Humanism, Kindness, Safety, and Trust | SMA Dialogue Series with Kathy Reeves, MD

Toyese Oyeyemi: All right. Welcome, welcome, welcome to the SMA Dialog series. We have an absolute treat today. I have the pleasure of being able to welcome our distinguished guest here in just a moment. But before I do, I am pleased to, welcome everybody to, what has been the third installment of our, SMA dialog series where we have an opportunity to, engage with some of the leaders across the Social Mission network, folks within health professions education, medical education, health workforce, health equity, health justice, who are leading different initiatives, who have different perspectives, that we can all benefit from.

And, I’m fortunate to be able to actually get a chance to just call up or send an email to friends who also happen to, to be, really impressive leaders across the, across the, across the industry and across, health professions, education and health workforce. So, today is no different. And in fact, today has been a special treat in particular, because I got the opportunity to welcome and introduce Dr. Kathy Reeves of the Arnold P. Gold Foundation. Dr. Reeves, how are you doing? 

Kathy Reeves: I’m well, how are you? 

Oyeyemi: It is good to have you on and welcome to the dialog series. I know that part of what the Gold Foundation has been quite literally the standard bearer of when it comes to medical education, is really this concept of humanism. And I want to talk to you a little bit about that and about some of these concepts that, maybe to some of us who are not, physicians may feel a little bit unclear.

I’d love to be able to kind of learn a little bit more from you on that and be able to just kind of hear some different stories. But before that, I’d love to just kind of hear, for folks who are going to be able to meet you for the first time. I’ve had the pleasure of knowing you for a couple of years now. For folks who are meeting for the first time, would love to just kind of hear a little bit about yourself. 

Reeves: Sure. Well thank you. It is a real honor to be here with you today. So, And thank you for doing this. So I am a pediatrician, I’m a pediatric hospitalist. I still practice, I am a mother. I have two kids, I am married, I met my husband in residency in Cincinnati. And my career, I believe, has prepared me very well for this amazing opportunity that I have. I believe that humanism, kindness, safety, and trust are scientifically proven to make care better, patients healthier, health care professionals more well, and honestly saved money. So, my career has been in medical education and my research has been community oriented. So I think that has really set me up well for this opportunity. 

Oyeyemi: Yeah, yeah. And I think that this is probably one of the more understated and underrated aspects of this concept of humanism is this idea that it also saves money.

You mentioned you mentioned the saving money piece of it, and I want to come back to that in a few minutes, because one of the one of the conversations that I know we have internally often is around these different incentives around improving and transforming health professions education and medical education and a lot of the misconceptions around what that means.

And what the actual cost benefit is of making these transformative investments. So I’ll table that for a moment. You mentioned humanism, kindness, safety, and trust. What? Why those four? It almost felt as though that was like a very specific set of principles and concepts that people maybe… Is there a rationale behind those four in particular?

Reeves: Yes, absolutely. You know, we talk a lot in health care about compassion. And compassion is very important. Compassion literally translates into “with suffering.” Health care is bigger than that. Kindness is, I believe, one of the most underrated behaviors in life, not just in health care. We can teach people how to be kind. It’s a behavior.

It’s not something people have to engage in. You know, we won’t always like our patients necessarily, but we can always care about them and we can always be kind. Safety, for me, is all about trauma-informed. We all bring our stories into the healthcare space. Whether we’re clinicians or patients or family members. We’ve all had lived experiences and some of them have traumatized us.

Some of them often prevent people from feeling safe. If COVID has taught us nothing else, it’s taught us we’ve– we can have the best vaccine in the world, but if people don’t feel safe, they’re not going to take it. And trust, I think, is the biggest problem in health care today. You know, in the 1970s, over 70% of adults trusted their health care professional and their institutions. We’re somewhere around 40% right now. We’ve lost the public’s trust and we’re not going to make them trust us until they feel cared about, they feel safe, and that we’re able to show them that they’re a priority, their lived experience is a priority. 

