Educating the Healers and Leaders Remaking Medicine

The data are stark on health disparities in America's under-resourced communities, but the prognosis for a better, fairer healthcare future is strong at the CUNY School of Medicine at The City College of New York. Newly installed dean Dr. Carmen Renee' Green, a nationally known pain physician and expert on health policy and social determinants of health, is building on CCNY's nearly 50-year tradition of educating diverse doctors to serve communities like their own. In conversation with CCNY President Vincent Boudreau, Dean Green explains that 80% of health and well-being is dependent on social determinants—making diversity, disparities, empathy, narrative medicine, and a greater understanding of treating pain essential to training America's next-gen healers and leaders.

Host: CCNY President Vincent Boudreau

Guest: Carmen Renee' Green, MD, Dean and Anna and Irving Brodsky Medical Professor, CUNY School of Medicine at CCNY; Professor, CCNY Colin Powell School for Civic and Global Leadership.

Recorded: November 11, 2021

Episode Transcript

Vincent Boudreau

Welcome to From City to the World. I'm your host Vince Boudreau, the President of The City College of New York. From City to the World is a show about how the work we're doing at City College matters to people across the city and throughout the world. So we'll be discussing the practical applications of our research in solving real world issues like poverty, homelessness and social economic disparities of all kinds.

Now, today, we're going to be discussing the CUNY School of Medicine here at City College. And I'm really excited to have our new dean of that school, Dr. Carmen Renee Green with us on the show. So let me first tell you a little bit about the CUNY School of Medicine and then I'll give you some background on Dr. Green.

The CUNY School of Medicine is located here at City College of New York. And it's a partnership with St. Barnabas hospital in the Bronx. The school is an expansion of City College's Sophie Davis School of Biomedical Education, and that school was founded in 1973. CUNY School of Medicine offers one of the oldest physician assistant programs in the United States. It's the only school in the country that has eliminated the MCAT as a barrier to access to medical careers, and offers medical education in the undergraduate curriculum.

It's also the only public medical school in Manhattan. And it's known for producing excellent and diverse professionals who are leaders in providing quality health care. I'll say City College has been deeply proud of our tradition in medical education, and it's a long tradition. Now Dr. Green is a fellow of New York Academy of Medicine and she joins us from the academic medical center at the University of Michigan which is one of the world's premier research universities.

She's tenured at University of Michigan as a pain medicine physician and anesthesiologist. She provided care for patients in Michigan's Medicine Back and Pain Center, and is considered to be one of the top pain doctors in the country by US News and World Report's her health policy research interests focus on pain, disparities and the social determinants of health. She's an expert in minority and women's health in aging, and diversity in academic medicine.

She's also the director of the healthier black elder center at the NIH funded Michigan Center for Urban African American Aging Research. Published articles focused on the unequal burden of pain shouldered by minorities. She serves on the advisory board of the National Institute for Health, that's the NIH, US Secretary for Health and Human Services and the American Cancer Society. She worked in the US Senate on the Children and Family Subcommittee, where she was instrumental in developing the National Pain Care Policy Act included in the Affordable Care Act and passed by the US Congress in 2010.

She's a graduate of University of Michigan's Flint and Michigan State University College of Human Medicine. She's a member of Alpha Omega Alpha National Medical honor society. And in addition to serving as Dean CUNY School of Medicine, Dr. Greene will also be the Anna and Irving Bronski, medical professor and professor in CCNY's Colin Powell School for Civic and Global Leadership. Dr. Green, that was a mouthful, but welcome to From City to the World.

Carmen Renee Green

Thank you. It's a pleasure to be here. That introduction means that you must be channeling my mother.

Vincent Boudreau

You know what, I contacted everyone in your family before we did that introduction. And they said not to miss a thing. And of course, as you know I edited drastically so that we could fit into your resume before the show was over. I'm so happy to have you on the show today. And at the CUNY School of Medicine here at City College. So let's talk about what brought you here. You're, as I said in the intro, you are in the early, early days of your what we hope will be a long Dean ship. What was it that brought you from the University of Michigan to The City College of New York?

Carmen Renee Green

Well, I must say you had me at hello. When the search firm contacted me and I saw the job description it really felt mission driven. It was consistent with the work that I care about, the work that I've done in the past, and where I think health care should be going in the future. So let me tell you a little bit about that.

