Moving Medicine
Physicians as storytellers, with Megan L. Srinivas, MD, MPH
Feb 14, 2024
Featured topic and speakers
Featured topic and speakers
In this episode of Moving Medicine, Megan L. Srinivas, MD, MPH, infectious disease physician, talks about how physicians can use stories to build trust, improve patient care, influence policy changes and combat medical misinformation. Dr. Srinivas is also a clinical instructor and translational health policy researcher. This episode was created in collaboration with the PermanenteDocs Chat podcast, and is hosted by family physician Alex McDonald, MD.
Speaker
- Megan Srinivas, MD, MPH, infectious disease physician; Iowa State Representative
Host
- Alex McDonald, MD, family medicine physician and host of PermanenteDocs Chat, Kaiser Permanente
Listen to the episode on the go on Apple Podcasts, Spotify or anywhere podcasts are available.
Unger: Welcome to Moving Medicine, a podcast by the American Medical Association. Today's episode was produced in collaboration with the PermanenteDocs Chat podcast. It features Dr. Megan Srinivas, an infectious disease physician and Iowa State Representative. She'll talk about how the ability to draw narratives from your background, experience and imagination can help you build patient trust and connection. Leading the conversation is the host of PermanenteDocs Chat, family medicine physician Dr. Alex McDonald.
Dr. McDonald: Hello, everyone. Welcome to today's PermanenteDocs Chat, the first one here of 2024. And so, thank you for joining or listening from wherever you may be. I want to give a shout-out to our LinkedIn Live listeners and viewers as well, a new thing we're doing this year. Looking forward to getting some in-person live interaction.
Again, I'm your host, Alex McDonald. I practice family and sports medicine here in Fontana, California, as part of the Southern California Permanente Medical Group. And today's podcast is brought to you in collaboration with the American Medical Association, and we have Dr. Srinivas here. So, Dr. Srinivas, welcome to the podcast.
Dr. Srinivas: Thank you so much, Dr. McDonald. It's a pleasure to be here with you all.
Dr. McDonald: Wonderful. So, Dr. Srinivas is an infectious disease doctor, a clinical instructor and a translational health policy researcher, I want to know what that means exactly, and also an American Medical Association ambassador. And so, we are excited to have her here today to talk about storytelling and physicians as storytellers because that is such a powerful tool that we should all have in our doctor's bag, virtual of course, in this day and age.
So should be a great conversation. We're going to keep this short and high yield, only about 20 minutes or so. If you have questions live either on the webinar or in LinkedIn Live, make sure you drop those in the Q&A. We'll try to get to as many of those as we can. And we're going to jump right in. So, Dr. Srinivas, tell us who you are and what you do.
Dr. Srinivas: Well, so my name is Megan Srinivas. I live here in Iowa, and I wish I was in California right now with the weather that we're having.
Dr. McDonald: Right.
Dr. Srinivas: But we'll do this virtually if you're going to make me stay in the snow. So, I'm an infectious disease physician, like you mentioned. And aside from working clinically, I work in health equity, a lot of rural health equity, both in the U.S. as well as globally. And then I'm also a state legislator actually.
Dr. McDonald: Oh, wow. Wonderful. So, you wear lots of different hats. Tell us a little bit more about … you're a state legislative physician.
Dr. Srinivas: So, it's basic advocacy for our patients, in all honesty. That's what drove me to run for office. And working within systems that we do; we see how much policy actually impacts the care that our patients can receive. And so honestly, it was using storytelling to try to create change that then put me on the other side of the table, creating the policy and using those stories to drive change.
Dr. McDonald: That is amazing. Wonderful. Well, great segue. So again, as you mentioned, storytelling is such a powerful tool. Why is it important this is something that physicians have in our skillset?
Dr. Srinivas: We do a great job of listening to patients, of treating them and treating them as a whole person, not just as the individual problem that they present to us. But in order for us to be able to reflect what they're experiencing and how we can better create systems, how we can better do our job and get the resources we need, we should utilize their stories to make others understand what we see every single day.
Dr. McDonald: Right. There's a couple of different layers here. So there's our patient stories that we can help use to advocate for hospital, clinic system change, but then there's also our own personal stories to connect with patients. And how do you use those, I guess, both professionally as a physician, as a legislator and as an individual?
Dr. Srinivas: You're right. There are so many different ways in which we can use storytelling. At the most basic level when it's interacting with our patients, it's enabling them to know that they're not alone, that we understand the path that led them to wherever they are, whether it's in a hospital bed, in the office, more than just being something that we read out of a textbook. And it’s that humanistic connection that enables us to truly understand how we can better treat our patients and create that bond.
