Susan J. Rehm, MD, FACP, FIDSA, BCC

Podcast Transcript

Cara King, MD:

Hello, my name is Dr. Cara King.

Mary Rensel, MD:

Hi, I'm Dr. Mary Rensel, and we are your host for inspirations and insights from Cleveland Clinic Women Docs.

Cara King, MD:

In this podcast, we'll share conversations with women doctors from all career stages and practices exploring the highlights and challenges of being a woman in medicine.

Mary Rensel, MD:

We hope these thought-provoking stories inspire you and provide insight into the unique challenges and accomplishments of remarkable women docs. Okay, everyone. We have a very exciting guest today. We have Dr. Susan Rehm. Dr. Rehm, thank you for joining us today.

Susan Rehm, MD:

My pleasure.

Mary Rensel, MD:

Yes, Dr. Rehm is Vice Chair of the Department of Infectious Disease here at Cleveland Clinic and Associate Chief of Staff. That seems like a lot of work. How are you doing?

Susan Rehm, MD:

Just having fun.

Mary Rensel, MD:

Are you? Good.

Susan Rehm, MD:

Yeah, yeah, absolutely. More and more grateful all the time for all the opportunities we have.

Mary Rensel, MD:

Oh, that's amazing. So Associate Chief of Staff, that does seem like a big role because Cleveland Clinic is growing and growing. We're global now, and we have, what do we have 11,000 doctors or maybe more now?

Susan Rehm, MD:

Yeah, it's interesting. I of course have been here since I've been training in internal medicine and then onto ID (Infectious Disease) and then onto the (professional) staff, and the way I think about it, just for this, our main campus, we've gone from essentially 400 physicians to 4,000 physicians just on this campus since I started here. And it's kind of an amazing thing to think about it. I remember when I first came to the (Cleveland) Clinic as a resident, I think there were 10,000 employees overall, and main campus was the only campus. Well, I was walking around like, "Oh my gosh, this place is so huge." The town I grew up in was about 4,000 people. And so I'm thinking this is two and a half times the size of my hometown, this is big, and feeling overwhelmed. But I think what we find out, and this is still true no matter what our size is, that as we, I'll say walk around as we go around doing our thing, you learn your neighborhood. You learn who your teams are, you build that relationship. And it's that network of relationships that really allows us to break it down.

Mary Rensel, MD:

I love that. And you've led in so many different areas in infectious disease, locally, regionally, nationally, globally, especially during a global pandemic. Can you share some of your surprise learnings from seeing infectious disease from different perspectives, like in the neighborhoods like you're speaking about, but also from your nonprofit view and your Vice Chair view?

Susan Rehm, MD:

The funny thing about, I guess, my career in ID is I see it book-ended by a couple of things, and this is only a matter of timing. But just as I started my fellowship, AIDS came along, and now that I'm ending my clinical career we just finished with COVID. And it's very interesting to compare and contrast those two pandemics, in essence very different diseases, very different manifestations and so on but bringing out so many commonalities. The whole importance of public health infrastructure, which people may or may not appreciate, is slightly different than the practice of clinical infectious diseases. We are certainly intertwined, but we're not the same thing.

Likewise, in a healthcare setting, infection prevention, or what we used to call infection control, is not the same as clinical infectious diseases, but we intersect. So those neighborhoods are neighborhoods that were reactivated during both of the pandemics and both of the pandemics really allowed us to intersect with people that we would not have been intersecting with otherwise. So amongst all the death and destruction and the horrible things, there are wonderful learnings I think from each, and certainly some things that I wish that the world would have learned a little bit better so that we wouldn't have to repeat it. But, such is the nature of human beings.

Mary Rensel, MD:

Do you want to give us a few of those, your wishes, so we're prepared for the next pandemic?

Susan Rehm, MD:

I guess if I could wave my magic wand, and by the way I have three magic wands.

Mary Rensel, MD:

Oh, good. Thank goodness.

Susan Rehm, MD:

But they're not all that powerful.

Mary Rensel, MD:

I disagree.

Susan Rehm, MD:

If I could wave my magic wand it would be to depoliticize public health.

Mary Rensel, MD:

Yes. Yeah, just people, it's neighborhoods, right? It's just caring for your neighbors. Yeah, I love that. So you mentioned your small town and coming to the big town of Cleveland. So from a small town to Cleveland, tell us your early journeys into medicine.

