Why human connection and caregiving are powerful resources in promoting exceptional healthcare, according to David Duong, MD

David Duong, a Harvard-trained physician, was five-years-old when him and his family migrated from Vietnam to the US in the early ‘90s. His experience of growing up in a migrant family is reflected as compassion for his patients in Boston and Vietnam. 

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Photo credit: David Duong, MD, MPH

Before coming to the US, David’s father fought in the Vietnam War alongside the Americans.

“After the war ended he was actually put into re-education camp for seven years, and really suffered quite heavily,” David tells me.

“Once he got out, he contacted the UNHCR (United Nations on Human Resettlement Programme) and was allowed to immigrate to the US.”

The family settled in Jacksonville, Florida then moved to Holland, Michigan. “My parents moved there because the jobs were just so much better there in terms of the auto industry and having a lot of car manufacturing plants they could get jobs in, and quite high paying jobs for the 1990s.”

At the time they were the only Asian family for miles around and felt quite marginalized because of it.

“Being the different one, it really made me understand and personally live through the experience of what we would consider the other,” says Duong.

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Photo credit: David Duong, MD, MPH

As a physician he now sees patients in all stages of life going through various circumstances—from a hopeful situation such as a baby being born, or a somber one such as a person dying of a terminal illness.

Medicine, as Duong refers to it, is “the manifestation of societal ills.”

What happens at a societal level can manifest as illness and ailments throughout the body.

For example, according to the WHO, there are approximately 1.2 billion people in the world living in extreme poverty (less than $1 per day). The downstream effects of poverty then lead to ill-health due to decreased access to clean water, sanitation, shelter and healthcare.

“Since they’re not healthy, they don’t feel like their best selves, they feel like they’re being discriminated or stigmatized against,” says Duong.  “I think that my own personal lived experience of that, has really enabled me to empathize with them and understand their situation.”

Duong has thought a lot about how to best deliver equitable and sustainable healthcare in communities to reduce societal ills. That is why in 2017 he was made Deputy Director of the Program in Global Primary Care and Social Change at Harvard Medical School.

As we sit and chat, Duong tells me: “The job entails thinking about how we best deliver healthcare to patients. It also entails shifting power dynamics between the patient and the physician or the healthcare professionals, to put the power kind of more into the person’s hands rather than the healthcare professional’s hands, so that they drive their own healthcare.”

One of the programs that Duong led involved a $14M partnership between the public and private sector to reform healthcare education for five medical schools in Vietnam.

The program centers around training prospective physicians and health professionals to consider each patient’s circumstance and access to healthcare.

Duong gives the example of prescriptive medication and health literacy.

“If a physician is able to think about, okay, I’m prescribing this medication to my patient, but this patient may be different from the previous patient I saw because they are of lower health literacy and I need to spend more time with them, then that will improve that patient’s access to healthcare because they’ll be able to understand why they’re taking the drug, and then will be more likely to adhere to the regimen that the physician has prescribed.”

Currently in Vietnam, Commune Health Centers (CHCs) have under-resourced infrastructure to deliver healthcare that address non-communicable diseases (NCDs) such as diabetes, heart disease and cancer.

The reason for the increased prevalence of NCDs—globalization.

“You have Vietnam reaching targets of 7% GDP growth a year, and you have firms such as McDonald’s and Burger King and KFC flooding the country,” says Duong.

As GDP increases, parents strive to give their child what they consider to be nutritious food from major global fast food corporations. Also, as vehicles become more affordable and more people move towards office jobs in Vietnam, a sedentary lifestyle becomes more prevalent.

Positive change and progress is not about judgement, but understanding the factors contributing to a population’s health, known as social determinants of health, and empathizing with that.

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Photo credit: David Duong, MD, MPH

Understanding an individual’s perspective is all part of good physician caregiving.

Four years ago, Duong had a female patient in Boston who was diagnosed with diabetes. As a result of the condition she developed a foot infection requiring amputation to one of her toes.

“She came to me and she said, I have nine toes left and I want to keep all nine toes, but I have to keep my blood sugars under control,” says Duong.

The first year was difficult for both Duong and his patient in keeping her blood sugars down.

“It took me a year to understand, or to learn that she was actually homeless and whatever I was prescribing to her was only actually effective 20% of the time because of her homeless state.”

Aside from being homeless, she was also a single mother raising two kids striving to put them through college. What she needed was not just medical treatment, but ultimately, empathic caregiving.

She needed someone who could listen and understand her circumstance without any judgement. About a year ago Duong said to his patient:

“You have sacrificed your body so that your two kids could have a better future. And they are now both college educated professionals, and you have lost seven toes because of that.”

That is human connection—the caregiving people need and desire.

“And I think that’s the human connection, and that’s what it means to care give to people is to understand how their body is manifesting within their social context, and recognising that and honouring it for them,” he says

Hearing Duong tell his powerful story of caregiving reminded me of the work that the Brigham and Women’s Hospital surgeon Atul Gawande also does with human compassion and end of life care.

tweet-graphic-transTweet: In the US, 18% of patients requiring in-hospital resuscitation efforts ultimately do survive.

“When you have conversations about DNR (Do Not Resuscitate) and DNI (Do Not Intubate), we frame it and say, it doesn’t mean I’m giving up on you, I’m actually doing this because I’m on your side and I’m advocating for you and I want what’s best for you,” says Duong.

Physicians showing patients that they are on their side and honoring them with compassion and empathy can be one of the most simplest yet impactful acts they can offer their them.

If Duong could speak to his 18-year-old self, he would tell him:

“It’s going to be alright. You’ll get where you need to be. You have good passion, you have good energy, and you have a good heart, so everything else will work itself out.”

 

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Afterthoughts

How do you show caregiving to those in your life?

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