Oyeyemi: You know, what does that– what does that look like? You know, because I feel as though one of the common threads of conversations has been around, and this actually came up even in a previous Dialogue, is waning trust. Not just of health care providers and a health care system, but waning trust in institutions, waning trust in organized principles, and organized institutions that have long been parts of our society. Whether that’s mistrust of government, which has always been a longstanding one.

But it looks different now that we’re talking, something a little bit different these days. Mistrust of basic civil services, mistrust of education, mistrust of science. You know, so what exactly– like, do you see this as being part of the bigger issue around mistrust, and if so, what does the change look like for you?

Reeves: Well, I think for me, you have to start with the understanding that you can only trust people. We can’t really trust science. You can’t trust an institution. You trust people. And it’s all about relationships and, you know, medicine talks a lot about personalized medicine. Well, for me, personalized medicine is not about your genetics. It’s about people understanding your life.

I worked in North Philadelphia my whole career, pretty much. I know the community. Someone’s address meant something to me. The school that their kids went to, go to. I generally knew something about most of the schools in North Philadelphia, so that’s the first moment people started to trust me is because I knew something. I knew, I cared enough about them to understand what it meant to live on 2nd & Tioga and I was able to learn about that community enough to impact the person sitting in front of me.

And then the other thing, how we interact, you know, we still teach medical students to start their interaction by introducing themselves and then go to a chief complaint. That is not a way to build trust. Who starts a relationship with “what’s your problem?” We have to start to teach people to connect right off the bat. And AI could really help us do that. It can hurt us, but it could help us do that. But I think it’s all about connection, and it’s about investing in the community and the people’s lives you have the privilege of intervening. 

Oyeyemi: Yeah. No, no. Well said. And to answer your question about who starts off a conversation with “what’s your problem?” Sounds like the kind of thing that you say when you run into somebody on the– when somebody runs into you, literally bumps into you on the street. “What’s your problem?” 

Reeves: Yeah, it’s a conflictual beginning instead of a connection. 

Oyeyemi: No question about it. So when kind of thinking more about that idea of connection and you know, I, my background also was in community health. And I think that there’s a lot of value in being able to— there’s an almost an unspoken, sometimes spoken, but often unspoken credibility that I think exists when you have a sense of this person who is responsible for taking care of me, gets me because they get– they’re from where I’m from.  And the “from” where I’m from may not even be a geographical thing. It may not be literally– maybe it’s a little bit of, like a cultural or a sensibility thing. Where, they’re from where I’m from, in terms of, you know, sensibility. They are from where I’m from. Maybe it is culturally, maybe it is some other type of shared connection point. It sounds like maybe that isn’t as ubiquitous of an experience as you would like to see it be. 

Reeves: Oh, absolutely. Very few of us who practice medicine live in the communities in which we work. We don’t know that anymore, which is why medical schools being diverse and being inclusive and nursing schools matters so much because I can learn from you and you can learn from me, and then that helps us understand patients that are different from us better.

But it has to be intentional. The thing we don’t often do in medicine, and this is what you guys are all about. We aren’t intentional. We think these things will just happen. It’s the “hidden curriculum.” Or if you happen to meet this person, maybe it’ll happen. When I believe these are the spaces we have to be very intentional.

We should be teaching people to walk through their communities, to talk to people in the community, to learn what the strengths and the challenges are. Because, you know, North Philly is a tough place. I met the strongest people I’ve ever known in that community. 

Oyeyemi: Yeah. Obviously we’re talking a little bit in the context of medical education, which is your background. Does that idea of humanism look any different in any other profession, whether clinical or non-clinical profession that has any type of impact around the health care system and health professions education? 

Reeves: You know, I think the difference in health care is the stakes are so high. You know, any good business person once they’re, you know, you run a store, you want people to be kind, you want the store to be safe, and you want people to trust you. That’s how your business model works. That’s why the business side comes back to that. But the stakes can be so high in health care.

You know, people are entering that space, meeting you often for the first time in what might be their most vulnerable moment.And they want to trust us. People want to trust us. We actually have a head start of most any other profession that we come in and we have to lose it sometimes. So I think it’s just that the stakes are so high and that and we haven’t, we haven’t concentrated on it.

