Karen Murray, MD

Podcast Transcript

Dr King:
Hello team Inspiration and Insights. Welcome back. We are incredibly excited to have Dr. Karen Murray on our show today. Dr. Murray came to the Cleveland Clinic back in 2019 as a Chair of Pediatrics, Physician in Chief at Cleveland Clinic Children's and President of Cleveland Clinic Children's Hospital for Rehabilitation. She is very busy. She's a practicing Pediatric Gastroenterologist with her main focus in the treatment and pathophysiology of childhood liver disease. On our episode today, Dr. Murray talks with us about transitioning to life in the Midwest and as a leader, why she appreciates and values Cleveland Clinic's annual professional review process and structure. Thanks for listening.

Dr. Rensel:
All right, everyone. Today, we have a very special day. We have Dr. Karen Murray, who is our Institute Chair of Pediatrics, our Physician in Chief of Cleveland Clinic Children's Hospital, and President of Cleveland Clinic Children's Hospital for Rehab. Wow. How do you fit that on your name badge Dr. Murray? How does that work?

Dr. Murray:
It was honors bestowed upon me.

Dr. Rensel:
Right. You have many titles. So you moved here just recently, right before that darn little pandemic moved across the globe in 2019, how has your transition been from Seattle to Cleveland?

Dr. Murray:
Thank you for asking it's been fabulous actually, it's really an absolute pleasure to have an opportunity to work with folks here at Cleveland Clinic who are not only devoted in our case to pediatrics, but hold themselves to a high standard and do so with a smile on their face. So it has been a lot of fun.

Dr. Rensel:
That's the Midwest attitude, the smile. If you had to look back, what would you say the big and small things that prepared you for such a leadership role with so many titles?

Dr. Murray:
So the titles are more reflective of the platform of pediatrics, just to be clear. If you work for different locations. In my prior environment where I was, prior to coming to Cleveland Clinic, over years I did have an opportunity to serve in a number of capacities at that institution. And I really want to thank the leaders there for having given me those opportunities and in so doing allowed me to gain some experiences that I think have been very relevant to the work here.

Dr. Rensel:
Nice, nice. You're now leading over 300 pediatric specialists. What can you say to our learners? We have a lot of learners, medical students, residents, fellows that listen to this podcast. What can you say to them about practicing in pediatrics for today and tomorrow? How's it looking? What's the forecast?

Dr. Murray:
So it's fabulous. So pediatrics is a bit unique in comparison to adult medicine. And some of those uniquenesses I think are very obvious. Number one, if you consider who our patients are, they tend to be children by definition, but those children almost always have with them an adult. And so some of the fun of pediatric care is not only caring for the patient themselves, but also the family, because they do come as usually a very firmly connected pair and how we communicate with the patient versus the patient's parent is an art in many ways, but it is also very important and critical to that child's care. And hopefully enriching to all of us who enjoy doing that. And then the other aspects that are potentially unique are the maybe the more obvious ones. And that is, although there are many diseases that overlap, there are many that are very unique to pediatrics even today.

Dr. Rensel:
Well, I want to take a public service announcement break here as a mother of four. And I know we're all mothers on this podcast here. Well, at least Dr. King and I and Dr. Murray as well is what I'm referring to, I am speaking to a pediatric liver specialist. I don't know that I've done that before. So I have four kids who have livers and I'm wondering, is there something I should be doing for them with livers? What should we know about pediatric liver health?

Dr. Murray:
Number one, I'm really pleased they have livers because not having livers can be somewhat problematic. So there are serious things we should know about our livers. Then there are maybe more fun things that folks would be interested about the livers. So I will share a fun thing first, because not everyone appreciates this. So yes, the liver is fundamentally important to our survival and our health. We can't live without it. There is no such thing fundamentally as liver dialysis. So it's really important to take care of your liver. And the liver is one of two organs in our bodies that regenerate. And that is just a fun fact, other one being the skin. And then as far as the more serious parts of liver health, I think it's important to recognize is that the liver filters all that enters our body for the most part.

