Dr. Luis Manriquez, MD, Community Health Equity Director at Washington State University, Elson S. Floyd College of Medicine, describes his experiences serving patients and teaching learners across the health sciences. Dr. Manriquez shares his passion for addressing the social determinates of health and his efforts to improve equity for all patients while being an advocate for advancement in medical education curriculum and to the standards of practice. He also discusses finding joy in community involvement through his unique position as a physician and educator.
“Finding Joy: The Health Care Professional’s Journey to Well-being" is a podcast resource developed by a team of interprofessional education researchers from Washington State University Health Sciences Spokane. They’re promoting well-being among students, faculty, and healthcare professionals during challenging times. Funding is provided by the Health Resources and Services Administration.
The Interprofessional Education Research team wishes to thank the following individuals for their invaluable contributions to this project:
• Dr. Barb Richardson, nurse, educator, and interprofessional champion;
• Cameron Cupp, creator of the “Finding Joy” musical score and current enrollee at WSU Elson S. Floyd College of Medicine;
• Washington State University staff from Marketing and Communications, Financial Services, and the Collaboration for Interprofessional Health Education Research and Scholarship; and
• Claire Martin-Tellis, Executive Producer, and Solen Aref, student intern, who developed the first five episodes of the “Finding Joy” podcast.
This episode of “Finding Joy” was produced by Doug Nadvornick, Program Director, Spokane Public Radio.
If you would like to reach out, please contact our team by sending an email to: email@example.com We also encourage you to visit our podcast blog as well as our team's website at: https://opioideducation.wsu.edu/about/.
This is “Finding Joy: The Health Care Professional’s Journey to Wellness and Resiliency.” This podcast is developed by the Interprofessional Opioid Curriculum team at Washington State University. The goal is to promote wellness among students, faculty, and healthcare professionals during challenging times. Funding is provided by the Health Resources and Services Administration.
I’m Doug Nadvornick.
Doctors are taught to treat the symptoms of the patients in front of them. But what can they do about the social and environmental factors that sometimes sicken those patients?
Luis Manriquez: “The way that we teach those things in medical education is mostly acknowledgement that they exist but with very little training or direction in how you might do something about that or how might you incorporate that into your work.”
Those factors were part of Luis Manriquez’s thinking as he prepared to become a doctor.
Luis Manriquez: “I came into medical school from a social justice background. I had been teaching a popular education program in New York with several other people to help students learn about social context, then a lot of activism around the environment, around anti-war work, around corporate globalization. I came into medicine, wanting the technical skill and the knowledge and the position of medicine to use toward those social justice ends. That was always, to me, part of what being a doctor needed to mean and I did not actually think that that was something that the health care system was particularly concerned about and the medical system was particularly concerned about. My mom’s a doctor and that was not part of her education and that was not something that was part of her life.”
Now Luis Manriquez has that opportunity to change medical education, to help students understand their patients’ living conditions, to understand why where they live often contributes to their poor health. On the clinical side, Manriquez treats patients in Spokane as a family physician at Spokane’s Range Community Clinic and on the academic side…
Luis Manriquez: “I work at the WSU Elson S. Floyd College of Medicine, where I am the director of community health equity in Office of Land Grant, Mission and Leadership.”
Luis Manriquez: “The health equity thread is really about understanding the context in which people get sick and the social context in which they are more or less vulnerable. Doctors have to diagnose and that’s the training that they have. But as a health care system, how are we addressing or connecting to the other problems that are driving, sometimes that are the primary problems that our patients and community members have? So that’s internally, helping students learn about social determinants of health and social determinants of equity. And then, externally, it’s focused on how is the university working to not just be an educational center of health science students, but also to be a partner in addressing those issues that we know affect health. This is one example from my education. We had a lecture around the disparity that exists between transplant recipients for kidney donation. Black people are getting a donor kidney at a lower rate than white people and they’re staying on dialysis longer and they’re dying earlier than their white counterparts. That’s a very sad thing that exists. To learn about it is certainly helpful, but what do you do about that? That’s the growing edge for medical education. In the same way that you have to learn not only about the names of then bones and all the notches on them, but then, what do you do about it when it breaks? What we’re doing right now is naming and understanding the problem with very rudimentary way of moving forward on it. That’s an area that medicine in particular, but society in general, is struggling with.”
