Ep 50: A Lifeline for Public Health

with Leana Wen, M.D.

October 13, 2021

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Leana Wen, M.D.
Professor of Health Policy and Management, George Washington University Milken Institute School of Public Health

Dr. Leana Wen is an emergency physician and professor of health policy and management at the George Washington University Milken Institute School of Public Health. A nonresident senior fellow at the Brookings Institution, she is also a contributing columnist for The Washington Post, writing on health policy and public health, and an on-air commentator for CNN as a medical analyst. The author of the critically-acclaimed book on patient advocacy, When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests (St. Martin’s Press, 2013), she has a forthcoming memoir to be published July 27th, Lifelines: A Doctor’s Journey in the Fight for Public Health (Metropolitan Books, 2021).

Previously, she served as health commissioner for the city of Baltimore, where she led the nation’s oldest continuously operating health department to combat the opioid epidemic and improve maternal and child health. She has also worked as director of patient-centered care research in the department of emergency medicine at George Washington University; president of Planned Parenthood; global health fellow at the World Health Organization; consultant to the China Medical Board; and distinguished fellow at the Fitzhugh Mullan Institute for Health Workforce Equity.

Currently, Dr. Wen serves on the board of directors of Glaukos Corporation and as the chair of the advisory board of the Behavioral Health Group. She is also a member of the board of directors of the Bipartisan Policy Center and the Baltimore Community Foundation. Her previous board experience includes being board chair of Behavioral Health System Baltimore for four years and serving on boards and advisory of boards to more than ten nonprofit and venture-backed health innovation companies.

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. 

A member of the Council on Foreign Relations, Dr. Wen has received recognition as one of Governing’s Public Officials of the Year, Modern Healthcare’s Top 50 Physician-Executives, World Economic Forum’s Young Global Leaders, and TIME magazine’s 100 Most Influential People.

Dr. Wen lives with her husband and their two young children in Baltimore.

 

Growing up as an immigrant who depended on public health as a core lifeline very much shaped why I went into medicine and appreciate the critical work of public health.

Transcript

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Sanjula Jain 0:03
Women make up 70% of the healthcare workforce but only 20% of its leadership. On Her Story, we’ll explore the careers of bold and influential women from Silicon Valley to Capitol Hill and learn how they’ve overcome the odds. I’m your host, Sanjula Jain and this is Her Story, a program where we explore what’s beyond the glass ceiling.

Dr. Wen is an emergency medicine physician, public health professor at the George Washington University, contributor to The Washington Post, medical analyst at CNN, and most recently authored her new book Lifelines. Leana, thanks for spending some time with us today.

Leana Wen 0:39
Thank you so much. It’s a pleasure to join you, and thank you for the work that you’re doing.

Sanjula Jain 0:43
Thank you. You have been quite busy. I don’t know how you manage to do it all. Let’s start with the core. One of your leadership principles is this idea that good public health needs to be invisible, and your origin story of how you grew up is a big influence in that. Tell us a little bit about how your childhood shaped your professional ambitions.

Leana Wen 1:05
To clarify, I actually don’t think that good public health needs to be invisible. Public health is by definition invisible because it’s about prevention, because you have prevented something from happening, but there is a real cost when the important work that you do is invisible because then it becomes the first thing on the chopping block when it comes to budget time. My life is dedicated to making public health visible, putting the face on public health so that we are able to recognize the life saving, life changing work public health every day. To your point, and so many of the individuals that you speak with, and who I have the opportunity to learn from, we all have something in our personal lives that informs where we are. One of my mentors was the late Congressman Elijah Cummings who talked about pain, passion, and purpose, that your pain is what drives your passion that then informs your purpose. Growing up as an immigrant, as someone who depended on public health as a core lifeline, that very much shaped why I went into medicine and appreciate the critical work of public health.

Sanjula Jain 2:19
You knew pretty early on that you wanted to go into medicine and what’s remarkable for many reasons is that you went to medical school at the age of 18, which is not normal. Tell us a little bit about that process and how you wound up starting so early.

