and author of the critically-acclaimed book on patient advocacy, When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests and a memoir, Lifelines: A Doctor’s Journey in the Fight for Public Health.
Previously, she served as Baltimore's Health Commissioner, where she led the nation’s oldest continuously operating health department in the U.S. to fight the opioid epidemic, treat violence and racism as public health issues, and improve maternal and child health.
Dr. Wen obtained her medical degree from Washington University School of Medicine and studied health policy at the University of Oxford, where she was a Rhodes Scholar. She completed her residency training at Brigham & Women's Hospital & Massachusetts General Hospital, where she was a clinical fellow at Harvard Medical School.
In this episode, you will hear about:
• 2:08 - Dr. Wen’s childhood as an immigrant to the US and her early experiences as a patient
• 6:34 - Why Dr. Wen decided to train as an emergency medicine physician and how she got into public health
• 9:27 - The ways in which emergency medicine training prepared Dr. Wen for a career in public heath
• 13:34 - Dr. Wen’s objectives as she entered the role of Baltimore City Health Commissioner
• 17:05 - Balancing priorities when confronted with the complexities of public health
• 21:50 - Navigating public health policy within our challenging political climate
• 26:16 - The importance of telling success stories in public health to spread awareness of its importance
• 28:24 - Dr. Wen’s advice on what to look for in a good mentor
• 32:15 - What ties together the many experiences Dr. Wen has had throughout her career
Henry Bair: [00:00:01] Hi, I'm Henry Bair.
Tyler Johnson: [00:00:02] And I'm Tyler Johnson.
Henry Bair: [00:00:04] And you're listening to the Doctor's Art, a podcast that explores meaning in medicine. Throughout our medical training and career, we have pondered what makes medicine meaningful. Can a stronger understanding of this meaning create better doctors? How can we build healthcare institutions that nurture the doctor patient connection? What can we learn about the human condition from accompanying our patients in times of suffering?
Tyler Johnson: [00:00:27] In seeking answers to these questions, we meet with deep thinkers working across health care, from doctors and nurses to patients and health care executives. Those who have collected a career's worth of hard earned wisdom probing the moral heart that beats at the core of medicine. We will hear stories that are by turns heartbreaking, amusing, inspiring, challenging and enlightening. We welcome anyone curious about why doctors do what they do. Join us as we think out loud about what illness and healing can teach us about some of life's biggest questions.
Henry Bair: [00:01:03] According to our guest on this episode, emergency physician Dr. Leana Wen, "public health saved your life today, you just don't know it." Having been appointed the Baltimore City Health Commissioner at the age of 31, she certainly has the credentials and the stories to back up this assertion. Prior to the Covid 19 pandemic, public health played a frequently misunderstood and certainly under appreciated role in our society, ranging from sanitation and immunization to mental health support and pollution control. Over the course of our conversation, Dr. Wen not only unpacks what public health is, but also shares her challenging upbringing as a child of immigrants; how she became the health commissioner of a city she had not previously worked or lived in; lessons on decision making in a crisis; the importance of finding good mentors, and more. Dr. Wen is the author of the 2021 memoir Lifelines: A Doctor's Journey in the Fight for Public Health. She is a regular contributor to The Washington Post, a medical analyst for CNN, professor of health policy and management at George Washington University, former president of Planned Parenthood, and was named one of Time magazine's 100 Most Influential People. Leana, it's such an honor. Welcome to the show and thanks for being here.
Leana Wen: [00:02:28] Thank you so much, Henry. Glad to be with you today.
Henry Bair: [00:02:31] So you've done so much with your career. I've read your book Lifelines and am so eager to dive into your life story to kick us off. Can you tell us what was your background? What was the context in which you grew up?