Susan Rehm, MD:

My early journeys into medicine, actually, well, I started out working in a medical microbiology lab... actually not medical microbiology, in a laboratory, a medical laboratory in our small town hospital. This was a 40 bed hospital.

Mary Rensel, MD:

40, wow, okay.

Susan Rehm, MD:

I walked to work. I cleaned test tubes. Yes, this was before everything was disposable. I filed lab reports. I drew blood. I worked up to blood drawing, that was a stretch goal for me. And I also was responsible for walking the lab results over to the doctor's lounge and putting them into all the doctor's mailboxes which were there. So it was actually on one of those trips where I ran into a family medicine doc whom I knew but not all that well, but he was being polite and said, "Hey, you're in college now. What are you doing? What are you studying?" I think I had just finished my freshman year at that time, and he said, "What are you thinking about?" And I said, "Well, I went in to teach but I'm getting a little disillusioned with that for a variety of reasons so I think maybe I'll be a med tech."

And he said, "Why don't you try for medical school?" I didn't say much at the time, but that question haunted me. A very good coaching question actually. And so the rest is history, as you say. I decided to switch. It didn't take that much. And at that time, Nebraska had a three-year program so you could be accepted to medical school after three years of undergrad and then a three-year medical school. So I went through both in six years and then came out to Cleveland.

Mary Rensel, MD:

Love it. And you've been here ever since.

Susan Rehm, MD:

Yeah. Very easy resume, right? I've only had one job.

Mary Rensel, MD:

Yes, wow, wow, I love that. Well, that does show the power of a question, right? A coaching question.

Susan Rehm, MD:

And I should have stated it better. He may have actually said why. We would not as a coach say why. But I think he might say, "Have you thought about it?"

Mary Rensel, MD:

Yes, yes, there you go. I love it. So don't forget to keep asking, poking people, a little accountability. Give them a little time to think about their next steps. So career transition is always something you've been interested in, it sounds like, through many different roles. What are some of your favorite roles here at Cleveland Clinic to support people in their career transitions?

Susan Rehm, MD:

Well, I would like to say that almost any role can do that. And as a matter of fact, I say I've only had one job for a long time, the reality is there've been micro and macro transitions within that job, and I am very grateful for having been allowed to occasionally redefine myself or to be asked to do something else. And that took the form of, at the beginning, just committee memberships. It's interesting, there were so many opportunities and various education-based committees, and then later search committees, review committees for the organization, pharmacy and therapeutics committees, all of those kinds of things. And the value of that at the time, I really didn't know. But part of it in retrospect is all of the networking contacts and new neighborhoods that I was able to walk through, some of which were literally a walkthrough, and some of them became long-term neighborhoods for me as well.

I'm very lucky from the standpoint that as an infectious disease doctor I spend most of my time in the hospital doing hospital consultations, and it's with every specialty, so literally every different part of the organization was part of my clinical world as well. And that was really cool. So by the mid-90s I was elected to the board of governors, to our governing board, there was already that background there. And one of the things that I really value is I work a lot with surgeons, and I have to give credit, a colorectal surgeon who was one of my biggest backers... a male colorectal surgeon... in getting on the board of governors, which was very cool. And just immediately before that I had started as internal medicine program director after having been an infectious disease program director. So there were people who were sponsoring me. I wouldn't have said that word at that time, but they were sponsoring me.

They were looking out for me. They were putting my name forward in a way that allowed me to continue to grow in roles and so on. So from the board of governors, that kind of led into the associate chief of staff work, which led into the physician health work, which initially was quite narrowly focused on impairment. And over the years grew, I like to say, from impairment to distress or burnout to wellness. The way we'd love to approach it would be to say how do we keep people well in addition to when things aren't going well? How do we move forward? My attitude is that we are a group of incredibly accomplished people who are lucky enough to practice with each other. And when things are rough, how do we go back to that gem that is there and move forward?

Cara King, MD:

That was amazing. I am so excited to have you on today. I have been waiting for this interview for a very long time, so thank you again for joining us.

Susan Rehm, MD:

My pleasure, thanks.

Cara King, MD:

So I'm going to continue your discussion about this area of wellness and burnout, because I don't want to let this go quite yet. And I love your coaching perspective on this as well, because it offers a really unique place for wellness. I always say wellness is truly two things to me, it's coaching and a scribe. If I have those two things, I'm very well. Right?

Susan Rehm, MD:

Love it.

