>> Hello, I'm Dr. Ben Vinson III the 18th president of Howard University.

And it is my pleasure to welcome you to this program, one of many we plan to bring to you as part of the "@ Howard" series.

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From stimulating lecture series and panel discussions on a wide range of topics to one on one conversations with captains of industry and international leaders of business, politics and the arts.

From time to time, WHUT will broadcast some of that content in the form of full programs to short excerpts that we believe will surely stimulate and engage you.

So sit back and enjoy.

We're proud to share with you some of what makes Howard University so special.

>> Yeah.

[ Indistinct talking ] ♪♪ ♪♪ ♪♪ >> Greetings from Howard University.

Welcome to this edition of "@ Howard."

We're so excited to have joining us today, Dr. Lakshmi Krishnan, who is co-executive director of the Georgetown Howard Medical Humanities and Health Justice Center along with me, and Dr. Sharon Malone, who is our guest for today's conversation.

We're really excited to have you learn a little bit more about a book that we have been talking about a lot about grown women and the conversations that they should have, don't have, but will have after having read this book.

Welcome to Howard.

>> Thank you so much for having me.

>> It's such a pleasure to have you join us.

We want to start with having you tell us a little bit about what made you write this book.

>> Well, I wrote "Grown Woman Talk" because I would think throughout most of my career, not only did I see patients in the office, but I spent a lot of time navigating the health care journeys of my family, my friends, friends of friends.

And the one thing that struck me was, if these are people who are very smart women, they have access, they have a good insurance, and if they walk out of an interaction with a doctor, not understanding what it what actually is being asked of them.

And not only that, but just how to navigate this crazy Byzantine medical system that we have right now.

And I thought it would be perhaps a good thing for people to have sort of a roadmap.

You know, there's so many things that we assume about what's going on in medicine, and a lot of that has changed.

And you need to know what's changed and why and what your responsibilities are.

>> I, um, resonated with this book on so many levels as a -- as a woman of color, as a physician, I was so I was just like cheering as I read this book.

Um, so could you, could you talk to us about how your experiences as an OB/GYN in DC for 30 years, 30 years of a career informed the shape, the structure, the content of this book?

>> Well, I was very fortunate and that I got to spend my entire career in DC in one practice, almost one location for almost 30 years.

So I had the good fortune of being able to observe not only my patients as they aged.

So I have many patients who I've seen through high school, college, childbirth and now menopause.

And I realized that is such a privilege that I have had.

And I realized as I got towards the end of my career, how much that was changing and that so many of us are no longer going to have that experience where we can have that one on one relationship with the doctor, um, throughout our lives.

So even though my experience has been wonderful, I'm quite aware of the fact that that will not be the wave of the future.

And that was also one of the reasons why I wanted to write this book, because somewhere along the way, things changed.

And no one certainly asked us doctors about whether or not this is the way we wanted it to be.

And certainly no one informed the patients.

And I think that we -- if we -- the more we know, the better we're able to advocate for ourselves when we're in that position.

>> And I just -- I just have to ask a kind of follow up to that, because I -- hearing you say what has changed over 30 years, it's so hard to boil this down to a couple of things, but what would you say are some of the most striking or notable things that you notice changing, and maybe that your patients picked up on as well and that went into the book?

>> Well, I'll tell you this.

I was present during probably the two most seismic changes in medicine, um, certainly in the past 50 years.

And the first one happened just as I started private practice, and that was the introduction of managed care.

Before that, and this really didn't start happening until like the '80s, late '80s, early '90s, where we went from a model where you go to the doctor, your doctor tells you, you know what they want you to do, you go get it done, your insurance pays for it.

End of discussion.

Well, that was a big change when we went to managed care, where now the patients are no longer really managed exclusively by the doctors, but there is a third party involved and that is your insurance company and HMOs and the like.

And when that happened, there was a lot of uproar about it.

It was like, oh my God, what do you mean?

I have to ask, you know, I have to get permission for things that your doctor, you know, has recommended.

Well, even though we complained mightily at the time, guess what?

It never went back to the old way.

And that was the first big change in how we -- doctors and patients interact.

And I think the next one that happened, which started happening probably about 20 years ago, you know, it happened slowly at first and then all at once.

Well, and that is the introduction of private practices really disappearing.

More and more now, the likelihood that your doctor is a sole proprietor in the owner of their practice and able to manage, that is going away.

And I think when I wrote my book at the time, the statistics were more like 70% of doctors practices are no longer owned by the physicians, they are owned by either large hospital groups, or they are owned by private equity groups who have come in and swooped in and bought up doctors' practices.

And the reason for that is that it has become increasingly difficult for doctors, um, trying to make ends meet.

