I am now back from internet holiday (hooray!) and spent my first day back in the all hands meeting for my organization, The Permanente Federation, where we concluded with an interesting exercise. We were asked to draw an image of ourselves and explain it to colleagues.
I drew a stick figure with a megaphone and described myself as working always to give those without a voice, a voice. It’s a theme that runs through all my social media content, and I think it’s the most amazing/important thing physicians can do in society (It’s the main thesis of my presentation at the 2011 ONC Meeting, in fact). Whenever I have observed a health care interaction where the patient voice was taken away, I left disappointed. Conversely, I am drawn to physicians and people I know who use their skills and tools available to give people a voice where there was none previously.
Today reminded me of my walk with Brigid McCaw, MD, MS, MPH, FACP, who is Kaiser Permanente’s clinical lead on family violence prevention and has earned local and national awards for her work. Here’s the photo I took of her right after our walk together:
She’s standing in front of posters for a campaign that she’s supported, part of the National Dating Abuse Helpline.
On our walk, we talked about Brigid’s own journey to prevent family violence, which began when she was a medical student who learned that her sister was secretly fighting for her own life, with virtually no resources available to assist her (you can read the story written about Brigid here). She told me about innovative work studying adverse childhood experiences (ACEs as they are called, with the original cohort from Kaiser Permanente patients), and about listening to patients and going deeper than clinical symptoms to understand the causes of unwellness.
We (of course) talked about social media and I think we had a mutual epiphany. We know social media can be a very powerful tool for the engaged, but what about the disengaged? How could we learn about the things patients don’t tell us in the exam room, or don’t e-mail to us in our secure patient portals? Brigid’s work has shown that asking more and then doing more is effective, and these approaches can be systematized to help a lot of people (meaning, saving lives). We both share the interest in using social media to listen more, and listen more to people who are not listened to normally.
Brigid’s work is accessible through the Kaiser Permanente Family Violence Prevention Program. Within this site is the silentWitness display and stories. The site is dedicated to three Kaiser Permanente staff members who were killed as a result of family violence. It includes 12 moving stories of Kaiser Permanente physicians, nurses, staff, male and female, who were the victims of family violence; it shows their courage, survival, and hope.
I asked Brigid what she would wish for if she had the superpowers of her choice, and she told me:
Using my US hat, I think healthy parenting and models of healthy intimate relationships are an essential key to preventing future domestic violence. So I would wish for each child a home with adults who love them and are caring and respectful to each other (and to their parents- this is a trans-generational thing).
Wearing my hat as a global citizen, I think that we may need to start at a more basic level- assuring women’s rights. Unless basic human rights are assured, the other things sound nice, but probably don’t mean much in real and practical terms.
Her colleague and my mentor of many years, David Sobel, MD, offered this unsolicited endorsement of the understanding that this work has brought to our profession:
Brigid is a gem. She has championed the work to help identify and support patients who are threatened by family violence… and develop specific resources and protocols to support clinicians and patients to take effective action. If a patient is facing threats at home, how likely is it that their number one priority will be managing their diabetes, exercising, taking their medications, etc.. We must help patients address what is most salient and important in their lives, and unfortunately, too often it involves family violence. Thanks to Brigid and others for bringing this issue front and center – for the benefit of patients as well as their caregivers.
It is interesting that these physicians, who train in and work in the most technologically advanced health systems in the world, conclude that the basic needs and environments of their patients and communities are key to supporting overall well being. One of the most important abilities physicians have to help our patients get there is listening and providing them a voice. It really is a beautiful thing.