Community Health MPact is a course in which students examine causes of and potential solutions to health inequities impacting urban communities in Minnesota. Urbanization can bring social and economic benefits, but structural inequities in these areas are the key contributors to health inequities which most often harm Black communities and communities of color. Dr. Priya Sury, a HealthPartners emergency medicine physician at Hudson Hospital in Hudson, Wisconsin, and assistant professor and course director for urban community health at the University of Minnesota Medical School, shares how she was inspired to create the course she wanted when she was a medical student.
Community Health MPact is a course in which students examine causes of and potential solutions to health inequities impacting urban communities in Minnesota. Urbanization can bring social and economic benefits, but structural inequities in these areas are the key contributors to health inequities which most often harm Black communities and communities of color.
Dr. Priya Sury, a HealthPartners emergency medicine physician at Hudson Hospital in Hudson, Wisconsin, and assistant professor and course director for urban community health at the University of Minnesota Medical School, shares how she was inspired to create the course she wanted when she was a medical student.
Hosts: Kari Haley, MD, and Steven Jackson, MD
Guest: Priya Sury, MD
HealthPartners website: Off the Charts podcast
Got an idea? Have thoughts to share? We want to hear from you. Email us at offthecharts@healthpartners.com.
Kari Haley:
He's a rehab doctor from Chicago.
Steven Jackson:
She's an emergency medicine doctor from the Twin Cities.
Kari Haley:
Together, we're examining the health equity emergency.
Steven Jackson:
Inviting voices for change without the cue cards.
Kari Haley:
I'm Dr. Kari Haley.
Steven Jackson:
I'm Dr. Steven Jackson.
Both, together:
And this is "Off the Charts."
Kari Haley:
Welcome to the show, everyone. We have a fabulous guest with us today. We have Dr. Priya Sury, who is a emergency medicine physician at HealthPartners and is also an assistant professor of emergency medicine at the University of Minnesota, where she's starting a course in urban community health. Welcome, Dr. Sury.
Priya Sury:
Thank you so much. I'm so happy to be here and to see you in a different context other than the ER. That's really fun.
Kari Haley:
I guess just starting things off, why don't you tell us a little bit about yourself, your journey towards medicine, and maybe a little bit into what makes health equity be really important to you.
Priya Sury:
Yeah, so a little bit about my journey to medicine. Medicine was always in the back of my mind. I was a suburban Indian American kid, so whose mind was that not in? I really resisted the idea initially, and in college I was studying Spanish and anthropology, which I loved. And for my introductory anthropology class, I did a project that involved interviewing a lot of Spanish-speaking folks around St. Louis. And I got to learning a lot about their life experiences.
And as we talked more and more, people were saying what they needed, people were saying what sort of services they wanted better access to, and a theme that came up again and again was that they wanted and needed better access to health care. Particularly people said they needed folks who could really listen to them and understand, but also really needed people who could help do something about the conditions they were facing.
Around the same time, I was taking several Latin American studies courses, and I became really fascinated by this idea of political figures who were physicians. So some examples are Salvador Allende, Che Guevara. I'm not really commenting on their politics, but people who saw medicine as a manifestation of society. And the more I learned, the more I really started to agree with that.
And just to fast-forward to my practice, I've really seen that be the case as well. What we see in the ER really reflects on what's going on in society and in the world. I also went on to have amazing professors at Wash U where I was going to undergrad who combined anthropology and medicine, and really were working in both worlds and made explicit the links between them. And then I went to medical school, and I got through that because of some amazing friends.
Kari Haley:
Getting through that, that is the truth.
Priya Sury:
Getting through that. So my friends and I in medical school had fun together, but I had such a sense of belonging in medical school because I had friends who were there for similar reasons to why I was there. And our paths kind of took us in similar directions as well. So my friend, Yael, is now a pediatrician in D.C., and she runs a clinic aimed to help teen moms and their babies all be healthy. And then my other friend, Lan, directs the Community-University health clinic, and just such a mission-driven organization that helps people find food and shelter. And then my friend Monaco is really active in the single-payer health advocacy scene.
So after medical school, which I got through, I went to Oxford and did a PhD for a while, and that was a really interesting opportunity to think about human health and suffering from a different perspective. And then I made my way to emergency medicine, and I really love emergency medicine because of how diverse it is in terms of patients and medical issues and providers you talk to throughout each day. And no day is boring, and I love that about it.
Steven Jackson:
Well, I'm feeling kind of outnumbered, a rehab doctor and two emergency doctors. I think I'm just going to leave and maybe come back when you guys are finished. Maybe not.
Kari Haley:
We need all the specialties.
