Talking with Medicine Professor Lisa Cooper

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Interviewer: Dr. Cooper, thank you so much for joining us. We’re really thrilled to have a chance to talk to you. Because we’re interested in innovation—and the story of innovation evolves over time—I’d really like to start by asking you about your evolution over time. I understand that you are not from the United States originally?

Lisa Cooper: Right. I was born in Liberia, West Africa, and my parents are both from there and grew up there.

Interviewer: Tell me about your childhood there.

Lisa: My parents are both professionals. My father was a physician, and my mother is a reference librarian. They had gotten their training in the United States and then gone back home basically to start their lives there. I was born there. My older brother and sister were actually born in the U.S. when my parents were getting their training.

Growing up there, I went to an international school. I was around kids from all over the world whose parents were working in Liberia for one reason or another. I think I had a pretty good childhood. Because my parents were professionals, I was exposed to a lot of things. I got to travel. I went to an excellent school. But Liberia is a country where there’s a lot of poverty, so I saw a lot of kids on the street who weren’t as fortunate as I was. I think I kind of had a sense from early on about how opportunities and privilege affect your life.

Interviewer: How did your parents or perhaps your teachers introduce you to the fact that there was poverty around you, even though you were not living in it?

Lisa: It’s hard to know whether anybody explicitly told me that or if it was just something that I observed and watched, as I went from school to music or ballet lessons, or went to play with my friends or whatever. I knew that my parents did a lot of work in the community, and we would sometimes have kids who would come and stay with us for a while because their parents were not well, or something like that.

We had a big extended family, and we had some family members who, for example, lived out in the country. They didn’t have as many opportunities to go to school there, so they would come and stay with us for a while. It was those kinds of things. No one ever gave a lecture about it or anything like that.

Interviewer: Do you have a sense of how that environment affected your view of life at an early age?

Lisa: I think it really did affect my view of life because I always felt like I was so lucky and that I needed to do something to share that with other people, especially other children. I really felt like other kids needed to be as happy as I was, or to have as many friends, or have toys, or be able to go back and forth and do what they wanted to do.

Interviewer: To me, one of the hardest things to teach a kid is to not take something for granted. It seems, somehow, you had that insight to not take what you had for granted. How long were you at the international school?

Lisa: I was there from first grade until 10th grade. Then, I actually left Liberia and went to another international school in Switzerland. My parents sent me there basically because the school in Liberia was not accredited for U.S. universities. I knew I wanted to go to college in the United States, and I wanted to graduate from an accredited high school, so I went to a boarding school in Switzerland, which was another really international experience, too.

Interviewer: Which part of Switzerland was that?

Lisa: Geneva.

Interviewer: What was that like for you? That would have been when you were a teenager, right?

Lisa: Yes, I was a junior in high school. I don’t know that I was all that happy about having to leave home and leave all my friends.

Interviewer: Had you ever been away from home at that point?

Lisa: I had not been away by myself. I had been on family vacations and things like that, but this was my first time actually away from my parents. It was hard. I cried a lot [chuckles]. There were people there from lots of different countries. In the dorm that I lived in, there were girls who spoke French only and girls who spoke German only. The school I went to had a U.S. high school diploma program and also French baccalaureate and international baccalaureate programs. I was around people speaking different languages, and I needed to learn how to speak French fluently. I knew French from high school and from elementary school, but I didn’t know how to speak it fluently.

Interviewer: That must have been quite a culture shock.

Lisa: It was. In Liberia, even though I was at an international school, because it was my home country, I sort of felt more comfortable. It’s like I’m at home and I was surrounded by a lot of people who were like me. But, at the school in Switzerland, I was one of very few African students there, so I was more in the minority there and had my first real sense of what it’s like to be a minority. Growing up in Africa, I didn’t have that sense of being only one of a smaller group of people.

Interviewer: Do you think that growing up never feeling as if you were a minority affects your view today?

Lisa: I think it does. From what I’ve learned from my friends who actually grew up in another country where they were a member of a minority group, I think that growing up not feeling like you’re a minority, you don’t have as much of a sense of trying to fit in or wondering where your role is or things like that. You have more of this sense that you can do whatever you want and the world is yours. I don’t know why, but that’s the sense that I had growing up in Liberia.

Interviewer: That must have been really important in terms of empowering you and giving you the confidence, the wherewithal, to see things more clearly. Did you eventually feel comfortable in Switzerland by the time you were done?

Lisa: I kind of adjusted over time. It took some work and also just learning more about how a lot of my friends were either French or German or they were from America. And just learning what kinds of music they like and the food they like to eat and what kind of clothing they think is cool, and that kind of thing. It was completely different from where I grew up. It took some work, but it was kind of interesting.

Interviewer: Tell me about the transition to the U.S. after two years in Geneva.

Lisa: That was another interesting transition because I ended up going to Emory University in Atlanta, which is a big city with people from all over the place—but it is a southern city. People kind of segregated themselves according to race in Atlanta. I came from this international school where there were people from all over the world, and I was one of a few people who belonged to an ethnic minority group. Then, I got to Emory where, again, I was in the minority from an ethnic standpoint, and from a national standpoint, there weren’t that many African students there. I was in a city that has a very rich history related to African-American culture, so there were lots of African-Americans there.