Dr. McDonald: Yeah, that makes perfect sense. I remember this experience so clearly when I was, I believe I was an intern actually. Prior to that moment, I felt like I had to be this stoic, kind of Norman Rockwell vision of what a physician is, right? And I had to be the professional in the white coat, and I couldn't smile, and I couldn't let my personality through. But then once I realized I could just be myself, and for those of you who know me, I'm kind of a goofball, that I could just be myself and I had so much more fun actually in the exam room.
And I was able to connect with patients so much more because I was a person first and foremost and second of all, a physician. And that's why I'm not worried that AI is ever going to take over our jobs because that humanistic connection is what I think drives patients to us and keeps patients with us and has patients listen to us, is we share a little bit about us and our own stories when we're interacting with patients. Tell us about your thoughts on that.
Dr. Srinivas: No, it's exactly right. Honestly, it was my intern year where I first really discovered the magic of storytelling. We had a patient who had been facing a lot of challenges when it came to her health care from both being able to access it from a cost standpoint, from the social determinants of health standpoint, but then also in processing everything that she was going through. She had had an HIV diagnosis for a long time, which had led to, unfortunately, renal disease requiring dialysis.
And it was this whole cascade of issues. And when I was able just to sit with her and talk to her about her experiences, but also share about my story, about she had an immigrant background and sharing how my parents were immigrants—it was that story that enabled her to see some similarities that allowed her to open up to me about what her real issues were so I could help get her the treatment she needed and overcome the challenges that were actually preventing her from being able to succeed.
Dr. McDonald: I think that's such a powerful story, speaking of stories. Well, but having something in common, you find some common point of connection with your patient and suddenly it just changes the whole dynamic of that interaction. I think when I see patients, especially when I'm meeting a patient for the first time, if they're wearing ... I'm in the LA area, if they're wearing a Lakers jersey or a Lakers hat, I tell them about how I'm a Clippers fan, right?
And obviously that creates a little bit of humor and breaks the tension, but there's this commonality of like, "Hey, we're both basketball fans, right?" Vernazza as an example. And that sometimes little comments like that can really just set the tone and change the dynamic for the conversation. What other tips or tricks do you find as individuals in storytelling in the clinical setting help us to better connect with our patients?
Dr. Srinivas: And honestly, it's those small things that you're talking about, things that matter to the patient that you notice, and you bring up that are so critical. And in the setting of the last several years, we've actually faced so many challenges as a medical industry, as a health care industry with people not necessarily trusting what is being told to them from a scientific perspective. But as physicians, we have a very rare opportunity if we utilize those links, if we talk about the stories of being in our own communities.
For instance, being in rural Iowa where I serve a lot of patients, we had a lot of people who had some hesitancy towards the vaccines. And I didn't approach it as we need to talk about the vaccines because this is the right thing to do. Instead, I approached it from a time when I was scared about doing something or how I viewed the vaccine being made as akin to making a batch of brownies. I do a lot of food analogies in my storytelling.
Dr. McDonald: Great. We'll get along well.
Dr. Srinivas: And it was really those type of conversations that over time, I would say about four out of the five patients that would come to me that initially were vaccine hesitant, eventually ended up getting a vaccine. And it's really just approaching it from that humanistic standpoint where we can really create that clinical change.
Dr. McDonald: I think for me to use that vaccine example to go a step farther, I think the number one thing that has convinced my patients to get vaccinated is when I told them that I got my flu and my COVID vaccines this fall, and I also got my children their COVID and flu vaccines this fall. And that example in telling my story that I care about my children, and I want them to be protected is the most powerful thing than any number or statistic out there. And so, I always use those examples.
Dr. Srinivas: Exactly. And in all honesty, also even just telling your story about the 24 hours after I got it, I had horrible fevers. It sucks. I'm not going to lie to you, but I also am much more protected now for the future.
Dr. McDonald: Right. Yeah, absolutely. So, you mentioned on medical misinformation and disinformation, which has now run rampant online in social media. How can physicians help to reclaim that space and reclaim that narrative or even just help to combat some of that misinformation both individually one at a time, but also on a systems level or even on social media? Do you have any recommendations from that perspective?