I fundamentally believe that healthcare is broken, but it's not irrevocable. We're in a time in which we need healers and leaders to heal this country's wounds. In health care, and social care, hence this joint appointment with my friends at the Colin Powell school. I believe that we will do this through a new generation of doctors or what I call people that we are enamored with, our emerging healers and leaders. And so I was telling people that this is the best Dean's job in the country.

The CUNY School of Medicine is the most important medical school in the state and a national treasure. So I thank you for asking me to participate today. Because one of the things that's been a challenge is that we haven't told our story well enough about what we're doing, what we're creating, and how we are making a difference for New York state and beyond. So you had me at hello.

Vincent Boudreau

Well, could we talk a little bit about what you see as... I mean, you and I, in conversation, you've brought up the phrase, population health. And I know that's a big part of what you think makes this school different. But could you lay out a little bit of what your vision is for this school. Whether it's around population health or other things that interest you?

Carmen Renee Green

Yeah, well, first and foremost, most medical schools, and none that I can actually identify right now, have eliminated disparities in their own community. In fact, US News and World Report's doesn't even rank medical schools on their ability to eliminate disparities. Well, we live in spaces within academic medicine and within higher education, where in some places, in some of our great medical schools and hospitals, there are people who are without homes. There are people without health insurance.

And the question, the fundamental question is, are we making our communities healthier. So at the individual level, at the community level, and at the population level. So going back to you had me at hello is I believe that this medical school can make a difference. That we can start to begin, start the process of healing healthcare by healing those in and amongst ourselves. Harlem, the five boroughs, we are uniquely poised to do so.

Our students, there are lots of public universities out there. I come from two great ones, Michigan State University, which is the first land grant university, the University of Michigan. But there are very few that are really based in the city, that are based within a community. And this medical school is based within Harlem.

I believe that because our students come from the community, they understand the social determinants of health, where people work, live, play, and pray. And how that influences their everyday lives, the lives of the community, how it influences health and health care. And so those are the underpinning that we move forward with.

Many people as I was looking at this position, they told me about Jack Geiger. And I think of this thing the school in many ways and the departments that Jack Geiger built, who was one of the premier leaders and educators as it relates to the social determinants of health. Our students live it, they understand it in a fundamentally different way. And so that's what moves us forward.

So our vision for this medical school, our mission is really to unlock the potential of those young people who come from these communities. So they become a community of healers and leaders for the future. Within that is also having compassion and empathy and potentially sympathy for those that they are going to be caring for, and that we're going to do these things, create the healing process for What I believe is the quadripartite mission. People talk about the tripartite mission, the three missions, education, clinical and research. Well, I fundamentally believe that we need to be thinking about the quadripartite technology, the four prongs, education, clinical research, and the social mission. And that's where we're going to be different. And that's where we're going to be start delivering.

Vincent Boudreau

Could I ask you a phrase you've used, and you talked about Jack Geiger, who of course was one of the great stars of our medical tradition at City College, but in talking about him, in your own discussion, you bring up this phrase, social determinants of health, and I want to just take a moment and unpack that a little bit. And talk about how social conditions need to be incorporated into a medical tradition. And what that looks like, in terms of how we educate our students and educate our doctors.

Carmen Renee Green

Well, place matters. I think the clearest example that is relevant today is COVID. And we see a disproportionate burden of those people who live in worlds where poverty exist, where they couldn't move around, they couldn't get... The whole conversation of who gets a mask and what type of mask. Those types of things come into play. So that's the relevant issue.

But we also think about in your neighborhood are there grocery stores? How far do you have to walk to the grocery store? Is it easier to get something at one of the drive thru places? Well, you don't really drive through a New York City, but you understand the places that give you burgers for $1, and fries and a Coke. It's easier for some people to do that than to go to a grocery store, or the bananas are much more expensive than the hamburger.

And so those are things that come into play. In the rest of the country there are also really places where there are food deserts, where you cannot get to a grocery store easily, or the bus doesn't run there, or the groceries that are there bumped and bruised. So those things play a major factor in how we think about health. We currently live in an obesogenic society. What does that mean? A society that makes us not move as much as we should, that makes us eat calorie-laden foods that have no nutritional value.

