Get to know 2023 AOA Visiting Professor Dr. Meghan Lane-Fall
Dr. Meghan Lane-Fall knows well that the journey from one point to another is rarely simple or direct. Her own story includes twists and turns that took her from to Chicago to California to Philadelphia and many places in between before she made a one-day stop at the Pritzker School of Medicine on Feb. 21 to serve as the 2023 Alpha Omega Alpha Visiting Professor.
Before presenting her Department of Medicine Grand Rounds lecture, entitled “First, do no harm to anyone: how patient safety aligns with inclusion, diversity, and equity,” Lane-Fall had the opportunity to reflect on the winding path that brought her to where she is today.
“Sometimes you can chart a linear path or describe a linear path, but it’s never really linear,” Lane-Fall said.
Lane-Fall is today the David E. Longnecker Associate Professor of Anesthesiology and Critical Care, Associate Professor of Epidemiology, and Vice Chair of Inclusion, Diversity, and Equity in the Department of Anesthesiology and Critical Care at the University School of Pennsylvania Perelman School of Medicine. But her journey began about a dozen miles northwest of the University of Chicago campus, where she grew up in Garfield Park. In a single-parent household and amid substance abuse issues in her family, Lane-Fall looked for a stabilizing force. She found it in her grandmother but just as much in science.
From the moment she saw a plastic surgeon slice open and then sew up a raw turkey leg on career day at age six, Lane-Fall felt she could herself be a doctor someday. Even as circumstances took her from Chicago’s West Side to Northern California, where one of the wealthiest counties in the nation proved to be a stark change, her interest in science blossomed. A first-generation college student, Lane-Fall applied to only a small number of colleges but got into them all and enrolled at University of California-Berkeley, where she studied molecular biology and human sexuality and got an introduction to research.
“I had a thesis advisor from my human sexuality major who when I told him I was pre-med said, ‘Well, you know you might not get into med school, so you should sort of think about alternative plans,’” Lane-Fall recalled. “So I did my MCAT, applied, all the things. I got into every med school I applied to, 11 of them. I sent him every acceptance letter! When I walked to get my diploma, I walked across the stage and he shook my hand and said, ‘I’m sorry.’”
In medical school at Yale University, Lane-Fall explored numerous specialties and felt destined for a career in obstetrics and gynecology due to her work in sexual health and HIV counseling.
“But I fell in love with anesthesia, started doing that, got into research, and I guess the rest is history?” Lane-Fall said. “The research interest evolved to implementation science, which is bridging evidence to practice gaps. The work I’m doing in quality and safety—mostly safety—evolved alongside the research for a long time, and then my interest in [diversity, equity, and inclusion] was sort of a parallel interest.”
On the morning of her Grand Rounds lecture and before a full day of meetings with faculty, residents, and students, Lane-Fall sat down with Akosua Oppong, a fourth-year Pritzker student, to discuss her career, her lecture, and how the healthcare field can continue working toward greater workforce diversity.
The following conversation has been edited lightly for clarity and length.
Akosua Oppong, MPH: So you talked a little about your lecture and the combination of DEI work, patient safety, and implementation science. For people who can’t join your talk today, can you tell us a little about where the merging of those things has really been in the past few years?
Meghan Lane-Fall, MD, MSHP: There are a couple ways that I think DEI is related to safety. One is if you think about patient care—you think about the patients and families themselves. And then another is thinking about healthcare providers and clinicians as a workforce. So I sort of think about them differently.
From the perspective of patients and families, if we don’t provide culturally responsive—or competent or humble; depends on which adjective we’re using—care, then folks that do not conform to expected cultural norms and who don’t speak English very well are at higher risk of adverse safety events. There’s very clear evidence that limited-English proficiency patients are more likely to have adverse events, and some of that has to do with communication and miscommunication. Some of that has to do with different cultural expectations about how patients interact with healthcare providers, such as how there are some cultures where you would never contradict what a doctor says or you would never speak up or correct them. That’s problematic, right? Because we get things wrong all the time, and it’s very important that patients are able to say, “Actually, I don’t take that medication,” or “I don’t do that thing.” If you’re dealing with a patient that doesn’t want to contradict you, and they’re like, “I guess that’s right because they said it, so I’m just going to take this medication I thought I was allergic to,” that’s a problem. That’s one example I’ll give in the talk.
