Oct 21, 2009

Transforming Leadership: From Individual Patients to the Community

About two weeks ago, I flew out to LA to take refuge from the Michigan cold. LA was unseasonably chilly, so I didn't quite get the sun and warmth that I had hoped for, but I got something better.

I attended the annual Asian Pacific Americans Medical Student Association (APAMSA) National Conference and spent my three days in LA meeting other medical school students and listening to inspiring lectures and workshops. The majority of the sessions focused specifically on health issues in the Asian American population. These include the incidence of Hepatitis B, the large number of uninsured in the Korean American community, the incidence of lung cancer, health awareness and education, and cultural competency.

California has a very large and diverse Asian population. I visited the Monterey Park/Freemont/Arcadia area on my last day in LA and could have sworn I was abroad! Because of this large Asian population, Asian American specific health issues are very apparent in California and there have been several great stories of progress. We had the privilege of hearing from Assemblywoman Fiona Ma of the San Francisco area and Assemblymember Mike Eng of the Los Angeles area describe the great strides that California has made in making the Hepatitis B issue a city-wide awareness and screening campaign (Hep B Free). We also heard from Dr. Jimmy Hara, Community Benefit Lead Physician for Kaiser Permanente Southern California, Dr. Arthur Chen, Medical Director of Alameda Alliance, Captain Cynthia Macri, M.D., Special Assistant of Diversity to the Chief of Naval Operations in the US Navy, and Dr. Paul Song, Director of Clinical Quality Improvement for Vantage Oncology who have all expanded their medical careers to address large scale efforts and discussions on how to better deliver health care, increase access, and shape national health policy. To top off this list of inspiring speakers and the many not mentioned here, our conference closed with talks from Dr. Sammy Lee, the first Asian American to win an Olympic gold medal for the US and Dr. Eliza Lo Chin, president-elect of the American Medical Women's Association.

Since most of these speakers hailed from California and have done such admirable work in the state of California, I felt a little discouraged at first. My hometown in South Florida's greatest health issues are geriatric and centered around ensuring that our seniors are able to live quality lives and obtain the health care that they need easily. My second home in Boston has nearly achieved universal health care access through its individual mandate, but now struggles to iron out the financial details of managing and continuing this initiative. And my new home in Ann Arbor? Unemployment is everywhere. I have yet to gain a better understanding of the health issues in Michigan, but my guess is that access is one of the top five concerns. With significantly smaller Asian communities in these three locales, how am I supposed to take the inspiring and encouraging words from the APAMSA conference and transform them into action locally?

The conference may have been for Asian Pacific American medical students, but the big themes of the conference were universal. The field of health care is changing as we speak and in order to prepare ourselves for the future we need to develop and transform our mindset and develop leadership skills. There are several junctions within a patient's pathway through the health care system that we as health professions students can act: from drug and medical devices development to care access to care delivery to care management. The one big thing that each of these areas of work have in common is expanding care from each individual patient, to care for a community and working with others as a team. I don't have to recreate the Hep B Free initiative in Ann Arbor. There are at least a million and one ways students can make an impact in health care. The safe surgery initiative: "Check a Box. Save a Life." is just one example (Tune into the launch tomorrow!).

As I think about transforming leadership and health care, here are a few considerations as illustrated by the Hep B Free initiative:

    1) Get to know and understand your community, your team, and the "system" in which they operate and function.
    Measure the burden of Hepatitis B in San Francisco, who this affects.
    2) What do you want to accomplish?
    Increase awareness about Hepatitis B, reduce the incidence of Hepatitis B, provide assistance to those who must manage Hepatitis B
    3) How does that benefit your community and your team?
    Decreased burden of disease and develop a replicable model for other cities to adopt
    4) How do you develop support for your goal?
    Involve community members, political figures, and anyone interested. This is a community effort that benefits the community, so the community itself should feel a sense of ownership for the initiative. To publicize the initiative and develop community support, the Hep B Free initiative hosted several dinner banquets at local restaurants with the understanding that "Asians bonded over food"
    5) What kind of help do you need?
    Medical support and expertise, community support, political clout, publicity, financial support
    6) What's the plan and how will you execute it?
    Launch educational messages to increase awareness, follow-up with health fairs that will provide screenings and vaccinations, provide information on how to manage Hepatitis B, train health professionals about Hepatitis B and how to help patients manage it.
    7) How will you adapt to change?
    Consistent feedback
    8) How will you measure your progress?
    Measure the number of people vaccinated, screened, trained, etc.
    9) What kinds of improvements can be made?
    Understand the best communication pathways: television/radio public service announcements, health fairs in conjunction with big holiday street fairs, transportation advertisements, how best to train health professionals, communication with public officials
    10) How will you share your progress?
    All materials are available on a website and direct support has been loaned to help Orange County launch a similar campaign

Don't be afraid to be creative and think out of the box! Also, words of advice from Dr. Dexter Louie, another great speaker at the conference, "Do what you can. We can't expect everyone to save the world quickly. Understand that whatever you do will be meaningful and will make a difference in the lives of others."

As I boarded the plane to head back to Ann Arbor, an idea popped into my head that I hope we as medical students can take ownership of to make positive change in our community. The Hep B Free initiative had developed lots of materials to educate their communities about Hepatitis B and the importance of getting screened and vaccinated. The area where they seemed to continue to struggle with was educating and training health professionals that would be caring for this newly informed community. Why should we wait till when physicians have begun practicing? Why not start the education process earlier?

Here at the University of Michigan, we have a curricular component called Longitudinal Cases. Every week, about ten of us meet in small groups led by a professor to discuss a case that is clinically relevant to the material we are learning in lecture. But, instead of focusing on the medicine of the case, we spend time discussing the sociocultural factors that may impact our interactions with the patient, how the patient interprets and manages the condition, etc. Understanding that our time in class is precious and that health concerns like Hepatitis B should be spread to all health professions students, why not develop a case study on Hepatitis B to be discussed in our Longitudinal Case sessions and make it a new standard addition to the curriculum? If we can make this happen, we will be expanding from individual patient care to caring for our community.

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