Um, and so we were sort of ripe for the picking, but did anyone ask us if this is how we want it to work?

No, they did not.

But the consequence of that is that your doctor is now more likely to be an employee, not -- not a, you know -- a business owner.

And so when the first wave happened, the patients no longer belong to us.

They belong to the insurance company.

And now we're at the phase where doctors, even your physical space, no longer belongs to you, nor do your employees.

They're going to be managed by another third party.

So where does that leave us, and where does that leave you as a patient?

It means that as a doctor, if it's not yours and you're not personally vested in that practice, it's causing more churn.

Doctors are employees, and once you're an employee, you behave like employees in any other setting.

Well, if this works for you or if you want to move, you're going to move out.

So there's much more turn-- I'd say turnover in the number of doctors.

We've also got a situation where, um, the technology has outpaced doctors' ability to use that technology.

So we are at a disadvantage.

Um, and I think that patients feel that because when doctors are employees, guess what else you're not in control of.

Not only your office and your physical space and your employees, but you're not in control of your time.

And so how much time do you get to spend with the patient?

How much time -- What's your throughput going to be?

That's really not dictated by you.

So it's making doctors move faster.

That means that you as a patient are going to get less time with that doctor.

On average now it's a patient gets about 5 to 7 minutes of doctor face time, which is not a lot.

And so you have to know how to show up for that.

If you're going to get 5 to 7 minutes you better use that 5 to 7 minutes very wisely.

>> Yeah.

>> So we're here in the Chadwick A. Boseman School of Fine Arts in the art gallery, in part because the work that we do at the Medical Humanities Center suggests exactly the point that you're making, that we have to put the patient at the center of the conversation and that there has to be a rightful kind of critique of the health care system and part of what we hope to be able to do as academics who are thinking about medical humanities is to advocate, along with doctors, to put the patient's needs and the humanistic enterprise like at the fore of the conversation.

You talk a lot in the book about experiences where you're putting the patient first.

And for those who are not fortunate enough to come to you, and as much as we would like you to work forever, you won't, how do you suggest that patients, particularly Black women, women of color, use their time in the doctor's office?

Lakshmi and I were talking about this, and we were just saying -- we're using so many of the concepts that you talk about, like this wellness journal.

Like we have to write down what is our wish for wellness, what are the things that we need to make sure that we're making note of?

Because we will only get 5 to 7 minutes in the room with the doctor, and you have to be prepared.

Tell us a little bit about that.

>> Well, I, I start my book at the very beginning, which is just how do you even choose a doctor?

What's important, what's not?

And many of us choose doctors the way we choose, you know, a grocery store or, you know, a good -- a good book to read.

You just ask your friends, "Who do you see?"

And then that sort of, you know, we go through word of mouth recommendations for most of our doctors.

But here is something that I think is important.

Um, we have got to learn how to be not only efficient, but effective advocates for ourselves.

And we also don't want to leave money on the table, you know, because just because a doctor is the best doctor for your friend, well, that doctor may not be on your insurance.

You know, that doctor may not take insurance.

So how are you going to use the criteria if you don't know and you're not a medical professional, how do you -- what do you look for when you're trying to one pick a doctor and two assemble your medical team because that's also important.

I think that when we choose doctors, sometimes we'll say, okay, well, who's the best internist, who's the best GYN, who's the best cardiologist?

Which is great, except for the fact that that may be very inefficient if those doctors are not part of the same system, if those doctors are not on your insurance plan, if those doctors don't know each other and know how to communicate, because you would think in this day and time, well, we have the ability to communicate.

You know, you can text, you can call, you can email.

There is probably less communication between doctors now than there was 30 years ago.

When you'd just pick up the phone and call somebody.

And that's a reality that patients need to be aware of, because I think that the assumption is, well, I have an electronic medical record, so you can access it.

And why don't you just send my records over to the new doctor?

Doesn't work like that.

And it's not an unreasonable assumption to assume that it did.

But that's not how it works.

So these are kind of the logistical things that I talk about, about how -- what's important, what's important about your family history and your personal health history, such that you bring that to the table when you see your doctor, certainly for the first time.

So that's part of the getting to know you moment.

But what's important, what's not?

These are the kinds of things that you need to know that are very important data points.

And I think it's going to require more of you.

Now that's good news and bad news, but that's what it is.

You are going to have to take more control of what type of interaction you have with that doctor, because the chances are more likely, more than not, you're going to see someone that you doesn't -- that you don't know and who doesn't know you.

You may come back the next year and you may see yet again someone different, or you may see a nurse practitioner.