Dr. Srinivas: Definitely. So, on a one-on-one basis, it's the fact that we are in a unique position where people are coming to us because they already have a certain level of trust for the profession and they're often seeking help or wanting to be reassured they're healthy. We're already in a position where there's an inherent amount of trust laid upon us. And if we utilize that to build upon it and create those connections, then we really can work to understand why somebody might have misinformation or disinformation that they're believing, and then work to tell them why that might not be correct.
And it's building upon those relationships that enables us to do that. But then on the grander scheme, once again, we still have doctor behind our names or MD behind our names or DO or MBBS, whatever it might be, the doctor in front of our names rather, and having that title also puts you in a spot in society where people inherently think that you are trying to help. Stats have shown that we are one of the most trusted professions out there.
So when we use our social media to magnify stories of people who've had good experiences, our own stories, or even just the information in relatable, small chunks without jargon, trying to break down the nature paper that went into all the different cohorts, but break it down into small words that are things that people want to read in a two sentence snippet on Twitter or X, then it actually can really impact somebody's decision making. Don't highlight the misinformation.
Don't reshare the disinformation. If you see something, instead, find a way to frame the correct information and put it out there. Because whenever we retweet, re-highlight, quote tweet, whatever it is, we actually are highlighting that for more people to see.
Dr. McDonald: Right. Yeah, that makes a perfect case. I do a lot of social media work as many of you out there know, and just trying to stay positive and focus on my voice and my story and not trying to directly respond to some of those other things because you just get stuck in the vicious echo chamber in some respects.
And so, I always tell people that if you're going to use social media, just set your framework and just stay with your own voice and ignore the trolls because they're out there. And in fact, if you're not trolling, you're probably not doing something right. So, I tell people, getting trolled is a badge of honor when it comes to social media.
Dr. Srinivas: It truly is. It honestly is. And sometimes it's really good for an evening laugh too when you're sitting around the family table.
Dr. McDonald: That is very true. That is very true. I mean, you touched a little bit on how physicians are uniquely situated to tell our own stories and tell patient stories to some degree, but I have a good colleague who likes to say that stories lead to outcomes. As much as we like to think about it, we don't legislate based on data and statistics. We really legislate based on anecdote and those stories. So how can we use patient stories and our own stories to really impact advocacy and policy, be it at the clinic, at the hospital, at the state, at the national level?
Dr. Srinivas: Honestly, every single speech that I ever start when I'm talking to my fellow legislators, I relate it back to somebody in my district or a patient I saw in the hospital and how this situation in life impacted them and how if we pass this particular law, it could fix the issue. Putting it into the perspective of this is actually happening in real life, this is how it's happening, changes the narrative completely. From a cognitive standpoint, humans always want to connect with something that's real that's going on.
And theoretical conjecture is really hard and abstract to actually think about how and why we need to do something. Why is this so important? Why is this so critical in the moment? So when it comes to whatever issue you're talking about, bringing in a patient themselves to tell the story. And if the patient can't come in, then asking them if it's okay changing their names, their initials, the information, the HPI, of course, if you can share the experience that they had to see if you can prevent other people from experiencing that same thing is so powerful.
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Dr. McDonald: Connecting with an individual, connecting with a patient—obviously with patient permission—I think is so incredibly valuable. I remember the first time I went to the State Capitol and met with legislator. I was blown away by how little they knew actually about medicine. They used the term podiatrist and pediatrician interchangeably—they didn't realize those are two very different medical specialties—and helping them to understand with a person or with a story from a patient. Particularly from our medical students, they actually listen to them more than the more seasoned physicians, if you will.
And I was just blown away by that experience. And I try to tell people, look, even though you think you're just one person, your voice is so small, again, as you mentioned, you have that MD or DO after your name and that's incredibly powerful. And then our patient stories are even more powerful to help educate others and help them understand the gravity and the scope of the potentially well-meaning or very flawed legislation they're looking at.
Dr. Srinivas: That's exactly right, honestly. Reproductive health is a perfect example of this. We had a huge debate in Iowa this summer, and the vast majority of legislators have no actual understanding of what's happening in medicine. They have never been in an office that they're not the patient in. And breaking down these technical terms is really difficult, especially when it's also put in policy. So talking about it from a patient perspective is so much more effective.
Dr. McDonald: Right, yeah. Again, it's kind of scary and there's so much hype and rhetoric around some of these very emotionally charged issues. But again, realizing that the person at the end of that conversation is a real living, breathing person and directly impacted.
