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The Clinical Excellent Podcast, sponsored by the Bucksbaum Institute for Clinical Excellence is a biweekly podcast hosted by Drs. Adam Cifu and Matthew Sorrentino. The podcast has three formats: discussions between doctors and patients, discussions with authors of research pertinent to improving clinical care and the doctor-patient relationship and discussions with physicians about challenges in the doctor-patient relationship or in the life of a physician.
[00:00:00] Dr. Cifu: On today's episode of The Clinical Excellence Podcast, we have Ms. Audrey Peeples and two of her doctors.
[00:00:10] Ms. Peeples: And I made a pact with God as I was sitting there. And I said, "Here's the thing. I've got trips planned for April, May, and June. And I'm going to the south of France in October. So if you'll let me live until the end of the year, I'll come back and renegotiate with you in December."
[00:00:35] Dr. Cifu: We're back with another episode of The Clinical Excellence Podcast sponsored by the Bucksbaum Institute. On this podcast, we speak to patients and doctors about all aspects of excellence in clinical medicine. I'm Adam Cifu, and today we have one of our occasional conversations with a patient. I'm joined by Ms. Audrey Peeples and two of her doctors, Marshall Chin and Justin Kline. Thank you all so much for joining me today.
[00:00:59] Ms. Peeples: Thank you.
[00:00:59] Dr. Kline: Of course.
[00:01:00] Dr. Chin: Thank you.
[00:01:00] Dr. Cifu: Since we're focusing on Ms. Peeples today, I'm going to give the briefest possible introduction to my two colleagues. Dr. Chin is a general internist and the Richard Pirillo Family Distinguished Service Professor of Healthcare Ethics at the University of Chicago. He is also a senior faculty scholar in the Bucksbaum Institute for Clinical Excellence. Justin Kline is a hematologist oncologist specializing in leukemia and lymphoma. He is also a professor of medicine. His clinical interests include allogeneic stem cell transplantation and the treatment of these malignant diseases.
Ms. Peeples, before I ask you some questions about your time here as a patient and your relationships with Drs. Chin and Kline, can you just tell me a bit of your story? Where are you from? What kind of work did you do? Do you have family in the area?
[00:01:48] Ms. Peeples: Born and reared in Chicago. Went to college at the University of Illinois as a liberal arts major. Thought I would become an English teacher, but got recruited by a bank. At the time the bank was looking not only for diversity, they were looking to change the sort of usual accountants and people like that, that they were hiring. They wanted people who had more people skills.
And so I worked there and ultimately became a trust officer and worked in personal trust. And then I was on the board... Representing the bank on the National Board of the Girl Scouts of the USA. And I had a baby. I mean, I got married late. I was 32. And I had a baby, and nobody in the bank had ever come back after having a baby, especially not the women.
Um, so I went back to work, but I felt that my career had been curtailed. I mean, people would say things like, "We know you can't go to this meeting tonight because you've got to go home." And I'd go, "No, I've got a sitter. I don't have to go home." So, I went to a national Board meeting and came back. And the officer who was in charge of my department said, "You know, we don't know what we're going to do now because we may want to send you to another division. And so when I went to the meeting, one of the directors, the regional directors, said, "How do you like being back at work?" And I said, "I don't."
And she said, "How would you like to come to work for us? We're looking for people with management skills." So I went to work for the Girl Scouts sort of supervising eight regional states. I supervised people who provided management and services, consulting services. And then, one day I got a call from a recruiter who wanted to... They were looking for a CEO at the YWCA, it was a bigger job, a bigger budget, more people. So I went to work there, and I worked there until I retired.
[00:03:45] Dr. Cifu: How did you, one thing that you went by so quickly, how did you originally get involved with the Girl Scouts?
[00:03:52] Ms. Peeples: I was on their national Board, and they had representatives from the regional... You know, I represented the bank because the bank gave them money.
[00:04:01] Dr. Cifu: Got it, so it sounds like you were an expert in managing people over your entire career.
[00:04:06] Ms. Peeples: Right, right.
[00:04:07] Dr. Cifu: How did you end up under the care of these two gentlemen who are with us?