So if you don't have the luxury of, you know, seeing patients the way I did when I saw people for 30 years -- I know your mother, I know your children -- then you're going to have to be -- the only person who knows your story is you.

So you've got to show up knowing how to effectively tell that story to a new patient -- to a new doctor, and to a new team perhaps every time you walk in the door.

>> And you also talk about how storytelling can be used to our advantage, and then sometimes to our disadvantage.

Those moments where you know how to tell your story to your doctor may be the difference between a solution and not.

But then sometimes there are those stories, um, myths that we also perpetuate.

We love how you start the book -- or at different points in the book there's the "Dear Sis," and then it ends, "XO Dr.

Sharon."

What informed your storytelling practice really to use stories as a way to get at telling this thing?

You say, for instance, "I'm here to cheer you on.

I'm not here to chastise you."

Even though I felt so judged and seen about my ultra processed food, I knew better.

But yes.

Tell us a little bit about structure.

Like what informs -- and the music.

There's so many different parts in the book that make it relatable so that it's not intimidating.

I'm able to approach this in a way that I own my space, I own my health, but you also join us in that work.

>> Well, the way I wrote the book, I did not want it to be intimidating.

I'm not trying to train anyone to be a doctor.

I don't want you to know -- I want you to know enough to advocate for yourself.

And really, when I started writing the book and I thought about it and I spent a lot -- I've spent a lot of time in menopause world and perimenopause world.

But I said, you know what?

The midlife health journey is more than that.

And I wanted the reader to understand a couple of things.

One, yes, I'm writing this book as a doctor and I want to give you good advice, but I'm also -- I'm a mother, I'm a sister, I'm a daughter.

And I have answered many of these questions for people that I love, and I want it to come with that tone.

This is not someone who's really trying to tell you something, or to shame you, or to make you feel in any way inadequate about what you've been doing.

Because I think that we all can do better.

You know, no matter where you enter this journey, we can all do better.

And I think we want to do better.

If we only knew exactly what to do and why it's important.

Because the way I always practiced was this.

You know, when I talk to my patients, I say straight up, "I'm trying to give you some good advice.

This is the advice I would give my sister and I would hope that she would follow."

And if you take it, if you take that tone, then people don't get put off by the message.

So -- and when you're trying to talk about things in a book that may be difficult, like cardiovascular disease and talk about obesity and chronic stress and all the other things that will -- may befall us in midlife, you've got to figure out a way to lighten it up a little bit, you know, and I think that that the using the vehicle of storytelling is important because that's really how we learn.

You don't -- if someone if I just wrote a big treatise about all of these things and gave you charts and pie charts and graphs, your eyes would glaze over and you'd go to sleep.

But when I tell you a story about a patient, or I tell you a story about a family member of mine, and I do use a lot of my family stories, then I think it sticks because you can relate to the story, even if you don't understand what some of the background information may be, but I wrote it to be accessible.

I wrote it such that anybody from any age, and that's why I called it "Grown Woman Talk," because anybody who's a grown woman can enter this book, whether it speaks to you at this particular moment or it speaks to something that you are dealing with your mother or parents, that is where I want the book to be.

And if it lands that way and people feel seen and heard by the stories that I tell, then I've done my job.

>> Yes.

>> Absolutely.

>> So many questions I could ask after that.

I was like, "Yes, yes."

I guess a very specific question around what do you think that we as doctors, as health care professionals can do better in terms of that storytelling piece?

And so much of that is implicit -- implicit and explicit in the book already.

But you know, when I think about my own practice, I practice inpatient medicine.

Our biggest failures, it's not because the technology is not there.

It's not because the science is not there.

It's communication.

Um, not understanding history and context of what our patients have been through personal history and communal history.

Um, and really come back to communication like, it's like you didn't know this or someone didn't tell you this, or how was this explained to you?

So one of our goals with the center is to help transform health professions education by bringing these concepts in.

Um, if you had like a couple of messages for those students at Howard and Georgetown who are on the path to becoming, you know, health professionals, what can we do better?

>> Well, you know, I think that one of the things that we can do better is in training our doctors to have them not only just to know the ins and outs of certain diseases and disease processes, but to have some cultural awareness of the communities and the people whom you serve.

And I think that that sometimes is is lost because we in medicine, we treat doctors, we treat diseases, we don't treat the patients.

And we know that no disease exists out of the context in which it, you know, it has been formed.

And if you don't have a good sense of the cultural awareness or what could be the things that are actually getting in the way of your patients not being compliant, say, for instance, you know, and you know, this doctors get mad.

"Well, oh, I gave her this prescription and she didn't take it."

Well, you need to understand why.

Maybe she can't afford it.