Leana Wen: [00:02:46] Yeah. So I was born in Shanghai, China. My parents and I lived there until I was almost eight, and then we came to the US. We initially lived in a small town in the mountains of northern Utah and then moved to Los Angeles subsequently. I guess I'm someone who's, when they ask the proverbial question about Why do you want to be a doctor? When did you know that you wanted to be a doctor? My answer was always very boring because I honestly don't know. I don't have an exact moment, but I can tell you that I've known that I wanted to be a physician for as long as I can really remember them. And I think part of that is because I was really ill as a child. I had severe asthma and so spent a lot of time going to the doctor's office, going to the emergency department, being hospitalized, I remember being intubated as a child. And so I think all of that gave me a different kind of understanding of what medicine is, which for me was about caring for the individual, helping someone who was really scared to feel better and also to help them through that really terrifying time. And so I knew that I wanted to be a doctor. But in the US things were really difficult for us. We didn't have connections. My parents aren't physicians. They're not a medicine at all. We also, I think, typical of many immigrant stories, my parents were professionals in China who then really struggled to make ends meet in the US, and so my father worked a number of jobs driving to deliver newspapers and working in a restaurant. My mother worked in a hotel and at a video store until she finally was able to get her certificate as a teacher. And so I think it's also through those types of experiences that shaped my interest not only in medicine, but also in what I later understand to be public health and health policy, because I saw a dysfunctional system and I wanted to help to change that.
Henry Bair: [00:04:36] When I opened your book, the very first chapter is titled Circle, right, which is this Chinese phrase that literally means "eat bitter." It's a philosophy, an ethos of approaching life's tribulations. Can you share with us? Why you decided to start your book with this concept and how it has influenced your career?
Leana Wen: [00:05:02] Yeah, it's interesting. So when I first wrote Lifelines, I didn't have that first section in the book at all, which for people who have not read, it is about my upbringing. I wanted to write a book about all the great work that my team and I and our partners did in Baltimore. I thought it told a positive story of public health about all that public health does and can do. And I wanted to share our thinking, our strategy, the impact of our programs. That's what I wanted to write about. And I had submitted actually an initial draft to my editor, and the editor read it and said, you know, kind of the the good news bad news sandwich. Right. Here's the good news. I like the topic and I like the writing. However, she said no one will read this book because you're basically telling people that they should be happy eating their vegetables, but you haven't convinced them of why they need to even look at these vegetables. I don't know what the exact analogy is, but she basically said you need to draw people into the story of public health. One of the initial working titles for the book is "Public Health Saved Your Life Today, You just Don't Know it." And I wanted to write about that theme. But I think her point was, if people don't know it, they're not going to read this book. So I started out differently and I started out with this story of my life because in many ways, my childhood and what I saw and my motivations for entering medicine are very much a story of public health as well. And so that element is part of that. And I think it embodied the ethos that my parents had and passed on to me in a way, also the ethos of practitioners in public health too.
Henry Bair: [00:06:44] So before you got started with public health, though, you were trained as a as an emergency physician. Why did you choose to go into that specialty?
Leana Wen: [00:06:53] Yeah. So another interesting story, and I'm not sure that I had I actually don't think that I put put it exactly in the book this way, but I gathered that there are some people who are listening who might be pre-med students and who might be wondering or medical students and wondering, how do you choose different specialties? So I think a lot of it, as you know, is you have the experience in your medical training. You do these different rotations and you like a field. And that's actually not the case with how I chose emergency medicine. So I had done my third year of medical school. I took a year off between second year and third year, a year off between third and fourth year, and then two years off between medical school and residency. So I took four years off in total before I started my residency training. But I had taken that year off between third and fourth year. And in that year, even without doing an emergency medicine rotation, I decided that I was going to apply to emergency medicine residency, and it was for three reasons. One was I thought that it would suit my personality. I am very high energy, very impatient. I thrive on adrenaline. I met a lot of e-med folks and I thought that I would really fit in and that turned out to be the case. So that turned out to be true. The second thing was I thought and still believe now, that emergency medicine, you are the front doors to the health care system. You see the failures of what happens upstairs in the hospital and how it impacts our patients. You see what happens with policies and barriers with policy and how that impacts our patients.
Leana Wen: [00:08:14] You see public health issues and infectious diseases. You're the frontlines of that. And so that aspect really appealed to me. That also turned out to be true. The third part that turned out not to be true, but it took until I became an attending to work this part out because I love emergency medicine and again, suits my personality, suits what I want to do for public health and policy. But the part that I thought was the case was that this would be a good field to have a part-time practice. And I don't think that that's true. I think emergency medicine, just like surgical fields, is very technical. And I don't just mean procedural technical, but in emergency medicine you have to feel sharp. When somebody comes in the door, you need to know exactly how you're going to triage them, what you're going to be doing for this individual, how you are to balance all the people who are waiting to be seen, the people who are already waiting for different procedures, which nurse and which tech and which student and resident, etcetera. You're assigning to each person. You're managing ed sometimes of 80 or more patients all at once. And so that type of sharpness I don't think actually lends itself that well to a part-time career. And I wish I had known that because I had always known that I was going to do medicine part-time. I think had I known this aspect more clearly, I might have chosen a different field, despite the fact that in so many other ways this is the right field for me.