[00:04:11] Ms. Peeples: Well, I had a primary care physician from the University of Chicago who moved to Pittsburgh, I believe. And I was looking for a new person and they assigned me to Dr. Chen, which was my lucky day. And in meeting with Dr. Chen, I kept thinking I had a spider bite on the side of my arm. And I kept saying, "This spider bite won't go away." And he said, "Well, let's look at it." So then he said he had done some research and he thought it might be lymphoma. And then I went to Dr. Kline, another lucky roll of the dice. And that's how it started.
[00:04:45] Dr. Cifu: How long ago is that? Do you remember? Was that four years ago?
[00:04:49] Ms. Peeples: Maybe four, it was before COVID. COVID kind of... Three or four years ago.
[00:04:53] Dr. Cifu: Okay. So fairly recently. One of the reasons that we do these podcasts is to talk to doctors about their experience, about some of the challenges in medicine, some of the challenges of our trainees and learners as they go along but also to talk to patients about sort of experiences that they've had with medicine that have been good and that they sort of say, "Wow, this is when you guys do things well," but also things that maybe haven't gone so well over time. Many of our listeners are physicians and trainees, and we always hope that we can sort of give some important information in that way. So just, I don't know, you know, reflecting at your time before I open things up, are there things, and it doesn't have to be recent, but over the years that medicine has done well with you or done poorly with you?
[00:05:47] Ms. Peeples: Well, fortunately for me, I've been pretty healthy but in the last incarnation, I guess you could call it, I've had a couple of physicians that I haven't liked particularly. And particularly for me, an interaction with a physician is important. And you know, I said to one of these guys, "I think you failed the course on patient interaction." And actually his associate was a woman and she went...
[00:06:16] Dr. Cifu: For those listening, there was a nod there.
[00:06:19] Ms. Peeples: Yeah, right, right, right. Shook her head. So, that's actually... I recently left someone for that same reason. It was an ophthalmologist because he had a private practice and he was so thrilled. He was listed as one of the best doctors in Chicago in Chicago Magazine. And he went on to Northwestern. And once he got to Northwestern, he was just like a different person. It was like Nirvana. And I decided that I was going to look for a new ophthalmologist, which I did. And I found one that I liked.
[00:06:51] Dr. Cifu: How quickly do you know if you're going to, you know, be comfortable with someone, communicate with someone when you walk into the office? Is it sort of instantaneous? Is it something you get over time?
[00:07:03] Ms. Peeples: For me, it's instantaneous.
[00:07:04] Dr. Cifu: It really is. Yeah. And do you think that that's a personal thing, or do you think that's something that, you know, one can be almost trained out of, right?
[00:07:16] Ms. Peeples: I think you can't help being who you are. I am who I am, and they are who they are. I just sort of don't like people who don't respond, who are non-responsive.
[00:07:26] Dr. Cifu: I understand.
[00:07:27] Ms. Peeples: So that, for me, has been a very happy situation here at the University of Chicago.
[00:07:32] Dr. Cifu: That's a great way to put it. Marshall, you suggested that we invite Ms. Peeples on. When you were thinking about the podcast and thinking about your relationship, maybe I'd ask you what sort of things came to mind first when you think of her and think of your interactions over the years.
[00:07:51] Dr. Chin: Well, Ms. Peeples is the truth-teller. One thing I've always appreciated with her is that we're able to talk about anything totally honestly, whether it's the medical and clinical issues or else about life that Miss Peoples has had, a very rich, diverse life and has grown up in a time of change in America.
So we usually talk a bit about issues of like growing up as a black woman in America during this era and my background, Chinese American, and it's been very enriching learning about people's life and how she's experienced a variety of challenges and really succeeded in an incredible level in our society.
[00:08:36] Dr. Cifu: Are there things that you've talked about sort of within medicine that those issues have been important? And I guess I'd ask that for both of you guys.
[00:08:45] Dr. Chin: Certainly. We talk quite a bit about like, how issues of both interpersonal bias among people and with health care, as well as we specifically talk about ways that structural racism may manifest itself in the care of people.
And so, you know, I just open up to them as people, sort of like, whatever she would want to say regarding, you know, some of her experiences and her, I think, very healthy attitude towards all of this.
[00:09:10] Ms. Peeples: Yeah, I think because I've had a diverse background, I'm very open and comfortable discussing race issues, as they relate to me or relate to somebody that I know. So, and you know, I'm aware of all these studies that talk about how black people don't get the kind of treatment that they should get in high schools.
[00:09:28] Dr. Cifu: Sure. Does that come out as you advocating for yourself, or in sort of bringing other people awareness when you think that things are being done wrong in the medical field?