And we're all at risk for that. We now know that how we practice medicine is based on the biology, the anatomy, the cellular, all those things, those basic sciences. So with that being said, that is the foundation of medicine. But we now know that 80% of health and well being is based upon the social determinants. Your race, your ethnicity, who you love, what language you speak, your education, all those things come into play.

So we're trying to produce at the CUNY School of Medicine, physicians, and PAs, and scientists who understand this intrinsically, and not just sort of understand but actually try to do something about it, and how it influences health and well being. Let me give you an example. Neighborhood socioeconomic status, your education. People say, "Well, isn't this all about socioeconomic status." When we see these health care disparities. Wide disparities with people dying before their time, babies being before being born before their time, mothers dying in childbirth.

Why is it that these people tend to be people of color? And even if they are higher income, it is not protective in comparison to Caucasian. We need to understand that. Is that just discrimination or racism? Or is it something deeper about our society? We know that 80% of health is dependent upon the social determinants of health.

Vincent Boudreau

Dr. Green, you're talking about social determinants of pain. And as I said earlier, you come from a history of, you've been directed the healthier black elder center. You were also at the National Institute for Health funded Michigan Center for Urban African American Aging research. And can you talk a little bit about... You ended with a question is it just racism? Some of the social determinants of class transcend socioeconomic category.

So, a wealthier African American is likely to have some of the same social determinants as somebody who's living closer to the poverty line. Can you talk a little bit about your experience at these two research centers? And what questions you've kind of... Or what answers you've come up with to the questions that you raised?

Carmen Renee Green

Great question. The Michigan Center for Urban African American Aging Research, and Healthier Black Elders comes out of a space in place of the program for research on black Americans. And my mentor was James Jackson, and I think you know him. He was the preeminent social [inaudible 00:16:29] and scholar. And basically said black people being compared to white people at some level, I'm paraphrasing, of course, was basically the whole conversation of a deficit model. And it isn't focused on the resilience of people of color.

And James, when he died recently, too soon. Has trained many are, some would say most, of the African American scholars or people who focus on health equity, health inequities throughout this generation. But I was really extremely [inaudible 00:17:11]... It was career changing, in many ways, President Boudreau that they took me in. This group of social scientists said, we're going to take this physician in. And they taught me. And I learned a great deal.

No one really at the medical school understood, what I was trying to study in the context of health disparities as it's related to pain. The program for research and black Americans, they were devoted to developing scholars. And I brought some of my ideas about pain there. I started off as a pilot investigator and then grew into helping to develop work with Robert Taylor and others as it relates to the investigator corps. And then working with Peter Lichtenberg at Wayne State.

So the Michigan Center for Urban African American Aging Research was a joint program really from Michigan. And then also Wayne State is where the Healthier Black Elders was relocated. So I had the opportunity to be the director for the Healthier Black Elders center. Now, I'll tell you one thing, if you do not want feedback, you don't spend a lot of time with elders of color. And that's just truth.

And my goodness, working with them on a community advisory board was so powerful. Because in many respects, they were telling... So we have learned for a long time you go in, you get the data, you write the papers. And don't be surprised, this is Carmen speaking, that people don't trust. Don't be surprised when people don't want to give or allow you to use their data. Because we were taking their data and not giving it back.

So the Michigan Center for Urban African American research was basically... And the program for research of black Americans was doing things very differently at a very early time. And so the elders would actually tell us these are what we think are important questions. And once a year, we would have a major reception where we would talk about the things that were important to them. And over 1,000 people would come. We had learning sessions were 40 to 50 people would come every month.

At the end of the year session, we would have an SI have different organizations coming in to check on blood pressure, diabetes, and we actually find that people needed sometimes to go to the doctor right then and right there. So there's some of the things I would like to see us at City College begin to do. Being really responsive to the community and their needs. We can't do everything. We can't be everywhere. But we can make our communities healthier.

And so I would say that, from our practice, with the Michigan Center for Urban African American Aging Research, we call it MCUAAAR. We wrote many, many papers, we developed lots of scholars, and extremely proud of that work. And by the way, Professor Boudreau, I still have a rich connection with them, so that's in many ways home. They have rooted me on to this particular position. And the one thing about the program for research and black Americans never really go away.

Vincent Boudreau

So how do you integrate? And what does it look like to integrate some of the lessons of that research into an instructional program for students here at the CUNY School of Medicine?