Steven Jackson:
All right. All right, thanks. Thanks for inviting me. No, well, first of all, thank you for what you do. There undoubtedly are challenges in incorporating health equity into practice, into education. I mean, for many reasons, whether it's, some don't feel like it's a priority to maybe not having the infrastructure or the resources or the finances. Just curious, what, if any, have been some challenges that you have faced and some of the things that you do in health equity?
Priya Sury:
Yeah, I think since George Floyd was murdered, there's been a real uptick in interest and passion for "solving" the health disparities that our system faces. And right now we're in this time where there's both an urgency about addressing health inequities, and also a sense of, "We've been talking about this for a long time, and what are the outcomes?"
And we see that there's been unfortunately a big attrition in workers who have health equity focused roles, because there can be a gap between the desire to create immediate change and the resources and infrastructure and attention in concerted systemic ways that we're able to provide to these issues.
Steven Jackson:
And that's ongoing. People say, "Put your money where your mouth is." And obviously George Floyd being murdered, although there were other murders and tragedies before him, but that really galvanized the world. I mean, they had protests across the pond, as it were. It seems like people were ready to have the conversation, and I think people continued to be committed to the idea of health equity and DEI initiatives not being this extra thing, but kind of embedded in what we do societally.
Interestingly enough, it seems like in some cases, and I might be bringing up other issues, in some cases people put out statements, like "I stand with" or "I might change my colors for a month" or something, to kind of check the proverbial box. But sometimes I ask myself, "What's the substantive thing that you've done to really contribute to the cause?" Because it's widespread, and there's also resistance as well. So more of a comment and less than a question, but just really highlighting, there's a lot of work to do in the health equity space.
Kari Haley:
Yeah, and I think going back to that, putting your money where your mouth is or going beyond checking the box. I mean, I think one thing that you're involved in is, at the University of Minnesota, creating a little bit more of a dialogue within the curriculum of medical school talking about health inequities, especially in urban settings. Which I think, thinking back to my medical school days, I went to medical school in the middle of a bustling city. We did not have anything on diversity or equitable care. I don't think that ever came up in conversation during four years of medical school.
Steven Jackson:
Wow.
Kari Haley:
Which is crazy. But maybe turning, trying to make that turn into making it be an important, embedded thing within the culture of medicine is starting doing things like this, doing a course. So do you mind telling us a little bit more about the course that you're starting at the University of Minnesota?
Priya Sury:
Yes, I would love to talk about that. So for similar reasons to what you just said, we're creating, and we've created, the course that I so desperately wanted as a medical student and what I felt like was missing at the time. I kind of talked about the reasons I went into medicine, and then you get to school and you're learning about a whole different set of stuff that's coming at you very quickly.
So the way that this course is structured, all of the medical students will elect into one of five pathways, and it's a required course that's two hours a week and five weeks throughout the course of two years. And so the different pathways are urban and community health, rural health, immigrant and refugee health, 2SLGBTQIA, and Indigenous health. Students select this year which one they want to go into, and we've gotten a lot of feedback from students already through a needs assessment that these are, of course, really overlapping, intersectional things and we need to be aware of that. So we're taking that into account as well.
But some of the principles of this course are, we really want to meaningfully center community and voices of the people who we're serving and their needs. That's something we talk a lot about. I can speak for myself. My tendency is to zoom out from there and go academic. I'm working with Rachel Witt, who's a neonatologist whose research deals with the experiences of Black mothers in the NICU (neonatal intensive care unit). And she has just been such a fervent advocate for, how do we really center community voices here?
Because we talk a lot about "What reading could we bring in?" and "What can we do to help students understand?" And she's been very clear about, "We can bring people to the table who are experiencing the things we're talking about."
Steven Jackson:
That's awesome.
Priya Sury:
Now, there are some structural issues with that. When we ask people to give their time, we need to be able to compensate them. And so that's something that, we have some infrastructure, but we're really working on, and we're also working on how do you build really meaningful, respectful relationships over time? And in such an urgency culture sometimes that we want the answer yesterday, and that's not how respectful relationships often work.
Steven Jackson:
That's right, that's right. I can only imagine how prepared I would've been personally as a physician if I had been exposed to curriculum, or even just having a sit down with a mom from the community to hear her story and to get her perspective. Imagine how much more, dare I say palatable, would a DEI conversation be to today's physicians, as opposed to, in some cases it seems like, "Well, we're talking about this again," or "There aren't any national tragedies, so why are we talking about this stuff at work?" But I think, I mean, that's amazing. A curriculum, a built-in curriculum, planting a seed for our future clinicians.
Kari Haley:
And I think that's a great tie-in too, because like you said, I feel like a lot of people who go into medicine, they are more academic and they go by the stats and they go by the actual numbers, and they want that proof, when a lot of it... There is that, but the bigger component to that is the human experience.