Maybe there are things that prescription is making her go to the bathroom ten times a day, and she can't do that in her job.

These are the kinds of things that we have to get to the bottom of.

Um, and I think in an ideal world, wouldn't it be great if everyone had the opportunity to see a doctor who was not only competent, but culturally sensitive and understanding and empathetic?

That'd be great.

Well, that's -- that -- When I get to Nirvana, I'll let you know.

But -- But we have to -- This is, again, something where we have to realize that even now, if we started today and said, "You're absolutely right, Sharon.

We need to start training doctors this way."

Well, that's a ten, 12, 15 year journey that we're on.

And part of what I want to do is to say, well, you know what?

I use a, um, a saying from Bill Withers, you know, because I have a lot of musical references in my book.

And Bill Withers has this great quote where he says, "When you're on your way to wonderful, when you get to just okay, you better stop and look around, because that may be as far as you get."

And that's sort of where we are.

And I think that, you know, even though there's a wide, you know, opportunity, a big opportunity for us to do better in the future.

We also have to deal with what we are -- what we're dealing with here and now.

And that's where it gets back to patient involvement.

And I think that at some point in the not too distant future, and I think probably like now, um, we're going to have to understand that patient -- artificial intelligence will be a part of the doctor patient interaction.

Um, there will be things that we have more of an opportunity to use that to our advantage rather than be afraid of it, because that is the only way we're going to expand our reach into communities, that we don't have enough culturally competent doctors to service.

>> While we're waiting for Nirvana, you give us the path to this wellness wish list.

What do you talk to your patients about to say, make sure this is on your wellness wish list, or here's how you begin to structure what that wish list should look like.

And we do this for so many things.

We want the perfect pair of black slacks.

We want the perfect pair of black flats.

We want the perfect earring.

But we don't tend to think about our health in that way.

>> Exactly.

I think the first place to start is to redefine what midlife and beyond looks like, because I think that we all have a picture or a certain narrative in our head about how we think this journey is going to go.

And if your experience has been watching older siblings or watching your parents sort of go in this -- this period of decline as they age and the decline starts way earlier than most people think.

If that's your vision of what getting older looks like, then that's what you accept.

>> Yes.

>> And the first thing that I want to say is to -- to sort of I want you to reimagine what being 50, 60, 70 looks like.

What are the kinds of things that you want to be able to do at that age?

Don't look at what your mother is able to do or what your grandmother is able to do, because that may not -- that should not be your journey.

We have the capacity to understand that I want to be a person who can get on an airplane, off an airplane, and walk to the baggage claim without the assistance of someone in a wheelchair.

These are the kind of -- when I say the goals in your wellness, you know, sort of wish lists -- how long, not just how long you live, but how long you live healthfully.

And that is the difference between your lifespan and your health span.

And we've done a great job in a lot of instances in improving people's lifespans, but the amount of time that people live healthfully is shrinking.

And so to answer your question, what I want people to do is to start thinking about how you want to be at a particular given age and then back that up and figure out, okay, well, then what do I have to do now to ensure that that is my future?

And if you expect a good outcome, then I think you can start working on it.

I tell people all the time, I'm like, look, I am 65 years old, and I feel great.

I feel -- you know, I have invested and put time into the things that will increase not just my lifespan, but my health span.

Um, because I didn't really get a chance to see what all of that looks like.

You know, my mother died when I was 12 years old.

And even though I have older siblings, you know, I have not had that full experience of watching the aging process.

I've lost two of my sisters prematurely.

One died at 63, another died at 71.

And that is -- that is a shortened lifespan.

And so, you know, I want to be a good model.

I want you to be a good role model for the people to come after you to know this is what 50 looks like.

This is what 70 looks like.

And guess what?

It's not that bad.

>> Yeah.

I'm curious, when you became most aware of that, of the possibilities of what you want to look -- what you want 50 to look like.

And we were talking about lifespan and health span.

I'm telling you, we were so buying all of these things.

So I can remember literally the -- my mother died, I think prematurely as well.

But I do remember very well we would ask, like my mother certain questions about why she did something, why she didn't do this or whatever, and she would just say, "Keep living."

And so now my sisters and my cousins we're on a group chat in the morning, and our like, kind of resonating theme is, "If 'keep living' was a person, I'm it."

We saw it and we still didn't have the conversations because somehow we didn't imagine we'd be 50 or 60.

We knew we would live that long, but we thought somehow, magically, we weren't going to be what we saw.

Do you remember when you became aware that you wanted -- this was your wellness wish list?

Like, "When I'm 50, I want this.

When I'm 60, I want this," or was it, "I'm aware of it now at 51.

Now I'm very clear.