The second thing is thinking about maternal health and maternal outcomes. Black women are at much higher risk for adverse events during and after childbirth. Some of that is related to comorbidities for sure, some of that might be related to social determinants of health, and some of that is related to the fact that we don’t listen to Black women. When they say, “I hurt, I’m bleeding, I can’t breathe,” all of those things—they are not listened to and end up being harmed because there is delayed recognition of things that are imminently treatable. If we don’t trust people, if we don’t interact with them, if we don’t have that awareness that we need to respect people, then we end up harming them.
The DEI relevance there is that the equity piece plays out in safety. But also if we think about the workforce, my supposition is that the more diverse workforce we have the easier it is to bring those things to the forefront so people can say, “Actually I think we need to listen to her.” My sense—and I don’t have empiric data to support this—is it’s easier to have those conversations when you have a diverse workforce. Then when you think about the workforce itself, we think about needing to be high performance and needing to work together as a team and needing to be resilient as a team. The more diverse workforce you have, the easier it is to be resilient because you’ve got different ways of thinking about a problem. If we’re not a diverse workforce and, more importantly, not an inclusive workforce—because you can be diverse, but if you’re not listening to the people that bring the diversity, then you haven’t really done anything. If you can build that psychological safety, then you have a team that can actually perform really well.
AO: There are so many things you said, especially when it comes to maternal health, that have created questions in my brain, so I want to run through a few things. You talked a little about limited-English proficiency individuals; in your work have you included anything about interpreter services? I think one thing people forget is that calling an interpreter on the phone is great but having one in person is so much better.
MLF: I did research at a health system where I was observing in the post-anesthesia care unit because I was observing handoffs, and I saw a patient roll out of the OR. There was a surgeon and a nurse and someone in a (cleanroom) suit, and I was like, “Who’s that?” and they said, “That’s the interpreter.” I was like, “They were in the OR?” and they said, “Yeah, if they’re going to wake up and talk to them, don’t you want to talk to them in their language?” My mind was blown. Of course that’s what you want, but many places don’t do it. I feel like there are a few exemplars here and there that really get it, and then there are a lot of places that are struggling.
AO: The second thing you mentioned in regard to maternal health and morbidity/mortality—that’s obviously a topic that’s close to my heart as a future obstetrician. I think OB as a specialty has done a good not great job of expanding the workforce to include diverse individuals. I just finished my residency interviews in December, and there was no interview day where I was the only Black person. That was reassuring, but I think about my colleagues that are applying into ophthalmology or plastic surgery or orthopaedic surgery, and they’re the only one on their interview days. I think, “What can we do to make this better?” because the current landscape is not going to help us improve outcomes if there are specialties that are invested but there are others that are not. I’ve thought about how to expand my career in this area outside OB, but I’m not sure how to do that.
MLF: So, I’m a qualitative researcher, which requires that you dig into the why and understand how things unfold. When you look at workforce diversity there are many different reasons we don’t have the workforce diversity that we want, and we have to be comfortable with the complexity around that so we can start to attack those different causes. Those causes may play out differently for different groups.
As an example, I remember a number of years ago I did a study looking at the critical care workforce. I called it “the emerging critical care workforce” because I was looking at fellows essentially. So we looked at women, we looked at Black folks, we looked at Hispanic and Latinx folks, we looked at Asian folks, and we asked, “What does representation look like, and what has it looked like for the last ten years?” The patterns are different for the different groups. For women, you see a lot of strides. Just a steady increase at every level—undergrad, med school, residency, fellowship. For Black folks, it’s consistently low, but there’s a drop off at every single step in the pipeline, so there’s something happening. The ‘leaky pipeline’ thing? I think it’s real for a lot of folks, and for these folks in particular it was a demonstrable drop off. For Latinx folks, on the other hand, it was low at the beginning and it stayed consistent.
I don’t mean to say that we know what the answers are for those different groups, but the idea that the patterns could play out differently, I think, gives us a little bit of insight. If for X group we see it’s a beginning issue, that’s where we go—let’s get more people into college, into med school that sort of thing. If it’s a leaky pipeline issue then it’s more of “I need someone there and there and there.” We have to know a bit more about how things are playing out before we can attack it.
Another thing I’m dealing with now as a Vice Chair is trying to figure out how to get people from training into faculty, which is a whole other thing. So the pipeline discussion is really important and needs to continue, but there is also this idea that people have to make real choices about their lives, about money that inform which specialties they choose and where they choose to practice. Without understanding that, we’re never going to get to the diversity we seek. And then we need to hold organizations accountable. This idea of “You have no people of color or you have no underrepresented people in your department?” That’s actually one of the things (University of Pennsylvania) tracks; not just proportions but how many departments have no underrepresented faculty. We’re now down to zero, which is good, but for a while we were not.
