Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!

In this episode, we are joined by Sarah Smithson, an internal medicine physician, as we discuss the stark disparities between the experiences within clinical settings and the broader public’s perception. Throughout our conversation, we explore the challenges of burnout, safety concerns, and the crucial need for collective support within the health care workforce. Sarah’s expertise sheds light on actionable strategies for individuals and health care leaders to address these critical issues and foster a more resilient health care system.

Sarah Smithson is a physician executive.

She discusses the KevinMD article, “Bridging the health care divide: All our actions matter.”

Our presenting sponsor is Nuance, a Microsoft company.

Together, Microsoft and Nuance are leveraging their rich digital technology and advanced AI capabilities to tackle some of health care’s biggest challenges. AI-driven technology promises to revolutionize patient and provider experiences with clinical documentation that writes itself.

The Nuance Dragon Ambient eXperience, or DAX for short, is a voice-enabled solution that automatically captures patient encounters securely and accurately at the point of care. DAX Copilot combines proven conversational and ambient AI with the most advanced generative AI in a mobile application that integrates directly with your existing workflows.

Physicians who use DAX have reported a 50 percent decrease in documentation time and a 70 percent reduction in feelings of burnout, and 85 percent of patients say their physician is more personable and conversational.

Discover AI-powered clinical documentation that writes itself. Visit https://nuance.com/daxinaction to see a 12-minute DAX Copilot demo.

VISIT SPONSOR → https://nuance.com/daxinaction

SUBSCRIBE TO THE PODCAST → https://kevinmd.com/podcast

RECOMMENDED BY KEVINMD → https://kevinmd.com/recommended

GET CME FOR THIS EPISODE → https://earnc.me/e7xqzy

Powered by CMEfy.

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 Sarah Smithson. She’s a physician executive, and today’s KevinMD article is “Bridging the health care divide: All our actions matter.” Sarah, welcome to the show.

Sarah Smithson: Thank you, Kevin. Very happy to be here with you.

Kevin Pho: So we’re going to talk about the article in a little bit. First off, just briefly share your story and journey.

Sarah Smithson: Great, well thank you. As you mentioned, I’m an internal medicine physician by training. I’m a primary care doctor, and I matched into not just an internal medicine residency at Brigham and Women’s Hospital, but a primary care track there with a focus on population medicine. So we got both a rigorous clinical training, and also we were encouraged to think about big picture problems in health care.

While I was a resident there, the dean at Harvard Medical School announced the defunding of primary care, and our residency colleagues at the time really felt like this was a great opportunity to mobilize the primary care community and identify the shared values between that community and the dean at Harvard Medical School. What that led to was the formation of the Harvard Center for Primary Care, and a nonprofit organization now called Intend Health Strategies that’s focused on transforming culture and health care. So I had the fortunate opportunity to work with that nonprofit from its earliest stages.

When I finished that residency program, I went to the University of North Carolina, where I really focused on clinical practice and primary care. And as I think we’re lucky in medicine our careers often do, I had the opportunity to delve deeply into things like quality improvement, medical education, where I served as an assistant dean for clinical education in the school of medicine, and interprofessional education and practice.

And along the way I was kind of staying tethered to this nonprofit organization, Intend Health, and keeping my antenna up for places where we could really incorporate relational leadership, which is the culture transformation framework that we focus on, into the work that was happening at UNC.

And that opportunity came through the interprofessional work that I was focused on. In 2018 we were able to introduce relational leadership as a leadership development program within the Office of Interprofessional Education and Practice. It turns out that this approach in relational leadership has been like the secret sauce for really making effective interprofessional collaboration in the health care setting. And that’s been so motivating and inspiring for me, that in the fall of 2022 I decided to join Intend Health full-time. And so now I get to work on sharing relational leadership on a national level.

Kevin Pho: So tell us more about what relational leadership is.

Sarah Smithson: Right. Relational leadership is really an approach to how we work together. We’re focused in the health care space. It’s how we work together to promote spaces where we all feel we have the opportunity to be fully heard, seen, and valued. Which honestly feels like it should be foundational in the work we do in health care, but turns out to be a bit countercultural.

Kevin Pho: All right, so you co-wrote this KevinMD article, was titled “Bridging the health care divide: All our actions matter.” Now, for those who didn’t get a chance to read your article, just tell us what it’s about.

Sarah Smithson: Absolutely. This actually came out of a conversation that the co-authors, Alexander Mansour and Matt Lewis, and I were having in the context of our work together with Intend Health.

We were talking about an exchange that this article references with a colleague who’s a nurse practitioner, and she was just reflecting. This reflection was happening last winter, when there was the tripledemic, the flu, COVID, RSV viruses were all coming together and essentially placing this crushing weight on clinical settings, that for this nurse practitioner felt very similar to her experience during COVID. And she felt the contrast between her clinical experience at work and what she was observing in non-clinical spaces, where people, she felt, had really returned back to just kind of normal life, life before the pandemic. And I think she was really feeling disheartened by just the disconnect that she perceived.