This is what I want to be able to do.

Here's -- I want to be able to take a trip.

I want to be able to travel."

All the things that you can afford to do in retirement or as you are progressing your career, your body has to cooperate as well.

>> Exactly.

Wouldn't that be a bummer if you finally get to the point in life where you don't have to get up and go to work every day, your children are gone, whoever it is, and you are finally into your -- you can say, "Wow, I come first now," and then to not be able to actualize that because of poor health, that would be the ultimate bummer.

And then it's like, oh, and you get to live another 25 years just like that.

>> Or slowly -- >> Yes.

>> Generously declining as you're going.

Yeah.

>> But you know where I think that we are -- we have already started to redefine what, um, aging looks like in women.

Um, and that is because think about all the people now who have come forward, you know, who have said, "Yes, I'm menopausal.

And yes, I'm still -- I'm still vibrant.

I can still be sexy."

There is -- You know, Kamala Harris is 59 years old, soon to be 60, and look at her.

I mean, she's the young, vibrant, you know, candidate in this race.

And I'm like, we have never said a 60 year old woman, "Oh look at that youngster."

But this is how we are changing the face of what we expect it to be.

And I have to tell you, I thought about it because -- we laughed.

I was together with my classmates this past weekend and we were talking about one of our advisors, and she's still alive.

Now, I was in a sorority, pledged almost 45 years ago.

And I realized.

I said, "Well, my God, she was our advisor."

And I'm like, "Well, that was 45 years ago.

She's still alive."

She couldn't have possibly been as old as I thought she was at the time.

I'm like, "What would she be?

120 now?"

You know, so I said -- when you're young -- and again, how the generation before us aged is very different than how we age.

You can't tell -- I defy someone to tell the difference between a 50 year old and a 42 year old or whatever.

We're sort of -- again, that -- that -- our expectations for what we're going to be at what age has changed.

And so I also had the extra luxury when you're the youngest of eight kids, and I'm the youngest by a lot, you get to see kind of what worked and what didn't work in terms of lifestyle.

And I'm not a -- I'm a lot of things, but I'm not a slow learner.

And I was like, "Hmm.

I bet I'm not going to do that."

Or, you know, figure out ways to sort of change that trajectory.

Because the one message that I get that I -- that I want to impart to my patients is this, you know, your family history is important.

It really is.

But your family history only tells you really one important thing, and that is what you are susceptible to.

Most of the things that befall us in old age are not because we are genetically predisposed to those things.

It is because we share environments.

We share habits, behaviors, all of the things that may affect your outcome.

So I say know your family history not to discourage you because you can -- I have a very terrible family history when it comes to cancer, but you learn from that, and it's as if someone put up a sign post and it says bridge out ahead.

And if you were on the road and a sign said bridge out ahead, you don't put your foot on the gas, you know, it gives you an opportunity.

The sooner you see it, then you know, well, I better at least slow down.

But preferably let's just stop and turn around and go in a different direction.

And that's really the message.

So, you know, yes, know your family history, know what's important.

Most things are not genetically programmed.

A lot of things you do have control over.

And that's the message of empowerment -- empowerment that I want women to get.

Don't you know, say, "Oh, woe is me."

Say that should be motivating for you, for trying to figure out how not to get to that same destination.

>> That's a great part of the story, I think, because I think I, too, was one of those folks who said, genetically, this is just -- it just is what it is.

We take the positive.

I love my mother's skin.

I'm happy about it.

I'm like, "Oh, this is just genetically."

But then, like when the extra weight comes after menopause, like, you know, I'm just my mama's apple, right?

No, because I'm eating what she ate.

>> Yeah.

>> Right.

And and I'm not -- you know, the whole notion of exercise, which I spend a lot of time talking about -- a lot of the things that I talk about in the, in the book, and at the end of each chapter, I try to make it easy such that even if you read it and you can't remember, then at the end of each chapter there is a list of like, okay, let me say it and let me say it again.

But just something like the importance of exercise, why it's important.

I have always found it to be the case that when I'm trying to give advice to patients, one, it's helpful to give the advice in advance of whenever the condition is that we're going to talk about.

Because once I know your family history and I know it's this, then I can give you what is considered anticipatory guidance so you know how to avoid these things.

But I want you to know that how we navigate this journey, you can choose.

You know, does your mother -- my mother used to say a lot of things, but, you know, you can make your bed hard or you can make it easy.

So you -- you decide which way you're going to do it.

And I think that if we knew what to do, I think we'd do it.

And I think that people respond to positive reinforcement, not negative reinforcement.

I would never approach a patient to come in and say, oh, you know -- who's gained weight from one year to the next and say, "You know you need to lose some weight.

