How to Change Healthcare from the Inside

Session 543

When Raj started his career in medicine he noticed an alarming trend in clinical care. Now he is advocating for a change. If you want to hear more of him, also check out his podcast, Healthcare for Humans.

For more podcast resources to help you with your medical school journey and beyond, check out Meded Media.

Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points.

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[01:51] His Interest in Becoming a Physician

Raj’s initial interest in becoming a physician came from growing up in a family of doctors in India. He said that becoming a doctor was like an “arranged marriage” for him, as all of his family members were doctors and they would always ask him what kind of doctor he wanted to be.

The idea of becoming a doctor was just a “family trade” that he chose to follow. However, much of Raj’s career has been focused on defining what being a doctor means for him and finding his own purpose and meaning in the field.

[03:06] Pressure From Arranged Marriage

Raj did feel some external pressure from having an “arranged marriage” with medicine due to coming from a family of doctors. However, he also said that he and others who end up in medicine tend to be the type of people who can self-select into it.

Raj acknowledges feeling both the external pressure to succeed from his cultural background as an Asian American. He also feels the internal struggle to determine if medicine was truly something he wanted to do or just what he felt the world told him he should do.

[05:26] The Sense of Disillusionment

Raj talked about experiencing disillusionment after finishing his residency training. He said that during medical school and the pre-med years, the goal is presented as taking a history, physical exam, assessment, and plan.

But after residency, nobody tells you what the next step is and you realize you have to figure it out on your own. This can lead to disillusionment for some people as they have been following a set path and checklist their whole career so far, and suddenly there is no defined next step laid out for them. Raj mentioned some of his friends experienced this disillusionment of feeling unsure about what to do with their clinical career after residency was complete.

[06:15] Raj’s Thoughts on the Medical School Training Process and Advocacy for Change

Raj has some mixed views on the medical training process in the US compared to India. He thinks the US process is better than India’s, which is solely focused on test scores. He sees the US process as more holistic by caring about personal experiences and activities in addition to grades. However, he still thinks the US system could be improved. He feels it overly emphasizes memorization and test-taking skills rather than focusing on developing skills needed to actually help communities and populations.

Raj believes the selection process should consider applicants’ capacity and ability to help heal communities and improve population health, not just be good test-takers. He wants the process to produce physicians who can address the root causes of illness in America rather than just treating symptoms, given the country spends a lot on healthcare but has worse health outcomes than other countries.

'When you go into the community, you hear so many other problems of why people are ill... the solutions need to be different than what we're doing right now.'Click To Tweet

Navigating Autonomy in the Healthcare System

Raj acknowledges that clinicians don’t have as much autonomy in their profession as they used to. He mentioned that healthcare systems are trying to stay profitable, so physicians are told to do certain things for financial or “quality” reasons as defined by metrics like Press Ganey patient satisfaction surveys. This sense that quality is tied to customer satisfaction surveys can make physicians feel like they are just trying to please customers, similar to working in retail.

Raj said this lack of autonomy as pressures from the system can be difficult for clinicians and potentially lead to something called “moral injury.”

[10:49] Leveraging Influence to Make a Greater Impact

While being part of a large healthcare system limits autonomy, it also provides opportunities to enact change. Specifically, he wants to make the system better by influencing decisions and moving the lever. Even if just a little bit, this can be done through positions of power or consulting roles.

Even small changes through his influence could make a difference in many lives, compared to being a solo private practice doctor with limited reach.

His goal is to advocate for specific community needs when in positions where decisions are being made about issues like where to invest resources or how care should be structured. His work with organizations and projects outside of direct clinical care also aims to make positive impacts on systems and policies.

[12:18] Intentionality and Dissonance in Healthcare

Raj emphasizes the importance of intentionality over just having goals. When discussing how students can prepare for the realities of being a physician, he talks about the value of being present. Bear witness to important patient moments and be astonished by both the beauty and struggles in healthcare.

'Primary care felt like that space where I could also connect with the community.'Click To Tweet

Raj adds that if you pay attention with intentionality, you’ll see things that can sustain you through difficulties with the system.

Therefore, students should learn to show up and observe authentically as witnesses to patients’ lives. They have to collect positive moments that will keep them motivated to work on systemic improvements later in their careers when they may be in positions of greater influence. He frames intentionality as a better approach than just checking boxes to reach the next goal.

Dissonance in Clinical Care

Raj recalls experiencing moments of dissonance in clinical care where he felt unable to truly help patients in the way he wanted to as a physician. He gave examples like being unable to afford a patient’s insulin or not having resources to help an isolated rural patient access food and medication.