Dr. Murray:
So this includes food. It also includes other things that are not typically food in the adult world. One of the things that's worried a lot about is alcohol and people are generally familiar with alcohol related liver disease. Fortunately not too big of a problem in children. In children, probably the biggest challenge in United States and in Europe and in many other parts of the world is correlating with the challenges of obesity. And when there is extra fat in our body that is frequently deposited in the liver and there are certain individuals who respond to that fat in an injurious way and it actually causes a hepatitis or an inflammation in the liver and fatty liver disease is the most common cause of fat of hepatitis in the country and can be a very serious condition. So it is very important to take care of your liver and that includes healthy eating and exercise on a regular basis.

Dr. Rensel:
Got you. Well, thank you. Gosh, fun things and very serious things. Okay. Now in certain areas of pediatrics, there's really encouraging groundbreaking research going on. I know in neurology we have a few areas like that. What's happening in pediatrics that is just getting you just charged up to get to work and work and have your 300 specialists working on certain things. What looks really encouraging in these days in pediatrics?

Dr. Murray:
So since we're on the liver theme, I will just share something that has been near and dear to my heart. Fortunately, it doesn't affect as many children as it does in adults, but, and that is our ability to successfully treat some forms of viral hepatitis. So this has evolved over just recent years in our ability in many children down to age three, truly cure hepatitis C and that's all from research advances. And that's very exciting.

Dr. Rensel:
Yeah. That's so encouraging. Yes.

Dr. Murray:
In other fields you had mentioned nephrology, oncology is an area where we are able more and more to understand the genetics behind an oncologic process and be able to personalize the treatment to the cancer that may be afflicting an individual. Similarly in the area of attention deficit and hyperactivity disorder ADHD. One of our colleagues here at Cleveland Clinic Children's Dr. Michael Manos is really revolutionizing the way that treatments for kids with ADHD are identified as appropriate for that child and then monitored to assure that they're efficacious. So really there are evolutions in treatment because of research and discoveries in the clinical space that are advancing our ability to successfully care for kids, which is really exciting.

Dr. Rensel:
That is exciting. That is exciting.

Dr. King:
I love all this liver talk. You're firing me up. Not going to lie. I just live in the vagina. So getting out of the vagina is just really exceptional today. It's great, thank you.

Dr. Murray:
Yeah. I'm not going there.

Dr. King:
I have some fun facts for you Dr. Murray, here we go. No, I'm kidding. I'm kidding. Okay. So when I was looking up your previous training, you had been coast to coast, right? Cornell, Johns Hopkins, Seattle, Boston, Seattle, here, been back and forth. I love the different stereotypes of east coasters versus west coast coasters versus Midwest. I'm from Boston originally. So I lived there until fifth grade and so most of my family still lives in New England. So I personally love the very direct nature of Bostonians. I'm just curious, have you noticed any difference training east coast versus west coast now in the Midwest? What has that culture felt like to you?

Dr. Murray:
I have no idea what you're talking about, differences. Yes, there are substantial differences actually, and even certain parts of the east coast versus certain parts of the west coast are very different. I'll speak to where I've been, although I've traveled as you have to other places and you feel those cultural differences, so you're right. I grew up outside of Philadelphia. Many would consider that the Northeast, I grew up in a somewhat rural and suburban area and then did my college in upstate New York and medical school sort of in that order in Baltimore, even Baltimore to upstate New York or Baltimore to Philadelphia is very different. It is technically south of the Mason-Dixon Line and with the speed with which things occur is therefore affected and then going out west in comparison to the Northeast, the west coast in my opinion has a much more familial type culture.

Dr. Murray:
So I went from medical school at Johns Hopkins where your coat length designated where in training or education you were, and everyone was most definitely referred to by doctor x or whatever their last name was. And I arrived in Seattle where most of them don't wear white coats at all, and everyone is on a first name basis. And so that took some adjustments. That said, I think Seattle in comparison to say Southern California has a crispness and the expectations of, and rapidity of response, that kind of thing. Although they tend not to be as direct. Matter of fact, it's a very indirect culture. And then the Midwest of course has a reputation as you said earlier for its friendliness. And I have to tell you I've been so struck by that. So I knew that, but to really experience it and understand what that really feels like and means has been incredible.