Oyeyemi: Yeah. This concept of humanism, specifically as it pertains to health professions education, maybe again to your point– ah, first of all, let me pause for a moment because I actually think it’s really salient. The idea that, in many cases, physicians actually already kind of walk in with a little bit of credit, and then it’s a bit of a it can be a diminishing resource.

That’s like a powerful thought as opposed to many other professions. It can, in fact, be the opposite, right? Maybe. There’s some professions who are walking into a room or a community with skepticism, and then they have to make up the ground in sort of actually building up, you know, kind of gaining ground to get to a place of trust. With physicians it’s often the opposite, you’re coming from a place of trust as an asset and then recognizing that it can diminish quickly depending on the interaction. 

Reeves: Yes, absolutely. 

Oyeyemi: Yeah, it’s fascinating. So the point that I was, I was going to veer off to was kind of asking, you know, you talk about humanism as it relates to medical education. In medical education, what is it that people should know about humanism? And is there anybody who does it particularly well? This concept of humanism. 

Reeves: So, you know, I’ve, I’ve had this job now for about three years. And it became very clear to me very quickly, the most trusted profession in health care are nurses. 

Oyeyemi: Without question. 

Reeves: And I will not be successful, we will not be successful, in trying to keep health care human without nurses. Nurses intentionally teach this. They talk about how to communicate, they talk about just the act of putting your hand on someone’s shoulder. And so I think of the professions, nursing does it best. Now, nursing is a really hard profession. I think that the thing that even nursing doesn’t do well, you know, if you’re on an airplane and the oxygen masks drop, what does everybody say? “Put the mask on yourself first.”

We have to start there. And I don’t even think it’s burnout. It’s moral injury that is killing our professions. So when you say “who does it well?” I think nurses do it well. But what do we need to do to help everyone do it? Well, first we have to take care of each other and ourselves.

You know, even when one other thought, what do we call it whenever in residencies, whenever you have to cover? You’re the “jeopardy” resident. Who would call it jeopardy, who wants to be on a rotation called jeopardy that you’re at risk of being called in? It should be called the “supportive” rotation. You’re the “support resident.” You get to help your colleague who’s sick or going through a hard time. It’s a privilege, not an onerous thing. We have to change the way we support or don’t support each other, and we have to prioritize that. I’m not sure I completely answered your question, but… 

Oyeyemi: Oh, no, that’s perfect. You actually, you actually brought up another sub question, though. I remember actually being at a summit hosted by your very foundation last year in Baltimore, Maryland, and a conversation that I was having with another one of the attendees at the summit last year was around this issue of burnout and moral injury. And I remember having a very sharp reaction when I was in this discussion and was reminded that there’s a difference between a moral injury and burnout. These are not synonymous. 

And you just you just you just pointed to it now, you mentioned that. What’s the distinction there? What is it that people– what’s the misconception around burnout and moral injury? Because it seems like people believe that they’re synonymous. 

Reeves: Yes. Well, I think burnout is just you’re overwhelmed with the work, overwhelmed with the charting, overwhelmed that you have too many patients to see that you– There’s just too much work to do. And I honestly don’t believe that is the biggest problem in health care. It’s a problem. It’s not the biggest problem, a moral injury. 

I’m a pediatric hospitalist. I know the best way to treat this young man who has diabetes is with an insulin pump and his insurance, Medicaid, won’t let me do that. That’s moral injury. That I have a child with asthma and they’re not documented and they’re afraid to tell me that. And we can’t get their medication filled. So they– I work hard in the hospital and get them healthier, but then they’re back in four days. Or, people don’t have a refrigerator to refrigerate the amoxicillin, you know. Or I have to send someone home when they’re not ready to go home because discharge planning is pushing me because we’re not going to get paid. You know, those are the spaces I believe people go into medicine and nursing and health care because they really want to help people, and then they’re prevented from being able to do just that. 

