Michelle Medina, MD

Podcast Transcript

Cara King:

I'm really excited to have Dr. Michelle Medina on Inspirations and Insights today. She's currently the Associate Chief of Clinical Operations within Cleveland Clinic Community Health System, which is a very large job, and pediatric residency trained. Is that right?

Michelle Medina:

Yes. Here at the Cleveland Clinic, way back. I wouldn't say way back, but back in the 90s, I think when we, I still remember the circular driveway before we had this huge building and that huge fountain that was there. Much smaller space. But I do remember Cleveland Clinic during those times, yes.

Cara King:

I love this. I love when people have trained here and then leave for a bit and then come back. Because it's such a cool perspective when you've seen kind of where we started in the beginning and kind of how we've evolved. I can't wait to hear your perspective on that for sure. No, I'd love to start at the beginning if that's okay with you?

Michelle Medina:

Yeah.

Cara King:

I was reading a previous interview that you stated that you knew you wanted to be a doctor, even from a young girl during childhood. And this is so different than my trajectory. I did not know I wanted to go into medicine pretty late in undergrad. I would love to hear your story. What was your childhood like and how did you know so early that this was your calling?

Michelle Medina:

I think I had a pretty typical middle class, actually boring kind of childhood, playing in the yard. I have a sister who's only about 16 months younger than I am. We grew up, and we're close. We're still pretty close. Amazingly enough, I am not from a family of physicians. I'm more from a family of engineers actually. And that's sort of the bent I think, of my entire family. Having somebody come out and say, I think I want to be a physician, in all honesty, was greeted very, very well. I think they were excited.

They didn't quite know what to make of that, but they thought, yeah, it's a great profession, seems to fit in with who you are as a person, so go for it.

And I've never really heard anything other than that type of support and acclimation and just the general sense of, you know what? If that's what you want to be, that's what you want to do, we're very, very supportive and that's how it's always been. Where it came from, I think is the question. And to be honest with you, I don't know. I do remember very distinctly waking up a Christmas morning and having a physician set, which sounds very cheesy during these times, but that's a very distinct memory as far as if I'm going to have an origin story, it probably is that present under the Christmas tree.

Cara King:

Wow. You said you had a physician set, you got up Christmas morning.

Michelle Medina:

Yeah, remember those things?

Cara King:

There was a doctor set underneath the tree?

Michelle Medina:

Yeah, these days it's like a Doc McStuffins set, right? But back in those days it was the little satchel with the little stethoscope and all the equipment there. And I do remember in medical school when I got my very first stethoscope, it really was that kind of feeling like the present under the Christmas tree moment, but it was a stethoscope. How boring is that? But it is still a very distinct memory for me.

Cara King:

I love that. And it's so true, the vision of a stethoscope, it's more than just a stethoscope, right? It's like just an image of what a physician can do, right? I think that's really inspiring that that's kind of the icon that you saw when you were younger. Then as you grew up you're like, this one actually works. This is wicked exciting, right?

Michelle Medina:

Yeah, exactly. This past summer, my family and I took a trip to Greece and in Athens at the base of the Acropolis is the very first hospital, and obviously it's in ruins right now, but among the ruins, they had marble etchings. And apparently if you were cured in that hospital as a token of your gratitude or an offering, you brought back a marble etching of that part of the body that was sick and was cured.

Cara King:

Wow.

Michelle Medina:

There were etchings of ears, there were etchings of feet, there were etchings of nose. And if you think about it, these are thousands of years old and it's still so very powerful. They're avatars of these people that lived back then and were very grateful for what they thought, and at that time was very progressive medicine.

Cara King:

Wow. I mean, that's so impactful about how you can change people's trajectory and how that lasts. And I love how your family is full of engineers because that's even more remarkable that you shifted gears like that at such a young age. I hear a lot of people saying they want to be physicians when they're really young because they grew up with that. But I think that says a lot about you in that you didn't grow up around that and that was your vision.

Michelle Medina:

Although I wonder if maybe that is a blessing. I don't know exactly how much work it took, and I just thought that it was pretty cool. Right?

Cara King:

Yeah, it's true.

Michelle Medina:

But I have to say there's a certain way that engineers think about problems and the way that they craft solutions that's actually very applicable to what we do every single day. Whether it's trying to figure out a diagnosis or a treatment or whatever it is in terms of your relationship with a patient. There's still something to be said about that particular mindset that you would really just use almost every day.

