February 25, 2022
Somewhere along the way, understanding bodies and health information became a jumbled mess for so many of our patients. Dr. Lisa Fitzpatrick, also known as “Dr Lisa on the Street”, is out to change that. Listen in on this conversation with Dr. Lisa about health literacy through proximity, and more importantly, following your passion and making a difference. The founder of Grapevine Health, and a former Medicaid Medical Director and former physician at the CDC, Dr. Lisa’s curiosity is contagious and her genuine desire to connect with people has made her an internet success.
Transcript
Dr. Angela Kade Goepferd: This is Talking Pediatrics, a clinical podcast by Children’s Minnesota, where the complex is our every day. Each week we bring you intriguing stories and relevant pediatric health care information, as we partner with you in the care of your patients. Our guests, data, ideas, and practical tips will surprise, challenge, and perhaps change how you care for the most amazing people on Earth, kids.
Welcome to Talking Pediatrics. I’m your host, Dr. Angela Kade Goepferd. I am thrilled to be recording another episode of our Trailblazer Series. Today’s trailblazer is Dr. Lisa Fitzpatrick, also known as “Dr. Lisa on the Street.” Dr. Lisa is the founder and CEO of Grapevine Health, an organization committed to improving health outcomes through proximity and advancing health literacy. Dr. Lisa’s career has spanned research, clinical medicine, global health, community health education and patient advocacy. She served as the medical director for Washington DC’s Medicaid program, and also previously worked at the Centers for Disease Control and Prevention. Dr. Lisa is also a clinical professor and professional lecturer at George Washington University School of Medicine and Milken Institute School of Public Health. She’s a member of the Aspen Institute Global Leadership Network, and was selected as the 2017 Aspen Institute health innovator fellow. In addition to her medical degree, Dr. Lisa has a master’s in public health from UC Berkeley and a master’s in public administration from Harvard. Lisa, my good friend, it is an honor to have you joining us today and talking pediatrics. Thanks for being here.
Dr. Lisa Fitzpatrick: Oh, likewise. I’m so excited. Thank you for having me.
Dr. Angela Kade Goepferd: Well, I’ve asked you to join our Trailblazer Series. So I’d like to talk a little bit about you being a trailblazer, which is very much how I see you. You have had such an interesting career that has really spanned a lot of different and sectors and have done much more than I was able to really talk about. So tell me about what does being a trailblazer mean to you, or what does innovating in the field of medicine mean to you and how have you gotten here?
Dr. Lisa Fitzpatrick: Angela, it’s an interesting question because I actually don’t see myself as a trailblazer. I see myself as someone who sees a problem and sets out to figure out why we have the problem and then explore solutions to fix it. And if that ends up being, I guess, trailblazer is a nice way of saying troublemaker.
Dr. Angela Kade Goepferd: Yeah, I like that. It’s like John Lewis said, it’s good trouble.
Dr. Lisa Fitzpatrick: I just, I follow my gut. If something feels like it needs some interrogation or some investigation, I’ll follow that until I get an answer. And if I don’t know the answer, then I go exploring. And so that’s always been the way I’ve been, since probably my CDC days, CDC turned me into a medical detective.
Dr. Angela Kade Goepferd: What motivates you to be that problem solver, or that innovator, or that detective? Where does that come from this desire to solve problems?
Dr. Lisa Fitzpatrick: It’s a good question. I think some of it’s just, I’m naturally curious. I ask a lot of questions. In fact, someone a couple weeks ago told me, she said, I think you’re the queen of follow-up questions. And I like that because it signifies that I do, I ask a lot of questions because I think we don’t ask why, and we don’t ask how enough. And if we were to ask these questions more, we could really get to root causes because we tend to be solving on the surface.
Dr. Angela Kade Goepferd: Sure.
Dr. Lisa Fitzpatrick: Instead of having the courage to ask why and how you really get of the root. And so what motivates me is the people I hear from, I hear how confused they are, how frustrated they are, and I want to help.