Tyler Johnson: [00:09:37] So let me ask you this question, though, Doctor Wen so while I can see some similarities between emergency medicine and what you do in public health, the one way in which it seems so very different is that in emergency medicine, as you mentioned, a person comes in, you assess what's wrong. You either. Decided to admit them to the hospital and get them the help they need. That way, or you do something to them, right? You put a splint on them or you put a cast or you give them antibiotics or whatever, and you get them better and then you send them on their way home. Right? But in public health, it's almost never that way. There are so many like layers between what you do and the people who benefit from it, which I'm not a public health person myself, but I have to imagine that one thing that would be potentially difficult about it is precisely the fact that you just don't get to see the immediate impact of your work, at least in as immediate of a fashion as you do when you're working in many kinds of medicine, but especially emergency medicine. Did that ever feel like a disconnect or how did you grapple with that difference between the two fields?
Leana Wen: [00:10:39] Yeah, that's a fascinating take on things, and I'll tell you why I don't feel that disconnect. It's for two reasons. One is that so many decisions in public health, especially in the kind of public health work that I do and did, which is in the frontlines. Right. I mean, I think if you're an academician, very different or if you're doing public health research, very different. For example, when I first started in the Baltimore City Health Department as the commissioner, we had a case of suspected measles and there was an immediate decision that needed to be made about do we send out a public alert? Do we end up treating this as measles, in which case we have to put a lot of people into quarantine and test them? I mean, there are significant impacts on fear, on economic resources, on general resources being deployed and funneled from elsewhere. And those are decisions that have to be made with incomplete information. Hindsight is always 20/20. People will always second guess your decision making once they know what the outcome is, which I feel like is what happens in emergency medicine a lot, right? That somebody, a patient is admitted and then people are like people on the floor. When's that patient is admitted to the hospital are like, how could you not have seen this? Why didn't you make this diagnosis? Well, we didn't have the results of the blood test or the CT scan at that time. That's why we gave antibiotics. And it turned out they didn't have an overwhelming infection and they had some cardiac reason why they're in the hospital, but we didn't know. So we had to treat them right. And so I think that that's one element where my emergency medicine training prepared me well for those kinds of decisions that had to be made, because not making a decision is a decision, too.
Leana Wen: [00:12:14] And I think there are a lot of people potentially who came from backgrounds where they they had more data before making a decision who might have waited longer than would be ideal. And so I think that's one element. And then the other element and I really appreciate you bringing this up because I think there is something to be said about the trajectory of time in public health, because you're absolutely right, the trajectory as we traditionally think about public health is really long. I mean, measuring life expectancy, if you're measuring the impact of an intervention on increasing life expectancy years, we're going to be waiting a long time to see those results. And the downside of that is that people are going to lose patience. And especially if we're talking about politicians and allocation of funding for public health resources, they're not going to wait until, you know, ten years later when the data come come in, when there are more pressing priorities that have more immediate impacts like policing or education or jobs. And so I think the challenge in public health is to have long term aspirations while having short term metrics and short term deliverables that we can show the community, that we can show politicians, that we can show decision makers and demonstrate that while we are aiming to get to these longer term solutions, because that is really important too, We can't just be doing things short term just for the show of it, but you do also have to make a show of it so that we don't let people forget about the impact of public health.
Henry Bair: [00:13:44] So this kind of gets to my next question, which is when I read the part in your book about how you came into this position, there have so many questions here, right? Because it sounds like you hadn't really previously worked in Baltimore, you hadn't lived in Baltimore, and here you were up for this position. Your experience is holding positions in public health. Leadership were rather limited. You were, I believe, in your early 30s. Correct me if I'm wrong. So here you have this position offered to you, the oldest public health department in the United States. Can you share with us how does one even go into that kind of a space? And what were some of your immediate missions or your, I guess, your overall objectives going in?
