Prime Time Living - Page 16 - The People's Doctor

Prime Time Living
- Page 16
The People's Doctor
Dr. Leana S. Wen, Health Commissioner Baltimore City Health Department

By Margit B. Weisgal, Contributing Writer

To most Baltimoreans, Dr. Leana Wen is well known for her aggressive approach to stemming the opioid crisis that is affecting the nation; she wrote a blanket prescription for residents for the antidote, naloxone, to save as many lives as possible. “Since then,” Dr. Wen relates, “Everyday people have saved the lives of more than 1,785 family members, friends and neighbors throughout our city.”

But there’s much more to Wen than we learn through her many interviews and press conferences. Although her background is in emergency medicine and as a patient and community advocate, what she brings to her position is her focus on who she views as her patient load: the local population. She is driven to be patient-centric, constantly focusing on what is best for the people she and her staff are responsible for.

What drove her to care so much about advocacy and health policies? It’s because of her mother.

“My mother, Sandy Ying Zhang, is my role model and my inspiration for what I do every day. She was diagnosed with breast cancer when she was in her 40s and fought it courageously for eight years until she passed away in July 2010,” Wen relates. “She went through a year of telling her doctor that something was wrong before she was finally diagnosed.

“My mother battled her cancer at the same time I went through medical training. I saw, firsthand, how this disconnect exists in medicine. Patients and family members are frustrated and scared. They have difficulty advocating for themselves at the time they need it the most. Doctors, nurses and all of the health care team are trying their best, but there is something wrong with our system that can lead to miscommunication, distrust and poor care.”

Wen took a year off from medical school to become her mother’s caregiver, and, in doing so, learned about being on the receiving side of the medical system, specifically what a patient needs versus what the system provides.

“Doctors always have the best of intentions,” Wen says, “but there’s still a disconnect. It changed my life and my approach to medicine. We – medical professionals – must learn to encourage patients to be empowered and help bridge the gap between provider and patient.”

Every day, Wen sees – and relates to – the challenges people face when it comes to their health. She grew up as an immigrant, arriving in the United States at age 8, and struggled during those early years with homelessness, unstable housing, poverty and dependence on government aid such as Medicaid and food stamps.

She developed an understanding of how public health can be a powerful tool to level a playing field filled with inequality.

Consequently, it instilled in her the sense of advocacy she brings to her role as the Baltimore City Health Commissioner.

Prior to this role, she was an emergency physician, professor and the director of patient-centered care research at George Washington University. She wrote a book titled “When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests.” It’s a practical guide on what you, as a patient, can do to advocate for yourself.

“Speak up the moment you have a question,” says Wen, “the moment you don’t understand something the doctor says. Don’t let more time – and more opportunities for misunderstanding – pass by. Bring someone with you who can help you be a better advocate. Start with your story – not a list of symptoms – but a story that provides context for why you are there. When you do this, it will revolutionize your interactions with your doctor, and potentially change how your doctor interacts with future patients as well.”

Wen also talks about how many of the tests and procedures we undergo are unnecessary. “A study by the National Academy of Medicine ( https://nam.edu ) says 30 percent of all tests and treatments are not needed, with costs topping $750 billion a year. This results in overtreatment, unnecessary side effects and more chances for infection. More is not better; we are practicing sick care, not health care. In addition, a quarter of a million patients die of medical error, and the major cause of medical error is misdiagnosis. If you start wrong, then what follows is wrong.”

A 2018 study by the Washington Health Alliance ( http://wahealthalliance.org ) titled “First, Do No Harm,” found that over 45 percent of the health care services examined were determined to be of low value, and 36 percent of spending on the health care services examined went to low value treatments and procedures. As the report states, this leads to both physical and mental harm in addition to wasted medical costs. Much of this is caused by pressure from patients or fear of malpractice.

For instance, women are still tested annually for cervical cancer when the recommendation is every three to five years if you’re not at risk. Many annual examinations include unwarranted tests for healthy patients.

Similar waste has been reported throughout the country and ties in to Wen’s belief that we have to be our own advocates. One way to help reduce this excess is to ask the following questions:

•What is this test intended to show?

•Will the result of the test change the treatment?

•Do I really need this test or procedure?

•What are the risks and side effects?

•What happens if I don’t do anything?

Visiting a doctor, continues Wen, is akin to going on a job interview: you have to be prepared. You are the expert when it comes to your body; your doctor is the expert when it comes to medicine. You need to be an active partner to ensure the best care possible. There’s a right way and wrong way to approach your appointment.

In advance, write down why you’re there, what factors surround the cause of the problem, and any background that will help the physician get the whole picture.

“Studies have shown that doctors will interrupt in something like 10-12 seconds after the patient begins speaking,” explains Wen. “It’s not out of a bad intention, but you need to be aware of this and be prepared to do something about it.

Bring your medical history, the pills and dosages you’re currently taking, and know what you want to discuss. When you can, bring someone with you to help you, someone empowered to ask questions you wouldn’t ask yourself.”

Beyond being the city’s patient advocate, Wen recognizes the unique challenges she faces as a woman in a maledominated field. She feels privileged to be in her position and actively promotes other women when she can. All three of her deputies and her chief of staff are also women, and she encourages her entire team to be mentors to others.

“The #MeToo movement brought back memories of what my mother went through as a poor immigrant,” Wen explains. “She had to accept any work available

Interview continued on page 22