Explore The Space

“It’s so hard to not want to have every single step planned” Dr. Anne Peled is a breast cancer & plastic surgeon in the Bay Area and is also a breast cancer survivor. She joins us during Breast Cancer Awareness Month to discuss moving from awareness to action from both the doctor and patient perspectives. She is simply remarkable, I am truly touched by our conversation. Please subscribe to and rate Explore The Space on Apple Podcasts or wherever you download podcasts. Email feedback or ideas to mark@explorethespaceshow.com Check out the archive of Explore The Space Podcast as well as our White Papers and much more! Follow on Twitter @ETSshow, Instagram @explorethespaceshow Sponsor: Elevate your expertise with Creighton University’s Healthcare Executive Educational programming. Learn more about Creighton’s Executive MBA and Executive Fellowship programs at www.creighton.edu/CHEE. Key Learnings 1. Emotions triggered by the words “breast cancer awareness month 2. Converting awareness to action around the calendar 3. Acknowledging racial and ethnic disparaties in care and screening as critical items requiring action 4. Action items from the patient perspective 5. How the spouse of a person with breast cancer can think about ways to be supportive 6. Wishing that back pain could just be back pain 7. Reinventing “one step at a time” & the importance of context 8. The value of getting out of your head 9. Acknowledging the experience of men with breast cancer Links Twitter @annepeledmd  Instagram @drannepeled Dr. Peled’s website Breast cancer resources from The American Cancer Society About Breast Cancer from The Komen Foundation Facing Our Risk The Breasties Transcript for this episode Mark Shapiro (00:01): Welcome back to Explore The Space podcast. I’m your host Mark Shapiro. Before we get to today’s episode, a word of thanks to our sponsor, Laurie Baedke and Creighton University. Creighton university believes in equipping physicians for success in the exam room, the operating room, and in the boardroom. If you want to increase your business acumen, deepen your leadership knowledge and earn your seat at the table. Creighton’s health care executive education is for you. Specifically tailored to busy physicians, our hybrid programs blend the richness of on-campus residencies with the flexibility of online learning. Earn a Creighton university executive MBA degree in 18 months, or complete the non-degree executive fellowship in six months, visit www.creighton.edu/CHEE to learn more. My guest in this episode of Explore The Space Podcast is Dr. Anne Peled. Dr. Peled is a breast cancer and plastic surgeon in the Bay Area, and she is also a breast cancer survivor. Mark Shapiro (00:57): This being Breast Cancer Awareness Month, she joins us to discuss a really interesting perspective of how we move this idea of awareness of breast cancer, to action, to actionable things, to tangible steps we can take to make progress around reducing morbidity, mortality, and disparities in breast cancer, diagnosis and treatment. And she brings some really brilliant insights from the perspective of both a surgeon who treats people with breast cancer and a patient who has survived breast cancer. It’s a really wonderful way to approach a difficult and charged and sad and sometimes inspiring topic. And it’s obviously one that has been a focal point of my life and certainly on Explore The Space Podcast we’ve shared on this show in the past, the episode that I did with my wife, Jessica, who is the voice of Explore The Space, she was also a breast cancer survivor. Mark Shapiro (01:51): And so we really try to make a point of focusing on this topic each October. And I’m delighted that Dr. Peled was able to join me to help us in that process. Before we get to our conversation, just want to invite everyone to please check out Explore The Space’s full archive is at www.exploretheshow.com. You can email me at mark@explorethespaceshow. You can find me on Twitter @ETSshow, definitely subscribed to Explore The Space wherever you download your shows, Apple podcast, Stitcher Spotify definitely leave us a rating and review as well. That really helps us out. We are adding a full transcript of each episode to the show notes. So you can look in the show notes and find a full transcript. And if there are episodes in the archive that you would like a transcript for, please email mark@explorethespaceshow.com as well. Mark Shapiro (02:41): Finally, just a reminder to everyone to check your registration status, to vote, get registered, make your voting plan. If you’re able to vote early, make sure you do so. There is a tremendous amount going on in the world that goes without saying, and it is also important too, that we pay attention to things that are happening on that recurrent basis, breast cancer awareness month being one of them. I’m delighted that Dr. Peled could come and join us to share some insight and some opportunities for learning and growth around a subject that affects so many people in the United States and around the world. So without further ado, Dr. Anne Peled. Anne, welcome to Explore The Space. Thank you so much for coming on. Thank you so much for having me. I’m really glad that you’re here. This is a heavy month. October is always kind of a heavy time. This October has been really heavy October of 2020, but for, for many people all around the country, it’s a little bit heavier in general because it’s breast cancer awareness month, and that’s really why you’re here. And I want to start, I always like to start strategically. I like to start really high level. When you hear the term, when you see it on TV, when you get an invitation to come on a podcast and talk about those four words, breast cancer awareness month, I want to start with the emotions that it triggers for you. Anne Peled (03:57): Yeah, it’s incredible. It’s been almost three years since I was diagnosed with breast cancer, but it was actually an October of 2017 where I first felt the lump that I was sure it was going to be a cyst because I was a 37 year old vegetarian triathlete with no family history. Like we hear so often, and I feel like this concept of breast cancer awareness. It just to think about everything that it entails from following up on lumps that you feel to getting your mammograms, to raising awareness around metastatic breast cancer, which is a big topic, especially with today being metastatic breast cancer awareness day. I feel in many ways, transported back very quickly. And it does amaze me. It’s been this way every year since my diagnosis. And so many different emotions come up, but I also love the feeling of action that I get as well. And I’ve been really excited to see this breast cancer awareness month at so many groups are really focusing on actions and not just awareness. And for me, that feels like as you could imagine, a much better place to be, and it makes me feel like I can really channel what I’m feeling to help others really do more than just awareness, but actually have action behind it as well. Mark Shapiro (05:16): That’s a good place to start with this idea of, of it being something that’s actionable because awareness months can become, or at least run that risk of becoming lip service or a platitude, or just sort of going through the motions, but the people for whom breast cancer as part of their reality, it’s not, does that sense of actionability. Does that help bridge that divide so that in February and in July and in December, it’s still awareness month in October, but it’s action around the calendar. Anne Peled (05:52): Yeah, I completely agree. I think that idea that how do we take, you know, something that has become in so many ways like commercialized and all of this, it’s more than pink. The ideas behind that are good ones. You know, we want to be getting more funds for breast cancer research. We want women to go get their mammograms. So the awareness part of it is important. But as you said, it’s for the women who are, and men who are actually diagnosed with breast cancer, what does that look like when they find out they’re diagnosed in a different month of the year end? Can they remember what they were told about? You know, for me, I focus a lot on how people can get better treatment options and know their options. And are they going to remember that genetic screening and counseling is a really important part of breast cancer treatment? And so I think you’re right, that it allows it to move past this month, but it also gives people the tools when they’re diagnosed or thinking about prevention and screening the rest of the year, they have these action items, this education to take better care of themselves and to get better options when that comes up Mark Shapiro (06:53): Is that level of action in your clinical practice, not from your experience as a patient, but in your clinical practice. Do you feel like the penetration at a population level is improving over time? Is it static or is it getting worse? Anne Peled (07:10): That’s such a fascinating question. No, I know, but I love the question to be honest cause there’s so many factors that go into whether or not people can take action on preventing and treating breast cancer. And I think we’re at this amazing place and amazing in a bad and good way where we’re really focusing on what are those barriers for people. And we know that COVID has been a major barrier for people going and getting the healthcare screening they need. And unfortunately, I think we’re going to see the impact of that for years to come. The other thing that there’s a ton of wonderful focus on right now is the racial and ethnic disparities in care and screening. And we know for instance that black women are much more likely to present with more advanced stages of disease, less likely to get the treatment they need and less likely to get the full spectrum just as one example. So I think in my mind that, yes, we’re getting better penetration than some places, but I think we’re really missing getting better care than others. And so again, super excited to see action around these kinds of issues so that we’re not just doing better for some, but we’re doing better for all, as we move forward. Mark Shapiro (08:21): That concept of doing better for all has come up more and more certainly on this podcast as well. So if you were to look in your toolbox and see things that are not there, that you would like to be there to bridge that divide, what would be kind of number one, two and three on the, on, on, on your wishlist? Anne Peled (08:42): I think one of the things that we see in medicine and in other industries is it’s difficult. If you’re a person thinking about whether it’s getting care, whether it’s advancing in your field, whether it’s taking the next steps to move, it’s really hard to do those things. If you don’t have people who look like you and feel like you, they understand your experiences. And so for me, when I think about it, I wish that we had more funding, more resources to get people into communities where they don’t feel like they’re being, well-represented where they’re not seeing people who look like them in advertisements, if you will, or social media or other educational pieces around getting screening, for instance, for mammograms. And I think if we did a better job, both representing different types of people, engaging in screening behavior, but then also really getting people out into communities to encourage that. Anne Peled (09:31): I think that would be a huge step. It takes a lot of funding. It takes resources, it takes commitment. When I was in DC, I worked with my dad, who’s a medical oncologist at Georgetown and we helped work on a program for Latina women on breast and cervical cancer screening. And honestly it was much better to have people from that community going and encouraging them then to have me and my dad in there. And so I think we see what that looks like. So for me, that would be a first huge step in terms of moving forward for getting better access to care. I think the next thing that we see has to do, and again, we see this across the spectrum in medicine, but it’s thinking about better representation in clinical trials. And there’s so much wonderfully, there’s so much research on breast cancer and on breast cancer treatments, but we do a very poor job with making sure that people are well-represented and that we have diversity in our clinical trials. So I think those would be two big areas that we could focus on both for screening and prevention and then as well as treatment for breast cancer Mark Shapiro (10:30): Context is always critically important in these interviews. And so as we’re sitting here, it’s 21 days before election day in 2020. And what you’ve just articulated is a