In these moments of dissonance, Raj said his response was to think about healthcare systems and how decisions are made. He carries with him the hope that he could someday get into a position of power to enact change. He also wanted to better connect with his local community to understand their needs.

These moments of feeling powerless as an individual clinician motivated Raj to explore ways to create broader systemic improvements through leadership, projects, and advocacy.

[17:49] Preparing for the Realities of Being a Physician

The Power of Being Present and Astonished

Raj’s perspective on preparing for the realities of being a physician is beautifully captured by the words of poet Mary Oliver. According to Raj, “All you can do in life is be present, be astonished, and tell others.” This simplicity resonates with Raj, as it serves as a guiding principle when navigating the difficult aspects of their profession.

“All you can do in life is be present, be astonished, and tell others.” – Mary Oliver

Being present is crucial for Raj, as they witness the most intimate moments in people’s lives. They witness moments of vulnerability, facing mortality, welcoming new life, and grappling with diagnoses. These moments, which most people do not have the privilege to see, hold immense value. By showing up and truly being present, Raj becomes a witness to these experiences, providing support and empathy.

Holding onto Positive Moments amidst Systemic Challenges

Additionally, Raj emphasizes the importance of being astonished, not in the sense of surprise, but rather in recognizing the beauty that exists alongside the brokenness of the healthcare system.

Paying attention to the positive aspects allows Raj to find sustenance amidst the challenges they encounter. These positive moments are like treasures that Raj collects, serving as a source of inspiration and fuel for their work toward making meaningful systemic changes.

One such moment that Raj recalls is when they assisted an East African family during the birth of their baby. The father, unable to physically be present, joined via FaceTime from Africa. Raj found this experience fascinating, witnessing how technology bridged distance and allowed someone so far away to be part of such a significant moment.

The trust and connection that Raj had built with the family over time made them an integral presence in that intimate space. These moments, filled with trust, cultural understanding, and shared humanity, serve as reminders of the impact Raj can have as a healthcare provider.

Raj acknowledges that these positive moments are part of a recurring cycle. By consciously collecting and holding onto these moments, Raj finds the strength to navigate the complexities of the healthcare system and work towards meaningful change.

[21:42] How Things Have Changed Over the Years

Raj acknowledges that some positive changes have been made to address physician burnout compared to the past. For example, they’ve capped resident work hours at 80 per week rather than the 120+ hours some used to work. However, he said burnout is still a major issue.

He believes healthcare systems are now forced to prioritize physician recruitment and retention due to workforce shortages. This has led to more focus on well-being, work-life balance, and burnout prevention.

'There's such a shortage of clinicians, physicians, nurses, medical assistants, that it's become imperative for organizations to recruit and retain people.'Click To Tweet

Raj mentioned the growth of the physician well-being field with models like the Stanford well-being model. Organizations are also paying greater attention to burnout drivers like administrative workload and loss of autonomy.

While improvements have been made, Raj doesn’t think burnout is fully solved. Physicians still face intense workloads, emotional challenges of patient care, and pressures related to the business of healthcare. Therefore, more support is needed to sustain the workforce over the long term.

[23:25] Becoming a Change Agent as a Student

According to Raj, some ways for students to become change agents while in medical training include building a group of supportive colleagues. That way, they can advocate for each other while gaining strength in numbers. Look for opportunities to gain positions of power, like leadership roles, where speaking up may be received better.

It’s also important to call out inequities and lack of diversity in leadership and encourage a more inclusive environment where all voices can be heard. Connect with community organizations and leaders to understand local needs. Then amplify those voices when able to influence healthcare policies or decisions.

'People should feel comfortable challenging me, especially people who are different than me.'Click To Tweet

Start exploring systemic improvement projects or advocacy work now to gain experience influencing the healthcare system from an early stage of training. Focus on building relationships authentically with diverse communities to become better advocates for improving healthcare equity.

[24:49] Leadership in Healthcare

Recognizing the Inevitability of Leadership

In the rapidly evolving landscape of healthcare, Raj acknowledges that being a leader is an inescapable aspect of their role. Whether working alongside medical assistants, nurses, social workers, pharmacists, or within large organizations, the need for leadership arises as they collaborate with others. Raj emphasizes that recognizing and embracing this reality is crucial, as it positions them to effectively navigate the complexities of leading a team.

'You're always going to be in positions of leading others so it is an essential skill.'Click To Tweet

Bridging the Gap in Healthcare

Raj highlights a gap in medical training. Sadly, the focus has primarily been on history-taking, physical examinations, joint assessments, and creating treatment plans. However, true patient care extends beyond these aspects. Raj emphasizes that coordinating care and leading others are integral components of providing comprehensive and effective healthcare.