Luis Manriquez: “Addressing the social contexts is as important or more important than many of the diseases I’m memorizing in medical school. And so then you have to work backwards. What is the appropriate thing for a physician to know as a leader in the health care system and as part of the health care system itself. It’s not that the doctor has to do everything, but the doctor has to understand, in the same way they understand anatomy, you have to understand the systemic racism. It exists in the same way your thyroid exists and then how is it going to impact your patient? How does it create social disease?”
Doug: “Do the students view this as a valid part of their medical education?”
Luis Manriquez: “I think more students expect this to be a part of their education and I think that’s a good thing, that they recognize this matters. It’s more in the mainstream as an issue of importance and they expect to get some answers to those questions in medical school or at least some framework on which to build their basis of knowledge and so I think that’s very encouraging.”
Doug: “Has Covid been a good tool to help you teach about social disparities and health disparities?”
Luis Manriquez: “Yeah, I think it can clarify in very short order how people are being affected. One way to think about it is that we’re all going through the same storm but we’re not all in the same boat. How is it that some people can work from home and do this interview and some people have to show up at Fred Meyer or at a post office, like, they have to walk their route and have that exposure and that risk. How is risk and vulnerability different for different groups and what can be done or should be done to minimize that vulnerability, to make everyone as safe as possible?”
Doug: “So how has the pandemic affected your work, both as a teacher and a physician?”
Luis Manriquez: “I think it’s created a bunch of specific needs that have to be addressed. Clearly it changes the work to be done because Covid is an infectious disease. And then, in a lot of ways, it highlights the inequities and makes them real and condenses them down. When you see we all got hit by Covid at the same time, it all started for everyone at the same time and yet, who’s gotten sick, who’s died, who’s vaccinated? All of those things are different, based on who you are, what access you have, what resources you have. All of those problems we had before the pandemic came right on into the pandemic too. Some of them got magnified. Some of them, I think, we’ve tried to address, but many of them are the same or worse and it almost gives you a very close ability to see it. In terms of medical education I think it’s hard. It would be hard for me to go to school essentially online as opposed to with other people, trying to work it out in person. I think that’s true for many positions and many professions that it’s difficult. It’s just harder to not have connections to other people. In terms of our community work, it has been clarifying and made clear some of the work that we need to do and some things it has derailed. Early in the pandemic we put together a support program, a community monitoring program for people who had Covid and that was a great way of engaging a bunch of community partners and working together and having a sense of being able to do something. Now, a lot of people are burned out, are feeling like they’ve been working really hard for several years and it doesn’t seem to be getting easier in some ways.”
Doug: “The name of this podcast series is Finding Joy. Where do you find joy, professionally and in the other parts of your life?”
Luis Manriquez: “It’s kind of a convoluted answer but I’m less concerned with finding joy or happiness at work and more concerned with what are the needs, what are the problems, what are the things that are happening that shouldn’t be happening? By being able to address those or at least take them on, then I think that is very satisfying. That produces the sense of purpose, the sense of satisfaction from accomplishing something that produces that joy. Through being able to have a sense of control of your ability to act for the betterment of the community, that produces joy. That’s driven by, one, can you see the problems that are going on, so having relationships in the community and identifying those issues, and then, two, do you have the space to act on those, to develop ways to find the creativity in addressing those issues and then, I guess, the last piece is the skills and resources to do that, but that kind of follows from the rest. So, if you have the relationships and then you have the ability to work together to think creatively to understand the problem, then you can perceive what we are going to do about it and that is gratifying and satisfying and meaning-making and all of that and that provides the joy. I will also just say that underlying all that is a foundation of abundance. I have healthy, brilliant, funny seven-year-old twins. My wife is my best friend. We have some land in Deer Park. We have a great house and some land in Deer Park where we have animals and all the things that are going on so it’s not like…I don’t have real problems, so I can then spend my time on the ones in the community. That healthy private, that healthy home life, makes it possible. If I was driving my mother to appointments because she had cancer, that would make it much more difficult to have professional joy at work because it would be just the sorrows and tragedies that just come from being human and being physically vulnerable that will affect all of us one way or another. But right now I have the opportunity and the capacity to put that energy outwards because we’re good internally.”