Carmen Renee Green

Oh, great question. Well, one you start off by how do we learn to listen to the community. Not passively learn, but actively learn from them, with them, what are the questions that are important. That's one, first and foremost. So that's one of the things that we're going to be doing. But I'll give you a good example. Some of the programs that we developed there, we can also develop here at City College and also across Harlem.

For instance, we were able to get funding for a summer immersion for science teachers. We'll need to have students who can potentially help with some of the new knowledge as relates to health inequities and how we might work on them together. How do we have science teachers come in, infuse their curriculum with information that is contested, evidence based, that influences health behaviors that make people healthier.

How do we cooperate that with all the other disciplines? We talk about health, but you can't have health without also having social health. So those are things that we will be doing. Teaching students how to... We've got young people, our brains of our students, when they start here, they start here in high school. They come from high school into the curriculum that will seven years later, without the MCAT make them doctors.

But because they are young, we often have to think about how we teach them start thinking about science. And even the most junior person in our curriculum, could be involved in science, asking or answering scientific questions such as using Photovoice. And that's a technique in which you have people take pictures of the places and spaces that they live in. And also using that to sort of use it to understand health and educational disparities through a different lens. And that's through the camera's lens.

Vincent Boudreau

What might a physician get from those pictures? And what are the sorts of things that she might be interested in extracting when a patient comes in with a stack of photographs of their home or their neighborhood?

Carmen Renee Green

Yeah. So it might tell you that the lights go out often. It might tell you, "Wow, there is no grocery stores there." It might tell you that you're having problems with your rent. How do we think about health in a fundamentally different way? That health is not just about the prescription of you've got diabetes, and here's your prescription for insulin. What's underneath that? Can you walk in your neighborhood safely?

How do we create safe places for people to do so. So we know that if people drop some weight, we know that if people eat a more healthy, balanced diet, we can actually to reverse some of the trends of diabetes. And diabetes rarely runs alone, it runs along with cardiac disease, heart disease and kidney disease. So to the extent that we could start doing some of that we start reversing some of these diseases that are taking 10s of, sometimes 20 years off of people's lives. And certainly impacting their quality of life. Some conditions we can reverse.

Vincent Boudreau

Yeah, I mean, some of what you've just mentioned obesity, diabetes, diet. In pretty clear ways, medicine has connected those preconditions to bad health outcomes. But I wonder so much of what you also were suggesting, points us in the direction of factors like stress, and anxiety and trauma, and the transmission of trauma intergenerationally, or across a community. I wonder if you could talk a little bit about... Because those feel to me the more kind of invisible social determinants and how important are they?

Carmen Renee Green

Yeah, well, there's reasons why some people don't trust doctors. One, we haven't listened carefully enough, we passively listen where we need to be active in listening. And the attitudes of healthcare professionals, the attitudes of patients, the people who are seeking care may all influence how care is received, or not received for that matter.

So these invisible things, we live in a society, particularly now with COVID. There's the whole conversation that began for some people with George Floyd, but many people know that that conversation began many generations ago. How do we deal with some of these ills within our society, anxiety, the trauma. We had a nice town hall yesterday that focused on wellness, at the college as you know. And there are biases in regards to who seek mental health care.

Well why would you have someone help you understand things when they don't understand you, or where you've come from. And so, again, that's where we at the City University in New York School of Medicine, are really trying to unpack some of those things. I'm excited that so many of our students now want to go into psychiatry. We're going to need them. There's a paucity of those in the mental health field, who are knowledgeable, or willing to listen to the stories or able to listen to the stories of people who don't exactly look like them.

And I would add that one of the things that we now know, is that living around stress, living within stress is actually decreasing the size of some of our telomeres. That's fascinating. That means that some of these things may be baked within our DNA. And so how do we address that over time. And so these are really important questions that we need to deal with. But we also need to recognize if you're not feeling well, that you actually may be perceiving something as the rest of the world. Or you may be early to the gate before the rest of the world, something that may be really detrimental to our community.

Vincent Boudreau

I wonder if you could talk to us a little bit about, a number of things about that. I mean, one is, of course what was it in that act that you think was unique or novel? How do we benefit from that act. But also so you're a physician from Michigan, and all of a sudden, you're in Washington working on a centerpiece of legislation of Barack Obama. And I just wonder what that was like for you. Maybe we start there, and then tell us a little bit about the content of the act.