What was interesting was that when people saw me, they assumed that I was African-American, and so, I almost naturally gravitated towards hanging out with African-Americans. I learned a lot more about African-American history and culture when I went to Emory.

Interviewer: Do you recall your sense at the time of the difference between being African vs. African-American?

Lisa: I think there are a lot of similarities in our culture. I think what’s interesting to me is that a lot of African-Americans didn’t realize how many of the things they did were actually things that were a part of African culture. They would say things to me, and I would say, “My grandmother in Africa used to say that.” Or they would mention certain types of food and they would be surprised that I was familiar with it.

I think I was surprised more by the commonalities that I saw. The differences I saw were related to how a lot of African-Americans that I hung out with thought other people saw them or just how they thought about race. For example, we’d go out socially and, let’s say we were at a restaurant where it took us a really long time to get seated. My African-American friends would say, “These people are racist,” whereas I thought people were just being rude. It never occurred to me that the way they were acting had anything to do with race. I just thought they were not being courteous. I think the way people thought about race and their cultural and racial identity seemed to be very different here than where I grew up.

Interviewer: It’s fundamentally different from how you viewed life in Liberia, where you were not part of the minority.

Lisa: Yes. I gained a whole different sense of what it must be like to have grown up in a country where maybe you were exposed more. Either that, or your parents or grandparents had experienced discrimination, or there was more of a discussion about how race affected life.

Interviewer: At the time, did you feel that you were naive or that maybe people were reading into things that were not there?

Lisa: Initially, I felt really like people were reading too much into different situations that took place. I think I really felt that way, like “That’s crazy. Why are they saying that?” Or “They’re too sensitive or self-conscious.” I think over time I began to see that both things are true in some ways. I think that there are some situations in which some of my friends may have overinterpreted behavior, or misinterpreted somebody’s treatment of them. And I think there were situations where I actually was being naive, because I hadn’t really been exposed to that kind of treatment as a young person, and so I just didn’t even know what to look for.

In most cases it was subtle. There were some instances where people were blatantly racist, but I think for the most part it was sort of subtle things where you couldn’t really pinpoint whether you were being treated that way because of who you were—like, you were a young person, you’re a college student, you weren’t dressed right, you’re a woman who shouldn’t have been there in a place where most people were men—or whether it was your race.

Interviewer: Interesting. During college, did you have a sense at that point of where you were headed in life?

Lisa: I don’t think I was 100 percent clear on that. I always liked science and math a lot. And because my dad was a physician, I had an interest in medicine. I was a little bit intimidated by the idea of medicine as a career because it just seemed so intense. My father works really long hours, and I thought, “Gosh, if I do that, I’m not going to have time to do anything else.” And there are lots of other things I like to do. I like to dance. I play the piano. I’m a sociable person. So I thought, “Gosh, I’m not sure if medicine is going to make me too narrow of a person.” So I struggled a little bit with that in college and I thought about other science careers. But in the end I ended up deciding to apply to medical school.

Interviewer: And did you major in science in college?

Lisa: I did. I majored in chemistry. There were no minors at Emory at the time, but I got a Bachelor of Arts degree in chemistry, which means that I took a lot of other arts-type classes. So I took a lot of French and music and religion and African-American studies and English.

So even though I was a science major, it wasn’t a Bachelor of Science degree, which is a more science-intensive degree. I took all the requirements for a chemistry major, but then I had a broad liberal arts experience.

Interviewer: How do you think that liberal arts experience affected your view on what a doctor should or could be?

Lisa: I wasn’t sure that it was going to serve me well in medical school, but I knew that as a person it was important for me to learn about all of those other areas and other ways that the world works. I just had curiosity about a lot of things other than science, even though I liked science. I felt like it kind of balanced me out. When I was a kid, I used to play the piano just to relax. And I felt like if I was stressed out and I needed to think about something before I could work on my homework, for example, I would go and play the piano for an hour or so. So I really felt like I was somebody who needed to have these other kinds of outlets.

Interviewer: You mentioned curiosity. Were you exposed to research as an undergraduate? I think that curiosity may be the fundamental driving force for researchers.

Lisa: You’re right, I think you are. I did try research as an undergraduate. The research that I got involved with was laboratory research, basic science research in one of the labs at Emory medical school. I’m trying to remember exactly what the project was, but I know we dissected frogs, and it was something to do with the way that skeletal muscle works or something like that. But it was very basic-science-oriented and lab-oriented. I actually didn’t have that much fun doing that. So I thought, “There is no way I’m going to do research. When I go to medical school, what I want to do is practice medicine and interact with patients, and I think that’s what I’m going to do for the most part.” That’s what I thought at that point.

Interviewer: A lot of undergraduates have a very skewed view of what research means—sort of a stereotypical image of somebody all alone at a bench working with chemicals and test tubes. Meanwhile, the whole idea of asking questions doesn’t really get into the mix. So then you decided to go to medical school—Can you tell me how you started to formulate your views on what kind of physician you wanted to be?

