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Join Erkeda DeRouen, a family physician, as we delve into the recent remake of The Little Mermaid. Discover how this Disney film led Erkeda on a journey to explore the inspiring story of Howard Ashman, his battle with HIV during the AIDS epidemic, and the lessons we can learn from his legacy. We’ll also discuss the power of storytelling in health care and how collaboration can revolutionize the system for better outcomes.

Erkeda DeRouen is a family physician.

She discusses the KevinMD article, “The Little Mermaid inspires a health care revolution: Breaking silos for equitable, accessible, and innovative solutions.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome back Erkeda DeRouen. She’s a family physician. Her KevinMD article is titled “The Little Mermaid inspires a health care revolution: Breaking silos for equitable, accessible, and innovative solutions.” Erkeda, welcome back to the show.

We’ll talk about your article a little bit, but for those who didn’t listen to your first episode, which was way back in 2021, just briefly share your story.

Erkeda DeRouen: I started out in traditional community health care centers, where I thought I would dedicate my whole life to FQHCs, but I discovered health care technology. From there, I have had a lot of different leadership roles, started doing speaking engagements, and grew my opportunities. Now I work as a health care consultant, and I’m also starting a new organization that’s going to work on decreasing health care disparities and addressing the social determinants of health.

Kevin Pho: Excellent. You mentioned that you were certified in diversity medicine. What exactly is that?

Erkeda DeRouen: As we know, there are so many different board certifications and things out there, and I am very passionate about decreasing health care disparities. Through the American Association of Public Health, they have a new board certification that highlights how to deal with different cultures, how to work with the LGBT population, and how to be more culturally competent. They have a lot of core competencies to go through, and then you take a board exam and get board-certified. It’s newer; I think it’s been out for about two or three years. But I think it’s an amazing thing for people who are interested in diversity to explore, so that we can be more educated as to how we can help and empower our patients.

Kevin Pho: For those who aren’t familiar, just give us the connection between social determinants of health and diversity, and how that impacts health.

Erkeda DeRouen: Especially for those of us who are in primary care, we know that 20 percent of your health is impacted by the health care system and everything that we’re engaging with patients on. Everything else is their outside part: their home, their education, their access to healthy foods, their access to jobs, their access to advancement. All of these things come together to make us who we are.

So if you have patients out there who may be, quote unquote, “non-compliant” and not taking their medicines, we have to dig deeper and realize why. Is it because they don’t know that there are certain things they need to eat? Are they choosing not to pay for it because they need to pay their rent? Or do they have a corner store, where they don’t have access to healthy foods? We just need to work on asking more questions and then figuring out how we can collaborate and innovate in this space to help people all have access to these things.

Kevin Pho: So your KevinMD article is titled “The Little Mermaid inspires a health care revolution: Breaking silos for equitable, accessible, and innovative solutions.” Tell us, how did your article come together?

Erkeda DeRouen: It’s a funny story, and I tell it a little bit in the article. The Little Mermaid came out this summer, and everyone was talking about it. I was really excited to see it because I was excited for the girl power and I was excited for the diversity. But I was a little skeptical, because when I was younger and the original Little Mermaid came out, it was my absolute favorite Disney movie. So I went in ready to critique it, and it was amazing.

So I started going home and looking at a few YouTube videos on the little theories and stuff, and it took me down a rabbit hole where I found out about its original lyricist, Howard Ashman. I didn’t know much about him, and there actually was a documentary about him that explored how he was living in the time of the HIV epidemic. It was a time, in the late ’80s and early ’90s, when people weren’t as open about their truth and what they were experiencing, and there weren’t a lot of things you could do to care for people who were living with HIV, so it was a death sentence. It showed us how he worked through it, and he actually died from it. But it also showed how scared he was to tell people, and what kinds of boxes he had to live in.

Now we live in a time where we have health care, we have ways to innovate, and we have medications to treat it, and we should. There are so many opportunities to decrease these disparities, so that we may continue to allow people to tell stories like Howard Ashman did. I think when he won the Oscar posthumously, they said he was the person who gave the Little Mermaid her voice and a beast his soul. So I’m sure there are so many other innovators out there, whether or not they’re in health care or other things, where we can come together and help people, despite what they’re going through.

Kevin Pho: One of the things that you mentioned in your article was the so-called Disney model of storytelling. What exactly is that, and how can that be applied to health care?

Erkeda DeRouen: Stories are important, and I think Disney hit the nail on the head with that. I was listening to the thing with Howard Ashman, and he said you always have to set it up for a moment, build, and have the point where the person finds out who they are, and they have that “I want” song. What I want is for us to have decreased health care disparities, and the way to do that is to use the power of storytelling to reach communities, to reach the government and change policies, and to reach different organizations that have the power to help us create these things.

So it’s going with storytelling to create innovation and to collaborate. Right now I’m working in the health tech field, and I realize that a lot of times we work in silos, where the medical people are working on one side and the engineers on the other, and we don’t necessarily speak the same language. So we have to figure out a way to mesh them together and help them understand, for example, why we need a history in the EMR every time instead of just asking it on the first visit: because things change, and things evolve. A lot of that just comes through storytelling and sharing these experiences, so that people will know what’s going on.

Last year I did a TEDx talk called “Did Disney just save health care? Imagine this,” and it goes a little more deeply into how we can use people from all walks of life, even outside of health care, to bring entrepreneurship or their states of excellence as subject-matter experts to change and innovate.

Kevin Pho: Yeah, I completely agree. When it comes to changing minds, we can’t rely on policy, numbers, PowerPoints, and statistics to change minds. You really have to use stories to sway the emotions, right, and really to make that difference. Now, when it comes to reducing health care disparities, give us an example of how storytelling, or how stories, can move the needle there.