AO: I want to pivot the line of questioning a little bit to your work as an anesthesiologist. Recently there have been statistics that show that more and more students are interested in a career in anesthesiology, and that trend has even appeared here at Pritzker. As an anesthesiology, what do you think is pulling students to the specialty, and what has influenced this trend?
MLF: It’s a good question. I think one thing is we see more role models and more diversity in role models. Anesthesia is certainly not at the forefront of diversifying medicine, but we have made strides, so I think there are more people who can see themselves in anesthesia. Secondly, we’ve done a pretty good job of differentiating so that if you’re interested in women’s health you can do OB anesthesia, there’s regional anesthesia, there’s cardiac, there’s critical care, there’s pain—there’s lots of ways to be an anesthesiologist. And it’s fun. There are a lot of procedures involved. I remember when I expressed interest in anesthesia my preceptors in anesthesia said, “We love our job, we would do it again in a heartbeat, here are all the reasons we love it,” and then I would talk to other folks and they would say, “Yeah, anesthesia is good.” Everyone had something good to say about anesthesia.
The compensation certainly does not hurt, and then I think especially as people are thinking about work-life integration, work-life balance, work-life harmonization, the idea that you could be in something that looks like a shift specialty can be appealing. I know there are ebbs and flows and trends in what people are looking for, but my sense is this generation of folks that are graduating now are really interested in “How can I have a full life that includes medicine but is not only medicine?” It can be easier to see that in specialties like anesthesia, emergency medicine, and hospital-based specialties where you can see where your day ends and you move on to something else.
AO: My last question for you: You have your hands in a bunch of different pots and you have a full workload—When you’re going through your day, going throughout your work, what are the moments that really fill your cup and remind you why you chose to do this?
MLF: When I see other people shining or excelling those are the moments that fill my cup. One of my mentors call me a self-basting turkey, which is high praise from this man. He’s like, “I give you an idea and you run with it, you execute, you get it done.” So when I see that with my mentees, when I can give them just a little bit of a nugget of something and they go and they’re like, “I got this grant”—that’s the kind of stuff I really love, where I can be impactful but see other people grow and shine.
I’m conscious that we all have limited time on this Earth, and I’ve already excelled beyond anything that was expected of me, so it all seems like gravy now. When I graduated from medical school, I thought, “OK, I can die now because there’s a doctor in the family. Everything else is gravy.” So the more I can do that has a lasting impact, that helps other people, the better it feels.
AO: OK, I lied; I have one more question: For individuals who are hoping to invest themselves in DEI work in the future who may feel like there are a lot of obstacles in the way, a lot of people fighting against the work you are trying to do, what advice to you have for them to keep pushing and keep going?
MLF: I have two big pieces of advice. One would be that this is a marathon. We did not get here in a short period of time, and we’re not going to get out of it in a short period of time. Many of us that are in the work want to go and we want to go hard because we feel change coming and we want to be a part of it. There’s a great book that talks about civil rights and relates it to punctuated equilibrium where you see these moments, like the civil rights era, where there’s a lot of change and people want to harness that energy. George Floyd’s murder? That was another one that kicked it off because we’ve seen countless Black folks get murdered before and since, but there was something about the confluence of circumstances—maybe it was COVID because people had a lot of time—that kicked off this moment. A lot of us were like, “We have to go and go hard because people are listening.” But it’s a marathon, and you can only go so long before you get tired. A lot of us now are like, “We’re tired, what do we do now?” So the first piece of advice is pace yourself.
The second piece of advice is you want to align what you want, your change objectives, with what organizations want. I do not believe that DEI is in conflict with other organizational goals. I think they can be perfectly aligned and synergized, but sometimes you have to help people see that. You have to help people see the value proposition of DEI, the return on investment, how it aligns with the organization’s culture or brand. You may have to sell it, so to speak, and you may have to sell it in a way that feels like it’s not true to the concept of…let’s say if you’re in it for social justice—“because this is what we ought to be doing”—that is not necessarily a compelling argument to an organization. The organization wants to know about the bottom line. I think that you can have both, but to be effective you need to know what different folks are looking for, what they are invested in, what their priorities are, and then align what you are trying to do with what they are trying to do. Otherwise you’re just going to butt heads.