Cara King:

So true. Especially in operations, your brain is scaffolded in that probably same type of order, right?

Michelle Medina:

That's probably true. I remember reflecting on my father many years ago, very early in this other trajectory of my career, going from just being a clinician to actually, how would you manage clinical systems? I remember talking to him very early in my career about how you would think about these problems as systemic problems and how they would all kind of fit together. And my dad's a military officer, a retired military officer, and what he was in charge of was setting up the communications and infrastructure at that time in the country. For him it was that kind of problem. How would you solve it? How would you get it up? Who would manage it, who would put it together? And it was kind of fascinating having that conversation with him. I remember that many years ago.

Cara King:

I love that. And I know I often talk about how innovation is really at the crossroads of different specialties, getting out of medicine, different subspecialties within medicine, but getting out of medicine and how parallel oftentimes our problems are and getting out of our field and seeing how somebody else would tackle it sheds an entire new light on a situation.

Michelle Medina:

Exactly. We have, I'm sure you know him, Jay Alberts here at Cleveland Clinic, and I love talking to Jay because of just the way that he would approach problems. And when he was showing me what they did for the MS Muscular Sclerosis Center and how they were able to incorporate even just the act of checking patients in, making sure that they fill out their paperwork, and it's no longer paperwork on an iPad, but at the same time you're clinically assessing them and it's like, wow, that makes so much sense. They're waiting anyhow, how would you incorporate that? And it removes a particular pain point in the clinician's life, that waiting time and patient sitting idle or getting very anxious about the visit. But by the time they get to the clinician with this particular tool, they actually have so much information already teed up and the conversation becomes richer so yeah, we do have to think about ways to incorporate a lot of different skills and a lot of different fields in what we do.

Cara King:

That sounds brilliant. I think I need that within (he Women’s Health Institute women's health.

Michelle Medina:

He's brilliant. Yes.

Cara King:

Right? Oh my gosh.

Michelle Medina:

Yeah, yeah.

Cara King:

Then did you grow up in the Philippines or did you grow up in the States?

Michelle Medina:

I grew up in the Philippines. I came here after medical school, which was an interesting transition in itself as far as the experience of, well, medical school in a different country and then doing your residency training in a different country. I mean, even in the small things, flu season was different. It was a different time of year altogether. And so, having to think about that and coming here and like, oh yeah, this is the time of year that you have to think about that, right?

Cara King:

Right.

Michelle Medina:

Common infections in children were different, obviously. And not to mention just everything else in terms of accessibility to different types of medication and accessibility to different types of technology. That just took it to a whole new level. Not just the medicine that you have to learn, but the entire system that you have to learn. But it was great. It was a really great time.

Cara King:

I'm sure. I mean, like you said, there's like a medical difference in regard to pathophysiology of different diseases, but then also the cultural differences. I'm sure that sure was a lot. How was that transition for you? Was it difficult? Did it feel pretty easy? How'd that feel?

Michelle Medina:

Probably a little bit of both. When we talk about disparities of care these days in the United States, we tend to think about structural racism as one of the key things that have put elements into place that leads to health disparities. In the Philippines, it's an economic structural divide, not so much from a racial point of view, but truly from an economic class type of view. And it makes a difference.

They needed someone, right? We ended up doing all the foster children screening exams, once again because I was the only pediatrician. Things like that. I literally took care of children in an orphanage. These days it seems so archaic to say orphanage, but it truly was an orphanage because they took in the babies of the women who were imprisoned in the women's prison, which was literally down the street. They needed somebody to attend to these babies whose mothers were incarcerated. These were things that, sure, its pediatric care, its actually fairly routine pediatric care, but the environment and the things that you had to take into consideration were all very different than I would've experienced at the Cleveland Clinic or even anywhere else as part of my journey getting there.

Cara King:

Such meaningful work. Such meaningful work. And you bring up a good point too, at the Cleveland Clinic, there are such amazing staff throughout. I mean, world renowned people come in, everyone is so sub-specialized and niched, which feels so great. It elevates everybody up. But when you go to a place in such a dire need as you went to, it really makes you flex a little bit. Because you're doing things that maybe you're not sub-specialized in, but there's nobody else, right?

Michelle Medina:

Right.