very clear vision for a better future. Would you ever take that into the political space? Would you ever run for office? Anne Peled (10:46): I would say seeing that the, what it would look like to be an office right now, that is a very hard no, but I do that so we can use, and I know your platform is important to you. I mean, I think honestly, as, as physicians, as healthcare providers, I think we’re often, we often feel like we can’t be political. I don’t know if you’ve, you have felt this previously. I know you don’t feel this now, but I’ve often felt over the years, like we’re not supposed to take a stand on political issues and we focus on our healthcare and what we can do. And I think the world we’re in now, we can’t do that anymore. As healthcare providers, we have to use our voices and encouraged people getting out and voting and explain to people what that really means, and that the link between voting and picking people elected in office and what your healthcare and what others health care is going to look like is very real. So I love seeing, again, I know that’s a big priority for you and everything you’ve done. And I think healthcare providers are really changing the way they think about being active in that way. Mark Shapiro (11:44): You’re right. It is a big part of what I do now. And you’re also right that for the bulk of my career preceding, it was not. And those were because of implicit and explicit messages that were conveyed during my training, that it was not the physician’s place to participate. And that disconnect is something that I do not recognize as being valid anymore and had been pretty outspoken about that on the show and on social media and in my personal life as well. So I’m glad that you also see it because we all have to walk that road and we don’t have to agree on what the policy should look like necessarily, but we have to agree that we’re participating and that we’re going to join the conversations and support others in doing that as well. And then once we’re doing that, then we can argue like crazy about what’s the right way to go forward. Anne Peled (12:23): Exactly, exactly. But no, as you said, I mean, I think it really is. It’s, it’s realizing that. And I think unfortunately with COVID we know more than ever how much politics impacts healthcare and what we as healthcare providers can do and have a voice. And so I’m, I’m so glad again, to see that that’s really becoming a part of all of our, our narrative as healthcare providers. Mark Shapiro (12:47): I agree with you. So then I do want to pivot, you’ve laid out that really clear vision of how we could make things better from the perspective of a breast cancer surgeon or breast cancer researcher or a breast cancer advocate. Now we pivot to that other place. You’re a breast cancer survivor and the road may or may not look different. And that’s what I’m really curious. I love, I love juxtaposition. And so having you kind of walking both of those roads literally and figuratively at the same time is really powerful. If you just kind of close your eyes, took a deep breath, and then I asked you that exists, those exact same questions. Would your vision for a different looking future around morbidity and mortality reduction in breast cancer in the United States, would it be any different? Anne Peled (13:29): I think for me, having gone through breast cancer, myself and being in a family of, I mentioned my father’s a medical oncologist who treats breast cancer. My sister and my mother are both breast cancer, radiation oncologist. And I think for me having gone through it personally in that context of my family and the real concerns they had, understandably at each step of the way of what the, the data we would find out, you know, everything from what was my, my longterm risk to what treatment I was going to pick and what the impact that would have on my personal wellbeing. Not to mention the fact that I’m a mom of young kids and I’m married to a surgeon who knows enough about breast cancer to worry as well. I think for me, that the way that I pivoted in some ways is really understanding the longterm impact of the treatments that we do and the impact on quality of life. Anne Peled (14:28): That many of the treatments that we do in breast cancer can have on people and their sense of self and their ability to move past their breast cancer. So on the one hand, there’s that part of it, where I, I love to focus on getting better education, getting better information about outcomes and quality of life. But on the other hand, when it comes down to it, I’m still a person that had cancer. And once you have had cancer, you sort of always have, cause it could come back at any time. And so thinking about the reality of metastatic breast cancer and what those numbers look like, that never goes away. So for me, again, I, I think better care for all and not just better care for some, but we all know that we can do better for stage four breast cancer, both from a funding standpoint, from a research standpoint, from an awareness, but awareness to action standpoint. So I think I would answer your question saying yes, some of it is the same, but a lot of it is just much more real and much more personal having been through it myself. Mark Shapiro (15:24): Can I add one as the spouse of a breast cancer survivor? And if you’d rather that I don’t like, I, I still don’t fully understand the role of the breast cancer survivor spouse as advocate. If it’s better to not have that voice or to be super loud or somewhere in the middle, I am still trying to figure that out and it’s been years. And so I’ll sort of ask you that question before I put my thought about what maybe could also be better into the mix. Anne Peled (15:52): No, I’m so glad that you brought that up. Cause I actually wanted to ask you about that as part of this, because I do think that that is, like you said, it’s a uniquely challenging place to be in and I don’t want to speak for you, but having seen my husband go through it, I think it’s a uniquely challenging place to be in as a spouse in medicine where again, you know, enough, but you don’t know quite everything. And I would say, I think sort of seeing his going through it. I think my husband did a remarkably good job letting me come to my decisions myself about what was going to be the right treatment plan for me. And I realized as a dual breast surgeon and breast reconstruction surgeon, I am in a lucky position if you will, to figure that out. But I have to say I’ve been so incredibly grateful for every step of the way. Anne Peled (16:39): You know, he’s there, he supports my, what I need in my choices, but he just really listens. And I I’ve seen how he talks to his patients. And I know that he’s so much more active and involved with them, but with me, he’s just, he’s been there and he supports, and I think for me, that was the right, that was the right path. But again, everyone’s different. So I’m really, really curious and excited to hear sort of about your experience and how things went through and what your thoughts are about that. Cause I think everyone’s different in terms of what that, that support can be like. Mark Shapiro (17:06): Yeah. It’s so thank you for that space. You know, your, your husband can call me anytime and he, and I can debrief together too. You know, I, I, the thing that I would say is an opportunity for improvement. You mentioned at the beginning of this interview, that idea of being transported back and you know, being transported back to that moment in time where you were informed. And, you know, thankfully I was with my wife when she was informed that her mammogram looked at normal and we, we kinda knew we were embarking on a journey together and I’m comfortable sharing that now because she shared it very transparently on the podcast before the, the, the, the construct that’s set up for a woman who’s being diagnosed with breast cancer or a man who’s been diagnosed with breast cancer and their partner, if they’re available at the time, or whoever’s there as support the construct around how that’s communicated should just never be underestimated because those people will be transported back to that moment over and over and over. Mark Shapiro (18:03): And it never, I’m like, I’m about to cry. It never gets easier. It’s, it’s, it’s so uncomfortable. You relive it. I don’t relive it in such a way of like, what would I have done differently as you know, obviously I wish you’d never been in that place, but it’s just, you relive that space and you’re feeling your heart rate shoot up and knowing that life is different and the word choices from the physicians and providers in those moments, they are a hammer and the hammer can fall heavily, or it can fall with a little bit more of a gentle touch. And that art is a place where I think we can get better. Anne Peled (18:37): Yeah, no, I, I think you’re so spot on on that. And I got, I really felt like before my diagnosis, I was thinking about, and I was thinking through it, but you’re right. The words matter so much. And then the timing of things, like, I think about the waiting over the weekend, right? Especially the waiting over a long weekend for test results. And sometimes it gets 8:00 PM on a Friday, and I see pathology results that came back that I hadn’t seen. And yes, they would have loved to have been doing that before, but I didn’t really know what it’s like to wait until you’re there. And you realize all that, all the data that you’re waiting for is agony. And so I will say, I think you’re right. I think that we could, we could do better in that space. I also think a lot about the level of information that comes out in those first visits is just, there’s so much of it. Anne Peled (19:28): And I struggle with how can we do better so that it’s more digestible, so people can make choices. So more of it can stick. And I love, and I’m so happy for your wife that you were able to be there because a lot of people, when they get that initial information, they don’t have someone there with them. You know, they’re not expecting it, that even the diagnosis, they may not be expecting it. And it is so much to process next step survival, longterm short term and having a person there and making it more digestible, I think would be hugely helpful. Mark Shapiro (20:01): It’s hard. It’s just, you know, you just want as a practicing physician, right? I always want my communication skills to be as optimal as possible. And I am sure there is a long gray line of people who would say, you know, dr. Shapiro in that moment, you could have also chosen words differently and chosen your affect differently. And we just, we carry that. And I, and I don’t bring that topic up to say, like, we’re not doing a good job of it. You’re not going to also hit a hundred percent and you’re not going to nail it. It’s a brutal thing to hear. And so when, I guess when I’m calling it out, it’s, I’m not calling out our physicians and providers on it. I think it’s just, it’s, it’s just that opportunity to just get more sophisticated in and more gentle and hopefully have a construct of care delivery where you have more time and you can choose the environments. And like you say, Friday at eight 30, that it’s still the right space and time to make those phone calls. It’s just, it’s that opportunity, right? It’s not, it’s not a criticism, it’s just acknowledging an opportunity. So that when you, as someone who has a clear vision of what good policy could look like, whether or not you choose to run on that someday, and I’m going to maybe push you again a little bit down the road, Anne Peled (21:14): It will be addressed later, maybe. Mark Shapiro (21:17): Right, right, right. I guess that, it’s just that it’s, it’s seeing it as that opportunity. And so when we’re sitting in a, a month of awareness, it’s being awareness of opportunities for improvement. Anne Peled (21:27): Yeah. I love that. And you think it’s also though that it’s the trying like we do as physicians to try to see where people are coming from and where they are, and to read that right. You know, which is really hard. And I remember for me, I kept it together so well, like traveled for my surgery because I needed to have the exact people and it was fine. And I was teaching the next week and everything went so smoothly. And then I drove in for my first day of radiation and I had to park in the patient parking space and it just did me in, I literally like, I, my radiation oncologist blocked in and I just lost it. And it was truly that act of parking in the patient parking space. That’s all, that’s what it was. And that is what it came down to. And so I think as you were saying with breast cancer awareness month, it’s that idea as we engage with our community about all of