Dr. Angela Kade Goepferd: So let’s talk a little bit about Grapevine Health and your journey to starting Grapevine Health. I mentioned it a little bit in the introduction, but how would you describe Grapevine Health if someone were to ask you about that organization that you founded?
Dr. Lisa Fitzpatrick: Grapevine Health is a trusted resource for relatable health information. And the reason we need that, well, I think this pandemic is showing us why we need that. People are really confused about health information. There’s a lot of conflicting information out there. It’s not culturally relevant for different populations. It’s not tailored. And a lot of it’s just not interesting. So we want to be the go-to source for trustworthy, relatable health information, particularly for underserved communities.
Dr. Angela Kade Goepferd: In that work, you talk a lot of about health literacy and the principles of work you do with Grapevine Health is as much about getting two people as it is about helping them understand their health and their bodies. How did health literacy become such a big part of the work that you’re doing and so important to you?
Dr. Lisa Fitzpatrick: I remember the moment, Angela, I was at CDC, it was 2005 and I was on a panel with a bunch of health experts. And the audience was asking us questions. And my approach to answering questions is usually to use analogies, or keep it very simple without the use of jargon or big words, big medical words. And at the end of this panel, a gentleman, he must have been in his fifties or sixties, came up to me and said, how does someone like me access someone like you on a regular basis? And it touched me so much because, and even every time I tell that story, it just makes me feel a little emotional, because this man had a doctor, he had chronic health conditions, he’s been on medicine for years. And something about the way I was explaining the answer to his question really spoke to him. And I realized there are millions of people out there like him who go and see their healthcare provider, or they’re discharged from the hospital, and they can’t tell you anything about what happened or what was said.
And that’s when I realized I have to become a vessel to help people understand this complex health information.
Dr. Angela Kade Goepferd: I love that.
Dr. Lisa Fitzpatrick: And that’s when I created Dr. Lisa on the Street, it was an experiment. It took many years to get to Dr. Lisa on the Street, but I never forgot that man and his question. And it’s just as relevant, if he were to ask me that question today.
Dr. Angela Kade Goepferd: Let’s talk a little bit about Dr. Lisa on the Street. For those of you who don’t follow Dr. Lisa on the Street, I highly suggest checking Dr. Lisa out on Instagram reels or TikTok or other platforms. You told the story of the man in the audience of the CDC. How did you get from there onto the streets? And what was that like to go into the streets with people and start having conversations with them?
Dr. Lisa Fitzpatrick: Yeah. I’ve always been someone who thrives on conversations, asking people questions and really understanding how they feel, what their perspectives are. So much so people have said to me, oh, you should run for office. I’m stating here right now, categorically, I will never run for office, but.
Dr. Angela Kade Goepferd: All right, we’ll hold you to it.
Dr. Lisa Fitzpatrick: It’s similar. Yeah. It’s similar though, in asking people, what are your concerns and what are your fears? And so after that encounter with the gentleman, I continued to do that in my practice and realized that I was also guilty of speaking over people’s heads. It’s a practice, even now I’ve gotten pretty good at it, but I still have moments when someone will stop me and say, well, now what is that?
Dr. Angela Kade Goepferd: Sure.
Dr. Lisa Fitzpatrick: Because it’s so easy for us to talk to each other. We have our own language.
Dr. Angela Kade Goepferd: We do.
Dr. Lisa Fitzpatrick: And we can carry on a conversation and to someone who’s not in the medical field it sounds like Greek. I think refining my approach to health communication over time, making sure people understood, asking follow-up questions, asking them to repeat back what I was saying and just asking them, what are you most afraid of? Just asking that question puts people at ease. It makes them feel like, okay, maybe I should talk about this.