Cara King:

It really helps you grow, right? In those areas.

Michelle Medina:

It does. I remember taking care of an entire family with sickle cell disease because the closest hematologist was two hours away. And it was really tough because when the mother was in crisis, it was difficult to take care of the children. Then it just was this vicious cycle as far as how they would come back fairly frequently to do that. Yes, it made you stretch. I did not expect at that time in my career, which was very early right out of residency, to actually not just be practicing, but also sort of running a center and having to figure out a way to manage the team, but also in a lot of ways, keep it afloat. Safety net clinics in our country, unfortunately, really, truly are fiscally tenuous. Having to figure that out to make sure that we continue services was also part of it. Lots of learnings. Yeah, those were very rich years for me.

Cara King:

I bet. Talk to me about it, because I envision that that role down in Alabama will set you up with such an incredible skillset to come back up here in Cleveland and be the amazing leader that you are. What skills specifically do you think that you gained from that environment that you brought back up here to Cleveland?

Michelle Medina:

It's funny that you said that because I was recruited here specifically to start a clinic, a Medicaid clinic, at Marymount Hospital when we still had the birthing unit there. And that area was rapidly changing and transitioning in terms of just the demographic makeup. It was actually pretty progressive, my chair at that time to think about being able to offer that at the time that we weren't really offering that within the clinic. But I'll tell you, when I first came here, that wasn't what was in my head. What was in my head was, there were obviously life reasons to move up north, but what was in my head was I don't understand why they want me here. I was running my little clinic, I mean, I had my issues. We were taking care of things. You just don't, it's hard to look up at different moments in your life, right?

Cara King:

Yeah.

Michelle Medina:

And understand what you bring to the table. For a long time, that was my thinking. It's like, I don't know why they brought me here. And it wasn't until several years when it was apparent that even our practice here at the Cleveland Clinic had to start thinking differently about the different groups of patients that we take care of and how we actually have to care for people specifically based on where they're coming from, that it finally dawned on me, oh, this is why. This is what I bring to the table. Yeah, it's hard. It's hard to see it. I think different things, right? I think that particular sensitivity to the fact that when you bring care, it doesn't, or when you deliver care, it never happens in a vacuum. It always happens in the cultural/social context of your patient, the family, and the entire community. I think that I hope, and I try to continue to keep front and center of what I do.

I think to your point, learning how to organize a clinic and learning how to think in a more systems point of view is also important. One other skill set that I learned when I was there was that same thing. Clinics don't exist in a vacuum. They exist in the context of what's happening with government, what's happening with insurance, what's happening with everybody else. Because at that time, for us to stay afloat, we actually had to talk to Alabama and Medicaid very intentionally to keep us afloat.

Cara King:

Wow.

Michelle Medina:

And it's not a dissimilar problem from how we would think about the many different payers that inform and really truly reimburse us for what we do. I think that having that sense of the cultural environment, having a sense of how to work in a system, those are probably the key things that I brought back with me.

Cara King:

So interesting. And two things come to mind. Number one, for new graduates who are getting out of residency or fellowship and taking jobs, you're really an inspiration that you don't always have to be at these huge, highly academic centers to get so many really amazing skills within leadership and to make a really big impact. Do you agree with that?

Michelle Medina:

I do. And I think it’s hard coming out of a place like Cleveland Clinic to think that oh, I'm never going to find anything like this, or this is the only environment where I think I will be successful. Absolutely not, right? And that is the best time in your life to actually try something out and figure out what you want to do, what you're good at, and what are the things that you would continue to want to gain in terms of additional knowledge and skills. Go for it. I mean, every opportunity you learn something different, and you can only bring that forward with you. You don't necessarily lose it.

Cara King:

So interesting. The positions that you had when you were down in Alabama, these leadership roles, you said you were very early in your career. You may have gotten those type of roles at a bigger place, but you jumped in, you embraced them, you built your CV, you learned the skills, and then you came back here with this whole new skill set. I think having that long-term vision, the long-term plan of your five and 10 year plan, seeing where you are now, and even if it's not the exact spot that you want to be, having that long-term plan of building the blocks of where you want to end up, I think you were a perfect representation of that.