Dr. Murray:
I remember I had been here probably a couple of months. My husband hadn't yet moved here and I was commenting how everyone is so nice. And when they say good morning, how are you? There seems to be a sincerity. Like they actually care what you say, and this is true at work, and this is true in the neighborhood. And I was really struck by that. And that's a very different feeling, not a better or worse. This is not a value judgment. It's just a different feeling than certainly in other parts of the country.

Dr. King:
That was very, very perfectly put. I know like I said, I grew up in Boston, moved around a bit for training. And I remember when I moved here, I went for a run, just running and someone like stopped and started talking to me and I was like why are you talking to me? It blew my mind. This person actually cared. They were like asking about my day. And I was like, wow, I am not in Boston anymore. It was much different, much different. Yeah.

Dr. Murray:
So correct. Absolutely.

Dr. King:
Have you felt like any of those places have felt most like home? I know you grew up in Philadelphia area, but do you feel more at home east coast, west coast, Midwest culture wise, or can you see yourself in any of those places, different traits that feel good?

Dr. Murray:
Honestly I feel very at home here, I grew up outside of Philadelphia. The flora and the fauna are very similar, that directness of the Northeast is familiar. Although quite frankly, I had been in Seattle for about 25 years and you learn, you adapt to the new culture. And so I'm having to readapt to the directness, but I actually find it refreshing. So I feel at home.

Dr. King:
That's great. One more question about your transition. So I moved here same year as you, 2019. And I moved from the University of Wisconsin and Madison. That was my first job out of fellowship. I was there for six years and then moved here in 2019. And just like you've alluded to transitioning to any new place takes some getting used to, and someone recommended the book “The First 90 Days” to me. Have you heard of that book before?

Dr. Murray:
I have.

Dr. King:
Yeah. So I remember reading that and the pandemic popped up, which kind of broke the book, but in general, I'm just curious, do you have any insights or tips on someone who's changing location or changing jobs and how to really get to know your space in those first couple of months?

Dr. Murray:
Yeah. It's such an interesting question. And I don't know that I have a deeply impactful answer, although I do think it's important to get to know the people. So to me, it's all about relationships, whatever we do, whatever the initiative are, it's about building relationships. And then of course, understanding whatever the facts are associated to what one wants to do. And so my biggest anxiety in moving here or any new place that I went was not having relationships. In Seattle, I knew everybody, I knew how to get things done. I knew who to go to and I knew none of that here. And quite frankly, I'm still very much learning. I've learned the areas closest to me, but even at two years, I'm very much learning how the enterprise works and how to move certain initiatives forward. And it's been fun to meet all these people and trying to develop those new relationships.

Dr. King:
I could not agree more. I think one thing that I noticed at least within WHI (Women’s Health Institute at Cleveland Clinic) is a lot of people here have trained here. A lot of people here have been here for many, many years, whether it be residency and then fellowship and then stay down as staff or fellowship, and then staff, I think that speaks a lot about the culture of the clinic. It's amazing and fantastic. And the resources are just through the roof. People don't want to leave, but I felt the same way in that just getting to know people and building those relationships and learning about the resources, because there's so many here can sometimes be a little bit daunting.

Dr. Murray:
Yeah. Fun. I must say very fun.

Dr. King:
Yeah.

Dr. Murray:
Part of that when folks have been here a long time, they do things a certain way. And so as a new person is trying to understand what that way is and adapt to it. So, yeah.

Dr. King:
Yeah. But it feels so good. It feels so good, I know. I'm honored to be here too. It's great. So my next question for you is about the US News and World Report jump that you guys have done. You have done such tremendous work within the Pediatric Institute, huge congratulations to you and your team.

Dr. Murray:
Thank you. And of course, all the congratulations goes to all the folks in pediatrics who work so hard to make it possible. Yeah. We're really proud of the US News. So two years ago we made a very substantial jump from where rankings had been previously really across all of our service lines this past year, COVID as you know is a little different in the way they did it. And we're very proud to say that we stayed steady, which is great. And we look forward to future evolutions, we are on an upward trajectory and very proud of the care that we are able to deliver to patients. And of course the recognition that that is receiving.