Oyeyemi: And that builds up over time. 

Reeves: It builds up. You feel bad and you remove yourself and, you know, it’s…it’s funny, even, the first thing you do in medical school and in a lot of schools is you have anatomy in you and you work on a cadaver. And the old teaching was: don’t connect. That’s so wrong. Learn about that person. This person gave you a gift. Connect with your patients, connect with each other. But when moral injury is there, you don’t want to connect. You want to dissociate because you want to protect yourself. And that’s wrong. You know, people and really hard jobs.

Oncologists, say, sometimes oncologists often feel like the chilliest people. But I think they’re protecting themselves because nobody else is. Every person that comes to them takes a little piece of them, and then nobody’s working to put them back together again. If we work to put them back together, they’d be more whole for themselves, their family and their patients.

Oyeyemi: And that seems like right on cue with this idea of keeping health care human. What type of shifts in the way that we both train and employ, foster, support oncologists and all other specialties, all of the physicians? What type of– what type of supports could change? What is something that we could institute? Magic wand, Dr. Reeves, this is something that we can change to be able to actually connect and allow and support them so that they can actually connect with their patients. I know that’s a big question. 

Reeves: Yeah there’s evidence here. There’s proven ways to do this. You know, when I was at Temple, I ran a program called Cure Violence. It was a gun violence prevention program in North Philadelphia, where we hired returning citizens from prisons whose lives were negatively affected because they took part in violence. And then we trained them to be in the community, working with young people to move them away from high risk situations. Terribly hard job, right? We were able to keep these, credible messengers employed for decades because we did a support group every other week with a trained facilitator where they could just talk in a safe space. 

No bosses, none of that. And they would just talk about how hard their job is, how hard their day is, and they’d support each other and we’d give them lunch. And it’s–  in the trauma-informed world it’s called a self group. Yes, you would have to take time away from seeing patients. But you know how much money you lose when you lose a mid-level practitioner? On average, $500,000 is what the institution loses from the patients, they lose recruiting the new person, building up a new patient panel, all those things, it’s a no brainer.

Oyeyemi: It’s a no brainer return on investment on that though. 

Reeves: Yeah. And– but, we just have to realize these are hard jobs and people need time to heal from the day. 

Oyeyemi: Yeah, we’re running up against our time. So. But I want to make sure that I learn a little bit more about this human– Gold Human-Centered Spaces and what exactly that looks like. I’m assuming that that’s what you’re describing right now might be a proper dovetail into what exactly that is, what that looks like, and what Gold Foundation is doing to support. 

Reeves: Well, they’re clinical spaces that include self groups twice a month for the, for the health care team. They include education generally around trauma informed work. They teach people how to be a trauma-informed clinician. They teach everybody in the health care team, from the wonderful security guard to the parking attendant to the, to the nurse at the registration desk, to the clinician, that everybody has a voice, everybody deserves support. And just to give you a, quick example, you know, it changes the whole demeanor.

Instead of having a sign above the registration desk that says, “if you’re 15 minutes late, you can’t be seen.” That sign instead would say, “if you find yourself late, come talk to me.” And I’m not saying you can take someone right back. You’re not going to do their whole visit. But what you can say is, “okay, have a seat. You’re stressed out. Get a glass of water, I’ll be right back. And we’re going to figure out one thing I can do for you today before you go home.” We can’t do everything, but we can do something. And because by the time patients often get to the clinician, they’ve already had so many bad interactions. 

So, it really is simply a trauma-informed space. And, you know, I’m a pediatrician. Trauma-informed schools have changed communities in a statistically significant way. The Harvard Business Review says health care should be trauma-informed. It’s a good business decision. We just need to do it. 

Oyeyemi: Who’s the opposition to this? Like, why is that not already standardized? If it’s evidence based, we’re seeing that statistically significant, we see that we can anecdotally point to experiences that this is in Harvard Business Review? Why isn’t this standardized across the United States right now? 

Reeves: Well, I think it’s two reasons. It’s culture. It’s not part of the culture of medicine. Medicine– the revenue margin is too thin that you need to dip down and then go back up again.