Michelle Medina:

Well, thank you. I would like to think that it was planned, but certainly not. There was one book I remember reading also very early, and I don't know if you know this, it's called On-Ramps and Off- Ramps, and it's not about women in medicine. Yes, you're nodding. And it talks about just women in general in their careers that there are on-ramps and there will be off-ramps. Life happens, something else happens, but it doesn't mean that you're off-ramped forever. It just simply means that maybe you'll just have to open your eyes for the next on-ramp for the next opportunity.

Cara King:

I love that vision. Dr. Margaret McKenzie actually introduced me to that a year or two ago, and I hadn't heard of it before. And it's really changed my view in that, just like you said, off and on and your life can flex and it's okay if you do as well. It's such good advice. Now I want to make sure we have time to, I want to just dive into your female leadership brain a little bit. I can't get out of a conversation with you without getting into a little bit of this because you're so inspirational with this. Being a female leader, I think there's really a unique subset of challenges that we have. We have to exude this confidence to our teammates, but also often push down feelings of imposter syndrome. And I feel like I heard a little bit of you when you're like, why am I coming to Cleveland? What do they see in me? Right? This underlying kind of what do I bring to the table? But also, being vulnerable and without appearing weak, right?

There's like all these things that we have to balance, I think as females. And I read in an interview once that you said, in my evolution as a leader, I've had to shed my fear of being vulnerable. It's led to more honest, respectful, and ultimately productive interactions with my teams. And this hit me really to my core. And I'm wondering if you can talk a little bit about the journey that you've had as a female leader, these challenges that may have come up, and how have you evolved to practice vulnerability with confidence?

Michelle Medina:

Since we're going way back, I do remember stepping into that very early role, right? Way back when I was in Alabama, and assuming a really tough stance because I thought, this is a tough crowd. I have to talk to my hospital president; and I really thought that that was how you would do it. And frankly, that burned me out at that time because it felt disingenuous. It was so much energy as far as having to maintain that. And I remember being very relieved actually when I moved to Cleveland thinking, oh, maybe I can just put that down for a bit and just have a break, right?

Cara King:

Right.

Michelle Medina:

Then when new opportunities started coming up, I'll be honest with you, the first instinct was to pull that back up again and say, okay, I'm going to have to have a tough stance now. But thankfully over time, I have had different mentors, different colleagues and peers who have basically told me, you know you can put that down. It's okay to put down the armor, right? And believe me, to this day, people still call me out on that one. "You're carrying this alone again, Michelle. This is not all of you, Michelle, right?

But it helps, number one, to have people that you trust who can actually take a look at you and say, it's okay. I think everybody needs that in their corner. Then the second is, once you've had one or two experiences of actually appearing vulnerable to your teams and you realize they value it, they actually appreciate it, and they feel that you have become much more genuine with them and honest with them. I'm not saying that you use it as a way to get what you want as a leader, but I'm saying that when you practice it, you'll find dividends, oh my goodness, many, many times over.

People see that you also are trying to feel, or you are feeling what they're feeling. People also see that you're doing your best, and maybe it's not always the outcome that you all want, but they understand where you're coming from. Then the next time that you have to go to bat for them, they'll basically tell you, you know what? We're right behind you, whatever you need. It's an amazing, amazing feeling. And I've had that among many different teams, and I feel very, very fortunate about this here at the Cleveland Clinic throughout the entire journey that I've had. And I can only say I'm really grateful for them because they also are truly just incredible people in that regard.

Cara King:

Such good advice. I'm hearing you say kind of build your tribe of these psychologically safe kind of people.

Michelle Medina:

Yeah. Build your tribe.

Cara King:

You know have your back, you have their back, right?

Michelle Medina:

Yeah.

Cara King:

Then I'm also hearing kind of a different lens that, I mean, it honestly takes more confidence to be vulnerable, right? Because that feels scary.

Michelle Medina:

It does. It's very scary. The first time that you do it, you're like, I don't know if this will work. Maybe everybody will just look at me and turn away, or they'll be embarrassed for me or just somebody will tell me to stop. But amazingly, none of that happens time after time. None of that actually happens. That is the complete opposite. And again, I understand that for many people, they're going to have to practice that at different times in their journey and maybe different stages of their journey. But I can only say try it once. Just try it once.