[00:09:42] Ms. Peeples: I think it's... The thing is that I really hear it, as he said, I like to talk to people and find out what their experiences are. So I often find it more common from other people. And I will say that hasn't been my experience, but you know, as I've said to my children, it's not if it's going to happen, it's when. So I'm always prepared and listening with a third ear to see.
[00:10:04] Dr. Cifu: Right. Was that something...? I mean, this is very, I feel like, common in the last you know, 20 years where we hear so much outside of the family about people preparing their children, right? For what they're likely to hear, what they're likely to experience.
And I understand, even though that's been, you know, in popular culture for the last 20 years, boy, it dates back well before this, right? Sounds like that's something that you did with your children. Is that something that was even done with you?
[00:10:36] Ms. Peeples: Yeah, I think it's, you know, it's just sort of being prepared, you know, keeping your eyes open and looking for, you know, not being so nervous about it that you get paranoid, but that you see it.
For instance, I was in a board meeting one time where I was presenting something and it was a meeting where we talked about racism. We went to YWC, one of their missions is the empowerment of women and elimination of racism. And so we have a primarily white Board, and we were discussing, we had a chart up, and we were talking about different forms of racism. And one of the questions was what do you like about being white? What do you like about being black? What do you like about being Latino? And one of the white women said, "Well, I never thought about what I like about being white. I just am." So it was a real eye-opener. And so I said, when it was... It was a sort of brainstorming. So you weren't supposed to respond. You just listened. And then we'd talk about it. And so I said, "Well, one of the things I like about being black is being loose." And so she immediately jumped in and said, "Do you consider yourself a loose woman?" So I said, "Well, no, actually that's a poor choice of words." I said, "I think it's..." She said, "Well, you are kind of arrogant." And so my response to her is, "You call it arrogance and I call it confidence. I'm a very confident person." And she said, "Well, you... You know, I don't know what to say sometimes to you." And I said, "Well, what I mean, again, if you want to use another term for loose, I like being irreverent."
"Because you, as a white woman, a privileged white woman, think that I can... Anything I say I don't know any better. So I just let it all hang out." You know what I mean?
[00:12:23] Dr. Cifu: I can imagine the people who organize this meeting thinking, "Oh, this is not going in the direction that we hoped."
[00:12:30] Ms. Peeples: The people who were handling the seminar were... Crossroads was the name of the organization. It's a very fine organization. But I don't think they were ready for that kind of discussion but it was not supposed to be a discussion. We were going to talk about it later but one of the responses, this is my last response, one of the responses when the one white woman said, "I never think about it, I just am." Now this is 25 years ago. We had two black women on the board and one of the black one was a lawyer who traveled and she said, "I understand that because when I'm traveling in a hotel and I get a run in my hose, I can't go down to the drugstore and find hose that match my color because it says nude and nude for me and nude for you are two different things."
And so it was a wonderful opportunity for us to lay those issues on the table in an environment that wasn't confrontational. It was wonderful.
[00:13:24] Dr. Cifu: Right, right, and topics that don't usually come up just when you're sitting around at work trying to get things done.
[00:13:30] Ms. Peeples: Sure, sure. So if you say, if I pass on my children, I just want to say one more thing.
My son is a vice president at a sports company, and he was in a meeting with a man and he was responding and the man said to him, "You're arrogant." And he said, "I channeled my mother," and I said, "No, I'm confident. I'm not arrogant."
And after the meeting, one of the younger men who was in the meeting said to him, "Well, you know, Mike, so and so is old school. So you know what that means,"okay? I suppose we're old school.
[00:14:02] Dr. Cifu: Justin, to ask you, so, I mean, it sounds like you met Ms. Peeples much more recently, and we heard a little bit about her impression of people quite quickly. I guess, what was your impression meeting her in the office for the first time?
[00:14:18] Dr. Kline: I think I was a bit, a bit intimidated. Honestly.
[00:14:22] Ms. Peeples: Were you really?
[00:14:23] Dr. Kline: A little bit. You know, obviously, you know, Ms. Peeples is a very intelligent person, and I think you had with you, was it your nephew?
[00:14:32] Ms. Peeples: My nephew. He's a physician.
[00:14:34] Dr. Kline: Who's a physician. And, I can't remember, I think your daughter might have been there as well.