Steven Jackson:
That's right.
Kari Haley:
And so having this course and having a dialogue with someone living that experience, I can only imagine, as a medical student who's still impressionable, how big of a difference that may make and how you end up practicing in the future.
Steven Jackson:
Absolutely.
Kari Haley:
If you get to experience that when you're just baby student doctor and learning, just learning and being wide-eyed, versus just being, when I feel like it was just hit with all the science, the science, the science, the science, and you don't even have time to think about the human experience.
Priya Sury:
Yeah, definitely. I think the timing of this course is perfect, both with what's going on in the world and also where students are in their knowledge. They're so far ahead of where, I could probably speak for any of the three of us, where we were when we were learning.
And another thing I'm so excited about this curriculum is, again, we wanted the answer yesterday. We don't have it. We're still working hard. But what's so intellectually interesting and critical about this is, health equity is such a complex, vast... It's a wicked problem, health inequity. And what that requires is true, genuine, interdisciplinary thinking.
So none of us is going to solve this problem by ourself. You can't say, "I'm going to go out and do a little bit of research and fix health equity." And when we have this time carved out in a curriculum, we're able to partner with all these experts who have dedicated their entire careers to understanding different facets of housing and food justice and the history of racism in the Twin Cities and how that impacts people's diseases.
And we can partner with the Center for Art of Medicine and understand how students can reflect on their experiences of themselves and within this context. And it just gives a lot of space to respectfully address all the different angles that comprise this problem, instead of going through all of the training and then looking back and saying, "Well, now I need to fix something that I didn't even begin to understand."
Steven Jackson:
For those that don't know what a wicked problem is, that's basically, I'm going to try to define it and correct me if I'm wrong. That's when you have a problem and the solution to the problem causes another problem. Is that kind of what a wicked problem is, in a nutshell? Maybe?
Priya Sury:
I don't exactly know. I think it's so embedded and so complex that, yeah, you can't affect one piece of the puzzle without affecting the other pieces.
Steven Jackson:
Affecting another piece, yeah. But I like what you said about how now we're ready to fix something that we didn't really understand to begin with, and so now we're retrospectively trying to go back and fix. And something like a embedded curriculum would give that understanding. Something you said, Dr. Haley, that was really, I think, impactful, was how we're so science and data-driven. And to some degree we should be, because we want to make sure that the treatment plan and the different workups and investigations that we do, they're clinically and medically appropriate, of course. So you want to have some measurables and those kinds of things. But I think that sometimes we, at the expense of hearing the patient's story, we get almost too data-driven.
Take patient experience, for example, whether here or anywhere else, we look at numbers and we can say, "Hey, those numbers need to be better. How can we fix the numbers?" But then behind every number is a story, and so how can we address the story? Then the numbers themselves will actually change. And I think it's not so much different than what we're talking about here.
And that, again, bringing in a community member, somebody with a voice, or giving voice to somebody that didn't have a voice, I mean, that's going to hit you differently than saying a percentage of infant mortality in African American moms. I mean, that'll still hit you, but to hear somebody share that experience, that they weren't listened to or they didn't really trust health care to begin with, that's going to affect you differently and maybe drive you to change and do something different.
Priya Sury:
Absolutely. And I think what you said is, I completely agree with the stories hit differently, and also the stats and the operations and the science, who does that leave out?
Steven Jackson:
Excellent point.
Priya Sury:
I'm telling this story as sort of a positive thing. It's a tough thing we're going through, but my mom's actually in the operating room right now as we're recording, here at Regions for breast cancer. She's having a lumpectomy with Dr. Fox, and we have had the most streamlined, wonderful, timely, sensitive care. And my mom speaks English, she has a car and was able to get to her routine mammogram. Was completely asymptomatic, so they found this mass that we wouldn't have known she had, and then she's able to engage because of herself and her family and our medical expertise with the system in a way that is so efficient and so wonderful.
And that experience also gets back to my passion for health equity, because what my mom is experiencing right now is so different from what so many people experience, and there are so many cracks where any of those levels, you can get lost. So how do we create systems that are that wonderful and that helpful to all different patients regardless of their background and their abilities?
Kari Haley:
That's the huge question. And like you said, it's going to be a multifaceted, interdisciplinary type of solution that is needing to have incremental steps, rather than just a snappy solution. The one thing that I'm thinking about is I love this course, I wish I had had this course. But thinking about us practicing physicians, those of us who are in our early to mid-career who didn't have this but still have a long way to go in our medicine career, what can we do? What can we learn? How can we learn? How can we get better and get those skills that maybe these newer generation might have coming in out of medical school that we're playing catch-up on?