Dr. King:
It's fantastic. Yeah. We, within WHI are starting a Mullerian Anomaly Center actually next month and pulling in so many people from your (Pediatrics) Institute to help with that. It's just, I keep learning about all these amazing procedures we're doing and amazing care that we're offering, that we start breaking down the silos of the amazing things that everyone's doing. It blows my mind. So again, congratulations.

Dr. Murray:
Wow. That sounds like a really exciting initiative. Congratulations. That's awesome.

Dr. King:
Thank you. Yeah, we're excited.

Dr. Rensel:
Yeah. I think part of the rankings a lot of times rest on research, like what years are active in research, what's happening in research and you've been very active with NIH grants. What would you tell some new staff or new docs that have done maybe some small projects and want to try to keep going forward in the research area and try to get to an NIH grant or have had one and want to keep going, what would you suggest for them or some positive action to take?

Dr. Murray:
Yeah. So thank you for asking, clinical research is an area that I'm passionate about and for individuals who are interested in it and want to have that commitment to it, it's something that I really want to be able to foster and encourage. To your point, I think it's important for number of reasons, number one and most importantly, it advances our understanding of disease or the cures we're able to bring to diseases and that's by far the most important reason, but it also brings recognition to the individual doing it, the group that they're in. And so from a US News context, a part of doing this work and publishing and giving talks is around that national recognition for the folks who are doing the work. As far as advice for young people who are aspiring to this, I think that ideas are of course very much needed.

Dr. Murray:
And so for folks who are visionary about the disease that they treat, and they have noticed that there is a gap in understanding or an advancement that is needed, there is the NIDUS potentially for research. Certainly if that area is thus far untapped or not very fully explored, and then I really would encourage these folks to seek mentorship.

Dr. Murray:
I think as we break into the space of whether it's partnering with industry to advance research or it is in the NIH or foundation space, we need to be able to make the connections with folks who can help us develop the ideas and also help us get connected in a way that allows us to get those grants. In pediatric research and this differs in some areas of adult medicine I know, much of our research is collaborative in nature because the number of patients we have in anyone center is more limited. So the NIH grants that I have had the opportunity to have are nearly all collaborative in nature, where they're NIH grants through a UO1 mechanism, for instance. But we certainly have colleagues here at Cleveland Clinic and other institutions that have RCRE grants which are individual and all of these really require that networking, connections and mentorship. So that to me is very, very important.

Dr. Rensel:
Okay. So find a mentor and then probably be active in the national meetings, right, because that's how you find your collaborators maybe. Is that how you-

Dr. Murray:
Absolutely.

Dr. Murray:
Go talk to folks. Some of these things won't necessarily be relevant, but it will be for many get involved in if you have a professional society, committee work, development of guidelines, just interacting with folks around posters, of course, publishing. These are all ways to interact, get to know and get to network.

Dr. Rensel:
Build a team. Right, so now that you're such a leader of people, you have 300, at least over 300, right? So what are some tips for the new leaders of maybe a new team or a new department? What are some tips you'd give to some of our listeners about being a leader of people?

Dr. Murray:
I aspire and hopefully am able to deliver to listen and really try to hear. I also, I personally am very committed to the success of others. And so how do you take that listening, hear the needs and be able to foster individuals' development in a way that is really successful for them while also being able to put some guardrails perhaps around that depending on what the thing is. But it's again, it's back to those relationships and how do we develop the relationships and see the opportunities, get folks to develop a vision perhaps depending on the space in which we're talking and work towards that.

Dr. Rensel:
I love it. Yeah. I love it. So maybe keep a notebook of all your ideas and find some people that run it by, get a team, definitely have a team, right?

Dr. Murray:
Have a team. It's all about collaboration.

Dr. Rensel:
It's all about collaboration. Don't go to a meeting and just sit in the rooms, meet people, just go with a goal and meet five to 10 people, get five to 10 new names. And then when you get home, contact them, right, email them and be in touch.