It's an amazing, liberating feeling, and especially during the times where I feel really, really stressed and in some ways, you feel boxed in by what's happening that's outside of your locus of control. There's something truly, and not just liberating, but also empowering, just kind of putting it down and basically saying, all right, this is it, guys. I've done my best. I've got nothing. Oh, my goodness. The ideas then flow organically from people, okay, we get it. You've done that. You know what? Maybe we can try this. You know what? This worked before. How about we do that? Your tribe will lift you up. It's incredible how they do that.

Cara King:

That's just so interesting to me, how once you take down the wall, creativity starts surfacing, right? It's like this space of reflection, this space of that we are all human in it together. And just being able to vocalize things, and I think as women, or at least for me, I oftentimes don't want to say something unless I know it's completely fact. It's going to be 1000 percent going to work. But I know when I find myself in a space where I can just say things, that's where creativity lays, right?

Michelle Medina:

Yes. But can we also call out that sometimes you actually say something that's very coherent and then nobody responds, and then a minute later somebody else says it who happens to be male? Then all of a sudden, it's a great idea.

Cara King:

Oh, my gosh.

Michelle Medina:

That still takes me back. Like, wait a minute. What just happened here?

Cara King:

What just happened? It's true. It's so true. And I feel like it, that's now surfacing where it's okay to call out, I feel like more now, right?

Michelle Medina:

Yes, yes.

Cara King:

Women, we have each other's backs, and we can be like, hey, Michelle just said that, just for the record

Michelle Medina:

Yes, yes. You're so right. In a room like that we're just yes, you are so right. And I think we have to keep doing that.

Cara King:

1000 percent. Keep showing up.

Michelle Medina:

Keep showing up.

Cara King:

Then to your point of leading with conviction, knowing when to be thoughtful and curious about a decision. Then once you make that decision, show up with conviction and really stand your ground. Do you have any tips on how to balance that fine line?

Michelle Medina:

Yeah, there's a way to show up that tells people in the room, whether it's your team or whether it's your leaders that, look, we've done the work and as a woman, you better believe you've done the work, right?

Cara King:

Yeah.

Michelle Medina:

We've done the work. We know we're up against it and we're going to do it. There is a bit of that fake it until you make it moment, the first time that you do that. But what keeps me sane, and I'll just say it keeps me sane, is the notion that, you know what? If I actually don't make it, I know what I need to do next to figure out either another solution or to figure out what the next step will be, right?

Cara King:

Yeah.

Michelle Medina:

And I'm okay with that, and I should be okay with that, right? Because there's nothing invincible about me or anybody. When we say when we talk with conviction, I always try to remember that that's tempered also by a certain amount of humility because it keeps you honest in terms of I know what the risks are and what I'm going to ask my team to do, but I have to be honest enough to say, and there's probably a limit, and there's probably a point where this is about as good as it gets, and we'll figure out another solution to this. From experience, most of the time, if you can say that, and that also you have to say with conviction.

Look, we've done our best. This is how it goes, and these are the roadblocks we're coming up against. Most people will say, well, what can I do to help you? Or most people will ask, well, okay, so what's next? I want to hear what you think, right?

Cara King:

Yeah.

Michelle Medina:

It is actually pretty amazing in that regard.

Cara King:

As you're talking about looking at the next step and having that scaffolding, all I can think about is your engineering family speaking through.

Michelle Medina:

Right. There are duplicate systems. You have backup to the backup, right?

Cara King:

I just saw it come through.

Michelle Medina:

That is what you do. That is so true. You're so right. I'm going to have to tell my dad about this, backup to backup. Oh, my goodness.

Cara King:

He'll be so proud of you. I know he already is, but.

Michelle Medina:

He'll be very proud.

Cara King:

You have documentation on our WPSA podcast of that coming through.

Michelle Medina:

Thank you. I will share the link. I'll have to teach him how to get to the link, but I will share the link.

Cara King:

Oh, I love our parents. I know. They're so funny. Well, Michelle, I think that's all the time we have right now. I absolutely loved our conversation. Thank you so much for sharing your afternoon with us.

Michelle Medina:

Thank you. Thank you for having me.

Cara King:

Thank you for listening today. Join us again as we draw inspirations and insights from women doctors, past, present, and future. You can follow us on Facebook, Twitter, and Instagram, @WPSA1, that's @WPSA and the number one. This podcast is supported by Cleveland Clinic's Women's Professional Staff Association as part of the Cleveland Clinic Centennial Celebration.