August 4, 2021, 3:05 p.m. David Mitchell — Cleveland Piggott, M.D., M.P.H., wanted a career — not a mere job — where he could make a real difference. He considered the ministry to support people at their lowest, politics to influence policy and teaching to shape the next generation.
“That all led me ultimately to academic medicine,” said Piggott, one of four family physicians who shared their personal stories July 30 during a National Conference of Family Medicine Residents and Medical Students mainstage event that highlighted different roles in family medicine. “It combined everything I loved about those careers in addition to coupling my love for science with making a difference.”
As Piggott was finishing residency and preparing to join the faculty at the University of Colorado Anschutz Medical Campus in 2018, the program started a new social justice working group. Piggott, who was a big fan of Spider-Man growing up, said improving equity, diversity and inclusion sounded like “superhero stuff.”
Although he was inspired, Piggott also wanted to be a great educator and clinician and feared being “pigeonholed as a Black diversity guy.” He expected to face many challenges but admitted “the greatest obstacle I faced was myself.”
The son of Panamanian immigrants, Piggott said he suffered imposter syndrome compounded by being educated in predominantly white institutions. The more he learned about diversity and inclusion, the more isolated he felt. When he reflected on how racism had affected himself, his family and his patients, he felt powerless to change it.
Black men represent just 2% of the U.S. physician workforce, and the inner voice that often told Piggott that he wasn’t good enough and didn’t belong was getting louder.
Piggott considered leaving academic medicine. Instead, he asked for help.
“I was afraid to reach out to my mentors and colleagues,” he said, “but I told them my truth. Thankfully, they welcomed me with open arms and empathy. They said ‘Cleveland, you are right where you need to be. You are more than enough.’ Every superhero needs help from time to time.”
Piggott, now vice chair and assistant professor, said he refocused his efforts on his own wellness and learned to give others the tools to address their problems rather than take everything on himself. He also co-founded a work group focused on diversity and inclusion issues, the Justice League.
“I’m so incredibly proud of all the work we’ve done and changes we’ve made in the policies, practices and procedures that impact health equity,” he said. “Now I truly love what I do, from the work with the Justice League to the relationships I have with my colleagues, patients and students.”
Piggott reminded students and residents that asking for help is not a sign of weakness and implored them to ignore their inner voice when it expresses self-doubt.
“You are good enough,” he said. “You do belong here. I’m excited about the amazing work you are going to do for your patients, colleagues and communities.”
Although she was presenting as a storyteller, Carla Ainsworth, M.D., M.P.H., emphasized the importance of listening.
“The story the patient tells us will reveal what’s wrong if we have the courage to stop and listen,” said Ainsworth, care team medical director for Iora Primary Care in Seattle. “Every patient has a story to tell. I fell in love with family medicine because I love hearing those stories. The older my patients become, the more fascinating their stories.”
Ainsworth switched her focus from full-scope primary care to geriatrics in the fall of 2019. The median age of her patient panel is 73. She shared a story of a patient with lung disease who was afraid of dying in a hospital and prolonging his suffering. Ainsworth helped him fill out do-not-resuscitate paperwork and arranged for hospice care that allowed him to die at home.
“Family physicians are perfectly suited to care for seniors because family medicine is the ultimate long game,” she said. “We’re here for the relationships.”
Ainsworth also told a story of an elderly Black patient with diabetes and high blood pressure who was struggling last year after a police officer killed George Floyd in Minneapolis. The patient confided that her brother had been killed by police decades earlier and that the Floyd case had forced her to reflect on that experience.
“In that moment I was so grateful not only to be a friendly Black face that looked like hers but to be her family doctor and hear what was on her mind,” Ainsworth said. “My listening that day was more powerful than another pill. I had to see and know about my patient’s trauma and resilience to understand what she is capable of as we try to tackle her chronic conditions together.”
Daniel Lewis, M.D., C.P.E., C.A.Q.S.M., of Greeneville, Tenn., shared his own patient story of surviving COVID-19 last year. He was hospitalized for a month, including 10 days on a ventilator.
When his ordeal was over, he used his platform as a survivor and a family physician to tell his story, encouraging people to follow COVID-19 mitigation recommendations related to masking, social distancing and vaccinations. Lewis initially told his story in a widely shared Facebook post that led to interviews with local, state and national news outlets.
Lewis has practiced in his rural community for more than a decade, caring for all ages, and also serves in multiple volunteer roles. He said his position as a trusted family physician gave him credibility with the public.
“There were individuals — whether I treated them as a physician or not — who would trust what I said because of my expertise as a physician, particularly a family physician,” said Lewis, vice president and chief medical officer with Ballad Health, a regional health system that serves patients in Tennessee, Virginia, North Carolina and Kentucky. “I had multiple people say that they didn’t take COVID seriously before my experience.”
Lewis is president of the Tennessee AFP as well as a member of the AAFP’s Commission on Education and the Academy’s Work Group on Rural Health. He encouraged students and residents to be advocates.
“We need your voice in family medicine as students and residents, and as those who will serve our communities as we go forward,” he said. “You will have a trusted voice that will be very much needed not only for patients but also for the communities you serve. Your reach will go far beyond the exam room.”
Alexa Mieses Malchuk, M.D., M.P.H., has been an advocate for family medicine, including a term as the resident member of the AAFP Board of Directors. She said it takes time for change to “trickle down and reach patients,” who may not be aware of the health policy physicians are working to influence. She sought out opportunities to inform the public, including a rotation as an ABC News Media Fellow. That experience taught her how to produce stories, online content and TV segments.
Mieses Malchuk, now an assistant professor at the University of North Carolina at Chapel Hill School of Medicine, said she felt a responsibility to provide viewers with accurate and up-to-date information by being a reliable source the media would call on regarding health care.
Mieses Malchuk has written for Medscape and been quoted extensively in the media. Although she values providing scientific evidence and accurate information to patients and viewers, Mieses Malchuk also learned the power of sharing personal stories during the pandemic.
Late last year on social media, she related a story about getting vaccinated for COVID-19 that got the attention of Oprah magazine, leading to a two-part series regarding women of color and immunizations in December and January.
“Minority and women’s health are near and dear to my heart,” she said. “I jumped at the opportunity to share my stories.”
The Oprah articles led to Mieses Malchuk recording an HHS patient education video for communities of color regarding the importance of being vaccinated against COVID-19.
“In family medicine, we value people for being their authentic selves,” she said. “Don’t be afraid to share your personal story because you never know what impact it will have on others. Think about the things that make you wake up in the morning and be excited about what you do and know there is a way to include that in your career in family medicine.”