Amplify their voice and share power with trusted messengers — no physician is an island to themselves. Institutions and systems demonstrate accountability by sharing power and influence with credible messengers in the community and using these community and people assets in care navigation and treatment validation. Practitioners in health care must recognize the power of narrative medicine, storytelling and lived experiences in driving self and collective efficacy, value and trust.
The COVID-19 Pandemic taught all of us many things. One of the sectors that the pandemic put a spotlight on was the healthcare industry. The pandemic showed the resilience of the US healthcare system, but it also pointed out some important areas in need of improvement.
In our interview series called “In Light Of The Pandemic, Here Are The 5 Things We Need To Do To Improve The US Healthcare System”, we are interviewing doctors, hospital administrators, nursing home administrators, and healthcare leaders who can share lessons they learned from the pandemic about how we need to improve the US Healthcare System.
As a part of this series, I had the pleasure to interview Dr. Chris T. Pernell.
Dr. Chris T. Pernell is a dynamic physician leader and social change agent. In her public health practice, she focuses on health justice, community-based advocacy, and health promotion, and disease prevention. Working as a senior executive in a hospital in Newark, New Jersey, she oversees a portfolio that includes Population Health, Strategic Planning, Community Affairs, and the Human Experience. Dr. Pernell serves as a frequent contributor across television, radio, and print media leveraging her lived experiences and expertise as America’s public health physician and health equity champion.
Can you tell us a bit about your backstory and a bit about what brought you to this specific career path?
Not unlike many children, I grew up knowing I wanted to be a doctor. But by the sixth grade, I was fascinated and focused on becoming a neurosurgeon. This became a steadfast goal which motivated me to push myself in academics and beyond. Ultimately, I decided on a different career path in medicine, one where I could combine my love of community, policy, politics, and health and well-being. Now, I’m a board-certified public health and preventive medicine physician and a fellow of the American College of Preventive Medicine. In my life, I’ve had to be tenacious and persistent in the face of adversity and use creativity and innovation to design life and career pathways that may not have crystallized otherwise. These are traits I learned from my parents, grandparents and family.
Can you share the most interesting story that happened to you since you began your career?
My career hasn’t followed a linear path. From having an epiphany that ended my childhood dream of being a brain surgeon to having to pause my training altogether due to an undiagnosed yet chronic health condition. At first, I figured I’d only switch disciplines but at one point my health threatened whether I’d be well enough to complete training and to practice someday. But, I clawed myself back to good health and out of one career path and into public health and preventive medicine.
Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?
Everything about medicine is a steep learning curve! And, it’s truly a sacred honor but looking back there were embarrassing moments, even moments that made me angry or sad but occasionally there were things that made me laugh. Like trying hard to prove myself and staying late on my first night on call as a medical student and then sleeping through my alarm the next morning. I can smile now, but I learned this journey would be a marathon and not a sprint and to work smart, not just hard.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
“I am of the opinion that my life belongs to the community, and as long as I live, it is my privilege to do for it whatever I can. I want to be thoroughly used up when I die, for the harder I work, the more I live. Life is no ‘brief candle’ to me. It is a sort of splendid torch which I have got hold of for a moment, and I want to make it burn as brightly as possible before handing it on to the future generations.” George Bernard Shaw
Someone once shared this quote with me after hearing how I described my purpose. I tell people what I do is “heart work.” My deepest motivation is to die empty — meaning that I’ve spared no gift, no talent, no love, no passion, and no enterprise, but I’ve sown back into my living all that has been sown into me.
Are you working on any exciting new projects now? How do you think that will help people?
Health justice is always in my line of sight; I continue to design creative ways to educate and share power with the masses to achieve health equity and racial justice — this happens in the community and social media space through my Life Clinic with Dr. Chris platform. I’d like to see this platform continue to grow and expand to the streaming and/or broadcast or cable media space. Public health correspondence focused on how central it is to our stories and lives and the souls who are too often excluded and forgotten
How would you define an “excellent healthcare provider”?
An excellent healthcare provider is one who shares decision making with the person under their care; one who knows the history of the community/ties they serve and seeks ways to share power or for institutional power and community power to be aligned; one who actively examines how racism or other systems of oppression may be operating within health care or their practice in order to design anti-racism strategies to help people achieve health equity; one who understands the role of implicit biases in the provision of care; one who understands how structural determinants impact health outcomes and therefore practices an integrated model of care; one who creates a culturally fluent care environment and one who understands the role of health literacy in care outcomes. Finally, an excellent healthcare provider works in partnership with other providers to provide whole person care.