this understanding how triggering, like we started this conversation and how triggering things can be and seeing where people are before we start, you know, unleashing the, the montage of pink things and breast cancer awareness. And how can we, how can we find out where people are starting to try to minimize, triggering and try to make it a safer space for people? Mark Shapiro (22:34): That’s a really smart perspective, because like you said earlier, right. It’s, you know, it’s the pink, and it’s the, you know, football games with the pink gloves and stuff. And it can start to feel performative as opposed to feeling like here are some actual, tangible learning opportunities if you are ever in this place, or if, you know, someone who’s in this place. I mean, I remember for me, it was a couple of days later and I was back to work and I bumped into one of my colleagues whose spouse had been diagnosed with a different type of cancer. And I just said to him, like, what the fuck do I do, man? And he said, and he gave me some really, really good advice. And so it’s like, you know, one day, you know, you, your husband and I would write the book, like, what the fuck do I do now? Anne Peled (23:11): Yeah. That’s really helpful. Mark Shapiro (23:16): We’re all thinking that. And we’re all kind of wondering, and it’s like, why do we have to keep reinventing the wheel? Anne Peled (23:21): Exactly. Or I think about the fact that like, I wish that I could get back pain and it could just be back pain. It’s just not anymore. Right. Like as of December, 2017, like back pain, doesn’t just get to be back pain anymore. And I feel like in those moments, the same thing, like as, as the spouse of this person who has back pain and their mind is going in a million different directions, what do you say in those moments and how do we support someone through that? And honestly, I think that would be so incredibly helpful. There’s never going to be right. It’s just hard, like you said, a few minutes ago, but there, I think there are ways of things to say in that moment that kind of, you know, would bring me back from that edge of that cliff. And you know, what it probably is just back pain. Cause I worked out for like crazy yesterday, but, but I think you need someone right. To kind of kind of reel that back in. Mark Shapiro (24:11): These are gratifying conversations. And I think it’s good that we have physicians that are sort of, of the same generation give or take trained in the same way and still have a long career who are going to navigate not just their careers, but life in such a fashion that we can call these sorts of things out and write books with provocative titles like what the fuck do I do now? Anne Peled (24:30): You guys are gonna so successful. Think about the politics of you and my husband’s even thinking about the book. Mark Shapiro (24:38): There you go. I am glad that you called out the exercise and cause there’s a topic that’s come up on the show, a great deal more actually in the past, but we’ve done a lot of content on Explore The Space around ultra running, endurance sports, and the lessons that can be learned and the toughness that can be gleaned and the, the way that anyone can look at a challenge and take lessons from that, whether they have the physical ability to, or desire to do a run or a walk or anything, there’s still lessons around using the muscle of brain to move through a challenge. And so for you, as someone who has had to navigate tough physical challenges before, were there things in the toolbox that you were glad that you had that can be generalized to other people? Not because they’re going to go run triathlons as part of their treatment for cancer, but that anyone that is going to move into that really, really difficult space of a cancer diagnosis or particularly breast cancer for what we’re talking about now that they can say like these are things that will help your mental toughness in terms of navigating all those challenges. Anne Peled (25:48): I love that question so much because there’s no doubt in my mind that having gone into cancer treatment, being an athlete helped across the board. And we have really good data that show that actually exercise decreases the chance of recurrence. So yes, not everyone is going to be calm, let triathlete, but even just the act of getting out and walking regularly that will bring down your recurrence risk. So I think for me, the things that I found that I was able to do one of the first ones is, is when you’re training for races or if you’re in a half marathon or marathon or triathlon, you know, that you can’t be thinking about mile 26 when you’re on mile one and you’re just going to destroy yourself that way. And so, you know, thinking about what is your next accomplishment, what is the next landmark or milestone you’re going to hit? Anne Peled (26:32): And you only have to get to there right now. And then you’re at the top of that Hill. And then you have the next tail, but you made the top of that Hill. And so one of the things I tell my patients is trying to things a step at a time, and it is so hard, especially people who like being in control of things like so many of us do, especially as physicians, it’s so hard to not want to have every single step planned, but I think that so clearly people do better when they’re actually able to just see that they’ve gotten through the first step and that’s what they focus on. So for me, I think that was a huge part of, as you said, kind of the mental toughness and preparedness is really taking it a step at a time, celebrating the victory of that step healing from that, and then being in a good place to move on to the next. Mark Shapiro (27:15): But, but again, context is critically important with that one because one step at a time can also be one of the things that I really don’t like, which is a platitude. Once one step at a time can sound really dismissive. And I know that when you say it, you don’t mean it that way, and I’m sure that you’re able to frame it in such a way that your patients and their families are like, yes, I get the message. But if, if we take on as the right approach to tell people, Hey, one step at a time that that really has that risk of someone saying, you’re not hearing me. You’re just telling me what you’ve heard over many, many years and in movies and stuff, one step at a time like that, that, that can feel like a platitude. Anne Peled (27:50): I think you were so spot on on that. And it’s completely right, as you said, it’s about the context. And I think it’s about describing the picture, feeling like have options laid out for someone and they feel like you are a part of their team and you’re on this journey together. And then once you have that rapport built, then you’re right. Then you get to the, then you get to celebrate those victories with people. So I think you’re spot on about that from a context standpoint. So I think that’s one of the big ones. I think the other one is the appreciation for space that is just yours, where you get out of your head. And I think it’s incredibly challenging. And now more so than ever to really have space where your mind isn’t going in a million different directions. And as a, as a cancer patient inactive treatment, you have only bad places to go. Anne Peled (28:39): Quite honestly, in your mind, you know, you’re not thinking about good things most of the time when you get into, when you get in that head space. So for me, I found that the ability to, to have that space when I was exercising I wore my running clothes to radiation every day. And I loved that. I was going to get done with my radiation. I was going to have time. That was just mine. I didn’t have patients to take care of. I wasn’t going to take care of my kids. I was just going to have that space to clear my head and it was hugely helpful. And not every exercise isn’t going to be that space for everyone. You know, there are so many other places people may find that, but that appreciation for that space, the knowledge that that space exists somewhere and that you can find it was incredibly helpful for me also. Mark Shapiro (29:17): Those are really good and useful tools. And in retrospect, they’re things that I think in part of chapter three and four of what the fuck do I do now, those will be really good ones to like help create that space, helped create that mentality. You know, just say you’re, you’re off duty for whatever. Just critically, critically important. Anne Peled (29:38): I love that because you’re right. I think and I think it’s, I do want to say, cause I think it’s so key that I think men with breast cancer that get lost a lot in this process. And I do try as much as I can to make sure that we’re being inclusive. Mark Shapiro (29:51): The first patient with breast cancer I ever took care of was a man. When I was a medical student at the Houston VA, they had a, a breast cancer clinic and it was the vast majority were men from all over the Southern United States because they would come to the Houston VA for treatment. Anne Peled (30:04): I mean, it’s amazing that you had that experience because I have to say in a, both having male breast cancer patients of mine and also seeing what the community is like, it’s a whole different set of challenges, right? Speaking of being in a space where you don’t feel like you’re necessarily being heard, you’re not getting full options. So I, I actually on my list of things that, you know, thinking about getting better access to care, it’s not just racial and ethnic disparities. Right. I think it’s also thinking about gender disparities as well. So I think that thinking about that as incredibly important, but I think getting back to your point given that the vast majority of people who get diagnosed with breast cancer are women and especially women who are used to, you know, taking care of families or their roles at work. Anne Peled (30:43): I think it’s very hard to actively make space where you don’t feel like you have to take care of others, even in the midst of active treatment. You know, I see so many of my patients who are going through very hard treatment and are still really focused on everyone else around them. And so I think your idea of as a, as a supporting person, as a partner of someone going through breast cancer, giving someone that space is it is a real gift that is very hard to make yourself. So I love that for chapters three and four. That’s great. Mark Shapiro (31:13): Yeah, exactly. So you’ve obviously given us a tremendous amount of insight and expertise and it’s all appreciated and I’m sure you’re asked this a lot, but acknowledging that it is breast cancer awareness month and unbalanced, this is a good thing that we’re doing when people do ask me, like, where should I go to learn more when, when the voltage drop hits into November and December and the next July and so on. And so where do I go? What, how do I learn more? Where do you like to refer people? What resources are your go tos for people who want to learn more about these various topics surrounding breast cancer? Anne Peled (31:44): So you get in my mind two separate things when you’re really doing research and some overlap, but you get a lot of actual statistics and data and care being laid out. And I like to send people to that as a first start before getting into the second, which is a community because there is so much misinformation about breast cancer, I’m out in the world and it’s especially true because so many people have breast cancer. So trying to figure out if your story is going to be the same as someone else’s and the different kinds is pretty overwhelming for most people. So personally, I really like to send people to the American cancer society. I think Komen also has really great resources and data, and I think that’s a great place to start just to get a real sense of what is breast cancer, what do I have, what are stages and what might treatment look like? Anne Peled (32:32): And I think that’s incredibly important for people who are diagnosed and may not have the support and framework of a nurse navigator or a program behind them. Which is unfortunately true for many people. So a lot of people are so lost right off the bat. And so the basics of breast cancer treatment is incredibly important. I do think though that once you have that, and especially as you start thinking about a treatment plan, I think it’s incredibly important to find a community. Not because everyone is going to be a person who wants to share their story and that is completely fine. And there’s no reason that everyone needs to be thinking about doing that, but it’s more so that you can hear people who have been through treatment similar to yours. You can get information on the types of care you