Leana Wen 2:34
I wrote about this in my new book Lifelines, but not because I have any pride in going to school early. If people ask me now, because I have two little kids, “Oh, do you want your kids to also go to school when they’re early?” Absolutely not. If I could do it all over again, in any other circumstance, I would have not wanted it. I went early because of financial circumstances. I knew that I wanted to support my family. We had come to the US not that long ago. My parents were working multiple jobs but still having trouble making ends meet. I wanted to contribute by working, but it wasn’t really possible to do that and also continue my education. The best way I could see was there was a program, a work-study program at my local university at California State University in Los Angeles. They also had an early interest program, so I knew that if I could test into college early, then I could work and support my family, which is what I did. I was single-minded in my goal. I woke up every morning, studied, and went to work. That’s all that I did. I didn’t make friends. I didn’t have any kind of what one would consider to be a typical or desired “college experience.” I didn’t really make my first real friends until medical school, where I just had a couple of friends I did and then I went to graduate school after that, and then made real friends. That is not the kind of life that I would choose for my kids. Many people make decisions in their life because of financial circumstances. That certainly was the case for me growing up.

Sanjula Jain 4:11
That makes a lot of sense. I think there are a lot of trade-offs along the way that many of us have to make in our paths. So while you were in graduate school, you went to Washington University in St. Louis, you got an MD Ph.D. Where did the interest in health policy emerge from?

Leana Wen 4:26
I had no concept of health policy. I actually chose the Ph.D. track in part because I liked science. I was working in a lab. I understood the idea of pursuing a career in science. But again, the finances and the decision about finances drove everything MD Ph.D. programs, some of them offered full tuition. I could not comprehend the idea of going to Medical School and taking on this huge loan. It wasn’t something I would have been able to do. so I applied to MD Ph.D. programs again out of necessity. Also, though I actually did like science, it wasn’t just because of finances. In the process of being in medical school, I recognized that that was not my passion, that lab research was not my passion. Instead, when I saw that what was making my patients sick wasn’t just about the medical care that they had access to. It was also about something else. And it was that something else that the public health health policy, and I didn’t have any concept of that until I started medical school, and until I started seeing patients, but once I realized that, some other thing that was that one of my mentors, Senator Barbara Mikulski says, “You should do what you’re best at and what you’re needed for.” I was like, “Science.” I was good at working in the lab, but I thought what I was the most passionate about and what I could do best was to be an advocate for my patients to work in this policy and advocacy and public health space.

Sanjula Jain 6:06
What’s so beautiful about your story is that you have really self-reflected along the way and you’ve pursued each of those new passions and interests to your point. Along the way, you found yourself going abroad through the Rhodes Scholarship and spent some time at Oxford, coming out of that experience. What did you intend to do career-wise?

Leana Wen 6:27
I went to Oxford on the roads after medical school, so I had a pretty good idea of what I had wanted to do because I was probably back to do residency. Going to Oxford was important for two reasons. One was I did want to have formal training in health policy, economics, public health, I don’t think I would have had the confidence to do the work that I’m doing. Now, if I didn’t have that formal training as then, having the vocabulary meeting individuals who are working in this field, I don’t think that that’s the only way you can work in public health or health policy is to get a degree in it. It was important to build the confidence that I subsequently needed, and then networks and connections that I would have otherwise not been able to have. But the other and actually, more important reason that I went to Oxford was I wanted that college experience that I never had, I wanted the experience of making friends with the totality of who I am. That was actually the key driver of why I went. I read Bill Clinton’s autobiography, My Life, and saw that Oxford was where he met so many of his lifelong friends. I identified with the person, the boy that he was growing up, not having all these connections. When I applied to medical school, I didn’t know anyone who was a doctor. I knew my pediatrician. But I didn’t know my parents, friends weren’t doctors. I wanted to do health policy work. I didn’t know anyone who did it. I could see people and read about their work, but I didn’t know anyone personally, so Oxford was really important to me for that reason. And so coming out, I had a very good, very good idea of what I wanted to do, which was I wanted to finish my residency, my medical training in emergency medicine. Then I wanted to pursue a career in medicine and public health, although something else happened in that which was that my mother, in that time period, when I was in my medical training, my mother was diagnosed and then she was first misdiagnosed and diagnosed with what turned out to be better static breast cancer. I ended up taking quite a bit of time, it was a detour of sorts, it was also public health and policy work. But I took a detour to do patient and family-centered care. I wrote a book about how to avoid misdiagnosis and unnecessary tests. I got involved with many organizations that are doing Patient and Family-Centered work, I started a center for patient-centered care research at GW. Again, this idea of pain and passion and purpose. I never intended to do this work, but it was something that was very painful (helping me to be my mother’s caregiver in this time) that motivated this passion and purpose, too.