So when Alexander and Matt and I were talking about this from our different perspectives, mine as a physician, Alexander’s as a public health practitioner, and Matt’s as an expert in narrative focused in the health care spaces, and of course all of us as patients and advocates for people we care for and who we help navigate through health care spaces, we felt like we were seeing an opportunity to align the values of those practicing in clinical spaces and those who are outside clinical spaces.

And so we wrote this article essentially as a call to action to encourage greater alignment and sharing of those values through really pretty straightforward and simple actions. It’s basically an invitation to patients to ask for the stories of clinicians, and an invitation to clinicians to share the stories of their experiences.

Kevin Pho: So tell us more about how this disconnect, you presented as almost two disparate worlds, how does that disconnect affect health care specifically?

Sarah Smithson: Great question. And I think presenting this as a binary is an artificial division, right? Because we often talk about our lives as clinicians and the lives of our patients, when in reality there’s a lot of overlap between those groups.

But when we really operationalize it in thinking about these two silos of experiences, that of a clinician and that of a patient, it really creates a barrier, a barrier in a space that honestly works best when we have a robust relationship. Robust relationship between clinician and patient, robust relationship in our health care teams, those interprofessional health care teams.

And when we continue to promote these silos, we do it in our language, we do it in really promoting transactional engagements in health care spaces, it isolates the clinician. And it really promotes this sense that, and I’ll speak for myself as a physician, I feel like I’ve been taught that when I put my white coat on, everything that’s inside the white coat stays inside the white coat. This is a space that is all about the patient. And yes, we all work in service of providing the best care we can for patients. I think part of that best care includes sharing a bit of ourselves with our patients and our colleagues, and when we close up and we’re siloed, it really does harm to us as humans.

Kevin Pho: So let’s talk about it as a practical matter. What are some ways that practitioners, physicians, and clinicians, how can we share a little bit more of ourselves with patients?

Sarah Smithson: I want to be clear that there are days and times and moments when we don’t have the space for sharing. There are times when a patient may really genuinely ask us, how are you today, and we just want to say I’m good and keep going. And that is great, there are times we need to do that.

There are also times when we can create spaces to share just a little glimpse into what our daily lives are like. So for me as a primary care doctor, if a patient asks how I’m doing and I really am feeling the weight of being understaffed or having a million messages in my inbox, you need to find the authentic space and way for you to share that experience. But I think saying something like, as a team we’re really trying our very best to meet every patient’s needs, and that is a challenge today, and that’s why I’m so grateful for this one-on-one time that we have together, I’d love to hear how I can help you today.

Right? That was 15, 20 seconds and just a little bit of insight into the struggle that we’re facing. It doesn’t have to turn into a whole discussion about what I need as a person, because it is a visit about the patient and what the patient needs.

Kevin Pho: Now, can this be done only at an individual level in the exam room, or are there any organizational approaches that can perhaps bridge those two worlds?

Sarah Smithson: Oh, absolutely. And this is where the work gets a little countercultural, right? I mean, that one-on-one engagement in the exam room is really viewed as an intimate connection between two people.

On a broader level, on either a team level, an organization level, there are ways that we can promote human-first kinds of engagement, right? We can invite the stories of other people, whether it’s through straightforward ways like written sharing of yourself. You kind of have to pause and ask yourself, what do people know about me, the people I work with? What do they really know about me, and what do they not know about me? What do I know about the people I work with?

And it can be something as simple as, when you meet at the beginning of clinic or the beginning of rounds, doing a quick check-in. And it can be something like, hey everybody, go around really quickly, what’s your internal weather today? Right? And if somebody says it’s bright and sunny, well, you’re probably going to approach them in a different way than somebody who says, it is a downpour in here. And they don’t have to say anything more than that. You may want to follow up with them later.

But engaging in these practices on a regular basis, seeing these practices encouraged by some of our formal leaders on a grander scale in our systems, can really start to bit by bit shift the culture in which we work and start to highlight our values in a really meaningful way.

Kevin Pho: You mentioned the word countercultural, and I think that makes a lot of sense here, because the education of physicians, they’re taught to have grit and not share any difficulties, right? Because that’s traditionally perceived as weakness. So just comment on that facet of education, where physicians are taught by their surrounding educational culture to downplay any weakness or any emotion that could be perceived as negative.

Sarah Smithson: I think that’s absolutely true, and I would even go so far as to say sometimes we use an extreme example of that, like shame, as a teaching tool, right? We teach people that there’s no better way to learn than by, in some ways, being humiliated in front of a group. And that is the antithesis of feeling included in a space.

And what we really know, if we look at evidence-based practices of how to get the most out of our teams, when people feel like they can bring their authentic selves, to whatever degree that feels right for them, some people are going to want to be very open, some people are going to want to be more closed, we should create spaces for all of those folks to show up. That’s when we really get the best patient care.