[Theme music break]
Luis Manriquez: “Burnout is something that I think comes up all the time in the practice and medical education. One of the things that we know from the literature, in terms of addressing burnout, is that people who have a sense of purpose with their work and feel that their workplace has a sense of mission, are less likely to have a sense of burnout. There’s a difference between being tired and working hard and being burned out. Medicine always requires enough of you that you’re tired and working hard. I work just as hard as I did when I was a student and just as hard as I did as a resident now as a practicing clinician. So the question is not how to make it easy. The question is how to get the meaning that makes it not being burned out. A football player gets tackled on the football field. That’s fine, that’s part of the game. That’s something that happens and they feel good about it if the play was worth it afterwards. How do we do that? The hardness of our job, how does it have enough meaning and purpose that it doesn’t burn you out, that it is like a gratification of doing that thing that you work so hard to get to do and now you get to do it.”
Doug: “Part of your job is to help students find that pathway that they’re going to find exactly what you’re talking about here, the thing that makes me want to jump out of bed every morning. How do you counsel students to find that pathway that’s going to be right for them?”
Luis Manriquez: “There was a surgeon when I was a student and was considering surgery and the question, how he answered it, was, think about the most mundane bread-and-butter part of the job and how do you feel about that thing? He was, for a surgeon, that’s hernia repair, for a general surgeon and, yeah, I like doing those. So, even the boring part, I like doing that and then everything else on top of that is great. That’s him. He’s a surgeon, right? He loves trauma surgery. He loves complicated things on top of that. That’s an important piece of self knowledge for students is what produces that sense of purpose, that sense of satisfaction in your work and how does that help drive you? When I was a fourth-year medical student applying for residencies, mostly students are anxious about should I be an ophthalmologist? Should I try to be an internist or a surgeon? What’s the box that’s me? I think it’s more like what do you want to do? What does joy with your time look like? For me, I had started this health equity circle student group. I had been spending my own money going to conferences and meet Jack Geiger and other luminaries and health equity and so I was doing all that for free or at my own expense and that really changed the question to not which part of the body do I like the most, but what’s going to allow me to pursue and develop that capacity? That’s where it was clear to me that primary care was really the launch point for that. So it was less about do I want to sit in an office five days a week and see patient after patient because I like talking to people. It was more about that social mission part. So if you love being in the operating room and that’s something you should do, that’s an question you can actually answer pretty quickly, if you’ve been in the operating room. Or if you like delivering babies, you can answer pretty quickly whether that’s something you want to do or you couldn’t wait to get done with your one-month or two-week rotation.”
Luis Manriquez is the director of community health equity in Office of Land Grant, Mission and Leadership in the WSU Elson S. Floyd College of Medicine. He is also a practicing family physician at the Range Community Clinic in Spokane. We thank him for sharing his perspective.
The Interprofessional Opioid Curriculum also wants to thank the following individuals for their contributions to this project:
This episode was produced by Doug Nadvornick from Spokane Public Radio.
If you are interested in sharing your perspective about wellness and resiliency as a healthcare professional or would like to reach out to the Interprofessional Opioid Curriculum team, please send an email to: firstname.lastname@example.org. We also encourage you to visit the team’s website at: https://opioideducation.wsu.edu/about/.