Carmen Renee Green

Yeah. Well, thank you. One of the beautiful things of being a full professor with tenure is that you get to go on sabbatical. And I remember when I talked to my dean at a time, Alan Lichter. And he had to approve... This is my going to what is now called the National Academy of Medicine. But at that time, was the Institute of Medicine, and working with the Robert Wood Johnson Foundation, health policy fellows. Which is considered their premier health policy program.

And so, my dean Alan at the time, who's now I would say, a really good friend said, "Carmen, I think you're going to go on sabbatical. And actually really work harder than you did when you left here. And that's unusual." And we did, I packed up my little suitcase and went to live in Washington, DC, and learned a lot about health policy. My interest is not to work on pain, actually, my interest was to understand why, in many respects, that we could find illness all around us, it was much more difficult to find health.

And what would be the levers to change health policy or health care policy, such that we could improve the health and well being of people. Now, certainly, my interests had been in pain and pain care research. But it was really more of a global perspective that should be there. Well, the thing about it is one of the things that happens is that when you walk onto the Capitol steps, people start saying, "Well, guess who's here, let's see..."

And they start thinking about what types of pieces of legislation. I was really very fortunate that there was a bill that focused on pain globally. And one has gone through the Congress and became law is related to our wounded warriors, who are struggling disproportionate from wars, that have taken too many lives and taken too many limbs and caused way too much trauma.

And then when it comes to pain as it relates to people who aren't in war, the grandmother. Seeing people in my clinic, who we finally get some better. And then they didn't have access to medication. Seeing people have a diagnosis of cancer, and their pain being discounted. So all those stories of my patients, and that's one of the hardest parts, as you know for me was to leave my patients, that many of them I've had the opportunity and the honor to have taken care of for over 20 years.

They were actually very happy when they knew that what I was coming to was to be the Dean here at historic City College in New York. But it was their stories that I took with me. And so there was an interest in thinking about pain. And despite the fact that the interactions in the House and the Senate, between Republicans and Democrats can be problematic, we were able to create this piece of legislation. And we did it in a bicameral, bipartisan approach. Because one thing that got people's attention, disparities, the word disparities. They couldn't imagine that people would get lesser quality pain here, members of Congress couldn't imagine because of their race, or their ethnicity or their gender.

And so that simple word led to us, really moving the needle. And our language was such that on both sides, both the House and the Senate, and the Republicans and the Democrat, we made certain the legislation was identical. So that when there was an opportunity for it to have a vote, it would go through, and that's really how it happened.

And so when President Obama came in, the legislation was already written and it moved. It was part of the Affordable Care Act. And that piece of legislation has led to several different products. One is a book from the Institute of Medicine that focused on pain and pain care disparities, that focused on pain. With that being said, despite the fact that the word disparities was in the legislation, only a small part of the book, the major book on pain and the report focused on disparities. So there's work still to be done there. It led to prevention strategy, a number of different studies at the National Institutes of Health or to sort of understand where the research needs to go from a US Secretary of Health and Human Services really sort of prioritized that type of work, that focused on pain.

I think we've talked about pain costs people, it costs this country more than cancer and diabetes, and heart disease combined. So 100 million people are impacted by pain. As we know, one in three people will be impacted by cancer at some point in time during their life. And so it is taking it's stealing. Pain is the thief in the night, it's stealing people's health, their quality of life. There's presenteeism, where people are present at work and not really working, because they've got a migraine. They're a disability, all those things really come into play when we think about pain, and it's equal opportunity.

So you or I could step off the curb funny and twist your ankle, break your ankle, and you could end up with a chronic pain problem. And so it's really incredibly important. And then you think about pain, it's a continuum. That the acute pain, which is usually post operative, or I fell, I broke my ankle, all the way to chronic pain, which tends to last more than six months. And then there's the pain that is associated with cancer, due to its treatment, or the surgery falling of it.

And then you can also have chronic pain after having cancer, the acute pain. So pain has really been a thief in the night. And there's far too many people who live with it. And we live in a society where it says you should suck it up, no pain no game. Well, in many respects, pain is a great equalizer. We're not just like the football players who kind of bounce, when you start having pain that persists, it starts stealing from you.