Drawing from personal experiences, Raj shares the challenges encountered when working with medical assistants (MAs). MAs play a vital role in primary care clinics by assisting with patient intake, including taking vitals, checking medications, and conducting initial patient assessments. Raj acknowledges that not all MAs consistently meet their expectations. Whether through making mistakes or inaccurately reconciling medications, this can lead to errors in patient care.

The Team-Based Approach to Healthcare

In this regard, Raj emphasizes the importance of mastering the skill of having tough conversations with team members who may not meet expectations. These conversations involve clearly articulating the desired tasks, explaining the reasons behind them, and addressing any concerns or challenges that arise.

'More and more, the only way we provide care is through teams.'Click To Tweet

Moreover, Raj understands that some team members may be receptive to feedback and willing to make improvements, while others may require additional support or guidance. Hence, effective communication becomes key to fostering a collaborative and productive team dynamic.

Raj highlights that the delivery of care increasingly relies on interdisciplinary teams. As such, the ability to lead and collaborate effectively with team members is crucial for providing high-quality, patient-centered care. This includes not only leading MAs but also working harmoniously with nurses, social workers, pharmacists, and other healthcare professionals.

Recommended Resources on Leadership

Raj recommends exploring various resources on leadership, including the works of Brené Brown, Adam Grant, and Simon Sinek. These notable figures provide valuable insights into leadership philosophy and offer perspectives on authenticity, effective strategies, and purpose-driven actions.
Raj particularly highlights starting with Brené Brown’s work as a foundation for developing authentic leadership skills. He stresses the importance of reflecting on important questions and embarking on a journey towards authenticity. By immersing oneself in these resources, individuals can cultivate their leadership abilities, which are greatly needed in the healthcare field.

[29:28] Increasing Cultural Competence as a Premed

Educate Yourself and Build Authentic Relationships

Raj emphasizes two key aspects of increasing cultural competence as a premed. Firstly, educate yourself to become a better clinician and caregiver. This involves actively seeking knowledge and understanding about different cultures, values, and beliefs.

Second, build authentic relationships with the community. By connecting with individuals from diverse backgrounds, premed students can become better advocates, regardless of university policies.

'There's power in building relationships and amplifying community voices.'Click To Tweet

Challenge Moments and the Need for Cultural Competence

Raj reflects on challenging moments in their career where they struggled to connect with patients from different cultural backgrounds. He shares examples of encounters with immigrants and refugees who held strong cultural values that clashed with Western medical practices. These moments prompted Raj to question the effectiveness of cultural competence modules.

Move Beyond Modules to Genuine Care

As a premed student, Raj found that theoretical knowledge alone was insufficient in navigating complex cultural situations. Instead, seek to truly understand the desires and needs of the communities you serve. Attend community events hosted by different cultural groups to develop a deeper understanding beyond what can be learned through course modules or profiles.

By forming meaningful relationships and actively listening to community members, you will gain more insights into what it means to provide genuine care. Advocate for specific community needs by amplifying the voices and recommendations of community leaders when in positions of influence over healthcare policies or resources.

Harness Power and Advocacy as a Doctor

Raj acknowledges that while doctors may often feel powerless within larger health systems, they possess a unique position of influence. As a doctor, one’s words carry weight, and decisions can shape the allocation of resources and the nature of healthcare delivery.

'You're going to have more power than most people in this world... people will listen to you because you're a doctor.'Click To Tweet

Raj urges future doctors to use this power to advocate for the communities they serve, ensuring that care aligns with their specific needs and desires. By actively engaging in the community and understanding their perspectives, doctors can make informed decisions and work towards positive change.

[34:57] Your Role in Making a Difference

In promoting equity and understanding, you should recognize that you have a role to play and can utilize your unique skills and abilities. If you find yourself lacking the time or capacity to attend a community event, you can still do your part. Initiate conversations with colleagues, seeking to understand their experiences, and exploring alternative approaches.

“Be curious and not judgmental.”Click To Tweet

Remember, even small actions like refraining from judging others can have a significant impact on fostering equality. It is important to reflect on your actions and consider how you may unintentionally contribute to worsening situations. Be mindful and respectful in your interactions, recognizing the power you have to make a positive difference.
[37:01] Final Words of Wisdom
As a premed aspiring to make change, Raj advises to listen to others. Pay attention to what they share about their experiences and needs, rather than just telling people what you think. Amplify the voices of community members by sharing what you’ve learned from listening to them with others. Whether that’s through podcasts, advocacy work, or conversations with colleagues. Build authentic relationships in the community and elevate community voices, as there is power in that approach over just individual actions.