Dr. Murray:
Follow up. When you have an opportunity to do something, make sure you deliver on it.

Dr. Rensel:
That's true. Right.

Dr. Murray:
Right. Perform even the little things, do your best at every stage.

Dr. King:
So I love your thoughts about listening for the sake of listening. I feel like so many times you have these conversations. When I have these conversations, I'll be listening and sometimes thinking about my response before actually just taking what that person's saying. So I love that you said that, I think that's really important. I also loved how you talked about really listening to what drives your colleagues and helping support them in that mission versus giving people a narrative, letting people create their own narrative. How do you help people? I just feel like you're so gifted in this, or how would you maybe recommend that someone finds the space for reflection to find what drives them? I feel like sometimes we get to the day in day kind of ins and outs of the clinical side of things or the research side of things. Do you have any tips on how people can take a step back and really have some guided reflection and find what's driving them?

Dr. Murray:
Yeah, this is not easy. And I don't know that, I certainly don't have all the answers that's for certain, but it's around goal setting. So what are your, if you're talking to someone, what are your goals? And then you can put those in different spaces. So one of the questions I really like to ask in the APR (Annual Professional Review) process, and it doesn't matter if the person is a senior person, or newly out of training or a trainee, it's what are your professional goals? And that may evolve over time. And it needs to be very individualized, right. So a person may aspire to be an excellent clinician, which is spectacular, great, depending on where they are, what tools do they need, what experience do they need to develop, whatever to get there. Maybe someone aspires to be a leader or have a grant, or be an expert educator.

Dr. Murray:
And then we can have a dialogue. Okay if that's the ultimate goal, then what are the tasks that we need to do between now and x time for you to achieve that goal and start whittling it down. And then we have that conversation every year to see how we're doing. And it's possible that the goals have changed. Of course. Right. So we have to pivot, but sometimes the identification of what the goal is, is hard. And then that also fosters a conversation around, well, what do you enjoy most? What really inspires you in 30, 40 years, whatever, when you're at the other end of your career and you look back, what are you hoping now for yourself to have achieved? What are you hoping to see in the mirror? You want to be nationally recognized. You want to be a great clinician. You want whatever it is, it doesn't matter.

Dr. King:
Yeah. Yeah.

Dr. Murray:
And start that dialogue.

Dr. King:
I love the fact that you even asked those questions, right. And that's why I think APRs at (Cleveland) Clinic are so critical. I mean, I went many years without anyone ever asking, actually, what are your goals, right. And so having that kind of the goal setting, the guided inquiry meeting, like those self-reflective questions to make you actually just ponder that. And then I love the action items that you set in place, where it can take some of that seems too big to ever be able to obtain and then bring breaks it down into these tangible steps where in a year, all of a sudden you've reached that goal. It's just, it's phenomenal.

Dr. Murray:
Yeah. I think the APR process that (Cleveland) Clinic has created is really fabulous. It is a structured way to have that at least annual dialogue, not all institutions, as you say, have that. And it really does. If you will force a conversation, which can be so valuable for everybody. And the flip is, it is also informing for those of us who have the pleasure of talking to others. Because if the individual says that they have whatever as a goal, that's now in my head, their department chair's head and so on. So that as opportunities come up, we are better more likely to think of that person and offer an opportunity that is aligned with their goals, which is really a precious tool to have.

Dr. King:
That's amazing. And I also love how you mentioned how your goals can flex and change. Life is not stagnant, right. We have partners, we don't have partners. We have kids, or maybe we don't have kids and all these things can make our goals kind of flex and change and being flexible with that and not, maybe putting too much pressure on ourselves that we quote unquote fail, but just flexing with that can be really important. So I think having a leader like you understand that can really change somebody's career.

Dr. Murray:
You bring up such an important point, and this is, it frequently comes up in the context of talking about women and careers. But in my opinion, it's relevant to anybody. It doesn't have a gender specificity. And that is how do you balance that home life or the personal life with the professional life and to your point, what that looks like, that balance if you will, or the integration as I like to call it changes over time. It changes entirely over time and we just have to recognize that and flex with it and recognize that we can't do everything on a given day. It just won't work. So allow us that flexibility.