might be getting. Anne Peled (33:14): Do you need second opinions, clinical research trials. So for me, a couple of places, I think that are great for that. One of them is Force, which specifically is focused on hereditary cancers. They’ve recently expanded beyond breast and ovarian cancer. But it’s a great resource. They have mentorship programs, they do a great job diving into research. So that’s a great post to start. One of my favorite communities from a breast cancer standpoint is a group called The Breasties. It’s focused on younger women. But really sort of includes all ages. And I have to say the events they host, which will currently virtually, but we’ll go back to being real. And the way that the women in that it is for women, but the way that women support each other and give advice, I have to say, my patients often know more than I ever could have imagined about options and what their recovery might look like and really become very close and have these women supporting them and sending them garments and sending them information on how to go through it. So those are kind of my, my go tos. But I do think we are doing so well with social media now in terms of allowing people to find their communities and get through. I actually think there’s no doubt in my mind that people who are better informed going into treatment recover better on the other side. And I think that seeing the communities on social media now is a huge component of that. Mark Shapiro (34:33): And we’ll put links to all of those in our show notes. And then for people who want to find you on social media or your website, where did, where do they find you? Anne Peled (34:40): Oh, thanks so much Mark. So on Twitter, it’s @AnnePeledMD and then it’s @DrAnnePeled on Instagram. And then my website is www.annepeledmd.com Mark Shapiro (34:50): This was an absolute treat. Thank you so much. It’s, it’s a, it’s an important month. It’s a very fraught and emotional month. I can imagine only what it feels like for you and for your whole family, but thank you so much for coming out and being this transparent and honest and, and really helping to continue to drive us towards a place of progress. So this was very special. Thank you. Anne Peled (35:10): Well, thank you, Mark. I have to say, I really appreciate everything you just said. And for me, you know, when I found out I was diagnosed, these kinds of conversations where I feel like we’re, you know, moving things forward, getting better for all and action, make me incredibly happy and make it feel like it was all worth it. So thank you so much. This is a treat for me as well. Mark Shapiro (35:29): My thanks once again to Dr. Peled for joining us on this episode of Explore The Space Podcast, definitely check out all of the great resources that she mentioned that are linked in the show notes. Please take advantage of those and share those with anyone who you think may benefit as well. Thank you also to Laurie Baedke and Creighton University for sponsoring this episode, learn more about Creighton’s executive MBA and executive fellowship programs at www.creighton.edu/CHEE. And to all of you, who’ve taken time to listen to this episode and to share it, I really appreciate it, especially on this topic. Thank you so much for your time and your interest and your support. It is inspiring and so appreciated. So as we continue to move forward, remember to wear your masks, maintain physical distancing, wash your hands, get your flu shot. Take good care of yourselves. We will see you soon. Thanks so much. Bye bye. #breastcancer, #BreastCancerAwarenessMonth, #podcast, #podcasting, #healthcare, #digitalhealth, #health, #leadership, #mentorship, #coaching, #FOAmed, #doctor, #nurse, #meded, #education, #hospital, #hospitalist, #innovation, #innovate, #medicalstudent, #medicalschool, #resident, #physician

“We need to become aware of the spectrum of disabilities that’s all around us so that the people who are disabled themselves don’t have to do as much teaching” Harry Paul is an MD/PhD student who speaks, writes, & researches about disabilities in medicine. He joins us to discuss disability & his superb STATNews piece as well as the impact of stigma & Covid19. He also provides critical insight and understanding around “Ableism.” Please check out the bottom of the shownotes for full transcript of our conversation with Harry. We will be doing transcripts of episodes going forward, and if there is a particular episode in the Explore The Space Podcast archive you’d like transcribed, please email mark@explorethespaceshow.com Please subscribe to and rate Explore The Space on Apple Podcasts or wherever you download podcasts. Email feedback or ideas to mark@explorethespaceshow.com Check out the archive of Explore The Space Podcast as well as our White Papers and much more! Follow on Twitter @ETSshow, Instagram @explorethespaceshow Sponsor: Elevate your expertise with Creighton University’s Healthcare Executive Educational programming. Learn more about Creighton’s Executive MBA and Executive Fellowship programs at www.creighton.edu/CHEE. Key Learnings 1. The value of wrecking hierarchies and building on bidirectional learning 2. Where Harry has decided to place his advocacy energy around his own disability and entering the profession of medicine 3. The opportunity for improvement around understanding what disability is and what it means 4. How the terms “disability” & being “on disability” are reductive and loaded words 5. Identifying as disabled & dealing with the concomitant stigma 6. What are hidden disabilities and the problems that arise when they aren’t acknowledged and accommodated 7. Harry’s description of his own hidden disability & the particular challenges Covid19 brings 8. Ways we can improve our acknowledgment of hidden disabilities in the hospital 9. What does leadership in this work look like 10. Defining and understanding the term “Ableism” 11. The 3 components of Ableism 12. A counterpoint to “don’t let your disability define you” Links Twitter: @_HarryPaul_ Thread on Alt-Text use on Twitter Link to Harry’s article in STATNews Harry’s archive of Twitter threads related to disability & medicine Episode Transcript Mark Shapiro (00:00): Welcome back to Explore The Space Podcast. I’m your host Mark Shapiro. Before we get to today’s episode a thank you to our sponsors of this episode, Laurie Baedke and Creighton University. Creighton university believes in equipping physicians for success in the exam room, the operating room and the board room. If you want to increase your business acumen, deepen your leadership knowledge and earn your seat at the table. Creighton’s health care executive education is for you. Specifically tailored to busy physicians, our hybrid programs blend the richness of on-campus residencies with the flexibility of online learning. Earn a Creighton university executive MBA degree in 18 months or complete the non-degree executive fellowship in six months, visit www.creighton.edu/CHEE to learn more. My guest in this episode is Harry Paul and Harry is an MD PhD student who speaks, writes and researches about disabilities in medicine. Mark Shapiro (00:56): I found Harry on Twitter actually several months ago and have found him to be extraordinarily transparent and informative and honest. And he recently wrote a superb piece in STATNews which is linked in the show notes, which discusses the topic of hidden disabilities. So he came on the show to talk about this concept of hidden disabilities and disabilities in general, the opportunity that’s in front of us to deal with this topic better, to understand it better, to find some shared understanding around what these terms mean, as well as the stigma associated with them and the impact of the COVID-19 pandemic. We also spent some time discussing another term ableism and the prevalence of ableism and the impact that it has. And again, opportunities to get better  and opportunities to lead that work. There’s also a host of other links in the show notes that Harry has provided. So I would really encourage you to take a look at those. Mark Shapiro (01:56): This was a really informative educational and quite frankly, motivating conversation that we had with Harry. And I think you’re going to really enjoy listening to him. Please do check out the archive of Explore The Space Podcast at www.explorethespaceshow.com, there’s over 200 episodes in there. So please take a look around, definitely subscribe rate, and review, Explore The Space on Apple podcasts or wherever you download your shows. I’m often asked what is the best way to help the show word of mouth and those ratings and reviews. So if you have a couple of seconds to spare to do that, I would really appreciate it. Definitely email me anytime Mark@explorethespaceshow.com and you can follow me on Twitter @ETSshow as well. Harry was a fantastic guest to speak with. This was a critical topic. It’s a great learning opportunity for me, I think will be as well for all of you. So without further ado, Harry Paul Harry, welcome to Explore The Space Podcast. I’m delighted you’re here. Harry Paul (02:50): Mark. Thanks so much for having me on. Mark Shapiro (02:52): I love that we have this opportunity because I say that you’re here, you’re about as far away from you and I could be in the continental United States, but we’re making it happen. So that’s good. The beauty of the internet that’s right. Good. So speaking of the beauty of the internet, this is where I found you. And this is where you, I think, found the podcast and that we kind of connected in that #MedTwitter environment. And one of the things that I love about it is it has taken the whole dynamic that quite honestly, when I was going through medical training, the, the aspect of hierarchy, the aspect of, you know, medical student leads to intern leads to resident leads to attending. It’s really dumped that out on its head because the fact that I’m an attending and you’re a medical student really has nothing to do with anything that you and I are going to talk about. Harry Paul (03:40): Yeah, I have, I’ve been thinking about that a lot and I love that you brought it up because I think the bi-directional learning is, is why I kind of got into medicine, right? Like I, I would never presume to, you know, even though I’m a second year medical student think that I know basically anything about medicine yet. And so having the space to think that, you know, there are things about, about disability, about equity, about the patient experience that I can share and that, you know, people who I look up to as mentors can can learn from is, is just incredibly cool. Mark Shapiro (04:19): I love that you just brought up by directional learning because I would assert that at this point in our lives and the short duration of time that we’ve known each other, I have learned 10 X more from you than you have learned from me. And this will evolve over time. And that’s great. But right now, as we sit, I am coming to you with the mindset that we bring to these episodes of look, there are opportunities for us to learn and for us to get better. And we need people who know these things and have expertise and comfort in discussing them. And that’s why you are here. And I love that you are already seeing that Harry Paul (04:55): If it’s been, it’s taken me some time to get into, but now I’m sort of leaning into it and finding, finding how to do that, right, because there’s really no rule book or guide book for advocacy. And, and so it’s, it’s its own little journey, you know, separately from my journey to medical school and, and, and through my life. Mark Shapiro (05:14): Start there then if there’s no guide book for advocacy, I mean, we talk about advocacy and explore the space, right? This has become a passion of mine. And I would agree that there’s no guidebook except chapter one is that you need to do it. You need to find what you want to advocate for and you have to do it. It does feel like for me, and this is where I have had the opportunity to learn a great deal from you is I think that you are done with chapter one, you’ve identified where you want to place your advocacy, energy and expertise. Is that a fair way to characterize where you are? Harry Paul (05:47): Yeah, I think so. I think so. I think, you know, I did not call myself disabled many years ago. You know, I had many surgeries as a child. I was in and out of the hospital. I dealt with things, you know, that came from that. Uh, but it wasn’t really, until I started thinking about working in medicine and then applying to medical school that I sort of recognize that this idea of, you know, probably if we went back to my application, I think I talked about like, you know, how important the conversations are, like how important understanding, you