Cara King, MD:

So with that being said, there's a lot of talk about burnout and this area of resilience. I've even read things such as burnout can be prevented or even reversed through cultivating resilience. How do you feel about that? Do you think that's true?

Susan Rehm, MD:

I have to tell you, I have mixed feelings about using the term resilience because it kind of hearkens back to the bad old days of if you're burned out there's something wrong with you. Everybody else is doing it, everybody else is getting along fine, what's the matter with you? Why can't you hack it? I think a more nuanced approach is to say, first of all, that there are major problems with our systems so that is not under the control of most of us. It is the environment that is around us. So what we're left with is trying to optimize our coping ability to a certain extent and to remember the things that are most important to us. Because if we can tap back into why we're here, we will be in much better shape to be able to withstand things. So resilience to me, I think everybody who's here is resilient, you wouldn't be here unless... and I say here, but I mean in any healthcare setting.

Cara King, MD:

Correct.

Susan Rehm, MD:

People who have gone through training to be a healthcare professional or a caring professional and fill in the blank other areas, whether it's teaching or the ministry or nursing or police work for that matter, you don't get there unless you are resilient. So the question to me is how do you tap into those things that have helped you in the past and that will make you even more receptive to growth in the future?

Cara King, MD:

Beautifully put, and I could not agree more. Finding your true north and your passion that brought you here, and then tapping into that when things feel hard or you feel stuck.

Susan Rehm, MD:

Yep, absolutely. Unfortunately, if we started today and we had all the resources in the world, the system will not be fixed very quickly.

Cara King, MD:

That's true.

Susan Rehm, MD:

Yeah, so in the meantime, tapping into that, and I will go back to my walk through the neighborhoods and relabel the neighborhoods as unofficial teams, it is those teams that help us remember why we're here and support us when things are not necessarily working in the same direction. I think teamwork is almost, it's tossed around, it's too light of a term in some ways. So obviously teams help patients. They get it when the people around them can, I'll say, finish each other's sentences so to speak, when they know each other, when they know how it works, all of those kinds of things. That's great for patients. But I think it's also really great for the members of the team, the multidisciplinary members of the team. That's an essence of wellness, to be in a work situation where you are surrounded by people who share the goals, who are all moving in the same direction and each contributing what they can to making that all work.

Cara King, MD:

I love that. And not having necessarily the same opinion. You don't want that. You just want the same common goal and differing perspectives in a psychologically safe space to voice that, because that's really where growth happens. Right?

Susan Rehm, MD:

That's when growth happens and that's when respectful discussion happens. Absolutely. When there is trust to be able to disagree, to be able to modify, whatever, but to work together toward the goal that's there.

Cara King, MD:

It can feel sometimes like a beautiful dance. We talk about this in the operating room, like when you're with an assistant or a team that we're just all in the same flow. It just feels so fulfilling, doesn't it?

Susan Rehm, MD:

Yeah, absolutely, yeah. I think of the operating room, and too bad this is just audio but I'm going to put my hand out like, okay, and the person there next to you puts into your hand exactly the instrument that you want at that time. Without you having to say anything, it's there. Isn't that the essence of teamwork?

Cara King, MD:

And it's probably not what I'm asking for because I'm probably asking for the wrong instrument, but put in my hand what I really actually want. That's when you know you have the most amazing team, like, "King, you actually don't want what you're asking for, you want this." And you're like, "That's actually exactly correct."

Susan Rehm, MD:

Well, and that's one of the things that's been so hard, I think, as our flow has been disrupted, fill in the blank. Obviously the big thing is Covid, and people are out, there's turnover, all of that kind of stuff. So how do you continue to build? How do you have a team when you may have new faces in the mix over and over and over again? So a lot of that I think is intent along with the respect.

Cara King, MD:

So true. And this term that has really surfaced, I feel like, over the pandemic is languishing, where I'm not necessarily burnt out, I'm not depressed, I still have hope, I'm still excited to come to work but there's just this kind of cloud over my creativity or a cloud over my flow state. And just acknowledging that and knowing how to get back can be a journey in and of itself, which is where I think coaching has been a huge, huge part of my life over the past couple of years.

Susan Rehm, MD:

Yeah, I think we've all grown in thinking about those things and maybe being more mindful of our career arcs than we might have been otherwise. This is what I consider a hidden "gift", gift being in quotes, of having lived through what we've lived through in the past three years, is just the opportunity to think about it a little bit more specifically with a little bit more insight into what's actually going on.