Leana Wen: [00:14:27] I think part of that has to come down to process, recognizing that process is as important as outcome. And in this case, I fully acknowledge that I was someone new to Baltimore, which is a city where everybody asks you, where did you go to school? Meaning high school, because it's a city of neighborhoods, people know each other. You are seen as a newcomer. Unless you were born and raised and your parents were born and raised. And I understood that and owned. At and came in saying that I wanted to learn even well before I started in the role, after I was officially appointed, I think there were several months before I officially started. I already began a listening tour. I asked people who I trusted in the city to identify others that they trusted. I met with them, asked everyone to come up with a list of people that I should meet with ahead of actually starting in this job. And a lot of the names overlapped. And so I. I met with dozens, if not 100 people prior to officially starting so that I could get a better sense of how the city worked, who were the the major stakeholders, what was on people's minds? What did they think that we should be addressing? And I also specifically sought out the advice of two past health commissioners, Dr. Peter Billings and Dr. Josh Sharfstein, who talk about a lot in the book in Lifelines, who were both actually quite young. Peter was my age at the time that he was that he was the health commissioner.
Leana Wen: [00:15:46] He was also 31, I think at the time, or 32 at the time. And Josh was also in his 30s when he started. I sought them out and I ended up on day one when I when I began, I already had my team. I had approached two people who were close confidants of both Josh and Peter, who had a lot of experience working in the city. I approached them and they were on board to start as my deputies on day one. And Olivia Farrow, Don O'Neill are phenomenal individuals. They also, crucially, had skill sets that I lacked, including deep experience in the city, deep experience working in in these types of government bureaucracies. They also were veterans to the health department itself and so had a lot of contacts already there. And so I think that intentionality of approaching people, surrounding yourself with with a group of individuals who complement your style and complement your your expertise are really important. And I would also say that people really should not discount the experiences that they already have, especially clinical experience. There are many lessons to be drawn from the way that we interacted with teams orled teams or worked in the nonprofit space or worked in other local government opportunities or something else. And I think that just because you're coming into a job, that's not exactly what you've done before. If you are intentional about drawing upon your past experiences, you'll actually find out that you have a lot of the skill set that's there already.
Tyler Johnson: [00:17:16] So I want to ask about a couple of specific public health challenges, one that you faced directly and then one that you didn't face directly but have spoken and written about quite a bit. So the first one is about the opioid epidemic. You know, one of the things that strikes me about the opioid epidemic is that there are so many ways of analyzing it. So on the one hand, you can take a very and I don't mean this pejoratively at all, but a technocratic like a technological, logistical analysis of how do we get the people who need help, the help they need when they need it in a way that they can access it, and that will be useful to them. Right. And I think that my understanding, again, not being a public health specialist, but my understanding is that when you were leading in Baltimore, your city made an enormous amount of progress in terms of things like making naloxone available and trying to destigmatize the problems associated with it so that people could get the treatment they needed when they needed it. At the same time, it also strikes me that one of the things that I think has been widely written about, including in a sort of seminal article in The New Yorker, when the opioid epidemic was still sort of coming into the consciousness of the United States, is the fact that it also is sort of a in addition to being a logistical problem, is also a wider sort of a symbol of a wider cultural problem, of the sense that we live in an era when many people have just arrived at a place of hopelessness or emptiness or whatever you want to call it, such that not that this is by any means the sole cause, but that one of the causes of the opioid epidemic is that people are trying to, in effect, fill a cultural or whatever you want to call it, hole with these kinds of medications that then end up being very dangerous. And I'm just wondering, as a public health leader, how do you think about that overlap and how do you try to approach all of the different aspects of such a complex problem at the same time?
Leana Wen: [00:19:13] It's a really good question, and I appreciate how you've very thoughtfully laid out the complexity of this. I think the short answer is that you can't. I don't think that a single entity should try to get to all aspects of a complex problem like this because you end up in a state of decision paralysis. You end up saying, unless I do it all, I can't do anything. And actually, I had this criticism a lot when we worked on our programs around opioids because we often had the criticism of, well, you're not getting to X, Y, Z, you're only doing ABC. And they're right. And I would look at them in the eye and say, you are 100% right. We also have to get to the root of. Why are people in pain? What is this hopelessness that's occurring? I mean, I so appreciate the work of Dr. Vivek Murthy in fostering connection and overcoming loneliness. I mean, I think that's a large part of it. I think we have to do a lot more with employment and giving people job opportunities that may also be contributing to this too. I mean, all of that is real. I mean, systemic racism, poverty, mental health issues, all of that is real. It needs to be addressed, too. But as a health department, that's limited in resources. You can't do it all. And so you pick what's in your control to be able to have an impact. And for us, we started with naloxone in part for this reason, because if people are dying in front of us right now, it's our obligation to save their lives.