know, patient’s perspectives and you know, all that. And I think that was sort of an abstract way of talking about what I’ve now come to understand is disability and the varying levels of disability that patients and doctors and everyone experience. And then how that disability is, is a part of our, of everyone’s experience of the world. Even if they themselves are not disabled, because it really shapes is one of the things that shapes society and, and physical spaces and internet spaces. And so, you know, I’ve, I’ve identified this because I think it’s a word people are scared to talk about and don’t know really what it means. And so just having those conversations has been, uh, a beautiful experience for me over the last, I don’t know, six months to a year Mark Shapiro (07:19): I would submit that your characterization of most people’s understanding and comfort level with the word disability, what it means its implications and how to talk about it is at an early stage of development. Shall we say is an opportunity for improvement? I would say, you’re right. I would say, you’re absolutely right. And I will put myself right in that place. Right. I’m a mid career physician. I finished residency in 06. We didn’t have this in a curriculum. We talked about things that cause disability, we talk, right. That’s, that’s what we did. That’s what we continue to do. Right. We, we learn and study disease and, and, you know, physiology, pathophysiology, all these things long and short term outcomes and, and acute versus chronic. Like we are steeped in that and we get super good at it, but we don’t have that shared understanding when we use that term, what it means, how it can be a positive, how it can be a negative. So it feels like, again, we’re, we’re in that place where we’re all maybe looking for understanding, but boy w that’s the opportunity for improvement, I think is just an establishing that we don’t really all know what we’re all talking about yet, but the entities for sure there. Harry Paul (08:29): Yeah. And, and you bring up such a, such a pivotal point of, you know, that medicine, you know, people in medicine, doctors, et cetera, are, are around this all the time, all the time. That’s our job. Our understanding, I think, is, is based on the people who do understand disability or, or who think they do when the word is used. I oftentimes it either goes, I think it goes one or two places. I think it either goes to, okay, that means that you’re a wheelchair user, right. Because that’s what is on the handicap logo. That’s what, you know, happened after polio. You know, that’s what people think a disabled person looks like, or it goes to oftentimes within medicine, all you’re going to be on disability. Meaning, you know, we’re going to give you the paperwork so that you can be on disability and get paid and not work. Harry Paul (09:26): And in both of those things, like not only are they with doctors, but, but they also don’t really take into account that two people, if we could clone them right, with the same exact condition, the same exact abilities symptoms, et cetera, in two different environments, one can be disabled. And the other nodded, all right, our socioeconomic status, the job we do, how accessible the spaces we inhabit are all of that changes, what a person experiences and, and that then leads to whether they take on the disabled identity, right. Because that’s what disability is. It’s an identity that, you know, it’s, it’s different than other identities, you know, B whether it’s, you know, gender identity or racial identity in that it’s, it’s very, very fluid through time. So people can be disabled one minute. Um, and, and not the next or vice versa, you know, and even in different spaces, right? Like I just told you, you know, a few minutes ago, I didn’t call myself disabled before. Now I talk about, you know, being a disabled medical student all the time. And it’s, it’s not that something changed for me, it’s that, you know, I came into this and I understood this and, and where I was, and what I was doing was different. Mark Shapiro (10:51): Would you characterize the term or would you agree with the way I will characterize the term? So I don’t put you on the spot the way I would characterize the term disability in quotes, it feels loaded. It feels like when you put it out there, people automatically take a posture of sort of a defensive readiness there. Isn’t the sort of, you know, you mentioned disability paperwork, right. That will engender a response. You mentioned disability placards, again, will engender a response. I would characterize this as, as sort of, and again, there’s a spectrum here, but it’s loaded. It’s a loaded term. Harry Paul (11:31): Absolutely. Absolutely. And, and those, those ideas, I don’t think really help the people who we’re talking about when we use those terms. And they certainly don’t help the many, many disabled people who don’t fall into those categories or who don’t even call themselves disabled. Right. So when I, when I begin having these conversations with a lot of people, one of the first examples I like to go to is that there are very few people, if any, who call nearsightedness a disability, but that’s because we have glasses, right? And so if you can afford glasses and you have access to glasses, you don’t experience ill effects or barriers from that problem with your eyesight, right? If, if for a member of the dwarf community, if you are in spaces where everything is within reach the fact that you’re of a different height than another part of the population, doesn’t make that a disability, because it doesn’t hinder you. Harry Paul (12:47): The way that they spend changes though, is because even if you’re, even if you’re fully accommodated, but then there was stigma attached. So even if you can do everything, the people around you either think that you can’t or treat you differently or have implicit or explicit bias about you, or you have those biases internalized within yourself, then you, I think you can still be disabled. Even if that’s not in a way that, you know, we sh we, we would have to categorize it if we handled it differently in society. Andrew, I think that comes around to this whole notion of identifying as something like, if you identify as disabled, you’re calling attention to the stigma of the barriers, though, whatever that you face and saying, Hey, this is me. I’m here. It’s not a bad thing, but I do need X because of it. Mark Shapiro (13:47): So it’s a complex tapestry just, and hearing you and hearing you lay it all out, right? You lay these things out in parallel, but they’re in parallel, they’re in series, they’re intersecting, they’re up and down. And then we have another element that I learned from you recently in this article that you wrote in stat news around this concept of the, and it’s a term that you use in it. And I was struck by how frequently you use the term in the essay, hidden disabilities, walk us through it. Cause when I, again, I mean, it’s, it popped up, I want to say five or six times in a, in a relatively short essay unlock the term hidden disabilities for us. Harry Paul (14:26): Yeah. I’d love to, you know, I think there was this whole category of disabilities that we used to call and some people still call invisible disabilities, right. Things ranging from hearing loss, you know, where you wouldn’t know that someone around you has hearing loss or is deaf, unless they, they told you, or unless, you know, you saw them using sign language or, or whatever, down to what I sort of was talking about in the piece, which is these disabilities that it’s hard to ever see because they are really symptoms. Right? So in medical school, we learn a lot about symptoms and trying to classify them into different diseases and what they might point to so that we can diagnose and treat like the medical model of disability. Something like fatigue, something like nausea, vomiting, pain, these things can be experienced by anyone. And they can be for a short period of time. Harry Paul (15:37): Right. And people likely don’t think twice about it, but for some people when it’s not short-lived and when there was not a treatment and when there’s not an understanding of where that comes from, things get really messy really quickly because in medicine, there is an inherent bend towards, we have to diagnose it in order to treat it. And if we can’t do either of those things, then maybe it doesn’t exist. And it’s hard for me to say that, like, because I’m a medical student and I don’t want to blame, you know, medicine for something I’m, I’m certainly, you know, thrilled to be in medicine, but you just have to go online and look up, you know, a few different patient portals or patient communities to see that there are hundreds and hundreds of people who have been basically written off by medicine because they, we don’t know how to help them. Harry Paul (16:42): Right. And so I use the term hidden, first of all, because I think it’s really important for us to realize that these sorts of disabilities are not invisible in the sense that we can’t see them. It’s that you have to look to see them. Like you have to see the little grimness of someone in pain. The fact that someone who’s, you know, as trouble balancing will often walk closer to the wall so that they can grab hold. The fact that someone with hearing loss often, you know, will, or who is hearing impaired or deaf will preferentially turn towards one side, you know, if they have better hearing in a, in one of their ears. So these are things that like being, you know, a really astute clinician, once you join the disability community and start getting to know more disabled people, you start becoming a tuned to, but general society unfortunately does not recognize these things. Harry Paul (17:41): And when we don’t recognize them, we don’t support them and we don’t accommodate them. Right. So within schools, businesses, it’s really hard to ask for accommodations or receive accommodations for something like fatigue, right? Oh, you’re tired. I’m sorry to hear that. Do you want some coffee? Like that’s not, that’s not what fatigue is. Right. And when we talk about something like chronic fatigue syndrome, right. And, and it’s hard to know what the answer is there right too often, we say, Oh, well, you can’t work. Okay. Let’s, you know, let’s get you on “disability” and you’ll get paid. And, and the fact of the matter is many, many disabled people who are on disability want nothing more than to work. Right. They, they miss having that aspect of their lives, not to say that the choice to go on disability, isn’t a valid one for some people, but it’s about that choice. Harry Paul (18:38): It’s about, you know, being able to do with your life, what, what you want. And so I wrote this article in the context of, of COVID-19 because, you know, as someone who kind of sorta looks disabled, but no one really knows what my thing is or what it’s from or what causes it or what it does to me. And, you know, I do find, but I look different. And what does that mean? I had a really hard time explaining to people that, you know, me being short and me being a little funny shaped in the torso is because of scoliosis and that scoliosis constricts my lungs and that constriction of my lungs means that if I get sick with, you know, a respiratory infection, it will be harder for me to fight. That doesn’t mean I’m immunocompromised, right? Because even within COVID and talking about risk, we often go to, we need to protect older adults and we need to protect the immunocompromised, but that’s what people say in their guidelines and on TV and whatever. Harry Paul (19:47): And immunocompromised means something specific, right. We know what that means in medicine, right? You’re, you’re more likely to catch infections. You’re more likely to transmit infections because of a deficiency in your immune system or an insult, you know, from something like chemotherapy. I am at the same risk of getting an infection as someone, you know, as anyone else without an immune compromise. But it’s what happens that if I get that, and so these are two different kinds of risks. Why? Because I am not a risk to the patients that I go and see, but when I’m hanging out with my friends or going for a walk, I need everyone around me to be wearing masks, if not more, to be keeping their distance to, I can’t, you know, do anything inside, even if it’s, you know, just a couple of people, you know, these, all these things we’ve been talking about have in, in COVID in the world at large, have started to affect me in ways that my disability never used to. Harry Paul (20:52): I used to deal with for lesser years, right. The fact that I’m short. And so I need to be able to reach