[00:14:38] Ms. Peeples: Yes, she was there.
[00:14:39] Dr. Kline: So I was a bit intimidated actually, and it's not like I was brand new at the job, but once we got to talking, I knew quickly that we would get on okay. I have the same feeling about people I see. I kind of know pretty quickly when it's going to be a good match.
[00:14:59] Dr. Cifu: I think that's interesting that it doesn't really matter where you are in your career, right? I think you are, I don't know, intimidated, challenged by fewer people as you get further along, right? But still, at any time, there are those people who are like, "Okay, this is going to take me a little bit to adjust to and kind of figure out how I behave with this person.
[00:15:20] Dr. Kline: Yeah, I think that's fair. I think experience helps. You know, when people come into their first visit with the oncologist, there's often a roomful and so I've gotten used to that and I'm less intimidated by it, but it never totally goes away, you know, and so I think it's important to...
You know, I don't want to say to be able to control the room, but to put people at is important. You need to, as a physician too, we need to show arrogance, I mean, confidence. You know, I think we need to give off the vibe that we... You know, folks are scared and they want to know that their doctor is going to know what to do. And so there's a fine line between confidence and arrogance.
[00:16:02] Ms. Peeples: I agree. I agree.
[00:16:03] Dr. Kline: We need to be confident.
[00:16:05] Ms. Peeples: But I think also both of these two men are very responsive. I mean, they... If you put it on my chart, they respond, or if you call them and they both gave me their numbers if I had... Because I was obviously very anxious about my... I had never been ill forever.
To find out you have lymphoma is kind of scary.
[00:16:25] Dr. Cifu: Absolutely. Can you as a patient, and I think I probably already know how you're going to answer this, but I'm curious, given our discussions about confidence and arrogance, is it obvious to you when people are sort of putting on an act in their confidence? Because I think we often, when we train young doctors, and we recognize how important it is to feel... For people to be decisive and clear, but when I see trainees, I often know, like, "Oh, patient's going to see right through them." Do you have those feelings when you're seeing some physicians?
[00:17:03] Ms. Peeples: I think I do but I think it's very... I have a good radar detector. And so it's very easy to see. I mean, I would love confidence, as I said but arrogance is something I won't abide. Because I don't like for people to treat me as if I don't know what I'm doing. I might not have their expertise, but I do know my body, and I know myself, and I know what I expect.
[00:17:28] Dr. Cifu: Right. And you're making decisions for yourself. Good. You guys have anything else that you want to bring up?
[00:17:35] Dr. Chin: Well, maybe something that we'd ask Ms. Peeples about, like, the system, the healthcare system, and navigating the healthcare system. And, like, you have a whole variety of interesting observations about that.
[00:17:49] Ms. Peeples: Yeah, well, I think navigating the system, I always, when I get the questionnaire at the end, the survey. The only people I have a problem with all the time are the people at the reception desk because I just think they're indifferent, they're rude. So but the care is phenomenal, and the response is phenomenal.
[00:18:09] Dr. Cifu: Yeah. You are certainly not the first person I've heard that from. And I always imagine, boy, that is an incredibly difficult job, right? Because they are seeing people they don't know who have no relationship with over and over again. And some people, you know, are frustrated or scared, can certainly be rude.
You're someone who sounds like has been, you know, a manager for much of your career. How would you think about, you know, how do you train those people, sort of the very first contact of our patients to try to make that a better experience?
[00:18:47] Ms. Peeples: One of my rotations when I worked in the management program at the bank was education and training. And so, you know, we'd hire new people and they'd come for training. And, um... Well, I got in trouble one time for saying this, but I said, you know, "You're the front line of the bank. How they get treated at the teller's window is they go away and say, I'm never going to go to that bank again," you know. And that's the way I feel about receptioners. You're the front line. And when I got in trouble in this training is I said to the young people because they were working in a program where they were hitting inner city kids and training them for jobs, and I said, "You know, if you don't like your job, you shouldn't be here. Because you spend more time at work than you do at home, up at night, sleeping. You know, you spend more hours at work. So if you don't like your job, leave." So that's sort of the way I feel about doctors and nurses and receptionists and managers.
[00:19:46] Dr. Cifu: Understand. I think it's telling also that you know, the behavior that we hear about people with our front desk staff is all... Is often very different from the behavior with us, you know, as doctors in the back that I sometimes hear complaints about people checking in, and then everybody's always, you know, an absolute gentleman or gentlewoman when they're in the room with me, right? Because...