Leana Wen: [00:20:39] And so that's why in 2015, we were one of the first jurisdictions to really put an emphasis on the standing order, the blanket prescription for everyone in the city to be able to get naloxone to carry it everyday. Residents used naloxone to save the lives of 3000 fellow residents and family members and friends in the first three years of this program. And so something like that is concrete. It's tangible. Sure, it does not get to the root causes, but it's something that makes a difference now. And by the way, something like that can also galvanize attention and resources to work on some longer term solutions, which for us was increasing treatment access. And we did a lot of work around treatment as well, including starting the beginning of a 24 over seven, essentially an E.R. for mental health and addiction. And so I think you can work on both things. You can work on all of it. And part of what I've learned over time is that we need to be cognizant of the ecosystem, that we need to support the ecosystem of everyone who's working in this field. But some people are going to be working on the downstream, some people are going to be working on upstream, some people are working on one population, some others on another. And at times there will be disagreements. Not everyone will agree on every policy solution. Some some policies may negatively impact one group over another. But on the whole, I think we need all of it.
Tyler Johnson: [00:21:58] Thank you so much for that answer. Let me follow that up by asking about a second challenge, which I know occurred after your time leading Baltimore, but which, as I said before, you've commented on a lot, which you know, of course, public health, I feel like was this thing that most people were only vaguely aware even existed. And if you had asked them to name a thing that a public health director did, many people would have probably drawn a blank even five years ago. But now we have gone through this period where many people knew like the name of the public health representative in their city or town or whatever. Right? Because during the pandemic, these people were all of a sudden who had mostly been toiling away pretty anonymously in offices and whatever were thrust front and center and in many cases became celebrities might be a strong word, but something on that spectrum, right? They became public figures, let's say, and had a much more public forward facing role. But the thing that is so interesting to me is that during the pandemic, in a way that I don't think had ever been, or at least in generations had not been nearly as true in the United States as it was then, is that public health became deeply, deeply politicized, almost definitionally politicized.
Tyler Johnson: [00:23:09] Right. Where it became almost a marker of your political affiliation and in some ways a marker of almost an identity marker for a lot of people, how you would respond to public health professionals. And you can look, I mean, the sort of easiest avatar for this, right, is to look at Dr. Fauci and the way that he became a hero for some people and a sort of a scapegoat or almost a villain for others. And so I'm just wondering, what can you, as a person who has worked so much in public health and commented so much on the pandemic and written in The Washington Post and other places about sort of how we've responded to that and all the rest. What are your thoughts about how to allow public health initiatives to still be effective in an era when it seems like almost nothing in the public sphere can come to fruition without it becoming so hopelessly politicized that it feels to me like it would almost be paralyzing.
Leana Wen: [00:24:05] That's probably the biggest challenge for public health right now. Exactly what you've just articulated. I think it's really sad. Let's just put it out there. I think it's really sad that we've gotten to this point. I wish we were not here, but I also think that we need to be realistic. And what I would say is what we do going forward has to be different depending on the part of the country that we're in. So let's use the example that you gave of Dr. Fauci. You're right. Dr. Fauci would be that symbol for many people of public health, for better or for worse. So let's think about if Dr. Fauci were to parachute into where he lives, probably in this area, so he wouldn't have to parachute. But let's say that he appeared in the middle of downtown Bethesda or he came to Berkeley or Palo Alto. I think that he would receive a hero's welcome. Certainly don't think that he would be booed or have things thrown at him in these types of places. I think that these places, public health has been elevated in a way that's really positive, because you're right, prior to the pandemic, people probably didn't know that there was even a local health department. They wouldn't have known about all the people who work in public health who are toiling away behind the scenes, invisible, because that's what public health generally is. And so I think these places can actually push the envelope a bit.