things. And that was basically the main symptom that I still felt from my disability. Right. As a kid, obviously there were, there were tons of things. I was, you know, a wheelchair user for a while. There was a lot of pain, you know, et cetera. But this is what I mean about context right now, when COVID-19 happened. And I had to start thinking about this risk, trying to explain that whisk, when people don’t understand it is really hard. And even the effort to try to call attention to that, if someone is not already thinking about it is even harder, right? And so that’s why I wrote this article because we need to become aware of the spectrum of disabilities that’s all around us. Harry Paul (21:48): So that the people who are disabled themselves don’t have to do as much teaching when we’re going on rounds in the hospital. We shouldn’t just by default say sprint, you know, sprint up the stairs to the next floor, because there can be someone with, you know, Charcot Marie Tooth who might not look disabled. But if they sprint up three flights of stairs, they’re going to get really weak and, you know, can, can fall and have an accident. And, and we don’t want to stigmatize them by making them say that out loud, where they might not want to, to explain why they can’t let up the stairs or why they are going to take the elevator. And so then we get into these complex, complex interpersonal and societal relationships where we started making value judgments. You know, we tell someone, well, it’s healthy to run up the stairs. Well, it’s healthy to run up the stairs for some people it’s not healthy to fall on your head, right? Like they are there. We all have different bodies. We all have different minds. And so I decided to use the term hidden, um, because it’s been talked about more and more within the disability community that, you know, the onus has to be on society to start looking. And when we call it invisible, we make it okay not to look. Mark Shapiro (23:17): So when we start from this place, that of this is a societal problem, I also will note that you identify some very striking examples of what can happen inside a hospital when we’re making rounds. Not that it can’t happen anywhere else, but obviously that example resonates. So then let’s get to that mindset of how do we start to make this better? How do we start to improve? How do we build a toolbox to at least begin to talk about it? Where are the places would like to see us? And when I say us, I mean our profession or shared profession, and maybe let’s just take it into the hospital. Let’s just start there. When we’re rounding in the hospital together, where are the places you would like to see us begin to move on the journey of progress? Harry Paul (24:01): Oh, this is, I mean, this is the million dollar question, right? Mark Shapiro (24:06): It’s a million dollar question for you. Harry Paul (24:09): I think. So. I think all the changes we have to make, but I can run through like a really quick list, right? Like we need to check that the doors that are supposed to be, you know, accessible actually are, we need to make sure that there’s braille signage on all the signs in the hallways and all the room noise. We need to make sure that our electronic medical records are accessible. If somebody is, is vision impaired and needs to increase the font, or if they are, you know, they need to use a screen reader that, you know, reads it out loud to them. We need to, you know, know how to access, sign language. We need to know when the phone rings and we hear a click that that’s actually someone trying to use adaptive technology to make a phone call. And if we just hang up on them, then we’re later going to say, well, we don’t need to do the acts because we don’t have any disease, any deaf patients. Well, no, you’re just hanging up on all your deaf patients before they have a chance to get connected, right? So like all of these, there are all of these things and I can keep on going, but they all come back to do we understand the spectrum of disabilities that exist, what those disabilities are like and what value is exist to keep disabled people out of these spaces or to make their experience worse in the space. Mark Shapiro (25:42): So then let me ask you the question in a different way. What does leadership in this work look like? Acknowledging that there is probably a, a lengthy list of boxes. We need to check to make sure the work is being done. Right. What does leadership in this space look like? Harry Paul (25:58): Couple of key things. I think one support and amplify the voices of disabled leaders in medicine who have been doing this work, especially those with other marginalized or minoritized identities gather the data, right? When every forum in, in school, in clinical trials, in employment that asks about race and gender and socioeconomic status. I can’t remember the last time that I saw, do you identify as disabled on one of those forums? I drove, we’re not asking it. We’re not going to know it’s there. It means that our spaces, academia need to be talking about this. When we talk about social determinants of health, when we talk about oppression, right? Because the intersection of racism and ableism has a long, long history. And it’s going to be really hard to, to fully get rid of one without getting rid of the other, you know, just to call out an example, not that not that disability doesn’t intersect with other identities, but, but the intersection of blackness and disability, especially when we start thinking about prisons and about our on house population is, is something we are not doing anywhere near enough. And it means that kind of to sum up that people just need to talk about disability. We dance around the edges so often, but it must be Mark Shapiro (27:41): Exhausting. I agree with you. I, I probably do it myself cause that’s just, we’re so acculturated to that, it must be really exhausting being on the other side of it. Harry Paul (27:52): It is. And I, and I, I definitely have had times over the last year or so where I have gotten incredibly frustrated, but I also, I derive so much joy and, and, and pleasure from, from doing this work with the people that, that I am with because the community is, is a fantastic one. And we have also, I mean, I’ll, I try to, I try to give credit where credit is due. And even in the last year or two, I’ve seen that so many more people are, are beginning to understand this when I talk about it, but I used to get a lot of blank stares. Yeah. Now I get, Oh yeah. I, I, yeah, you’re right. Mark Shapiro (28:42): So that may be, hopefully that’s indicative of the needle moving just a little bit. Harry Paul (28:46): Yeah. Now we need to go the next app of me walking into a room and hearing someone else talking about it. Right. That’s the, that’s kind of the goal. Mark Shapiro (28:56): There’s another term that I would like to ask for your insight around, because I think I understand it, but I’m not totally sure. My understanding definitely get to the point where it’s something that I think we want to be mindful of, if not try to avoid entirely. And that’s the concept, especially on social media of ableism, but I think it would be helpful just again, making sure that we’re not assuming knowledge or making sure that we have shared understanding, give us, give us your understanding of what that term ableism means. Harry Paul (29:35): Absolutely. So this is, this is also a hard question and I, I do not presume to have, you know, definitive knowledge or control of the definition. Sure. The way that I think about ableism is, is I think of it as the systems that we have built in our world that are built by and for abled people, right? So people without disabilities have the body or mind, and that’s important because it means two things. It means one that the values are there. We don’t put all text on our images online. We don’t have ramps in our buildings or elevators. We, you know, don’t caption our lecturers and videos, all that sort of stuff. And then it also means that when we say things, whether in writing and social media, in conversation, that act as if disabled people aren’t there. Right? So that means making jokes about a patient or saying something about a patient’s, uh, you know, poor outcome, you know, likely poor outcome without recognizing that one of the students or residents or doctors you’re talking to could have that same likelihood of poor outcome. Like, so it’s within medicine. It’s this belief that, well, if we’re in medicine, everyone around us must be able to, and the more you start to look at it, the more you start to think about it. And this happens for me all the time. I start seeing it in places I never ever would before. Right. Like I was talking to a friend just last night that, um, who’s an autistic med student. And she was saying that she did, uh, an OSCE, you know, and observed, standardized, clinical exam. Harry Paul (31:41): And yeah, one of the things on, on her evaluation was doesn’t make eye contact. Right? We have this inherent assumption that making eye contact is part of being a good physician and providing good patient care for someone who’s autistic, that can be hard. And for a patient who’s autistic, that can be hard. And so when we make that, the standard we’re making it harder for both autistic patients and autistic physicians when we don’t need to be right. Why, why do we need to be granular, right. Like that. Like, why can’t it just be about, we need to create really good spaces to care for our patients in whatever way that means for some patients that’s going to be eye contact for some patients that’s going to be please not force eye contact upon them. Right. Mark Shapiro (32:42): So a level of sophistication that would then allow for a more dynamic, sensitive interaction. Harry Paul (32:49): Exactly. And I brought that example up because it’s, you know what, I just, you know, it was last night, but I think that there are so many examples. I mean, I got, I got a text from a friend at another medical school, uh, you know, just a few weeks ago that she was in ethics class and her professor said something like, you know, and I’m paraphrasing here. Um, you know, if I, if I had to be wheelchair bound, I would kill myself. Right. And so then, then we look at why there are very few doctors who use wheelchairs, first of all, but wheelchair bound is so do arbitrary. And then there’s assumption that being a wheelchair user is, is something bad. Something that, you know, you, no one would walk. Right. I think what we need to get to is I would, if I was a wheelchair user, I would hate to have the people around me not recognize what things I needed to make my life, you know, to give me the same equity in life as, as other people. Harry Paul (33:57): Right. And they are, there are dozens and dozens of examples of this. I could go on and on. But I think that that Abel is in, is this is three parts to sum up one, the belief that being disabled is bad to the fact that our society and our systems are built for people without disabilities. And then three, that when we’re talking about these things, we sort of have a tendency to Gaslight disabled people and say, well, you know, you’re overreacting, or that’s not what I meant, or it was a joke or whatever else we say to excuse away. The fact that our society, our world is not built for disabled people, both in our interactions and our spaces. And it’s not enough to just say, Oh, sorry, that was offensive. Right? It’s you have to start thinking about what that means before you say it. And this isn’t, this isn’t politically correct stuff. This isn’t cancelled culture. This isn’t any of that. Those things are words that have been created by people who don’t like thinking about other people’s emotions to excuse a way their own lack of thinking about those emotions, right? These things matter because they matter to someone and if they matter to someone, they should matter to you too. Mark Shapiro (35:26): I think that that’s a great way to call to action around this. And I think what I’m taking away from this as our first call to action is for us just to understand the words that we do see flying around and that sometimes trend on social media and are making their way into public discourse that we at least have a beginning of shared understanding of what they mean. And then for those of us who work in healthcare to again, understand what they mean in the context of providing care and being part of a team and leading teams and recruiting it’s, it’s gonna be a lengthy and long challenge because we have multiple generations of physicians and healthcare professionals that have, I might even think at best, a limited or moderate amount of education around this, but most probably have very