And it's not just the young person, it's the grandmother who can't go to her grandkid's soccer game. So that's the work that we've done. And I hope, I'm really hopeful that we will be able to bring some of that, and actually, I'm not going to be hopeful we're going to be bringing pain to The City College of New York as a fundamental thing that we'll be studying. And certainly within our medical school. Far too many physicians, healthcare professionals know very little as it relates to pain. And we have this mindset that no pain, no gain, or you should just suck it up when in actuality, one of the studies that we did, that showed the variability in how pain is treated in men and in women, meaning men received better quality care, and certainly racial and ethnic minorities receive lesser quality care.

Vincent Boudreau

Can we talk about that? I mean, you said a couple of times that pain is an equal opportunity thief in the night. But we've had on this show, Linda Villarosa, who's talked a little bit about how pain is received, understood, responded to in the medical profession. And I wonder if you could talk a little about that. What happens when different kinds of people say to a doctor, "I'm in pain." What are the dangers, the pitfalls in the way we respond to those kinds of assertions?

Carmen Renee Green

I'm a great fan of Linda Villarosa in her work, and I think... So you've got two people to come into the emergency... Well, I'll give you an example. What got me started asking the questions. So when I was a pain management fellow, we had these patients who would come into, say they have pain. I watched you know a man handsome like yourself, Caucasian. I'm assuming you're Caucasian. I'm not quite certain we haven't had that conversation.

Vincent Boudreau

Well, people don't even believe I'm handsome probably.

Carmen Renee Green

I can vouch for that, that you are. You come in with your shirt and your tie. And we automatically believe you and your pain. A woman of color, African American woman comes in, and she has to prove to you that she has pain. So whose voice do we hear. And it's at the essence of the unequal burdens and unheard voices of people with pain. So I look at some of the studies in which you have a long bone fracture, okay, those are the big bones in your body, they're broken. You come into the emergency room, you can see it on X-ray.

The black person, the Hispanic person is less likely to have their pain assessed, on a zero to 10 scale, what is your pain? The Caucasian person is more likely to have their pain assessed. And then even if it's assessed, we know what the pain score is. We know that the people of color, and often women have their pain receive less treatment for the same type of fracture. And that's the crux of the issue the variability in decision making based upon the healthcare professional, how people present, the expectation.

So we could go through a long conversation, I've started talking about this, and I guess some of this is online, in regards to the history of the under treatment of pain and to whose pain story do we believe. And the whole perception that black and brown people don't have pain, and that it's an insensitivity of their skin.

And I would say to you, my friend, that we actually may need to go back and fundamentally reset the hypotheses that have driven the work of pain. And some of this goes back to 1619. And even the conversation as it relates to doctors day. Who was deserving of getting anesthesia, J. Marion Sims, his statue in Central Park was recently taken down, I believe, across the New York Academy of Medicine. Considered the father of gynecology.

But yet this is a person who experimented without the ascent or consent on enslaved people. They weren't animals, they were enslaved people. And in areas that were very sensitive, in the genital system, using steel sutures, those type of techniques that he developed, were taken to a Caucasian population who were often given anesthesia for it. Whereas these enslaved women did not receive the same. So there's a history behind some of this, as to who is deserving of having pain. Even if you look at disabilities and the rating of disabilities. So two people, African Americans, they look at the work of my friend, [Ray Tate 00:44:16], and the disability ratings for people of color are less than that for Caucasians. Yet if you look at their spine on MRI, you see that there's no difference. So there's a lot of work to be done.

Vincent Boudreau

Does the ethnicity of the doctor or the nurse or the physician's assistant matter in that assessment?

Carmen Renee Green

Great question. The numbers of some of the doctors who are African American or health professionals or African nurses physicians, PAs is exceedingly low, it is not reflective of their representation in the population. We do believe that the complaints of people are heard differently when there is congruent, meaning the physician and the patient are the same race or ethnicity or gender. We also know that women tend to listen better and longer to patients, than male physicians.

So all those things come into play. But we don't know some of this. I can tell you, and with a good example, is that I had a colleague who broke... A surgeon. And once they broke their extremity, they got it as it relates to pain. And so one of the things that we shown in some of our studies is that once a healthcare professional has experienced pain, or has a close family member that they take care of pain, they treat it very differently. So there is certainly a component of empathy. And so one of the things that we do need more, I guess society wide is empathy. And certainly within the healthcare profession.