[00:20:10] Ms. Peeples: My favorite is standing at the desk, and somebody says, "Did I call your name?" "No, you didn't but there's nobody standing there. So I walked up to the desk." I think both of these men, I started to say fellows, both of these men have excellent nursing people who work with them. They are very wonderful. It's just that front desk person, as you call them, who's just out of control.
[00:20:33] Dr. Cifu: Yeah, it's hard, it's hard.
[00:20:35] Ms. Peeples: Maybe it's an employment problem, I don't know.
[00:20:37] Dr. Kline: You're the manager.
[00:20:40] Ms. Peeples: I'm retired.
[00:20:41] Dr. Chin: So one question I have for you, Miss Peeples, is you talked about like radar, about people, and then this idea of like authenticity, and Adam mentioned this like, well, if someone's putting on sort of a phony facade, versus like being authentic to themselves, and authentic to whoever they're interacting with, and whenever you're communicating in a situation with someone, there's both like what's overtly being said as well as there's the sizing up of the two people. And so can you talk a little bit about that, like, you know, as a patient and as sort of navigating the system, how you sort of navigate what's overtly said versus like the, you know, sizing people up in terms of the, all the sort of like nonspoken things.
[00:21:23] Ms. Peeples: I think that's part of it. It is sizing people up as well as... I want to be sure that I'm not too arrogant myself when I'm dealing with them so that I get the vibe. It's important to me that I recognize that kind of, well, I'm the doctor and you're not. But it's my body. And so, you know, I have a question for you about my body. So don't poo poo the things I have to say. So when people started doing that, like, "Oh, it's nothing, you know, you're getting to be paranoid." No, I'm not paranoid. You know, I'm anxious, but I don't need a therapist because I'm not so anxious that I can't move. It's just, I think when you've had cancer, you know, the odds are that it's going to come back. And I think right now, I think I'm in remission, but I, you know, I just made a deal on Ash Wednesday. I went to church on Ash Wednesday, and I made a pact with God as I was sitting there, and I said, "Here's the thing. I've got trips planned for April, May, and June, and I'm going to the south of France in October. So, if you'll let me live until the end of the year, I'll come back and renegotiate with you in December." Because it might pew. And the lady sitting next to me said, "What?"
[00:22:43] Dr. Cifu: She said, "You are driving a hard bargain here."
[00:22:45] Ms. Peeples: But I'm going to go back and renegotiate. But I've got to see Dr. Kline next month. So I'll find out if...
[00:22:51] Dr. Kline: I can hardly wait.
[00:22:52] Ms. Peeples: Yeah.
[00:22:54] Dr. Cifu: It's interesting listening to how you talk, because I often feel like, as doctors 90 percent of the time, if we're just ourselves, everything goes fine. And 10 percent of the time, we have to put on a little bit of an act, right? To be able to work with, you know, the sort of breadth of people who come in. And it sounds like you, from sort of, you know, the other side of the bed, we can't really expect our patients to put on an act, right? Because you have to be yourself. You have to be comfortable with the doctor. But it sounds like you're aware enough of yourself in those visits that you, you know, sometimes have to adjust a little bit to the person you're working with.
[00:23:31] Ms. Peeples: But it is intimidating. And I agree with you. It is intimidating because you know something about me that I don't know about myself.
[00:23:37] Dr. Cifu: Absolutely.
[00:23:38] Ms. Peeples: And I'm not so arrogant that I won't listen to what you tell me to do but if you will explain to me why I need to do that, then I can deal with it more comfortably.
[00:23:50] Dr. Cifu: So, I wanted to thank you again for taking the time to talk to us. It was wonderful.
[00:23:55] Ms. Peeples: My pleasure.
[00:23:55] Dr. Cifu: Very enlightening, I think.
[00:23:57] Ms. Peeples: I get two free visits.
[00:23:58] Dr. Cifu: I know. I'll step out of the room at the end of this. So thanks for joining us for this episode of The Clinical Excellence Podcast. We're sponsored by the Bucksbaum Institute for Clinical Excellence at the University of Chicago. Please feel free to reach out to us with your thoughts and ideas on the Bucksbaum Institute website or Twitter page.
The music for The Clinical Excellence Podcast is courtesy of Dr. Maylyn Martinez.