Go Retire Psychiatrist

Yesterday Sena and I listened to the Zoom lecture “Pursuing Health Equity—A Call to Action,” delivered by Louis H. Hart, III, MD from noon to 1:00 PM. Dr. Hart is the inaugural Medical Director of Health Equity for Yale New Haven Health System and Assistant Professor of Pediatrics and faculty member in the Yale School of Medicine. The lecture was sponsored by the University of Iowa Office of Diversity, Equity, and Inclusion in the College of Medicine. The introductory remarks about him were that his “leadership work addresses unjust structural and societal barriers that lead to inequitable health outcomes for the patients we serve.” His lecture was intended to “focus on efforts to ingrain an equity lens into clinical operations.”

Sena and I talked a lot about Dr. Hart’s presentation, as usual in a spirited way. We don’t always agree on everything and we’re not shy about saying so to each other. The lecture was recorded. However, since I don’t know when it might be publicly available, I looked on the web, and as luck would have it, I found a YouTube (see below) of a similar lecture he gave on June 22, 2021 in New York. The message was basically the same, and included many of the same slides.

Dr. Hart is very committed and passionate about health equity. Calls to action typically, as you’d expect, are delivered with passion, which sometimes entails emphasizing the “whys” of what must be done over the “hows” regarding implementation of changes to our health care system.

He began by letting the audience know that we’d all probably be a little uncomfortable about some parts of his message. He had a little original one-liner about comfort zones, which I unfortunately can’t recall exactly, but it conveyed a message similar to the one below:

A comfort zone is a beautiful place, but nothing ever grows there.

John Assaraf

In the YouTube video below, Dr. Hart reminds me of myself in my role as a consultation-liaison psychiatrist many years ago, when I was trying to persuade our general hospital medical staff to take delirium much more seriously, stop seeing it as a psychiatric problem, and treat it as a complication of severe medical disease. I got acquainted with a famous critical care doctor, Wes Ely, MD, who recently published a fascinating book, “Every Deep Drawn Breath.” He has worked tirelessly for most of his career to teach his colleagues, nurses, and trainees, especially those in critical care, to get the point he made so succinctly in his research notebook: “Hypothesis: The lung bone is connected to the brain bone.” I wish we could keep it that simple.

I was a crusader at the time. I often took nurses and doctors and medical students out of their comfort zones, driven to ingrain in them the delirium lens that would help save patients from developing dementia and dying from the deadly syndrome of delirium.

My approach sometimes probably didn’t sit too well with my peers and my trainees. My call to action for preventing delirium likely moved a few clinicians—but just as likely alienated others.

I can see how some people might get that feeling from Dr. Hart in the video, although when I compare him with others who beat the drum loudly about structural racism in general and get pretty confrontational, I think he does a pretty fair job of moderating that approach. I get his passion and his urgency, which is for the most part balanced by his impressive ability to articulate all the “whys” about what must be done. I was reasonably confident he could collaborate with all of the people he needs to figure out the “hows.”

Now, to throw you a curve ball, I’m giving you the link to a podcast in which, if I close my eyes, I nearly don’t recognize Dr. Hart as he describes in polished detail the “hows” of his plan to improve health equity. It seemed almost miraculous. He’s just as passionate about his mission, but the crusader gives way to the thorough, confident, caring and even witty administrator presenting his very sophisticated vision of what the health care system of the future might look like. See what you think.