Can you teach empathy in a medical school setting? Are there ways to do that? And do you have plans in that direction inside the CUNY School of Medicine?

Yes, yes, I think we can teach empathy. I think we can do it in a way that we can inform the curriculum by our own experiences. We can teach health professionals to actively listen, the whole role of Narrative Medicine, which is basically writing down exactly what someone says, as opposed to shortening. So for instance, let me give you an example.

So, Mrs. So-and-So, Mrs. Smith, is a 65 year old woman, African American, who comes from the South Bronx and has a diagnosis of pancreatic cancer. Her children are now in Michigan. And she's very scared. Versus the 65 year old woman with pancreatic cancer in room 60. Very different stories. So as the CUNY School of Medicine, we've embraced the role of Narrative Medicine.

Lots of people have talked about narrative medicine, but they haven't talked about it in the ways in which the patient informs the story. And hearing the unequal burden and unheard voices of those people who are sometimes othered or stigmatized, or we aren't used to hearing their stories. So we'll be working, we've got a outstanding young faculty member who focuses on narrative. And so we'll be doing more of that. And I've got some exciting ideas that potentially can engage the community in this process of how we might think about telling stories in a very different way.

Vincent Boudreau

I think, you talked about othering somebody else, whether it's across gender lines, or linguistic or national or ethnic. One of the things that happens when you under somebody is you radically diminish your ability to perceive fear or vulnerability or anxiety, and all of those things get translated in the perception into something that's more aggressive and more dangerous.

So, fear becomes anger. And anxiety becomes instability. And that bleeds the empathy out of the exchange. And I say that because one of the things we talk about all the time in relationship to the student body of the CUNY School of Medicine, is that it is certainly the most diverse medical school in New York State. But nationally, those diversity rankings are right up there.

I think we have a higher percentage of African American students than any college that's not an HBCU, and we're number five in the country, at least last I checked. And I say that now towards the end of our conversation, because I think the push for diversity is strengthened if it has a context. I mean, obviously, you want a diverse set of opportunities for people just from a question of fairness and a question of equity.

But here, we're actually talking about something very different. We're talking about remaking a medical profession by shoring up weaknesses that exist in the ability, or at least the frequency with which people do things like empathize with patients or perceived pain across lines. So all of which is to invite you now at this stage of the conversation to talk about the diversity of the school and why you think it's important.

Carmen Renee Green

I was struck by your comment about the othering. And how also people who are LGBT, too often are othered. And so there's work to be done there. And there's a very active interest group here, in regards to that. We are all human. And we live in an increasingly aging and aging... I'm sorry, increasingly diversifying, aging, and female population. But our health professionals do not reflect that. And they haven't reflected that for a number of... Actually, our numbers of, strictly as it relates to African American men are at 1970s, 1960s levels.

That has a huge, huge impact on their communities, and on the population as to who receives care. So I'm not saying by any stretch of the imagination that you can only see... If you are Puerto Rican, you can only see a Puerto Rican doctor. What I am saying is that by having physicians and PAs who are Puerto Rican actually diversifies the class and helps other people who are in the health profession understand the context in which people live in.

We are currently in a point in time in which more non-white children are being born than white children, we've got more non-white teenagers than we have white teenagers. The question, the fundamental question is our health care system, is higher education, preparing for that change. It's going to require empathy, it's going to require actively listening, it's going to require us to do things differently.

Now, at the CUNY School of Medicine was things that I am so exceedingly proud of, is that we have always been MCAT free. That's a major exam that people take to get into medical school. We have taken a holistic approach, taking people from the very earliest you say, "I want to be a doctor." And you're seventh eighth grade. And you get into our school, which, by the way, my friend, it is. We are the most selective medical school in New York State.

You come into our medical school, we do a whole... You come, we do a holistic process, see whether or not we believe that you would fit into our curriculum. Seek in many ways, what type of doctor you're going to be. We want to be doctors who serve the community. And in three years you get accelerated Bachelor's, in four years, you get your MD. Now, why is that important that you don't have the MCAT. The MCAT just like the GRE and SAT-

Vincent Boudreau

These are the other standardized tests that you have to take to get into college or graduate school or law school.