You need to -- " No.

If patients want to do -- people want to do better.

But if you explain to them why it's important, what are the things I want to -- you know, one of the things I talk about a lot about weight is that after a certain age, I want to talk about weight per se, because the more important thing is what are your health parameters?

If you are healthy and you do not have what we -- what we call the metabolic syndrome, which is high blood pressure, elevated cholesterol and triglycerides, um, and diabetes, these types of things, whatever weight you are, I want you to still exercise.

You don't exercise to lose weight.

That's not the point because you don't, by the way.

I'm sure everybody knows that, you know, and and you'll be so sorely disappointed.

You know, "Aw, I've been going to gym every day," and it's like, I don't care.

You're healthier for having gone to the gym, so don't stop simply because you say, "I've been going to the gym for six months and I haven't lost any weight."

Well, guess what you have done.

You've improved your heart health.

You've probably done something for your blood pressure, your blood sugar, helping maintain all that stress level.

And you feel better.

So I'll take it.

And if you give people that message as opposed to, "Go lose weight," then, you know, I think you're going to be much more successful.

And I think patients are much more likely to sign up for that rather than, you know, say, "Oh, I don't want to see her because I've gained another 10 pounds this year," you know, and that -- that's happened to me.

"Oh, don't make me get on the scale."

It's like, no, I want you to, but not to -- you know, more often than not, I want you to get on the scale because it's -- I want to encourage you.

I tell my patients all the time if they come in and if they haven't lost any weight, and you're a woman above age 50, if you haven't gained any weight in -- from last year to this year, then I say, "Well, congratulations, because most people will gain anywhere from 2 to 3 pounds in a year.

So I'm going to give you credit for the 2 or 3 pounds that you didn't gain."

Yeah, let's celebrate that, and then we'll work on the things a little bit at a time.

But I don't ever want to give anyone the impression that the point of exercising and the point of, um, of all of this is to lose weight or to to be in a certain size jeans.

And I don't want you to be -- I certainly don't weigh what I weighed 25 or 30 years ago.

Okay.

And I'm not trying -- That's a fool's errand if I thought that I was ever going to get in those college jeans again.

That's not happening.

So I might as well say, you know, it's what it is.

Am I healthy or all my parameters good?

Then I'm good.

I'm going to be okay where that is.

And that's the other thing we have to do as women.

We have to say, "If I'm healthy, I'm okay."

Do not adhere to some outside standard about what you think you should look like and what you should be able to wear.

No, we're -- that's a part of being a grown woman.

You realize, "Okay, I had that day, and that day is past.

We're onto something else now."

>> Yeah.

>> I love that.

I love that.

I'm just thinking wellness list for our whole team.

We're going to do it as a team exercise too.

I'm like adding things to my wellness list as we talk.

And just one thing I wanted to mention was I'm so taken by how much like metaphor and story you use, just even in this conversation and thinking about how much, um, there's a message here about how good doctoring and a good patient/physician relationship is about storytelling and teaching, like being a good teacher.

Um, so kind of a bit of a pivot, but one of the things that has come up a lot since we -- since our center launched and we announced our first year's theme, which is story and lore.

Really, what are the things that folks talk about outside of institutions that aren't recorded in traditional ways?

And a lot -- as we started putting out those calls, a lot of what started coming in was how many people in DC feel unheard, dismissed, ignored by the health establishment, especially women.

Um, and so I guess the question for you is what strategies would you recommend for women, women of color, Black women who, um, are being dismissed and further marginalized by the health care system?

>> I think that is the history of women in the medical profession.

Women have always been dismissed.

We've been told it's all in your head or, you know -- or we have really accepted an unacceptable, um, amount of women's suffering and that we sort of chalk it up to, well, you know, that's just women.

You know, you suffer from cramps, you suffer from migraines, you suffer through childbirth.

And we have sort of incorporated that language into the lexicon.

And we -- we as doctors have become insensitive to that because, you know, it's like, "Wah, wah, wah, wah.

Women complain."

Well, we complain because these are things that are distressing to us and to not have those things addressed or to be told, "No, no, dear."

You know, "Don't worry about it," or, "That's normal," you know, and particularly when it comes to menopause, I think this is one of the areas that, you know, I have spent a lot of time in, in talking about the disparities in menopause and menopause care and what we have allowed women to endure is, to me, unconscionable.

I think we should be able to discuss these things.

We should be able to give women good information.

I think that whether or not how you sort of navigate this whole menopause journey really is going to depend on, one, that, you know it's coming, and, two, that you know that menopause is way more than a hot flash.

There are probably over 34 symptoms of menopause that start way earlier than we would ever expect.