Leana Wen: [00:25:19] Maybe they can even use the fact that public health is this kind of symbol and say, hey, here in Bethesda or Palo Alto or wherever, we really believe in science. And so we're going to do more with public health. On the other hand, there are many, many other parts of the country where, frankly, Dr. Fauci's life would be in danger if he were to suddenly appear in the middle of who knows where. And I think that the public health officials in those areas, my advice to them would be, do not talk about Covid. Do not talk about masking. Do not talk about things that unfortunately, have become so polarizing. Do I wish that that were not the case? Of course. But the fact that Covid vaccines are so polarizing, I think it's a good idea for people in those areas to rather look for other topics, other issues, the many other topics that remain in public health and almost rebrand for individuals who only associate public health with Covid. Maybe they should think instead about what public health can do for seniors, what public health can do for moms and babies, what public health can do for vulnerable individuals, what public health can do for for middle class families. I mean, I think that all of these types of things are important. And the more hyperlocal, the outreach, the better it's going to be to rebuild trust in public health.
Henry Bair: [00:26:45] So one of your mantras, as you've mentioned already, is public health saved your life today. You just don't know it. Which gets at the point that if done well, you don't really see the effects of public health on society. Everything is running smoothly and you don't know what's happening behind the scenes. It's a little like how you don't think about the doctor when you're perfectly healthy. So how do you balance that with efforts to demonstrate to people the value of public health?
Leana Wen: [00:27:15] I think that it is telling stories much better than we currently do. It's putting the face on public health in a positive way. What I mean is the following. When you go to a fundraiser for a hospital, you often see patients talk about their experiences. They talk about how they received cancer treatment there or they were in a terrible car accident and they received care and now they're alive. I mean, these are really heartwarming stories, but what is the story of someone whose child could have been lead poisoned but was not lead poisoned because of interventions that were done in the home to remove lead? Right. What is the face of a child who didn't die in infancy because they were given a safe crib to sleep in and the family had good post-partum support? I mean, it's much harder to tell those stories. And so I think that one solution is to when there are tragedies that occur. You do mention how programs can help and what is already being done, and that's not shying away from the tragedy, but rather explaining that the tragedy is something that's so unfortunate. But it does draw attention. It should draw attention to this really important issue. Another suggestion is for individuals working in public health to make the connection for others come election time. There are people who care about the standard issues. They care about jobs, policing, education. But actually all those issues also have a close tie to public health. But we're the ones that have to make that connection for them.
Henry Bair: [00:28:54] When I read your book, it's abundantly clear that you are an extremely ambitious and accomplished person. And yet one of the themes that comes up over and over again is the importance of advisors and mentors. You write about how when you were in college, someone helped you get into medical school. While you were in medical school, someone gave you the confidence to craft your professional identity. Even while you were the health commissioner, you relied on advisors to help you make the best decisions. So let's talk more about that. What advice do you have for medical trainees and early career clinicians about finding mentors and what makes a good mentor?
Leana Wen: [00:29:36] I'm so glad you asked about this, because this is a topic that's really close to my heart. I mentioned early in our conversation that when I first started in my my journey to become a physician, I really didn't know how to get there. And it took really a village. I mean, I didn't know this exactly at the time, but I was so fortunate to have met in college this professor named Dr. Raymond Garcia, who drew out of me, that I wanted to be a physician. I didn't I was too afraid to tell him because I thought people would laugh. He helped me to connect with other students. I was attending California State University in Los Angeles. I didn't know other people who successfully came out of my my college and became medical students and physicians. He introduced me to them, to people that he had mentored before. And that kind of of connection, which I think may be easy for some individuals, was really not for somebody with my background in medical school, I was fortunate to meet other mentors, including Dr. Fitzhugh Mullan, who I was given the opportunity to work with. And actually on that note is the point that you brought up, which is what advice would I have for others about mentorship? I'd say two things that I've learned over the years.
Leana Wen: [00:30:42] One is that often when we think about potential job opportunities or internship opportunities, we think about what is the organization that we're going to be working with and then what are we going to be doing? And then we think about who are we going to be working for. I would recommend that people think about that backwards, that rather we think about who we're going to be working with. And for first, because as long as you're working with somebody that you really trust and has the same values as you, they're going to put you to work doing something valuable. And you're also not likely to be at a cigaret company or a gun manufacturer or something if you're working for somebody that you really believe in. So I would say look for the person even more than you look for the organization and the specific title or something else that that you might have. And then the other piece of advice I would say is, especially now as a mentor who is approached by others about mentorship, I think it's really crucial for people, for mentees, to be actively thinking about what can you bring, what can you bring to the mentor.