Cara King, MD:

Exactly. And when you mentioned your career arc, it brings me back to something you said earlier with Mary about how you've had a few moments where you've had to redefine yourself, and you said sometimes it's been a decision that you made amongst yourself that you were going to make that pivot, and sometimes it's been external factors asking you to make that pivot. So I'm just curious, in people who are early career or mid-career, do you have any advice about being reflective and knowing when to make that pivot? How did you know when to do that?

Susan Rehm, MD:

It's a great question, and I think that I've probably gotten better over the years at acknowledging what it is that drives me, what motivates me, what do I love doing? What do I want to do more of? What maybe I could leave behind, so to speak. And then allowing myself what we would in coaching call the magic wand moment. If you could do anything that you wanted to do, if you could rewrite your job description, what would that look like? Years ago, Mary mentioned, I have been involved for a number of years with a nonprofit in infectious diseases, and I started out on the board and then moved into leadership roles, and then ended with being a medical director for this nonprofit for a number of years. And so as I was finishing my presidency, the person who was, actually it was a slightly different title but it was a physician who was a senior director, so to speak, in a salaried position, left.

We actually had turnover on the presidency of the board, and all of a sudden it was like, okay, what are we going to do? We put out flyers or feelers to try to get someone into that salaried leadership position and it just wasn't happening. I don't know how it hit me one day, I thought, "You know what? I could do the parts of this job that I like. I could do it remotely. I could do it part-time. I could still keep doing what I'm doing at the (Cleveland) Clinic." And so I pitched it. I said, "Hey, how about we do a part-time distant thing?" And they went for it. I did it more as a kind of a consultancy. The reimbursement went back to the department.

I was still full-time here, and it was a wonderful opportunity for many reasons but one of the things was that I got to meet people from all over the infectious disease community and public health community just in the course of my work. The contacts I made during that stint, in addition to the fun of being involved in that kind of work, which include media work and things like that, it was really cool. But I'll never forget kind of that feeling when that idea hit me like, "Oh, what about this? I could give this a try." And unusually enough for me, I didn't ask permission.

Cara King, MD:

Yes, I love that.

Susan Rehm, MD:

I just said, "Okay, here's what I'm thinking about," and went back to it. And it's funny, I recall our upper level leadership at the time said, "Hey, that sounds like a really good retirement job."

Cara King, MD:

You're like, "Hey."

Susan Rehm, MD:

Okay, well, I'm not retiring.

Cara King, MD:

Let me be clear.

Susan Rehm, MD:

Yes, exactly, yes. But that's what I would invite people to do. Think about what it is you like and how can you do more of that within your current job or outside that role. Just allow yourself to dream about it. It is that creativity and that dreaming, and I'll go back to your wellbeing comment, it's healthy, it's good for you. It activates the parasympathetic nervous system. I'm talking with a neurologist next door, I realize that. But allow me, ID has to do a little bit of everything.

Mary Rensel, MD:

I'm just a surgeon. You can [inaudible 00:23:59] to me.

Susan Rehm, MD:

There you go, whatever. Yeah, don't hit the vagus. Instead of what we do every day, which quite frankly is totally sympathetic drive. Right?

Cara King, MD:

It's true. Fight or flight all day.

Susan Rehm, MD:

That's not healthy in any way. So just thinking about it, just visualizing it, just allowing yourself that option. Even if you don't do it, dream it.

Cara King, MD:

I love this and that magic wand that you mentioned, I call it the ideal state. Give yourself space to reflect on that ideal state, right?

Susan Rehm, MD:

Yes.

Cara King, MD:

And then it takes bravery and it takes courage to do what you did, to go to your boss and say, "Hey, I'm presenting this," but what's the worst that can happen? They can say no, right, and it will likely move you closer to that ideal state. So I think that is just a really amazing piece of advice. And also giving yourself space to understand what may not feel good anymore, like things that you may have thought were what you wanted to do when you got out, take the time to notice what feels like work or what's painful to hit that deadline. And listen to that. Like I thought I loved this but I cannot meet the deadline to get these presentations done on topic X, maybe it's time to shift, maybe I'm actually not enjoying it as much as I thought I was.