Because you think, oh, menopause.

That happens to old ladies.

No menopause happens, and the menopausal transition happens sometimes to thirtysomethings, to fortysomethings.

And so we've got two problems.

One, not enough patient education about what to expect.

But we also have the additional problem of physicians not knowing and understanding and seeing and hearing what women are saying.

And if you don't acknowledge that, then how on earth are you going to treat that -- that person that's sitting in front of you, not some textbook.

You can't do a blood test and say, "Oh, well, it's normal, so you're fine."

"No, I just told you it's not fine."

And that's where I think we certainly can do better.

And that is to be able to listen and to believe the person that's sitting in front of you, because she didn't come in here to make up a story.

She's telling you her story.

So listen and address it.

>> You also suggest that when we are in the position where we don't feel heard by our doctors that you probably should consider changing if it's an option.

>> Yes, yes, >> Certainly feeling comfortable enough to advocate for yourself, I think we tend to think about doctors as people who are much smarter than we are, who know what they're doing, who are thinking exclusively about you in that moment when the reality is a lot of things are happening.

And if you ask your doctor to slow down and hear you, the odds that your doctor will actually do that are pretty high.

>> They will.

Because again, I don't think doctors are out here trying to do a bad job.

Let's say this.

I think that doctors are squeezed for the reasons that I talked about in the beginning, because yeah they're being asked to do more and more work with less and less.

And so -- and then the treatment options are, you know, um, much more varied now.

And to have a fulsome conversation takes a lot of time.

And that is really in short supply in most doctors' offices.

So that's why I said, you know, the things that I write about, even the chapters that -- that I discuss things like female troubles.

And that was something my mother used to say.

I was like, "What the hell is female troubles?"

But, you know, that was everything from fibroids to cramps to menopause.

It was like, whatever it is, it was all fall -- you know, fell under female troubles.

But being able to -- I don't want you to -- again, I'm not -- I didn't write this book to make, uh, women have to be doctors and be well-versed.

But I want to give you enough information such that when you show up, you know what questions to ask.

You've thought about it in advance, and you have learned how to tell your story.

Because the one thing that I don't think that people really understand is that medicine and history taking, it's all about storytelling.

You tell your story to me.

I interpret your story.

And when we're residents and we're in training, then I have to take your story, synthesize it, and tell that story to someone else such that we can together come -- come up with a -- an acceptable ending for your story or resolution for your story.

And if you're not a good storyteller, you know, the old garbage in, garbage out.

If you tell me a story that's inaccurate or you tell me a story that's incomplete, then I will not be able to make a good -- you know, a good plan for you.

And so that's why I said the importance of storytelling.

I mean, I cannot emphasize that enough, and that this is what we -- we should look at this as we're a team, you know, and we are on the team.

And our goal -- we should have a common goal is to make you be the best person you can be, to be the healthiest person you can be.

And it's not an adversarial relationship.

It's a team -- It's teamwork.

>> So I think I'll have one more question and Lakshmi will have one more question.

I think mine is going to be what surprised you the most about the book?

Maybe it's reception or the experience that you've had post writing the book.

>> There are two things that surprised me, and one of which is that as I started doing research, you know, I thought, I'm like, oh, I got this.

I know, you know, I have a pretty good grasp on -- certainly on menopause and perimenopause.

But as I started to delve into the other things, what surprised me was how large the disparities are when it comes to Black women in this country.

It's not just about maternal mortality.

2 or 3 times?

Yes.

That same health disparity extends to cardiovascular disease, to cancer, to, um, high blood pressure, diabetes, everything.

You can almost apply that same sort of 2 to 3 times in terms of outcomes, worse outcomes for Black women.

Alzheimer's.

This was one, I think that surprised me the most.

Um, I did not realize that for Alzheimer's, women are twice as likely to be diagnosed with Alzheimer's as men.

I was like, hmm.

But when you think about it, go into a nursing home and see who's there.

Black women are twice as likely to be diagnosed with cognitive decline or Alzheimer's than white women.

Now, that was surprising to me.

And I said, "Wow, I did not know that.

You know, I've been in my little corner of medicine and I didn't -- you know, I didn't venture out to know how bad the disparities are.

And what I really wanted to do was to sort of create the story that shows you is that when we talk about health care disparities, when they're not isolated, they are pervasive throughout all phases of our lives.

And to highlight, okay, we've talked about the disparities.

Now what are we going to do about it?

Because I think that the reason why we have not effectively advocated for ourselves is because we didn't know, you know, yeah, we're doing a good job now, and we're sort of brought the maternal mortality and infant mortality out, and we should.

But I want to talk about all of it.