And every– chief financial officers are afraid to do that. They’re living in the moment. So when people don’t show up for appointments, instead of trying to figure out how to get them to show up, they double book. That mentality and that culture of reactivity instead of thoughtful planning is medicine’s problem. And we have to realize, you know, we’re not going to double book our way out of patients not showing up for appointments.

So it’s a root cause analysis versus a reaction. And medicine is reactive. I don’t mean that to be quite so simple, but… 

Oyeyemi: Of course, I mean I understand that. Yeah, yeah. Let me get you out of here on this Dr. Reeves because, I actually find that that component– you know, one of the things that I’ve often, sort of reflected on is so many of our colleagues who have gone through very specific programs, whether those were MD/DO programs at the respective schools, respective medical schools, public health training, dental schools, there there seems to be, a growing contingent of practitioners, providers, physicians, dentists, etc., who understand that some of those like upstream causes, social and structural determinants, some of these, other skills that are needed, perspectives that are needed to be able to actually have a transformed education system, right? A transformed way of doing things and a transformed system of delivery of care.

It really does feel as though there’s a growing contingent of folks who truly believe that because they’ve received it as part of their education, you know, whether, you know, whether undergraduate training, graduate training, etc.. I’ve always been of the mindset that maybe we have a missed opportunity here, which is: a lot of the folks who actually end up as decision makers within some of these different companies or organizations, businesses, who may not have gone to, you know, a medical school with a, with a really core social mission and a curriculum that that integrated these things.

Is that a missed opportunity? What more can we do that we’re not currently doing that you think would be important? That would be an important note or message for the broader network of people. 

Reeves: Yeah. Well, you know, and it’s actually, you’re the perfect organization for this because we need to not just be post Flexner. We need to go way beyond Flexner. We aren’t necessarily recruiting the right people even into medical school, because we don’t need people to memorize things anymore. That’s not a skill that matters so much. What we need are people who can connect. What we need are people who can solve, think through problems. People who can build trust. People who can make people feel cared for and that doesn’t necessarily mean all A’s in organic chemistry.

And it means, you know, I’m a philosophy major. Most of the most of that, not all, but a lot of the clinicians I know that I have an affinity with around humanism are humanities majors, or at least have a strong humanities sense in their education. And I think we have to spend more time, really, these are teachable moments.

You can teach people how to be kind. You can teach people how to make sure they’re ready to enter a room, even if they just had a really bad moment in the room before. You can teach people to build trust, and we don’t concentrate on those things because people aren’t dying in our hospitals today, for the most part, because we don’t know what to do. It’s because they’re not coming or they don’t trust us, and I think those things are teachable. And I think it has to start with who we’re bringing into the schools. 

Oyeyemi: Yeah. Couldn’t agree more. You’re preaching to the choir on that. I do think that that’s one of the many things that schools can do is really look at the ways in which they’re recruiting and matriculating and training students. No question about that. Dr. Reeves I’m going to get you out of here on this. What’s the one thing that you’re really optimistic about? Send us off on a good note. 

Reeves: I think people in health care are wonderful people. Good has power. Good has so much power. It’s contagious. We’ve all seen it. And if we can all work together, we will be exponentially better, not just additive. 

Oyeyemi: Whew. That’s a mic drop moment if I’ve ever heard one. Dr. Kathy Reeves, president and CEO of the Arnold P. Gold Foundation. Dr. Reeves, I really appreciate you, appreciate your time, and I’m looking forward to hopefully being able to welcome you back into the space here when we, when we run it, we run it again for the next, for the next round.

Reeves: Anything for you. 

Oyeyemi: That’s much appreciated. I might take you up on that. I’m going to hold you to those words. Thank you all for being able to join this incredible conversation with Dr. Kathy Reeves. You can find out more information about the work that the Gold Foundation does at goldfoundation.org. And we’ll look forward to seeing you on the next episode of this series. Thank you very much. 

Reeves: Thank you.