Sanjula Jain 8:59
It sounds like a lot of your foray into Public Health Leadership really isn’t in some part accidental, but then there have been some intentional moments in terms of seeking out those experiences. What do you consider your first leadership success to be?

Leana Wen 9:13
In medical school, I got involved very early on in the American Medical Student Association. When I was in Amsterdam, I led a number of projects. I then ran for national president, and then it was the person who was advocating on behalf of 65,000 physicians in training. It took a year off to work in DC to do this work. But actually, I would go before I would say them in college, I, again was this person who didn’t know how I could possibly go to medical school, and I had a mentor who introduced me to other students for his former students who were now in medical school or were in residency and I benefited so much from their experience. mentorship. And then I thought, well, why doesn’t everyone have these opportunities. And so in college, I had started a pre-med club, specifically to help other students to be able to have these opportunities that I was so grateful to have. And so I actually think that that was my first experience of leading something, and doing it in a way that levels the playing field and gives additional opportunities to so many people like me, who were so passionate about going into medicine, but could literally not see our path for getting there. Some of the work of this pre-med club were really basic as if people were going to bed school interviews, we shared outfits, we bought like one nice purse, like one nice briefcase that we all share with me, things like that, that were really basic, but it otherwise cost was such a prohibitive factor for many other people, including me.

Sanjula Jain 10:48
I remember reading about them in your book and thinking about how those early experiences are so important in how they are formulated in our later life, so thank you for sharing that. To that point, congratulations on writing your latest book Lifelines. That is no easy feat. What inspired your decision to write Lifelines?

Leana Wen 11:07
I actually wrote the book with a very different intention than what it ended up turning out to be as then I wrote the book to talk about my experience leading Baltimore’s health department, and I wanted to highlight the work that we did to reduce infant mortality by 38%, in seven years, and reduce the overdose deaths by or save over 3,000 lives from opioid overdose in three years. I wanted to talk about how public health saved your life today, you just don’t know it through the lens of the work that we did in Baltimore. But then when I submitted the Baltimore chapters to my editor, to the publisher, she basically said to me, You can’t read this, because it’s, you’re basically telling people, they have to eat their vegetables, but not telling people why they should care. She said, “You need to write about your own experience and get them to care about you, and then in doing so, they’re then reading the story of public health as well.” That was hard for me to write about my own story. The Baltimore chapters were easy. Writing eventually about COVID was easy, too, because that’s the work I do every day. But writing about my own background, as an immigrant facing evictions with our family going in between different shelters was really hard. Then I ended up writing a lot about my relationship with my mother in a way that I definitely had not intended. Part of the reason was I was pregnant with my daughter when I was writing the book, so I think I was reflecting on this a lot. My mother and our relationship ended up being a through-line I did not anticipate when I first started writing this book supposedly about public health. In all, once I knew what I wanted to write about, it took about five months to write. Then I submitted the book in February of 2020 and my publisher said, in the months that followed, “I’m really sorry, but you have to rewrite this book.” My initial intention was to write the book and then deliver my baby because she was due in March of 2020. I thought, “Let me deliver the book. Now it’s delivered, I can focus on the baby.” Obviously, my editor was right. It took me nine more months to write the next four chapters on COVID, not because I didn’t know what to write, but because things were unfolding all the time and I wasn’t sure how to talk about the lessons learned when we were living through this excruciating period.