Susan Rehm, MD:

Well, and I think the other thing to realize in that process is something that came out in the literature, and I know you've read a ton of Tait Shanafelt's work, but one of his early pieces pointed out that if we're doing what we really love to do, our top passion, only 20% of the time that's enough to sustain us. The reality is there are very few situations where you're doing what you love to do 100% of the time. The people who have that are really, really lucky. But most of us, there are things that are kind of baggage that you have to do it, and the only thing that you can do is to revel in your 20% that you love, and to think about ways for that 80% to be less burdensome.

Cara King, MD:

Exactly. Mary and I, in our 0.5% podcast time, we are obsessed. This brings us joy.

Mary Rensel, MD:

It sure does. Okay, well, I love hearing how you're so willing to say yes and to think deeply about when people ask a question of you like way back in Nebraska when you were delivering the results, physically delivering the results to the mailboxes. I love how that, like you said, got stuck in your head. So here you are, Susan, I want to thank you for all your years of service to Cleveland Clinic, because I don't want to say how many years, but a few decades are under your belt here at Cleveland Clinic. And do you have a magic wand for your next phase? Have you taken some magic wand time?

Susan Rehm, MD:

Yes, I will continue to coach and to consult, but it probably won't be as much clinical consulting as others. And I'm going to continue to work with the medical school. And the main thing is I think I'm buying a little bit of my time. I can set my pace a little bit more mindfully, so to speak, and I'm trying to leave space to explore as well. I was talking with my personal coach a few weeks ago about what I envisioned doing after I was through with my current job, and he said, "Hmm, are you really leaving that job?" Another question that stuck in my head, even though it's a closed end question, I will take it for what it is.

When that happens I tell him I'm taking this as a rhetorical question. And it has helped to refine it because I think to really allow possibilities, I can't simply go from being scheduled in this way to scheduled in another way. I've got to leave more clear space, so to speak. I have a friend who does a little bit of music composition, and he is obsessed with telling me, "Oh, listen to all that space in that song. It's awesome." You don't have to put 25 notes on every beat. You've got to leave a little bit of space. So I'm buying myself a little bit of space.

Mary Rensel, MD:

I love that, I love that. Is there someone that modeled this for you, this willingness to say yes and to explore? It sounds like your career has been full of exploration. You have one job but many hats and you've looked at this at all different levels, like we talked about, so many neighborhoods here locally and regionally and globally. Is there anyone that you feel like you're modeling them or is it a group of folks that have shone a light or shined a light on how to maintain exploration in your career?

Susan Rehm, MD:

I have to give credit to a ton of people. Early mentors I think were... like Marty McHenry, and we're so lucky to have his daughter with us on the staff who is as incredible as he was, in her way. I think of myself as taking the best of from a lot of people and so on, too numerous to mention. And I will also say a lot of people who are not in medicine, which I think for those of us who have been nose to the grindstone for year after year after year, it's very healthy to just take ourselves out of that medical milieu and examine and look and learn from people who've had a different milieu, who've gone about things perhaps a little bit differently.

This is one of the things I really appreciated when I was at Weatherhead (Case Western Reserve University Weatherhead School of Management) doing my coaching certificate. There were people there from all walks of life, and the commonalities were far, far, far in excess of the differences. But when you're in it, when you're the frog who's being boiled, so to speak, we don't necessarily appreciate that. So I think there's so much to learn from everybody around us.

Mary Rensel, MD:

Wow. Yes, I love your perspective. Just to keep an open mind and explore and take the best learning from those you interact with, that's amazing. Thank you for your wonderful example of building a really interesting, deeply thoughtful career where you just continued to explore and learn from others. And the neighborhoods, I think the neighborhood is a really neat perspective that you've given me, that we have different neighborhoods that we cross through each day and to just stop and learn and look around and explore. That's wonderful. What are some parting words you would like to give our listeners today?

Susan Rehm, MD:

Get out there and keep walking. You don't know what neighborhood you're going to run into, and you don't know who you're going to run into or who may be your inspiration for the day. But we are so fortunate because we've got 80,000 plus stories out there, and we don't have to physically walk anymore, we interact in a variety of ways so get out there and just get to know people.

Mary Rensel, MD:

I love it. I love it. Well, thank you for sharing your time with us. We wish you well on your journey.

Susan Rehm, MD:

Thanks, and good luck to you guys. This is a fabulous opportunity.

Mary Rensel, MD:

Everybody go out there, explore a new neighborhood today. Keep walking.

Cara King, MD:

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 1. This podcast is supported by Cleveland Clinic's Women's Professional Staff Association as part of the Cleveland Clinic Centennial Celebration.