Can you share with our readers a few examples of where we’ve seen the U.S. healthcare system struggle? How do you think we can correct these specific issues moving forward?
Racism has stained the American healthcare system just as it has impacted every facet and aspect of American life. As we’ve seen with the COVID-19 pandemic, inequities are the root of the disparate healthcare outcomes experienced by communities of color. This has proven true in the disproportionate hospitalization and mortality rates for Black and Brown communities as well as the lack of vaccine equity, in particular, around access to those communities most disadvantaged and devastated by coronavirus.
I too have experienced bias and racism in care and I’ve seen it perpetuated in the substandard care provided to loved ones. Before losing my father and two cousins to Covid and my oldest sister being both a breast cancer survivor and Covid-19 long hauler, we had been stung too often by the pain of racism.
Sadly, I’ve learned more about my profession as my parent’s daughter and advocate than I’ve learned in classrooms and treatment rooms and thus I’ve committed myself to transforming and “treating” systems.
A doctor once dismissed my mother in the Emergency Room after failing from a wheelchair at a sub-acute, long-term care facility implying that there wasn’t anything wrong with her without performing a thorough exam or work up. She was later confirmed to have experienced a traumatic splenic artery aneurysm. My father who lived with chronic HIV infection had a physician scream, “here comes HIV,” as he was wheeled into the ICU with severe hemoptysis. My father was mortified but not too sick to demand decency and respect at one of the most vulnerable moments in his life. I had multiple physicians insinuate that my symptoms which were ultimately diagnosed as Postural Orthostatic Tachycardia were not real or valid. It didn’t matter that I was a peer in the field. And, once while in the emergency room with my sister who had developed a blood clot in her lung, a nurse called security on me for asking too many questions and suggesting she check my sister’s chart before discharging her.
It is necessary for hospitals to become hubs of racial healing, instead. As anchor institutions, hospitals and health care more broadly must do the work to identify and address implicit biases and structural racism in care. Hospitals do this in part through structured training but equally or more importantly health systems must develop fulsome health equity and anti-racism strategies to ensure all people are treated equally and to integrate clinical and non-clinical solutions into achieving population-wide health and wellbeing outcomes. Health care needs to diversify who is trained and create pathways for physicians and providers of color to excel and advance within the field. Health care should evaluate itself by quality, safety, equity and cultural competency metrics with equal enthusiasm and importance. Hospitals need to value business diversity through hiring, sourcing, procuring and investing in equity-driven ways.
Can you share a few ways that our healthcare system really did well? If you can, please share a story or example.
Health care and public health had to adapt very quickly to many unknowns in order to save lives and put our nation in the position to beat back the pandemic. The ability of our research scientists to develop multiple safe and highly effective vaccines and to conduct ethnically and racially diverse and ethical clinical research trials should be celebrated and become a blueprint for future success.
Given my personal loss and experience in the workforce, I was motivated to volunteer for a coronavirus vaccine trial to become part of the solution against the backdrop of earthquakes of devastation.
As a healthcare leader can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.
- Improve access to care — the integration of public health and clinical medicine is an imperative in order to achieve health equity. Especially since much of what impacts health is rooted in social, structural and political determinants of health. Care must be designed in a community-integrated model where people are connected to care in the most socially and culturally fluent settings (i.e., community health centers, local pharmacies) and modalities (i.e., mobile health and virtual care) and at times outside of brick and mortar hospitals (in-home care) and facilitated through collaborative arrangements with clinical and social service agencies and SDOH partners (e.g., co-located in schools or housing).
- Improve the quality of care received — health equity is achieved by valuing all people equally and everyone having the opportunity to attain their highest level of health. To do this, providers and systems alike must demonstrate accountability by identifying how racism and systems of oppression have influenced care provision and health outcomes. High quality care is care provided in culturally-tailored, linguistically appropriate and health literate approaches. Quality is tied to diversity of providers where cultural competence is a priority and inclusive care environments are intentionally designed. (Again, please see the response above). “It is necessary for hospitals to become hubs of racial healing, instead. As anchor institutions, hospitals and health care more broadly must do the work to identify and address implicit biases and structural racism in care. Hospitals do this in part through structured training but equally or more importantly health systems must develop fulsome health equity and anti-racism strategies to ensure all people are treated equally and to integrate clinical and non-clinical solutions into achieving population-wide health and wellbeing outcomes. Health care needs to diversify who is trained and create pathways for physicians and providers of color to excel and advance within the field. Health care should evaluate itself by quality, safety, equity and cultural competency metrics with equal enthusiasm and importance. Hospitals need to value business diversity through hiring, sourcing, procuring and investing in equity-driven ways.”