Sanjula Jain 13:37
Writing is surely an iterative process, and I’m sure that was not easy, but we’ve all benefited from learning from your story, so thank you for putting some words on pages for that. Writing requires a lot of discipline, and we get a lot of questions about how to carve out the time to do that when writing isn’t your full-day job. Any tips for other aspiring writers out there?

Leana Wen 13:59
Here’s a tip that may not be very intuitive: People shouldn’t write unless they really want to. I have had so many mentees and students over the years who are saying, “I feel like I should start a blog” or “I really need to be writing these articles” and “it’s really hard” and “I don’t want to do it.” My response to them is, “Don’t do it.” There are so many ways for people to make a difference. Do what’s natural for you. Don’t make yourself into somebody else as then. I am not someone who enjoys writing research papers. I don’t write them. Sometimes I co-authored papers with others who are writing them on a particular topic that I may offer expertise, fine, but I’m not going out there every day looking to write journal articles and science articles because that’s not what I’m good at. That’s not what I like doing. If you love writing, that’s great. You’ll already be writing. You won’t be asking this question about how to carve out time in your day. For me, writing was cathartic. I could come back from a long shift working in the emergency department in residency and I would want to write. That’s it. I didn’t carve out time. It’s what I wanted to do because that was my release from everyday life. If you don’t have that passion, there are so many other ways to be heard to get your voice across to do the things that will impact whatever you want to make. Think about that. Then think about your skillset. What do you enjoy doing? Maybe it’s speaking, that’s great. Maybe it’s doing social media posts or Tick Tock videos, that’s great. Don’t make yourself into something that you’re not.

Sanjula Jain 15:31
That’s really well said. We’re in an era where there are so many digital mediums where there is this perceived pressure that to have a voice, to have an influence on whatever issue that you’re trying to shed light on, you got to do the Twitter, you’ve got to do the blogs, you got to do the writing, do all of that, but focusing on your interest areas is really key there. In your book, you have several stories about your experiences as a female leader and what you’ve observed along the way from folks calling. How have you addressed female physicians to working with the mayor in Baltimore? How has the fact that you’re a female shaped your approach to leadership?

Leana Wen 16:09
It’s about people’s identities. I think a bit about myself as a female leader very explicitly, as then, it’s taken me years to understand my role as an Asian American. I still wouldn’t identify first as an Asian American not that I’m not an Asian American, I’m trying to deny it. But rather, if you ask me who I am, I would say I am a public health expert. I’m an emergency physician. I’m a mother. I think of myself in that way, as a female leader specifically. So many of my experiences early on are because I was in a very male-dominated field. And so I just always was very conscious of being a woman. I also identify so much with being a working mom and a leader and everything else, so that also shapes my identity.

Sanjula Jain 17:03
On the working mom piece, you had this incredibly moving story that I think we can all relate to in your book about falling asleep in the bathroom at a dinner party. What advice would you have for other women who were juggling demanding careers and a family?