Dr. Angela Kade Goepferd: Is it intimidating to have these conversations with strangers? I see you talking to them now about COVID and asking what people know about COVID, or if they’ve been vaccinated, or why they have, if they have, or why they haven’t, if they haven’t. And to be honest with you, that would scare me to go up to a stranger on the street and say, hey, have you had the COVID vaccine? So does it scare you? How do you get over that?
Dr. Lisa Fitzpatrick: It doesn’t scare me. Number one, because they’re people too. Number two, I think the biggest reason it scares people is because of this fear of rejection. And you’ve seen those people who stand out on the corner to try to get you to save the whales or send $25 a month for a child in another country. And you feel bad for them because so many people are just blowing them off. That happens to me too. But it’s so fun and interesting when you do have a successful interaction. So the first Dr. Lisa on the Street video was created in 2013 and there was a little bit of intimidation, but the first one went so well with people wanting to talk to me. I thought, okay, I have to do much more of this, but then I bought an organ model and I put it out on the street. And I didn’t have to ask anybody to come talk to me, because guess what? They came over to see the organ model, and they said, what is that?
Dr. Lisa Fitzpatrick: Imagine how unique that is to be walking down the street and to see a doctor with the organ model. That’s a conversation starter. And so once they come over and start inquiring, where is my liver? And do I have spleen?
Dr. Angela Kade Goepferd: Yeah.
Dr. Lisa Fitzpatrick: You can ask all sorts of questions, after a while you just get used to it. And then once the pandemic happened, people were starved for information. And so it was much easier because they just wanted some information from a relatable source.
Dr. Angela Kade Goepferd: And you find that people trust you when you’re telling them information, the white coat and the organ model, does that give you some cred on the street as being a doctor? Or how does that go?
Dr. Lisa Fitzpatrick: It does, I think people gravitate to the white coat only because I’m out on the street, but also, in fairness, I should let people know I’m intentional about working in underserved communities. So usually Black and Brown communities. And I go to these places because I think this is where we need to show up, we need to be visible. So if I were to go stand on the street, in an affluent part of a city, I don’t know if the receptivity would be quite the same, but it’s pretty good in the areas where I am. And I’ve had people say, I’ve never seen a doctor out on the street trying to help me. And that’s pretty powerful.
Dr. Angela Kade Goepferd: I guess the flip side of the intimidation then is what happens when folks form a real connection with you and want you to be their doctor, or have a long term relationship with them, but your role really is these moments on the street with people. How do you handle that?
Dr. Lisa Fitzpatrick: Yeah, I’m still trying to figure that one out. It’s a difficult balance because I want to be accessible, but I don’t want to be at the same time. And we have a number people can text us because I’ve always envision Grapevine Health being tech enabled or a digital health support tool for people who can’t talk to their doctors readily, or who maybe use the emergency department because they have a question. I’ve had a few instances with people who keep following up because they want a relationship with me. And it’s always difficult because you don’t want to turn them off. The whole mission, the vision for what we’re doing is to become trustworthy and connect to people and make them feel valued and comfortable.
So I’m fortunate that, that doesn’t happen very often, but when it does happen, it gives me pause and makes me say, do I really want to be doing this? It’s not like we have five million followers yet, but is that going to happen once we become more visible? And one way I’m safeguarding against that is that we’re adding doctors to the team. So I’m finding other doctors who like doing this kind of work and it won’t just be Dr. Lisa, it would be, look at the Grapevine doctors. So then I can spread the love around.
Dr. Angela Kade Goepferd: Yeah. Many of the folks listening to this podcast are folks who care for kids and clinicians who are working in a traditional office setting and are probably not going to go out on the street and talk to patients, but you’re learning a lot in those interactions that I think could benefit us in the office setting. So what pieces of advice would you have based on your conversations with people in the streets that could help us have better conversations in the office with the kids and families that we’re caring for?
