Dr. Katherine Gergen Barnett is the Vice Chair of Primary Care Innovation and Transformation and the Program Director in the Department of Family Medicine at Boston Medical Center. Prior to BMC, Dr. Gergen Barnet attended Yale University School of Medicine, worked at NIH, and completed a fellowship studying a model of group prenatal care for underserved women. Dr. Gergen Barnett’s research career has been primarily focused on innovative models of care to address chronic medical conditions, mitigate physician burnout, and engage community partners in creating feasible solutions to increase health and wellness in urban communities.
This interview has been edited for clarity.
HPR: What drew you to your current work at the intersection of medicine and social justice, and what you think is the role of such work today?
Katherine Gergen Barnett: The intersectionality of social justice and health equity and urban medicine and medicine generally has become much more inevitable than what I first saw, when it seemed very unique if you had these sets of interests and you wanted to weave them together. I think COVID-19, as I’ve shared, has really laid bare the incredible disparities that exist in our country that many of us have always known, seen and experienced. But, I think the pandemic highlighted it for so many more people in a way that became a call to action. And George Floyd and Breonna Taylor and the countless names and marches around the country have really served to ignite the possibility of this intersectionality.
Now, that being said, I think we need to capitalize on this moment to perpetuate it and push it into the future and bake it into policies so it’s not just that we were moved to do something and then all of a sudden, we easily turn our eye. So, I think about it a lot in terms of the future of training of doctors and the way that hospitals and medical centers around the country need to make sure that we talk very specifically about anti-racism work in medicine. We need to build it into the curriculum and use that lens for every patient encounter. We need to ask very deeply about causes of health and disease, without immediately turning to the quick answer.
My own personal journey is that I was at Yale University for undergrad and I was interested in being a pre-med, but then in pre-med classes, I was in a milieu where I was not with people who I saw eye-to-eye with. So, I actually was turned off by medicine and it took years to get back to it. So, I did anthropology, psychology and a lot of public health initially. It was only when I met physicians working in the HIV community — who are at the intersection of social justice advocacy and medicine — that I realized that I could actually find my people. And so, I went back to the Yale School of Medicine and really just felt like from there I totally felt at home, and particularly at Boston Medical Center as well.
HPR: How has knowledge of COVID-19’s disproportionate impact on BIPOC communities factored into BMC’s commitment to urban underserved populations?
KGB: I think BMC is incredibly unique in its longitudinal commitment to social issues. That is the backbone of who we are, and it has always been who we are, even when our voices were alone. I feel an incredible amount of pride around the fact that we are known in Boston and in New England for the work we do. Do I think COVID-19 accelerated our work? Yes. I think it helps highlight and underscore the work we’ve always been doing. And it allowed our clinicians and our researchers to garner more support for some of their work as public figures.
I certainly never imagined I would be doing radio and television or writing for the Globe nearly as much as I have in the last eight months, but I think all of us have really felt drawn to add our voice. We’re at a nexus point where people really need some clarity. There’s so much confusion and so much fear. So how do you cut through it with the medical information but also have that go hand in hand with a compassionate sense of healing and recognizing the larger cultural and societal norms and distrust that loom so big in these communities? And how do we address that as well?
HPR: In regards to your work with Everyday Boston, why do you think it is so important to continue to share the stories of our community during a pandemic? Is there a healing aspect to this work, and if so, how do you think it can be incorporated into the practice of medicine?
KGB: Medicine is the art of receiving people’s stories. I have always been drawn to that part of medicine and the importance of becoming a better listener in order to be a better healer. So many times in medicine we’re taught that we need to have the answers in order to be a better doctor. But sometimes, actually, the answer comes from the patient, and you just need to lay out that time, safety and space for those answers to arise.
That being said, I also think the actual art of collecting stories is another beautiful tool for healing communities. I saw in Everyday Boston a real possibility for collaboration, in part because I love their model of having people from all over the city garner each other’s stories. I love the model of the Bridge Project where they’re using the skills and strengths of somebody who’s been previously incarcerated to collect stories. Maybe the stories are gems that are waiting to be discovered and we just never know where we’re going to find them. And we never know who the right person is to collect that story because a story is a relationship; you only get a story when you’re in relation to one another.
And so this brings in all my work in anthropology and public health and psychology because I really feel so deeply that one of the things that we need to get out of the pandemic, is the sense of being in this big, huge thing together, and recognizing that we’re all human, and that we’re all suffering, and that we’re all hoping and we all love, and that we all have these things that draw us together. And part of that recognition is collecting and listening to each other’s stories.
HPR: How do you envision restorative justice in medicine to be compatible with a private health insurance system which cuts off access to vulnerable communities?
KGB: I’m deeply grateful for MassHealth, and Medicaid, but it’s an incredibly flawed system. They reimburse at much lower rates and that tends to impact Black and Brown communities. And so, I try not to think about payer-specific plans because what I most want to do is improve the health of all and work in advocacy at the state level so we can actually mandate a certain level of care that payers have to get on board with. I think the restorative justice model has a ton of possibility.
I haven’t quite wrapped my head around how we can disseminate it into mainstream medicine, but what I really love about it is that it recognizes that people get hurt on all sides. For instance, I was just speaking with somebody from The Bridge Project and he shared that it took years of him being in jail for someone to finally ask him, “What happened in your life? How did you get hurt? And how did this impact how you’re hurting somebody else?” And for the first time, he felt like somebody thought that he was a human and recognized that part of what he did to land him in jail stemmed from a long life of trauma that had never been addressed. And so, part of what I do see as being able to take out of restorative justice ideas is doing more training and awareness around intergenerational trauma.
HPR: When we are thinking about vaccine delivery, do you see any guiding principles to ensure that the most vulnerable populations receive preferential access?
KGB: I’m incredibly aware that there’s a large amount of distrust that exists in many communities as lots of data shows. In particular, in African American communities the distrust is very high for the COVID-19 vaccine, for incredibly good reasons. And so how do we, again, use storytelling and collecting narratives and really getting leaders from each of the communities to serve as ambassadors in some way to recognize where a community is coming from or where an individual is coming from and bridging those gaps of trust. And rather than just assuming that we know why people are distressed, or assuming we know what’s best for somebody, how do we continue to keep the lens of curiosity open for everything we do. That’s truly the only way that we’re going to actually get to a better place.
HPR: As a doctor, how are you feeling right now about caring for your patients in such a trying time?
KGB: I feel very grateful for the work. I feel so grateful to be let into people’s lives in such a beautiful, intimate way and getting to know them and having them trust me. I feel a little bit exhausted. Not just for my sake but also for all my colleagues who have been fighting so tirelessly on the front line. I’m an optimist, and I also really hope that we’ve learned some important lessons about the need for public health and the need to address in a more robust way the health inequities that are in our country.
Image Credit: Photo provided by Katherine Gergen Barnett MD.