Leana Wen 17:19
I have two kids. The second one is almost a year and a half. My first is a son who just turned four. My son had terrible stranger anxiety. My daughter is like the happiest person in the world, but my son had terrible stranger anxiety. I just thought, “That’s how all kids are.” He would cry when he saw strangers and it would be really hard to bring him to places because he was so anxious. When he was about a year and a half, one of my best friends from medical school came to visit with his family. He also had two young kids around the same age as my son. Everybody was hanging out and at that time I was in a job where I was working all the time, I was on the road all the time. I was on the road Monday through Friday and barely saw my son. That was the decision my husband and I made together, but it was really hard to not be present for my son. So everybody was playing in the back. My husband went to get people drinks and my son started crying. I couldn’t console him and I realized at that moment that I had been away so much that I was a stranger to him. I thought at that moment, “I don’t want that to happen again.” People make different decisions about their lives, I have no judgment for what other people do, and some people have to because of necessity. I think back to my relationship with my mother because I was really resentful of my mother and I didn’t even realize why I was resentful. It was because she was always gone. Why was she always gone? She was studying to be a teacher, she was working full-time jobs. I just didn’t see her. We didn’t go to our parents. She was never there preparing teacher things for all these recitals and sports games and whatever because she was always working. I understand that many parents may not have the privilege of making this choice, but I do and I don’t want to make decisions in my life where I’m not present for my children. It’s this idea of work-life balance I had always thought of as static. I thought the work-life balance was making a decision at one point in your life. You decide for this job and this. You decided this job is a really time-consuming job and you won’t have the time to see your family. Work-life balance is actually minute-by-minute decisions we have to make every day. It’s the, “Am I going to have dinner with my family or am I going to work on this paper? Am I going to watch a movie with my family or am I going to finish this additional blog post?” Or whatever. They’re constant decisions. “Do I bring my son to school or do I take this conference call?” It’s all the time. My one piece of advice to other women is it’s okay. Whatever our decisions are, we need to give ourselves a lot of grace and recognize that our decision today may change from our decision tomorrow. It may change from our decision two weeks or two years from now, and that’s okay.

Sanjula Jain 20:44
That’s a really helpful way to frame it and put it into perspective. Going back one step, you became Baltimore Health Commissioner at the age of 31. There is no playbook for how you take on that role, nor are you really taught in school how to lead a city. What kind of training or capabilities did you feel like you needed to develop on the job as you assumed that role?

Leana Wen 21:11
I cite a lot of things that other people have said to me because that’s how I learn. Somebody told me you should do everything first as in, if you’re entering a new job where there are new skill sets, would you be better qualified at that job if you did other stuff first that gave you those specific skill sets? If I had led a similar-sized city, prior to becoming the Health Commissioner for Baltimore, would I have been better prepared? Sure. If I were the Deputy Commissioner prior to becoming the commissioner I would have been better prepared, but I would have also missed out on other experiences. Prior to my coming to this role, I had extensive media experience. I had a lot of experience in health policy and public health. I had a lot of national connections. I also worked in local health policy. My point here is, you should do everything first. The other way of looking at it also is that you should draw upon all the strains that you’ve had before, all the experiences that you’ve had, and just be really intentional about learning about each new experience. When I first started my job, for example, there was a case of possible measles in Baltimore, I had never encountered a case of measles in a major city to figure out quarantining and other things. But I had dealt with many emergencies. working as an emergency physician, I understood infection control, I knew how to coordinate among different partners, I understood the principles of public health, I could draw upon those other experiences. And also, of course, draw upon the experts within the department who are able to fill in knowledge and other ways. There’s no way that we as an individual can possibly be experts at everything. It’s about embracing our strengths. And then also embracing the strengths of the people in our team, being intentional about recruiting other people around us, so that we can then fill out as a team and be the strongest possible. I actually don’t think about women too often. We had an open position in my department. And there was one person, a woman who was the natural to be stepping into this role. She was essentially the deputy for this role. Anyway, it should have been in the department for 10 years. Everybody would have said she is the natural person to be in this role. However, when I approached her for this role, she said, “Oh, there are 10 qualifications,” and I only met eight out of 10. Then I said to her, “That guy who’s sitting right there has been here for six months.” He looked at the same job spec and said, I made three out of 10 qualifications. I’m a shoo-in. So often we as women in particular and women of color do ourselves in even before we even try. We say to ourselves, “Oh, we don’t meet these criteria. We’re too young. We don’t have this experience,” we’re whatever. We need to flip this around and say, here are the strengths we have, here’s the will to bring to this position, and here’s how they are. There are areas that we don’t meet, but you know what? We’ll find other people who can be strong in those areas.