little to none. And that is a sturdy challenge for us as we go forward. Harry Paul (36:22): Yeah. And I, on a, on a sort of positive note, I think that a lot of this, the groundwork is already there for, right. Yeah. Yeah. I got really, really good clinicians, really good people already know that understanding the context of someone’s life is important. They already know that getting at what is troubling, someone is important and working to alleviate those things. So, so I think there are a lot of people who are helping out on providing good care to disabled patients and to their disabled colleagues without knowing it. What I think is important to talk about that says, because it’s not an isolated incident, right? So in order to get at the systemic change, we need to go from, this is the really nice thing I do for my patient who’s in a wheelchair to, well, what are we missing? And there was never, ever been a more important time for us to be talking about this than right now, because you know, health is quite literally on the line in this election. Harry Paul (37:44): Right? And, and I bring up ableism not to make any political statements, but because whenever we’re talking about a candidate or about a policy, just as, it’s not enough to say, Oh, that was meant as a joke. It’s also not enough to say, Oh, you know, this is really helpful for some, you know, we’re sorry that it leaves out disabled people, right? We, we can’t, we cannot keep writing off disabled people. What disabled people need, what things are going to be really harmful to disabled people. It’s if we want to move towards a more, just a more equitable, a better world for everyone, we have to talk about this and, and it’s not selfish, a more accessible world. It has been shown in the research is better for everyone. When we start putting elevators into buildings, people who are fully able bodied seal really appreciate that when their arms are full of groceries, right. People who are trying to watch a continuing medical education credit on the subway, you know, when we used to take the subway, really appreciate if there are captions on that, if it’s hard to hear, you know, without, without any hearing impairment, right? So accessibility is better for everyone. And I just wished that people would start seeing that rather than as you put it, taking that defensive stance of, well, we’ll provide this if you know, we, you reach out, uh, well, you know, we’re not sure how many people it would help. Mark Shapiro (39:28): I think that you’ve provided the right call to action with that as well. And I will also say, and one of the things that I’ve really enjoyed and learned a great deal from is you also put the information out there for us to learn from and get better. We’re going to have a variety of Twitter threads and other links that you’ve created that’ll be in our show notes of how to use alt texts, which I learned from you and a variety of other really powerful tools. Those will all be in the show notes though. And where else though, do you like to direct people who want to learn more about this and where do people find you if they want to follow you? Harry Paul (40:02): Yeah. So I do most of my disability advocacy work on Twitter. It’s been such a fun community to become a part of both, you know, in the medicine and diagnostic reasoning and, and science world. And mostly in, in disability, which is what I post about. I’m @_harrypaul_. And I, I think that more than just, you know, me, there’s sort of a two part thing, right? Look up, read about, visit the websites. The Twitter handles the books and, and, and, and TV and movies about, and by disabled people, like that’s the first thing, right? Read our actual words, just like with any other movement in an equity or social justice, right. Listened to the people actually affected by it. Especially within disability, you will find that there are many people who talk about disability, who have no idea what they are talking about because they are not disabled themselves. Harry Paul (41:01): Right? So they, they, they make these movements to say, you know, things like, don’t let your disability define you. What if your disability does define you, right. Why not work to make that define you in a good way? Why not work to recognize that it is defined for you by the society we live in than to try to erase it by saying, don’t let it define you. You know? And so I think, I think be very wary when you read or listen things about disability and think about what is the angle of the person who’s saying those things. And then beyond sort of that, you know, reading homework, like everyone listening or reading this show after knows disabled people. I guarantee it a hundred percent. But if you don’t talk to them about it, if you don’t make your own existence, one that seems open to, to hear from those people. You’re not going to know it. And so in your own lives, make space to talk about that and you will learn a tremendous amount. Mark Shapiro (42:09): Here’s the thing I like about you being visible, too. And like you said, people who have listened to this or read it, guarantee they know someone. Yeah. Cause they know you now. And I think that that’s exciting. And so obviously I, I w I’ve learned a tremendous amount from you. I found you through Twitter. I would encourage everyone else to access the stuff that you’re doing and the people that your thread directs us to as well. Because look, we are starting out on this road. It is going to take some time, but we all know someone now. And I think for a lot of those people, the first one that might come to mind is you. And I would submit that that is great. It’s a challenge, but it’s great. And I’m grateful to you that you came on the show to talk about it, that you are as open and transparent with your writing and with your work on social media, as you are down the road, we’ll have you back and we can reconvene and see where progress has been made and see what impacts policy making and elections are having on this work. Mark Shapiro (43:05): But Harry, thank you very much. I really enjoyed this. Harry Paul (43:08): It’s been an absolute pleasure. I love the show. Great to talk to you as always. And thanks everyone for tuning in, and don’t hesitate to reach out if there’s any questions I can answer, or if you just want to chat, I love talking to people. Mark Shapiro (43:22): I can confirm he, you are available and you are helpful for all those things, man. Thank you so much. Harry Paul (43:28): Have a good one. Take care. Mark Shapiro (43:30): My thanks once again, to Harry for joining us on this episode of Explore The Space Podcast and definitely check out the links that he has shared with us there in the show notes, please take a look, some great opportunities for learning and definitely check out his article in stat news, which is also linked in the show notes. Thank you to Laurie Baedke and Creighton University for sponsoring this episode of Explore The Space Podcast. Learn more about Creighton’s executive MBA and executive fellowship programs at www.creighton.edu/CHEE. Thanks to you so much for listening to this episode as well. Really appreciate you taking the time. We will be back soon with more great content in the meantime, make sure to wash your hands, wear your mask, maintain physical distancing, get registered, make your voting plan and get ready to vote or vote early if you have the opportunity. We will see you soon. Bye bye. #disability, @disabled, @ableism, #Covid19, #podcast, #podcasting, #healthcare, #digitalhealth, #health, #leadership, #mentorship, #coaching, #FOAmed, #doctor, #nurse, #meded, #education, #hospital, #hospitalist, #innovation, #innovate, #medicalstudent, #medicalschool, #resident, #physician

“We are making sure voters really understand how important leadership is” Dr. Joe Sakran is a Trauma Surgeon and a co-founder of Doctors For Biden. He joins us amidst the most bizarre and unsettling election season in our memory to discuss why more doctors and healthcare professionals are engaging in the political process, the growth of Doctors For Biden, and the sense of energy & community that comes from being a grassroots organization Please subscribe to and rate Explore The Space on Apple Podcasts or wherever you download podcasts. Email feedback or ideas to mark@explorethespaceshow.com Check out the archive of Explore The Space Podcast as well as our White Papers and much more! Follow on Twitter @ETSshow, Instagram @explorethespaceshow Sponsor: Elevate your expertise with Creighton University’s Healthcare Executive Educational programming. Learn more about Creighton’s Executive MBA and Executive Fellowship programs at www.creighton.edu/CHEE. Sponsor: Vave Health believes that personal ultrasound is the future of medicine, with an aim to empower both clinicians and patients.  Check out their website for details on their free virtual ultrasound educational events and more, at www.vavehealth.com/live Key Learnings 1. Some situational awareness of when we recorded this episode 2. The mindset of a physician who is openly engaging in political discourse and endorsement because of issues that make it impossible to stay silent 3. Acknowledging that physicians are whole people and having a political voice is part of that 4. Who makes up Doctors For Biden and why they’re there 5. Creating a runway for people who might feel hesitant about sharing their voice and opinion 6. How a community has formed in this space 7. The stories of people joining the movement who have not done something similar before 8. The growth of Doctors For Biden 9. Why Doctors For Biden stays independent from the Biden/Harris campaign 10. Making non-physicians feel welcome in joining Doctors For Biden Links Twitter: @DoctorsForBiden, @JosephSakran Doctors For Biden website Virtual Conversation with Doctors #election, #President, #Biden, #Harris, #ElectionDay, #podcast, #podcasting, #healthcare, #digitalhealth, #health, #leadership, #mentorship, #coaching, #FOAmed, #doctor, #nurse, #meded, #education, #hospital, #hospitalist, #innovation, #innovate, #medicalstudent, #medicalschool, #resident, #physician

“When I’m looking for change I try not to wait for an unnecessary landmark. I just start now.” Dr. Dara Kass is an Emergency Medicine physician, the founder of FemInEM and a nationally-sought after expert for all topics related to COVID19. She joins us the break down the calendar fallacy and her extraordinary mindset around creating change amidst chaos. We also get into how & why the media space is becoming more representative and the vital need to those doing the work to be compensated and supported. Please subscribe to and rate Explore The Space on Apple Podcasts or wherever you download podcasts. Email feedback or ideas to mark@explorethespaceshow.com Check out the archive of Explore The Space Podcast as well as our White Papers and much more! Follow on Twitter @ETSshow, Instagram @explorethespaceshow Sponsor: Elevate your expertise with Creighton University’s Healthcare Executive Educational programming. Learn more about Creighton’s Executive MBA and Executive Fellowship programs at www.creighton.edu/CHEE. Key Learnings 1. The calendar fallacy and the need to feel like things will be better when the year changes 2. Celebrating the Jewish New Year (Shana Tova everyone) while acknowledging the calendar change isn’t going to drive change 3. The origins of the advanced mindset Dr. Kass carries around maintaining a sense of control amidst chaos 4. Dealing with exhaustion and input fatigue 5. The impact of not having to travel for work anymore 6. The childcare crisis, gender bias, and the Covid19 pandemic 7. Why Dr. Kass is prioritizing the need for people to verbalize their own voting plan this election season 8. The critical need to make a voting plan 9. The confluence of Vogue Magazine and being Covid19 positive 10. How the ability to film from home has been critical to elevating so many diverse voices during the Covid19 pandemic & is it sustainable? 11. The critical need for proper compensation and support for physicians who are doing work in media while publicizing the organization they work for Links Twitter: @darakass #Covid19, #NewYear, #RoshHashanah, #ShanaTova, #control, #chaos, #podcast, #podcasting, #healthcare, #digitalhealth, #health, #leadership, #mentorship, #coaching, #FOAmed, #doctor, #nurse, #meded, #education, #hospital, #hospitalist, #innovation, #innovate, #medicalstudent, #medicalschool, #resident, #physician