Dr. Lisa Fitzpatrick: The first thing, and I’ll just give kudos to pediatricians, because I think of all the specialties in medicine, you are one of the best at talking in plain speak, listening to parents, understanding all the social context associated with the kids’ health, like few others. I think you’re already doing a great job. If there was one thing I would offer is just to continue to edit yourself as you’re talking to people and ensure you’re bringing people along and not speaking in language they don’t understand. And you can simply do that by just asking them to either repeat back, like this is a tried and tested principle in health literacy, asking them to repeat back what you said to them in their own words, to make sure they understand it, or ensuring they know they can ask questions. I had someone say to me, because we’ve also collected some data on why it’s difficult for people to ask questions in the clinic, because it’s such a truncated time you have with the patient.
And this woman said, well, I can always tell my doctors in a hurry because she puts her hand on the door. And I just don’t want to ask my questions because I know she’s in a hurry and I don’t want to bother her, inconvenience her. And that just makes me so sad. I’m sure it makes you sad too, to think that we are making them feel so rushed, as if they’re inconveniencing us because they have questions. And so these are just ways that we can mind our own behavior and be aware of how it’s being perceived with families in your case.
Dr. Angela Kade Goepferd: One of your clips that I remember where someone walked out of a grocery store and you were talking to them about their health and then telling you that their health was important. And then you said, let’s see what’s in your bag. And then you started reaching in this person’s bag and pulled out just the unhealthy food. And so that made me think, I don’t know what’s in my patients’ shopping carts. What else are we missing, or could we learn from getting more of an insight into people’s lives like you are?
Dr. Lisa Fitzpatrick: And I know it’s tough, being a clinician myself, the time constraints are real, but I think this is where we have to rely on the extenders, the helpers in our clinics and in our offices, whether it’s the folks who are greeting people when they come into the clinic, social workers, all the other people on your team who can also help gather information and share it amongst you to create a better experience for the patient, I think it’s really important. It’s something we overlook because we don’t empower our teams like the front desk person to say you are just as important in this person’s care as the healthcare provider who sees them in the room. And so I think that’s a lesson I’ve learned many years ago. And I think it’s really important for us to think about the team in that way to serve the patients.
A lot of people don’t really like the health care experience. To think you have to go and see a health care provider, a lot of people think there’s something wrong with me. And it’s because as a society, we don’t think about prevention. Again, pediatricians are a bit of an outlier here because so much of what you do is prevention in the clinic setting, but I think just remember that not everyone thinks of this as a positive experience and tuning into that and figuring out how you can make it easier for them. And trust is also a piece of this, and the trust comes from listening, letting people feel like they’ve been heard. And so these are just reminders because, again, I suspect pediatricians are fairly good at this compared to so many of us.
Dr. Angela Kade Goepferd: It does bring up for me the issue of health equity and how we are actively keeping certain populations away from health information that they need and their access to health care is so poor. And you mentioned that for you, it’s really important to be doing this work in Black and Brown communities. And are there insights around this quest that we have to provide more equitable health care that you could share with us from your work in those communities?
Dr. Lisa Fitzpatrick: Number one, a lot of these conversations are not granular enough, so it’s not enough for us to say, oh, we’re going to, and we use jargon, center health equity, or we are embedding health equity, or we’re prioritizing health equity. What does that mean? And how do you know that this is needed within your organization? And if it’s needed, what could you do concretely to address it? All that to say, I think we have to do the work to identify the specific issues that are leading to inequity, whether it’s access, can people get appointments when they need them, or maybe doing some review of your telemedicine implementation? Was it lopsided? If so, why? How could you change that? Language, when’s the last time you looked at educational level and figured out if there’s an intervention that needs to be in place for that? There’s so many ways to think about and look at equity. And I think each organization has to look at their data, but then move beyond the data.