Priya Sury:
Yeah, that's a great and tough question, and I think we can go about it a number of different ways. For me, I'm really interrogating, who did I learn from? What perspective were they coming from, and what did my education leave out? I went to elementary, middle, and high school in suburban Minnesota. Most of my educators were white. I went to Wash U where all of my educators had a PhD. Most of them were white.
I went to the University of Minnesota Medical School, where I do not remember... I had a few professors of color, but not many. And then I went to the University of Oxford, which is my program, even when I was learning about Hinduism and Buddhism, they were filtered through the Western, white male lens. So that's a perspective that's really overrepresented in my psychology, in my epistemology, the way I see the world, and it'll probably take the rest of my life to balance that.
And I'm not studying as hard as I was in those days, so maybe it'll never be balanced. And I also think a lot about how many of the problems that we're dealing with in western medicine are created by the thought processes and ideologies that we learned from, like the separation of the mind and body and the dealing with bodies as discreet parts that are malfunctioning. And I think about the loneliness in our culture that our surgeon general has called an emergency. So what are other epistemologies, worldviews, perspectives able to teach us that we are not very good at, or practiced at, engaging with in our standard western education?
Steven Jackson:
Yeah, I think about... And go with me for a second, but I think about "The Matrix." Have you seen "The Matrix"?
Priya Sury:
Yes.
Steven Jackson:
OK, good. You've seen "The Matrix"?
Kari Haley:
Oh, yeah.
Steven Jackson:
And it's almost like you're in this society, or you're in this space, where certain things are just deemed normal, so normal that they've become mundane, so mundane that you don't begin to question them anymore. And I think that's what you're speaking of. We're bathed with certain lenses that, and I've talked about it on previous episodes where in a lot of spaces, I'm a Black doctor. I'm not a doctor, I'm a Black doctor. That's because Black doctors are rare. Two percent of Black men make up the physician population in our country. And so when you see me, well, I'm not just a physician, I'm a Black physician. But that's a lens. And I agree with you. It might take the rest of my life, if ever, because I myself have lenses as well.
But I think something that you brought up, I think attacking the mindset, and attacking it, not just discussing it, but really calling it out, calling out our biases, calling out the connection between how we see the world and how it can negatively affect relationships, especially the relationships that we talk about on this podcast, which is us and our patients and the communities that we serve.
And we have to be brave. We have to stand up against some questionable ideologies. And they might be rooted in, like you said, Dr. Sury, how one was raised, how they saw the world, who taught them along the way. That's a lot of undoing, a lot of unpacking, and whether they intend it or not, the impact is great. And so, a lot of work to do. But I mean, what you're doing is, it's a big piece of the solution.
Kari Haley:
Yeah, I think that, again, what you... Just creating this course in general and just the passion that you bring to it, you being in our physician group, I think, only is additive for us as a group as well, to be able to help us get to a different mindset, a different frame of reference, potentially. And that hopefully, with new courses and new mindsets coming into medicine, as the years go by and people who've taken these types of courses, we can start to move the pendulum a little bit, potentially.
Priya Sury:
Yeah, and...
Kari Haley:
It's hopeful. It's hopeful.
Priya Sury:
Thank you so much. And I think you bring up a really good point about seeing if we're moving the pendulum, and that's another area we really need to focus on. So many curricula have popped up, and we are doing a systematic review on anti-racist curricula in medical education. And there's over, I think, close to 3,000 articles of different programs coming up.
But we really need to start also seeing, are these, is this time and is this effort substantively shifting the way people think about their medical career? Is it negatively affecting the student experiences in some kind of way that we're not thinking of? Is it having benefit to patient outcomes in some kind of way?
So we're in a phase of a lot of generativity, a lot of trying to do things, and I think that's important, and we also need to be very mindful of the wicked problem impacts. We're moving the needle on something; what are we creating as an effect of that? And make sure it aligns with what we want to be doing.
Kari Haley:
I really want to thank you for coming on the podcast, coming and sharing a little bit about yourself, and then just, again, all of the work that you're doing with incoming medical students. And I'm really excited to see what the future of medicine holds in this space.
Priya Sury:
Thank you so much. Thanks for doing this podcast. It's been really fun to hear.
Steven Jackson:
Like Dr. Haley said earlier, you're giving us hope, and glad to know that this new generation of docs coming into the world, they're going to be a little further along than I know I was.
Priya Sury:
Hopefully they'll teach us something.
Steven Jackson:
Yeah, exactly. Thanks.
"Off the Charts" is a production of HealthPartners and Park Nicollet.
Kari Haley:
It is recorded by Jimmy Bellamy, with Creative by Peggy Arnson, Tina Long, Tim Myers and Jeff Jondahl.
Steven Jackson:
Production services provided by Matriarch Digital Media.
Kari Haley:
Our theme music is by Ryan Ike.