- Amplify their voice and share power with trusted messengers — no physician is an island to themselves. Institutions and systems demonstrate accountability by sharing power and influence with credible messengers in the community and using these community and people assets in care navigation and treatment validation. Practitioners in health care must recognize the power of narrative medicine, storytelling and lived experiences in driving self and collective efficacy, value and trust.
- Invest in health literacy and 5) cultivate the power of prevention — too often patients are left confused and with incomplete understanding around their diagnosis and treatment plan or options. Health literacy like digital literacy must be cultivated. Just like there is a role for community health workers and care navigators, there is a role for health educators who can help people understand the factors that contribute to health promotion and disease prevention more broadly as well as specific to their conditions. A priority for public health is building a prevention army. There are multiple health professionals who would be implicated in such a corps of health promoters such as nutritionists, mental and behavioral health specialists, i.e., whole person care teams and care networks.
How do you think we can address the problem of physician shortages?
Solving physician shortage is not distinct from addressing the issue of physician diversity. These solutions mutually serve one another. For instance, it is necessary to ensure a diverse pipeline of talent is exposed to health care early on. In essence, health care must remove the barriers to entry — there are financial barriers to entry, there are other structural barriers to entry around how competitive applicant pools are defined, and there are a lack of development and mentorship opportunities for young persons of color.
How do you think we can address the issue of physician diversity?
Additionally, physicians of color need access to professional growth and development pathways to ensure they are retained in health care and achieve the highest levels of academic and professional success. The system too often cannibalizes its diverse providers by failure to demonstrate support and/or by creating or allowing non-supportive even hostile work and training environments to be the status quo.
How do you think we can address the issue of physician burnout?
Health care must care for the whole person — the whole person of its providers. During the pandemic, the lack of system and organizational resiliency has led to moral injury among physicians and health care workers. Too often, the dialogue is centered on personal resilience which is short-sighted when the conversation must be rooted in how systems provide for the emotional and psychological well-being of its staff. Emotional, mental health and psychological first aid and robust peer supporter networks are ways in which organizations drive empathy through the system.
What concrete steps would have to be done to actually manifest these changes? What can a) individuals, b) corporations, c) communities and d) leaders do to help?
As individuals, providers can do their part to understand the upstream and structural factors that determine health and outcomes and then can ask themselves, how is racism operating in their individual practices and networks? We, as providers, must reflect on the truth that racism is a system of structuring opportunity where some groups are advantaged and others are disadvantaged based on the social construct of race. Like providers, all people can ask this question and be present to reconcile with this collective truth. Then, each of us must commit ourselves to one action of accountability to transform the community or world around us. In a singular and cumulative sense such solution building matters.
As corporations, truth and reconciliation is more than statements or hiring persons to symbolic positions but devising a multi-year strategy to combat systems of oppression and inequities. This is every sector’s work. And, it is important to start somewhere finite and to lay out credible action steps with metrics and to demonstrate accountability within an organization or system as well as within a community or region.
Communities can operate in their collective efficacy and exercise their communal power by engaging in the spaces and places that contribute to health outcomes and create opportunities for life success. To be in the room where it happens is to understand that the social determinants of health are truly the community foundations of health — where we live, learn, work, play and pray. This level of involvement is speaking truth to power which concedes nothing without a demand. Communities can take action by voting, by demanding accountability with their purchasing power and by not remaining silent but speaking, preaching, documenting and performing their life stories.
Leaders lead by taking inventory of the forces at play that shape the social, political, financial, business and cultural spaces about us. Then leaders must be intentional about sharing power with those who have been historically excluded or marginalized. This can look like leaders creating opportunities or pathways for human potential to be harnessed — such as job training and workforce development or sponsorship and mentorship. Our greatest leaders recognize that our truest success is in our diversity and inclusion of voices, skills and talents. Otherwise, we operate in blind spots. Equity, on the other hand, demands leaders to think around corners.
You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be?
The movement I’m walking. This is a movement to drive justice — health justice and racial justice — through system redesign, system accountability and national transformation. We all have a role to play. Those in positions of power and privilege must be aligned with and conspire alongside those from communities who have been historically excluded or disenfranchised to achieve and sustain meaningful change.
How can our readers further follow your work online?
This was very meaningful, thank you so much. We wish you only continued success in your mission.