Carmen Renee Green

Exactly. We're questioning their very reason for the existence. Now somebody may be benefiting from it. But I'll tell you, from my personal experience with a number of [inaudible 00:54:30], people take that exam, that MCAT exam one, two, three, four times. Because the score's not great enough, it's not high enough, and they get their head slumped each time. And then lots of people fall out. They no longer can become doctors or they stop believing that they can stop.

We bypassed that barrier. And you know what? Our students become wonderful doctors. And I think about what have we lost as it relates strictly considering that racial and ethnic minorities tend to do worse on these exams. And there's no data to suggest that their intelligence is less. These are social constructs that are designed by certain population that is not reflective in the general population. What have we lost? And what could we have gained?

Vincent Boudreau

I think this is an important moment. One of the literature's around standardized test is literature that's referred to as stereotype threat. And there's lots of social experiments around stereotype threat. And a lot of times people talk about, "Well, could we design a test that is not culturally biased." But one of these really compelling experiments that I read about at one point was a set of tests, like the MCAT, or the SATSs or any of these standardized tests, was given to two different groups of young African Americans.

And in one group, they said, We're going to give you this test, and it doesn't matter, "We're just trying to see if it's a good test, so do your best. But this isn't important." Sorry, it was a group of mixed African American and white students. Other group, same demographic, same age, they gave the same test and said, "We're going to give you this test. And we're going to use it to determine what colleges you get into and what scholarships you might have."

And not surprisingly, in that group, African American students did markedly worse than the white students, while in the group where they said the test didn't count for anything, there was almost no difference in their scores. And the explanation was, it's not the content of the test, it's the idea that you're going to go into a room and sit down and with the whole burden, in some cases, of am I going to be the one to change the trajectory of my family by getting an education and making sure my children get an education. That burden sits on the shoulders of the African American students.

And so it's a tremendously important thing, to figure out how we can be rigorous in evaluating our students, make sure that when they graduate, they're no less prepared than any student in any other medical school, but not knock them out in a test, that activates the stereotypes, that then threaten their performance.

Carmen Renee Green

And you're exactly right. I mean, first of all, expectations matter. My goal is to say to my 500 plus students, just like I say, to my kids, "I believe in you, and because I believe in you should believe in yourself as well." And that's why we refer to our students as healers and leaders.

And with that being said, this holistic admissions process becomes really very important. About who becomes a doctor. Patients don't walk in and say, "Did my doctor gets this score on the MCAT? Or this score on the USMLE?" Or do they say, "My doctor is a good doctor? And this is why they're a good doctor, they actually listen to me." Those are things... And that's part of the reason why... We're a professional school. Yeah. So we also need to make certain they're going to go out into a public that's going to be able to lay hands and heal, we need to make certain that we're rigorous in that approach. But we can do better and making certain that doctors are reflective. We are number five in the country. And this school is a national treasure, no ifs, ands, or buts. I have the best Dean job in the country.

Vincent Boudreau

That sounds like a really good place to put a punctuation mark on this interview. Let me say before we break, if you are listening, and you've got a young son or a daughter or you're a young person thinking about whether or not medicine is for you, what Dr. Greene is saying is that the CUNY School of Medicine will take its time to look at all aspects of who you are and what you can be.

And so don't you be the one that says medicine is not for me. This is an opportunity for an institution to take a 360 degree look at who you are. And if you want medicine to be in your future, you should take a really close look at us. Thank you for listening to From City to the World. I want to especially thank our guest, Dr. Carmen Renee Green, whose background and vision poise her to take the CUNY School of Medicine to new heights and to really as she said earlier, make it the most important medical school in the country. Dr. Green I want to give you just a second to put in any last thoughts you want to lay down before we wrap up the show.

Carmen Renee Green

I thank you so much for inviting us. We are in the business of making great doctors. We will continue to do that. We're excited, I'm excited too, in the heart of Harlem.

Vincent Boudreau

Fantastic. Well, I believe that as Harlem gets to know you a little bit better they'll be excited that you're here as well. The show is produced by Angela Harden, and yours truly Vince Boudreau. I'm your host Vince Boudreau, the president of The City College of New York, saying once again, thank you so much to Dr. Carmen Green, and hope you'll join us again for the next edition of From City to the World. Thank you, everybody.

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