So, we have a question here in the chat. And if there are other questions, please drop them in the Q&A box. In terms of physicians as storytellers, do you think there are certain authors or speakers who set the bar, so to speak, when it comes to telling stories and sharing stories? Off the top of my head, I think of Atul Gawande. But are there any specific people that are high on your list?
Dr. Srinivas: He's great, and I always love reading Dr. Paul Farmer's books.
Dr. McDonald: Oh yes.
Dr. Srinivas: I've seen him speak, I mean, he was just such a magnetic personality, but then having him share his stories of things he saw in real life, people had no idea that situations like the ones he described even existed, and somehow, he was able to utilize storytelling to create this massive movement that has changed health care throughout the world.
Dr. McDonald: Yeah, that's a great example. Do you have any recommendations for individuals maybe who want to find their voice, who want to share more than one-on-one with individual patients who want to try to get out there? Do you have any recommendations or advice for those individuals who want to better share their own stories and their patient stories?
Dr. Srinivas: So, the American Medical Association actually has free resources available on their websites too surrounding storytelling, just because we know the more physicians are able to reflect their stories, the better it is for our patients, both in the clinical care, but also in creating the systemic change that we need to advocate for our patients. So that exists. And then there's also the American Public Health Association has some tools for it. A lot of individual organizations. So, for myself as an infectious disease doctor, Infectious Diseases Society of America, we also have some resources available for free.
And then actually there are some other places that give great tips on this too. So, the Mullan Institute, which is out of GW, they do a lot in the health equity space and they have a lot of storytelling tools. The Rockwood Institute. And then there are also tools out there specifically to different niches in medicine.
So, if you're in HIV medicine, if you're looking at LGBTQ medicine, if you're looking at, honestly, probably ... And in sports medicine actually, there is really good tools out there too for yourself that talk about how you can relate to athletes at every single age spectrum and utilize your stories to be able to better connect. So, there's a lot out there on these different organizations' websites, and honestly, most of it is all free.
Dr. McDonald: Yeah, that's actually a really great example in how there are so many resources. One thing that I actually share on my online bio, on my Kaiser Permanente page, I actually share a little bit about my experience as a professional athlete and then getting injured. I was actually hit by a truck and was a patient for a number of months or years actually. And patients will actually come in. Sometimes they'll actually seek me out because I shared. Even just my little blurb, there's one sentence on my bio online about my story and my experience, which led me to medicine and sports medicine.
A lot of times patients come seek me out because they're like, "Hey, well, I know you got injured and I'm injured. I want a doctor who understands where I'm coming from." And so that's one quick, easy way that I always encourage my fellow colleagues to share a little bit about themselves in a print bio wherever your organization may have those.
Dr. Srinivas: That's awesome. And in all honesty, just humanizing ourselves too in the sense of—if you're out and about and taking your dog on a walk, taking just even a picture of your dog and saying, "Hey, we're going on a walk around the lake," or doing a quick video that you can say, "Hey, it's a beautiful day outside. I love going on a walk around the lake with my book." Those kind of things, patients see that on Instagram, they see it on TikTok, on Facebook. And they think, okay, this is somebody who has a normal life, who's more like me than I think. And they start to really connect with you on a different level that make them willing to trust you more.
Dr. McDonald: Yeah, that's such a great example of just sharing a little about who we are on our regular day-to-day lives. It doesn't have to be anything fancy or special. Well, again, stories lead to outcomes, and I think that's a theme that I hear you saying over and over again is if we really want to make change, we need to start with stories because stats and data doesn't really move the needle, even though that's helpful for us in our physician scientist brains. Last question, what makes you most proud to be a physician?
Dr. Srinivas: It's really the interactions I have with my patients. I still remember one patient when I was beginning my fellowship down in North Carolina in ID, and I walked into his room and he just looked up at me and stared at me for a second with a huge smile on his face. And I introduced myself and I sat down and his exact words to me were, "You look like me. And I didn't think somebody who looks like me could be a doctor at a place like this."
And just having that grasp that my patients can connect with me on a different level, that because of that I want to use my identity to be able to help them and be able to connect with them and make them feel like they can get over whatever struggle it is that they're facing. That's what makes me grateful to be a doctor. It makes it worth it every single day because there is a niche that I can fill that sometimes people feel like they haven't seen filled before.
Dr. McDonald: Amazing. All right, we're going to end on that high note. So, thank you so much, Dr. Srinivas, for joining us today, for sharing your expertise. I've really enjoyed our conversation.
Dr. Srinivas: Likewise. Thank you so much, Dr. McDonald, for having me on.
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Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