Leana Wen: [00:31:42] I was intentional about doing this, especially as I proceeded in my career. I knew what skills I could bring to the table, which is I'm an efficient and fairly good writer. And so I would always find mentors who needed things written up. And I don't just mean journal articles that would benefit me, of course, but also emails. I mean, this is before generative AI and people actually needed others to draft memos and and talking points and speeches. And I would be I would have been happy to do that. And I was I offered those as the services to the people that I worked for in exchange for being with them as their special assistant in high level meetings or whatever else that I wanted to get out of it. And so I would just say to people, often mentees approached mentors and say, Will you be my mentor? Will you help me? Another, maybe more effective way is here's what I can help you with. I would like you to help me with this, but here's what I can offer you as well. And perhaps that's another way of thinking about mentorship.
Tyler Johnson: [00:32:39] I know that we're very close to the end of your time. You've been so generous. Let me ask you this question as we're wrapping up. So, you know, we mentioned the many causes of the opioid epidemic. I think that there is also a we have spoken often on the podcast about the epidemic of burnout and the loss of meaning in medicine. Right. Hopefully not too, although there is, of course, also a problem with inappropriate use of substances in medicine as well. But even if it doesn't get to that point, many people are leaving the practice of medicine. There is, I think, a real problem with people no longer feeling like the practice of medicine is meaningful. And so one thing that I wanted to make sure that we ask you is you have done so many different things in your career, right, from working as a doctor, taking care of individuals in an emergency room to leading a public health department to and have now gone on to write and to be a commentator and many other things. But through all of that, if you had to sort of trace the golden thread that brings meaning and purpose, that sort of binds all of those things together, how would you think about what that looks like for you?
Leana Wen: [00:33:49] I think that thread is caring for the individual and caring for everyone, no matter where they came from, no matter what their background, no matter their economic status, no matter their race. That's why I wanted to be a physician in the first place to care for people and their physical and mental well-being. And I think that the work in public health is very much about that, too. And the work and communication, especially during Covid, which as we have all lived through, was such a confusing and terrifying time. It was very much about providing accurate information and helping people, guiding people through these very confusing and challenging times. So and I think you're right, too, about this epidemic of burnout and the moral injury that health care workers have really been suffering. I don't have a good solution to this except to say that for all of us, we need to remember our North Star and what keeps us in this. There is a quote that I use a number of times in in Lifelines, which is from Senator Barbara mikulski, who says you should do what you're best at and what you're needed for, do what you're best at and what you're needed for. And that might change over the course of your career. It'll change over the course of your training. I would also add as advice, especially for trainees, is don't wait. A lot of people wait for that perfect opportunity. That perfect opportunity may never come. And also the perfect opportunity for you in ten years is not the same as the perfect opportunity for you now. And so I would just encourage people to take advantage of the opportunities they have right now to make a difference. And I think that kind of agency, in seeking out ways to help our patients, to help our communities, that also helps to counter burnout to.
Henry Bair: [00:35:29] Well, with that, we want to thank you again, Dr. Wen, for taking the time to join us for sharing your story and for all the wonderful work that you've done. We really appreciate this.
Leana Wen: [00:35:38] Thank you so much. Thank you for having me on The Doctor's Art and also for the great work that you both are doing. So best wishes.
Henry Bair: [00:35:47] Thank you for joining our conversation on this week's episode of The Doctor's Art. You can find program notes and transcripts of all episodes at www.thedoctorsart.com. If you enjoyed the episode, please subscribe rate and review our show available for free on Spotify, Apple Podcasts or wherever you get your podcasts.
Tyler Johnson: [00:36:06] We also encourage you to share the podcast with any friends or colleagues who you think might enjoy the program. And if you know of a doctor, patient or anyone working in health care who would love to explore meaning in medicine with us on the show, feel free to leave a suggestion in the comments.
Henry Bair: [00:36:20] I'm Henry Bair.
Tyler Johnson: [00:36:21] And I'm Tyler Johnson. We hope you can join us next time. Until then, be well.