Dr. King:
Those words resonate deeply. I have a five year old, three year old and one year old and some nights I am just trying to keep them alive. And if they go to bed alive, then I won for that day. But my manuscript did not get written at night. So I understand that completely.

Dr. Murray:
Yeah. And even the five year old and the one year old are in different phases, aren't they?

Dr. King:
Oh my gosh. Yeah. And even like when my older two kids were one, they were nothing like my one year old, right. They're all so different. Their personalities are so different. Like right. When I think I have things figured out, it's like, something's on fire. So yeah. It's true. You have a few kids, is that right?

Dr. Murray:
I do. Yeah. There, you can sort of see them on the picture behind me. I have a son and a daughter.

Dr. King:
May I ask how old they are?

Dr. Murray:
Of course, they get older every year. So I have to keep up.

Dr. Murray:
They are 24 and 20.

Dr. King:
Oh my goodness. It goes by fast. Doesn't it?

Dr. Murray:
It's amazing. It's amazing.

Dr. King:
Talk to me a little bit about, if you don't mind some of your home life balance when, when they were at home, are they at home now? Are they still home? Are they out? They are not.

Dr. Murray:
No. The 20 year old is a rising junior in college and is in Philadelphia. And the 24 year old is a PhD student in the UK.

Dr. King:
Awesome. So talk to me a little bit out when maybe when they were at home and you did have those kind of competing responsibilities. I sometimes think about this on ramping and off ramping of kind of like flexing with your career and home. How did you manage that? Do you have any tricks that really got you through those years when you were really in it at with the home responsibilities?

Dr. Murray:
I would give thanks in this case to colleagues who recognized that some flexibility in work in order to, in my case, and this is personal, be present for my children in a way that I want it to be is important. And also to my partner, my husband, who is very much a partner and a very involved father and very supportive of me pursuing a full-time career, which is very important and was very instrumental in allowing me to proceed. As I reflected earlier, as someone who was a clinical researcher and working in an academic medical center, trying to get promoted and so on, you can't do everything every day, right. And so when the children are very young, they tend, again, tend to go to sleep earlier. And then if I didn't fall asleep with them, which was probably 90% of the time, then I was able to finish whatever it was I was trying to work on that day.

Dr. Murray:
As they are older, helping them with homework for instance, older, yet they're doing homework on their own and they don't want your help. And these are all different opportunities for how you embed any work that you may feel you either want to, or need to do at home or not with balance and the other things. I always felt it, I was committed to making sure to the best of my ability, I was at my kid's soccer games and going to their concerts and things like that. And for me that was really a priority.

Dr. King:
Yeah. I love that. You're seeing me. I feel like you see me. Yes. But what I'm hearing is build your team, build your tribe with people that you really trust, right because I'm not going to be at everything. We're not going to be at everything and that's okay. And then pick the things that are important for you to go to, like the soccer game's really important. And maybe other things I can miss and have my loved one there, that gives them the love and support that they need and being okay with that. And I think that resonates really deep with a lot of our, at least a lot of our listeners, a lot of our colleagues who have responsibilities at home, that it's okay to not be there at everything. And just building that team is really, really where it's at. So thank you for being so vulnerable and transparent with that. I appreciate it.

Dr. Murray:
No. I think it's so important. And it's an individual choice where that threshold is, what folks want to be available for, or feel they should be and what they feel less strongly about. And that varies to everyone. The other thing is planning ahead. And how do you flex your schedule so you can still fulfill all of the work commitments that you have agreed to do yet do so in a way that allows you to also go to the concert or whatever it is that you want to do.

Dr. King:
I love it. When I see you where you're at, I'm like, we can do this. Mary, I can do this.

Dr. Rensel:
You got this.

Dr. King:
Oh my goodness. Do you have any more questions? I think that's all the time that we have, but Dr. Murray, it was so, so great to have you on our show this afternoon. Thank you so much for your time. I always learn so much from these conversations, so thank you so much.

Dr. Murray:
Absolute pleasure. It was a real honor. Thank you for asking and you have a great day.