I also think that when we reflect on either the people we look up to the most, or when we reflect on those moments when we felt closest to someone else, it is rarely when they are wearing a cape and standing tall and giving us the illusion that they’ve never made a mistake or never done anything wrong. Rather, when they ask our opinions, or when they express vulnerability, that’s often when we say, wow, that’s really different, and I really feel more connected to that person in this moment.

And I think one thing that I’ve learned over the decade or more of doing this work is that that connection that we make with another person, that is powerful. I think we often go about this work in health care feeling like these problems we face are huge, because they are, and they’re complex. But what I’ve started to learn is, the reality of it is, the foundational unit of making change in these big problems starts with us understanding ourselves and connecting authentically with the people around us. And when we do that, we increase our power, we increase the power of the person we’re connecting with, and that’s how we really formulate change.

So when it comes to our educational practices, I think that starting to help our learners see this at the very earliest stages is ultimately how we’re going to promote meaningful change in our health care system in the future.

Kevin Pho: So tell us a success story. It could be on an individual level or an organizational level, where you implemented some of these interventions and really moved the needle, either for the health care professional side or for patients.

Sarah Smithson: So we have been really fortunate at the University of North Carolina. I mentioned that we started implementing this leadership training in 2018, and since then we have had, I think, 400 or so folks go through the training.

And what I always find interesting is that the way the training works, as it’s designed at UNC, people can come back as facilitators and trainers, and about 25 percent of people who go through the program end up coming back through, and usually they then want to bring this training into their teams where they work.

And one of our facilitators and trainers really has a remarkable story. We’ve actually interviewed him and he’s on our website. In this interview he talks about how this experience was really transformational for him. That he always viewed leadership as, a true leader is that person who’s at the front of the room with all the answers, but that never really felt authentic to him. And in fact he would show up in spaces where he was expected to lead and feel impostor syndrome.

And when he started learning about and engaging in relational leadership tools, which he said initially he was very skeptical and he thought, I don’t need this, I don’t have time for this, I don’t want to go through this. When he realized that he could incorporate check-ins, establish group commitments, incorporate feedback into his daily practices in ways that were really authentic to him, and that he could kind of pull out of his tool belt what he needed in different situations, he said it really helped resolve his impostor syndrome.

Which is something I think we never anticipated really having the power to navigate, I mean, essentially resolve impostor syndrome. That has felt remarkable to me. And so for him to share that, and to talk about how essentially everyone in their office has gone through this training, and they have a shared language, they work more effectively together, they navigate challenges more effectively together, it’s really been remarkable to see that transformation.

Kevin Pho: Now, how about those clinicians who may be listening to you now that may not have the opportunity to go through that training? What kind of tips do you have for them?

Sarah Smithson: Great question. I think the beauty of this work is it’s not rocket science. It’s actually about how to be kind humans to each other. And so these are things that we really learned when we were in grade school, about how to connect with other people. But it is essentially not only kind of taught out of us, we’ve touched on that, but it’s actually trained out of us through the way our work is organized. We are very transactional, we make our checkboxes. That was like what I did in residency, I still do it today, I make a checkbox and I check it off, and that’s important. But what helps us check those boxes off are those connections with others.

We can come in in the morning and ask those around us how they’re doing. Maybe we get really caught up in the day and we observe that someone is becoming withdrawn, or they really seem upset, or they’re getting short with us. Maybe we feel that within ourselves, right?

We can take a deep breath, pause in that moment, really ask ourselves, how am I feeling? Let me just step back and understand. Maybe it’s something as simple as, I’m hungry, I’m angry, I’m lonely, I’m tired, right? Just to be aware of how we’re feeling in ourselves, and then have a sense, observe how it affects the way we’re engaging with others, and start to open up a dialogue with those around us by just checking in with them and expressing to them, you don’t have to say the words I care about you, because simply asking, hey, you seem a little bit different, are you doing OK? We’ve worked that out of our day-to-day because we’re so busy, and that can be a really powerful way to engage with those around us.

Kevin Pho: We’re talking to Sarah Smithson. She’s an internal medicine physician and physician executive. Today’s KevinMD article is “Bridging the health care divide: All our actions matter.” Sarah, as always, we’ll end with some of your take-home messages to the KevinMD audience.

Sarah Smithson: I think in doing this work, what’s really become a valuable lesson that I’ve learned is that, again, these big, big problems can feel intractable and exceptionally complex. There are many things beyond our control. But probably the most powerful thing that each one of us has control over is how we show up, the actions that we take in engaging with those around us. That is where the real power and leverage lies.

And we can start making changes in that, or continue to engage in really positive ways today. We absolutely control that. And so that’s what I would offer to the audience. Start today.

Kevin Pho: Sarah, thank you so much for sharing your perspective and insight, and thanks again for coming on the show.

Sarah Smithson: Thank you.