And once you sort of get people activated and they realize, you know, wait a minute, why don't I have access to this?

Or why don't we know why the disparities exist?

And it's not enough to blame the patients?

Because I think that's been -- that's where the conversation has -- "Oh, if you would just stop doing this, and if you would just stop doing that, then it's your fault."

It's your hair perm.

It's you're too fat.

It's this, it's that.

It's all the things that we blame people for.

Who are the unfortunate, uh, benefactors of these health care disparities.

We can do better, and we must.

And that's part of what I want to do.

And that those things were surprising, even to me for someone who's been doing this for 30 years.

But I think if you say the thing that's been most surprising to me when I talk about these issues in, um, audiences is, one, how receptive people are to this message and, two, you know, you can say perimenopause and menopause and I could be here all day because so -- it doesn't matter.

Black, white, rich, poor, LA, Atlanta -- women do not know enough about this phase of life.

And it is almost, you know -- and I keep thinking.

I've been talking about it so much, I go, "I already said that.

Didn't you know that?"

>> No.

>> No.

Every room I go in, this message is so well received, and they are saying, "You know what?

I never thought about it that way.

Let me go do a little homework and let me make sure that I know how to advocate for myself."

And, you know, again, don't accept it, ladies.

We can do -- you know, we can do a lot of things.

And one of the things that I want us to do is to be better advocates for ourselves.

>> Yeah.

>> That was a -- that was just lovely.

Um, and anticipated what was going to be my final question, which is kind of a doozy.

But if anyone can -- anyone can do this, um, which is that you mentioned social determinants of health.

We know about political determinants of health, that there's so much work that you are doing and that patients and communities are doing at that level of the clinical encounter.

But what would you say is a policy change or something that we should be advocating for amongst ourselves, in our communities and honestly, to the power -- to the powers that be?

>> That is an excellent question.

And what it is -- it sort of falls under what I say my big "A" advocacy is and that is, you know, finding out that women -- you know, as women, we are 51% of the population, you know, NIH, which funds research, you know, as of the writing of my book, they had a $45 billion budget that they funded research for.

Of that $45 billion, less than 11% of that went to conditions that either primarily or exclusively affect women.

Now, when you talk about women in midlife, most of that goes to breast cancer and, you know, some of the other, um, more common things.

But the things that women suffer from, you would be -- we should all be appalled by how little money goes to perimenopause, menopause, migraines, depression, things that disproportionately affect women.

And I think that, again, now, you know, only 11%?

Well, wait a minute.

We are 60% of the voting population.

What gets funded depends tremendously on not only the person is making the funding decisions, it is also dependent upon who the researchers are, who's deciding what questions are important enough to answer or to ask.

And until we get a more diverse, I think, you know, people in the research world that -- that are trying to answer some of the questions that we are still asking, that we've been asking for 30 years and have been left to the side.

This is where policy and politics matter, because there are only so many things we can do on an individual basis, and there are certain things that we have to go back to our legislators.

You know, I mean, the policing of women's bodies has always been political.

So I say political, not partisan.

Political.

So if you want to make sure that the questions that we still have are being answered, then it matters.

Go look at the people that you're going to vote for.

And I'm not telling you who to vote for, but look through that prism and say, what is your policy on women's health?

You know, how are we going to make sure that these things get funded?

It's one thing to talk about them.

But no, you need to do research.

And I think that we also need to hold our academic institutions accountable.

Because again, you're deciding what you're going to study, what you're not going to study.

And unfortunately that's driven by what gets funded.

Um, but you also have to make sure that women are adequately included in trials, and women of color are adequately included in trials.

And it's not enough to say, "I put an ad up and no one answered."

There are particular ways that you recruit for people.

If you find it important to have them be in part of your study.

And I think those are the kinds of things that now we're aware, and now we can put on our big "A" advocacy hat and say, "I need you to do better, NIH.

I need you to do better, National Cancer Institute.

I need you to do better American Heart Association," all of these, um, uh, institutions who are out there that are driving the conversation.

Well, then we're saying include us in the conversation.

>> Thank you so much for joining us today.

But more importantly, thank you so much for the book.

"Grown Woman Talk" is available at your local and independent bookstores, online too, but really at your local and independent bookstores, especially if you are in our viewing audience.

We have to say thank you to the Chadwick A. Boseman School of Fine Arts and the gallery, which we hope you will visit.

And finally, if you want to learn more about the medical humanities initiatives at Howard and Georgetown, you can visit www.mhhj.org.

And of course, we hope that you're already a sustaining member of WHUT.

Thank you all.

And thank you again, Dr. Malone.

>> Thank you for having me.

>> Thank you.

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