The easiest thing to do is say, oh, we’re going to look at our data and then characterize this or that. That’s not enough. I think the first step is to look at the data, but then you have to come up with a series or action steps to help you address them. I gave an example the other day on my LinkedIn page, because there’s a lot of conversation right now about maternal health inequity. And there’s a lot of money flowing into that space. But when you talk to moms who’ve either recently delivered or who are pregnant, about their health care experiences, the things they say don’t seem to map to the things that are getting funded.
I’m actually not sure what’s getting funded, but they say things like, well, the doctor was really rude to me. Why would I go back there? Or I only went there because I wanted to see my baby. They wanted an ultrasound and then didn’t get an ultrasound. But did anyone ask, well, what are your goals for this visit? What would make this a great visit for you? If we’re not asking those questions, we can’t close these inequity gaps.
Dr. Angela Kade Goepferd: What would you say are your guiding principles? Have you distilled down what those are? What it is that drives you? What fuels your work professionally?
Dr. Lisa Fitzpatrick: I think a lot of us wore out our welcome. When we realize we’re no longer adding value or making impact, or we become too frustrated to be effective, it’s time to leave. And I have long been attuned to those things in my work. And I’m someone who’s not as risk averse as others might be. And also it’s my curiosity that drives me to pivot and try something different. And starting Grapevine Health is maybe the third or fourth pivot I’ve had in my career because I realized either this isn’t working, or I need to follow a different path. And it can be scary, but each time I learn something in the process. And when you make a decision, the decision will either be a great decision, or a not so great decision. And if it’s a not so great decision, then try to make another decision.
Dr. Angela Kade Goepferd: Yeah.
Dr. Lisa Fitzpatrick: That’s how I approach it. But you asked about my guiding principle, it’s really around humanism. We’re all human. And to approach my work without judgment, in the beginning it’s hard, it’s a practice, we all need to practice, and be aware of when we are showing judgment. So if you have a Medicaid mom coming in and she’s got three kids, what are you thinking in the back of your head about this mom? Or are you looking at her purely as someone who needs your help in that moment? It’s things like that, that drive my work. I try to separate the judgements that often creep in because as a society, we like to label people and put people in buckets, as you all know.
Dr. Angela Kade Goepferd: Yeah, it’s that the danger of a single story or a single narrative. And I think what you’re really hearing in your work on the streets is so many different stories of people who we may all assume have a similar story, but probably in all reality, do not. I have learned so much from you as a friend and as a colleague, and even more in this conversation. And I’m a big believer in passing it on and mentoring those who are coming up after us. And so what would be the advice you would either give to yourself as a younger professional, or that you would give to younger professionals now who are really seeking to make an impact and hope to one day be innovating and blazing trails in the way that you have?
Dr. Lisa Fitzpatrick: Well, it’s really simple, but it’s hard to do. And that is if something doesn’t feel right, you have to push back, you have to speak up. And particularly for people who are in training, this can be very difficult, but I think it’s like a muscle, you have to exercise and massage in order to get comfortable with it, because people will encounter many things in their careers and in their training that make them uncomfortable. And they have to decide, where is the line that either is going to make me walk away from this, do something different, speak up? And it’s different for everybody, but you have to listen, because we all have that, we have that voice inside of us. But because it’s not that loud, we tend to ignore it. But I guarantee the longer you ignore it, it’ll just keep getting louder and louder and louder until it forces you to some action.
Dr. Angela Kade Goepferd: Well, thank you so much for joining me today, and for the work that you do. And for our listeners who haven’t already searched for you on social media, please look up Dr. Lisa on the Street and follow her incredible work. Thank you, Lisa, for joining me.
Dr. Lisa Fitzpatrick: Yes. And thank you for having me, Dr. Angela, because I’m so inspired by you as a person, but also as a healthcare leader. So I’m actually honored that you asked me to come on your podcast.
Dr. Angela Kade Goepferd: Thank you for joining us for Talking Pediatrics. Come back each week for a new episode with our caregivers and experts in pediatric health. For more information and additional episodes visit childrensmn.org/talkingpediatrics.