Erkeda DeRouen: First of all, there are a lot of people who don’t necessarily know what is going on. They may not have experienced it; they may have always had a job with insurance, and they just think that’s how things work. So you give an example. For example, in my TEDx talk, I talked about a patient. This isn’t his real name, for the listeners out there, but I’m going to name him Mr. Jack. Mr. Jack was uninsured and undocumented, and he had some kidney problems. They began to evolve because he couldn’t see a specialist and couldn’t afford the medicines, to the point at which he had kidney failure. Instead of him being able to go get dialysis and all the things that he needed set up, the only solution was for him to go to the emergency room every three days, because he couldn’t afford to go to the dialysis center and they wouldn’t accept him.

So telling these stories and sharing these things could lead to other innovations. We’ve seen a lot of dialysis and kidney health tech companies coming up, where we can get some subsidies in these environments, and we’re just figuring out ways in which people can connect and learn from these things.

Kevin Pho: Another thing that you mentioned, drawing parallels from how Disney tells stories and how that could be applied to health care, is embracing what’s called a “no-box” approach, right, without limitations. What exactly is that? Tell us more about it.

Erkeda DeRouen: It’s just to think outside the functions of where you are. A lot of times in health care, we say we’re doing these things just because we’ve always done it that way. For example, “We need to use Epic,” because that’s what we’ve been using since we got the EMR, and most hospitals use it. But we don’t have to; we can think of other ways. We can actually learn from other industries, as we have before in terms of learning from the airline industry with surgeries, with their check boxes and the universal checklist, or use information from other organizations to learn how they run.

For instance, we could learn from Costco, instead of other large health care systems, how they make things cheaper and more affordable for everyone. We could learn from teachers, or bring them on board to work in our health care systems, to help create patient information that’s more digestible and understandable. There are so many different ways we can think outside of the box to create solutions and learn from others, even if it’s not necessarily tied to health care.

Kevin Pho: Now, you’re a health care consultant, so I’m sure you straddle a line between the traditional health care model and health care innovators, right? So what are some of the barriers that you see that prevent these no-box solutions? What are some of the limitations and obstructions that separate what you want from what’s happening now?

Erkeda DeRouen: I think a lot of it is the mindset, as well as the money, of course, the stuff from the VCs. Venture capitalists always have a little more say than they probably should. But at the base, it’s more about speaking each other’s language. Say you have someone who is a business expert who has grown many companies. I’m just making this up; this isn’t someone that I’ve worked with. But maybe they created Kodak films, and they want to come together and create something in the health care space. Yes, you’re an amazing business person, but we need to know how to work through the processes.

I’ve definitely noticed that there’s a disconnect. In health care, we like to say, “Here’s the problem, we know how to fix it, let’s do this to fix it.” In engineering and things like that, of course, they have the design thinking method, where they come together and they’re like, “Here’s the problem, let’s get an example, let’s talk through it, let’s figure out the low-hanging fruit that is the cheapest, then let’s come up with the cheapest version one, put it out, get feedback from our different users, and then reiterate it and make it better.” Now, neither way is wrong, and they both will get to a wonderful solution, but one doesn’t necessarily go with the other.

We have to figure out a way to, one, communicate this with each other, so that people in health tech know that that’s how the system works, because a lot of us are leaving traditional health care to get there, and we may not understand the process. Then we need to communicate with those in that field to merge it and figure out a happy medium.

Kevin Pho: Are you encouraged by what you’re seeing? Are you seeing both sides listening to each other, from your role as a health care consultant?

Erkeda DeRouen: Absolutely. I think people are looking; they’re looking to be the next big thing, and they’re looking for these solutions. So as a health tech consultant, it’s my role to figure out a way to explain this and help them go through the road map of how to get to the point where they are merging their health care teams with the others.

Kevin Pho: We’re talking to Erkeda DeRouen. She is a family physician. Her KevinMD article is titled “The Little Mermaid inspires a health care revolution: Breaking silos for equitable, accessible, and innovative solutions.” Erkeda, tell us some of your take-home messages that you want to leave with the KevinMD audience.

Erkeda DeRouen: Storytelling. We have to figure out different ways to reach people. But at the core of all of this, for those who are listening, we have to remember our why. There are a lot of people who go into health care, and then they may not necessarily remember, or they remember but become more distant from the patients that they serve. Or you’re in health tech, and you may not necessarily have what they call the user, which is the patient. We have to remember that the patients are at the core of everything we do.

For instance, I have a more recent story that I’ll tell quickly, because I know that time is dwindling down, but it brought me back to my why. With working on all of these different things, of course I love my patients, and that’s why I’m here and why I’m doing this, to reach people from a higher level. But on a personal level, my cousin, who’s 30 years old and did not smoke, was diagnosed with stage four lung cancer about three or four weeks ago. She has Medicaid and is from a more underserved environment. The initial hospital that she went to just diagnosed her and told her to go figure it out on her own. There was no social worker. There was no collaboration or connection to who else she could go to, just because she didn’t have the insurance in that jurisdiction. It took me a while to help her navigate, and even calling in to the hospital, the care was horrendous.

So I want those who are in health care to remember the patients that you serve. Although you may see a lot of patients with the same condition, remember that it’s their first time, and it’s their only diagnosis, and they’re dealing with it. So even if you’re not able to help them, it’s OK to give them resources, it’s OK to navigate, and it’s OK to be nice. Just bring the humanity back into medicine. That’s what I would ask.

Kevin Pho: Well, thank you so much for sharing your story, time, and insight. Thanks again for being on the show.

Erkeda DeRouen: Thank you.