Sanjula Jain 24:06
Absolutely. Your strengths have paid off and have made Baltimore a much-improved city, which we’ll have to do a part two on to dig into. But looking at public health today, you have become a national voice during the COVID pandemic, from your role on CNN and the writing that you’re doing with the Washington Post. What lessons have you learned from your ability, how you’ve had to manage influence through the local level with Baltimore to now at a national stage?

Leana Wen 24:32
You know, I again, would emphasize that people should draw on their strengths, my strengths, and what I love doing is in this outwardly facing media, public policy advocacy framework. I’ve also recognized over time that where my voice is the strongest is in a nonpartisan, political, but not partisan way as by engaging in policy by definition, you have to understand politics, but you do not have to Engage in partisan debates and ideological culture wars. My recommendation is to find what you really want to do. Do that, but also find your voice and where you are the strongest. Another piece of advice I would give, and that I often say to young people in particular is, don’t wait. So often people will say, “I want this ideal opportunity,” and they might be offered something from a mentor that’s a part-time thing or a research paper or whatever it is and they’ll say, “Well, I don’t quite want to do that.” That’s totally the wrong approach. Early on in my career, in particular, I turned nothing down. If my mentor said, “Can you work with me on this project?” My answer was, “Absolutely. When do you need it to be done by?” Some of the experiences that I had as a result of working on things like that weren’t totally unexpected. And were the best experiences that I’ve had. I met incredible mentors that way. And so I know, in Baltimore that I had interns or fellows who are starting, who just wanted to work on one very specific thing. And you know what, I’m happy that you’re passionate about that one thing, but especially early in your career, you should work on what’s important to the person that you’re working with. I think we have a backward so often young people are thinking, what is the thing that I can work on? Rather than who am I working with identified mentors as specific people that I wanted to work with? And I would have washed dishes for them? If they said, do this project, I would have I that’s absolutely what I would have done. And I got the best experiences that way. One of the stories I talked about in Lifelines, for example, is about a law student who came to work with a beam. Initially, he was supposed to work on a project with public health law and researching public health policy and but then right as he was about to start was the unrest that followed the death of Freddie Gray while in police custody in 2015. I called Gabe and said, Can you come to work right now, and you’re working? Forget this writing your law paper, but you are now coming to work with me on this response in the wake of what just happened, you’re going to help me figure out a medication delivery system for people who are seniors whose pharmacies have burned down. He didn’t say, “I don’t know anything about medication delivery.” He said, “Absolutely, I’ll be there in half an hour.” His first day on the job was with me in the Emergency Operations Center, delivering and figuring out this 24 seven prescription access program that we ended up setting up. Subsequently, he worked on whatever the needs were, he helped me to set up, for example, our program to get glasses for every child who needs them in Baltimore, that is the type of person that I want to work with. That’s the kind of person who will be successful because they are willing to work on anything, and they will thrive as a result.

Sanjula Jain 27:45
Dr. Wen, this has just been so empowering and so inspiring. I have so many more questions, but we’ll have to save them for another day. We typically close by asking our guests what would be the title of their autobiography, but you’ve already beaten a lot of us to that punch, so I’ll reframe to say you still have many more chapters to write in your leadership journey. What’s one thing you hope to tackle in the next few chapters?

Leana Wen 28:11
That’s really interesting. It’s a good question that I’m not sure I have the answer to and that’s because I don’t plan my life this way. I never said at the very beginning that coming into Baltimore, for example, that I want to work on the opioid epidemic, but because that was the pressing issue for residents of our city, that’s what I ended up working on. I never said that I want to work on patient-centered care, but because of my mother’s experience, that’s what I ended up doing. I never said I wanted to work on a global pandemic, but because we’re living through one, that’s what ended up being my focus and so I think I will continue to abide by what Senator Barbara Mikulski always says, do what you’re best at and what you’re needed for. In my case, that also involves being a mom to my kids.

Sanjula Jain 28:54
Thank you for all that you do. On behalf of our entire audience, I can say your servant leadership is so apparent and the passion for what you do to make our public health care system so much better is very well noted, so thank you for spending some time with us today.

Leana Wen 29:07
Thank you so much.

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