“Our policies are the way we deliver healthcare. If we don’t have a say in that, then what are we doing?” Dr. Stella Safo is an HIV Primary Care physician & Assistant Professor of Medicine at Mt. Sinai Health System as well as a founding member of VoteHealth 2020. She joins us on National Voter Registration Day to discuss the barriers physicians & healthcare professionals face around talking about & activating around voting. We also jump into the remarkable work being done by VoteHealth 2020 and The Morning Report Initiative. If you would like a VoteHealth 2020 physician to virtually join any meeting you’ve got for a <5 minute, nonpartisan, free presentation on voter activation with 1 slide you can share, please email info@votehealth2020.com Please subscribe to and rate Explore The Space on Apple Podcasts or wherever you download podcasts. Email feedback or ideas to mark@explorethespaceshow.com Check out the archive of Explore The Space Podcast as well as our White Papers and much more! Follow on Twitter @ETSshow, Instagram @explorethespaceshow Sponsor: Elevate your expertise with Creighton University’s Healthcare Executive Educational programming. Learn more about Creighton’s Executive MBA and Executive Fellowship programs at www.creighton.edu/CHEE. Key Learnings 1. Stella’s journey seeing colleagues and teammates struggling during early days of the Covid19 pandemic 2. Understanding the tool of voting in advocacy work 3. The barriers that physicians feel around voting and talking about voting 4. Advanced techniques for talking to patients about voting 5. The art of nonpartisan voter activation 6. The genesis of VoteHealth 2020 & the critical need for tempo in building a movement 7. Honing the VoteHealth 2020 value proposition to an audience that is already incredibly busy 8. The Morning Report Initiative 9. Would Dr. Safo ever run for office? Links Twitter :@AmmahStarr, @votehealth2020 https://www.votehealth2020.com #voting, #NationalVoterRegistrationDay, #election, #physician, #podcast, #podcasting, #healthcare, #digitalhealth, #health, #leadership, #mentorship, #coaching, #FOAmed, #doctor, #nurse, #meded, #education, #hospital, #hospitalist, #innovation, #innovate, #medicalstudent, #medicalschool, #resident, #physician

“A lot of this work we expect women to do, it’s uncompensated & often unappreciated” Dr. Shikha Jain is an Oncologist, Assistant Professor of Medicine at U of Illinois & co-founder/Chair of the Women in Medicine Summit. We discuss what empowerment for women in medicine looks like now, the absurd barriers to progress & impact of Covid19, as well as the virtual structure of the upcoming summit Oct 9-10. Please subscribe to and rate Explore The Space on Apple Podcasts or wherever you download podcasts. Email feedback or ideas to mark@explorethespaceshow.com Check out the archive of Explore The Space Podcast as well as our White Papers and much more! Follow on Twitter @ETSshow, Instagram @explorethespaceshow Sponsors Elevate your expertise with Creighton University’s Healthcare Executive Educational programming. Learn more about Creighton’s Executive MBA and Executive Fellowship programs at www.creighton.edu/CHEE. Vave Health believes that personal ultrasound is the future of medicine, with an aim to empower both clinicians and patients.  Check out their website for details on their free virtual ultrasound educational events and more, at www.vavehealth.com/live Key Learnings 1. The evolution of empowerment for women in medicine 2. The barriers presented by being in a hierarchical system 3. Explaining the Third Shift 4. Does the public understand the impact that diversity has on health outcomes? 5. Curating diverse speakers for Women In Medicine Summit 6. How much is Covid-19 impacting the goals of the conference 7. The focus of the #HeForShe allyship track 8. Pivoting to the virtual platform Links Twitter: @ShikhaJainMD, @WIMSummit Register here: Women In Medicine Summit homepage Position Paper: Covid19 Contributions on a Professional CV https://www.womeninmedicinesummit.org #equity, #gender, #WomenInMedicine, #leadership, #CME, #Covid19, #HeForShe, #podcast, #podcasting, #healthcare, #digitalhealth, #health, #leadership, #mentorship, #coaching, #FOAmed, #doctor, #nurse, #meded, #education, #hospital, #hospitalist, #innovation, #innovate, #medicalstudent, #medicalschool, #resident, #physician

“It’s there for us to enjoy, & the people who are playing it, they’re doing their jobs” Rod Brooks leads the “Tolbert, Krueger, & Brooks Show” on KNBR, the Bay Area’s leading sports radio station, &  is one of the finest sports talk-radio hosts in America. He joins us to discuss the power of money when it comes to Covid testing, are people enjoying professional sports this year, “The Last Dance”, & why it’s ok to engage with sports while acknowledging this is all very bizarre. Please subscribe to and rate Explore The Space on Apple Podcasts or wherever you download podcasts. Email feedback or ideas to mark@explorethespaceshow.com Check out the archive of Explore The Space Podcast as well as our White Papers and much more! Follow on Twitter @ETSshow, Instagram @explorethespaceshow Sponsor: Elevate your expertise with Creighton University’s Healthcare Executive Educational programming. Learn more about Creighton’s Executive MBA and Executive Fellowship programs at www.creighton.edu/CHEE. Key Learnings 1. The challenge of making & keeping new friends as an adult 2. Feeling disinterested and disconnected from professional sports 3. How a new priority set has changed the way we engage with sports 4. The anger that comes with the excess Covid-19 testing that sports leagues have access to 5. Are professional sports providing a service to its fans or is that narrative nonsense? 6. Rod and I talked about “The Last Dance” ,  Jordan’s famous dunk and my goodness this segment is the best 7. Will leagues need to do some service recovery with their fans 8. What will happen with the return of the NFL? 9. The persisting and wildly frustrating issues with college sports 10. Do these seasons count? 11. How a friend can help change perspective #sports, #NBA, #Jordan, #LastDance, #NFL, #football, #basketball, #MLB, #baseball, #podcast, #podcasting, #healthcare, #digitalhealth, #health, #leadership, #mentorship, #coaching, #FOAmed, #doctor, #nurse, #meded, #education, #hospital, #hospitalist, #innovation, #innovate, #medicalstudent, #medicalschool, #resident, #physician

“One of the things that’s been lost is that complexity & the nuance that’s necessary to understand” Dr. Angela Rasmussen is a virologist at Columbia Mailman School of Public Health who studies host response to viral infection. She is also a brilliant writer and communicator, particularly around Covid-19. We discuss communicating uncertainty with the public, dealing with failure as a scientist, specialization as a barrier, and false dichotomies. Please subscribe to and rate Explore The Space on Apple Podcasts or wherever you download podcasts. Email feedback or ideas to mark@explorethespaceshow.com Check out the archive of Explore The Space Podcast as well as our White Papers and much more! Follow on Twitter @ETSshow, Instagram @explorethespaceshow Sponsor: Elevate your expertise with Creighton University’s Healthcare Executive Educational programming. Learn more about Creighton’s Executive MBA and Executive Fellowship programs at www.creighton.edu/CHEE. Key Learnings 1. Starting off with complexity and uncertainty juxtaposed with the binary choices that frame Covid-19 2. The fear response to complexity and the demand for an answer 3. Defining a fundamental misunderstanding between the science community and the public at large with respect to communicating uncertainty 4. The challenge of misinformation and the terrible conflicts of interests that exist with those who are promoting it 5. Trust, transparency, and inspiration 6. Why the idea of “virus hunter” is steeped in exclusion and colonialism 7. Dealing with different types of failure when the stakes are high 8. How misinformation and lack of understanding may impact the Covid-19 vaccine process 9. Why specialization is a communication barrier & how we can make scientific discussions more inclusive 10. The origins of her superb article on false dichotomies and Covid-19 Links Twitter: @angie_rasmussen Dr. Rasmussen’s website Covid-19 & False Dichotomies: Time to Change The Black-Or-White Messaging About Health, Economy, SARS-CoV-2 Transmission & Masks #complexity, #failure, #virology, #virus, #Covid19, #vaccine, #science, #podcast, #podcasting, #healthcare, #digitalhealth, #health, #leadership, #mentorship, #coaching, #FOAmed, #doctor, #nurse, #meded, #education, #hospital, #hospitalist, #innovation, #innovate, #medicalstudent, #medicalschool, #resident, #physician

“When we start to tell our stories, there’s a way that we change” Margaret Shapiro is a writing coach, psychotherapist, and my Mom! She joins us for a very special 200th episode of Explore The Space Podcast. We discuss her immigration journey, maintaining a sense of optimism, and how the word “practice” informs her love of writing and her teaching style. Please subscribe to and rate Explore The Space on Apple Podcasts or wherever you download podcasts. Email feedback or ideas to mark@explorethespaceshow.com Check out the archive of Explore The Space Podcast as well as our White Papers and much more! Follow on Twitter @ETSshow, Instagram @explorethespaceshow Sponsor: Elevate your expertise with Creighton University’s Healthcare Executive Educational programming. Learn more about Creighton’s Executive MBA and Executive Fellowship programs at www.creighton.edu/CHEE. Key Learnings 1.  Margaret’s experience leaving her family and emigrating to the United States from South Africa 2. How Margaret maintains a sense of optimism over the course of her life 3. Experiencing a “dark night of the soul” 4. What being married to a physician has been like 5. The importance of the word “practice” and why it’s in the name of her business “Sonoma County Writing Practice” 6. Teaching what you need to learn 7. What keeps Margaret fulfilled on a day to day basis, and how she’s sustained it during the Covid pandemic Links Sonoma County Writing Practice #immigration, #writing, #therapy, #optimism#podcast, #podcasting, #healthcare, #digitalhealth, #health, #leadership, #mentorship, #coaching, #FOAmed, #doctor, #nurse, #meded, #education, #hospital, #hospitalist, #innovation, #innovate, #medicalstudent, #medicalschool, #resident, #physician

“The is probably the most precious 2 minutes you can spend on completing  your Hippocratic Oath” Dr. Ankita Sagar is Assistant Professor and Director of Ambulatory Quality at Hofstra-Northwell who has had a profound impact on my mindset around physicians registering to vote. We discuss her advocacy in encouraging physicians and medical students to register, the barriers that have previously existed, and how and where to go to get registered. Really inspirational and motivating stuff! This episode is stocked with great references, please check out all the links below in the shownotes Click here to register to vote or to check if you’re eligible to register Please subscribe to and rate Explore The Space on Apple Podcasts or wherever you download podcasts. Email feedback or ideas to mark@explorethespaceshow.com Check out the archive of Explore The Space Podcast as well as our White Papers and much more! Follow on Twitter @ETSshow, Instagram @explorethespaceshow Sponsor: Elevate your expertise with Creighton University’s Healthcare Executive Educational programming. Learn more about Creighton’s Executive MBA and Executive Fellowship programs at www.creighton.edu/CHEE. Key Learnings 1. Dr. Sagar’s superb and profoundly influential presentation slide encouraging physicians to vote 2. The unspoken threat that has kept physicians from talking about voter registration or politics 3. How others can follow Dr. Sagar’s road to being vocal 4. The critical need for physicians to be civic-minded and engaged & how we can propel one another 5. The evidence of just how disconnected physicians are around their own voting practices 6. Places where physicians can make a change around their own engagement 7. Imagining how a medical school or medical school could support student, resident, and faculty registration to vote 8. Where Dr. Sagar has met resistance around physicians registering to vote 9. Would Dr. Sagar run for office? 10. The deadline of September 3rd to be sure if you register to vote and request an absentee ballot it will come in time Links Twitter: @Sagar_Ankita Dr. Sagar’s wonderful infographic on physicians & voting Annals article: https://doi.org/10.7326/M16-2470 SGIM article: https://doi.org/10.1007/s11606-007-0105-8 Vot-ER: https://vot-er.org #Vote2020, #voting, #register, #election, #podcast, #podcasting, #healthcare, #absentee, #digitalhealth, #health, #leadership, #mentorship, #coaching, #FOAmed, #doctor, #nurse, #meded, #education, #hospital, #hospitalist, #innovation, #innovate, #medicalstudent, #medicalschool, #resident, #physician