Lisa: In medical school, I think there were some courses that really sparked my interest or tugged at my heart. Because I believe that I’m one of these people who lets feelings guide a lot of my ideas about where I want to go. I don’t know if it’s feelings or intuition.

At UNC Chapel Hill, where I went to medical school, there was a course called Introduction to Clinical Medicine. It’s similar to the Hopkins course titled Physician, Patient and Society. I loved that course because they would actually bring patients into the classroom, during the basic science years, and they would have a master clinician interview the patient about a particular problem or dilemma, and then the patient would talk about how he coped with that problem and what he did to take care of himself.

We would learn a lot about that patient as a person, as well as the disease itself. And then we’d learn about how the doctor had interacted with and influenced that patient. That was one of the courses I really enjoyed a lot. At that point, I thought I was going to be a pediatrician. Because remember, I loved kids when I was growing up, and I always wanted to help other kids have a better life. So I always thought I was going to be a pediatrician once I got into medical school and I was looking forward to my pediatrics rotation, but I ended up doing internal medicine as my first rotation. I really liked how intellectually stimulating it was. When you saw a patient, there were all these different potential things that could be going on with that patient, and it seemed like you really had to draw on a lot of different knowledge areas to determine how you were going to come to a diagnosis and develop a treatment plan with this patient.

Interviewer: How did that appeal to your emotional instincts?

Lisa: One of the reasons I liked internal medicine as a field was that since the patients had relatively long hospital stays, you actually got to know them and their family members pretty well. And then, after they got discharged, they would come back for follow-up in the clinic. Because they had these chronic problems like diabetes, high blood pressure, asthma, whatever, you would end up seeing them back over and over again—it wasn’t something where they were cured and then they left. So I kind of liked the idea of knowing people over a period of time and learning more about their families, and learning about how they were growing and changing.

Interviewer: Why do you think that is? Is that just the way you wanted to practice medicine?

Lisa: You know, I’m not really sure. Relationships have always been central to everything that I do. I’ve always been interested in how different people relate to each other. Even when I was in high school, or in Liberia and Switzerland, I found it interesting that people from all these different backgrounds had all these different ways of interacting with each other. Who fit in with whom, and who liked whom. All those kinds of things I found to be interesting.

Interviewer: Did you enjoy medical school in general?

Lisa: I did. In fact, I liked medical school so much that I had a pretty hard time deciding what I was going to do for residency. Because I liked so many different things, it was almost like—what am I going to do? I liked everything. But then I just really had to think carefully about the kind of person that I am and the kind of life that I wanted to live. On the one hand, I liked surgery because I like all the technical things that you did with your hands, and you got a sense that you did something that was complicated, or you actually fixed something. It was a lot more like playing the piano. But I didn’t like the hours and the lifestyle. I remembered my dad and I thought, “You know, I know the kind of person I am. I would have a hard time doing that and doing some of the other things that I wanted to do, too.” That’s what I thought, anyway.

I actually did not like pediatrics, even though I love children. I just couldn’t handle the pain and suffering in children. I had just a really difficult time with that. I didn’t feel like I could always understand what they wanted or needed. It seemed like instead of really interacting with the kids so much, I was interacting with the parents. It was a little bit more complicated.

Interviewer: Did it surprise you that you didn’t like pediatrics that much?

Lisa: It did. It really took me for a loop. And, in fact, I think that was one of the reasons I had such a hard time figuring out what I was going to do, because I was like, “I don’t like pediatrics, what am I going to do now?”

Interviewer: I guess there’s a difference between liking children and liking the study and the care of sick children.

Lisa: I think so.

Interviewer: And so you decided on internal medicine.

Lisa: I did. I like the breadth of it because I like so many different things. I can get exposed to all the different subspecialties in it. And I get to have relationships with these patients over a period of time. I really like this opportunity in internal medicine. There’s a longitudinal clinic, where people come in over time for follow-up of their conditions.

Interviewer: So it sounds like residency must have felt comfortable for you.

Lisa: It was comfortable in many ways but not completely. I was at the University of Maryland hospital, not far from here. One of the things I found frustrating was that it seemed to me that a lot of the reasons that people were sick had nothing to do with the actual illness they had. It had to do with everything else—where they lived, what kind of job they had, whether they had family support or not, whether they had money or insurance. It was just all these other things that were outside of my control, as a physician.

I’d tell them all these things about how to lose weight, which medications to take for their problem, that they need to quit smoking, all of these things. And then they would tell me about all their other problems and struggles, and then I just thought, “What can I do about all this?” Because of my experiences in Africa, what I saw in the inner city of Baltimore was similar to what I saw in Liberia. There were the same kinds of struggles that people were having.

As a result, I felt like this was the kind of place that I wanted to practice medicine. I wanted to understand more about the rest of the health care system and, outside of the health care system, what people could do to stay healthy. I think that’s what really led me to public health here at Hopkins. Actually, I was on a rotation in the emergency room where I was the medical admitting officer. I was talking to a senior resident who had already been accepted into fellowship. I had heard about people doing different fellowships in gastroenterology, cardiology, endocrine, all of these subspecialties, but there was no single subspecialty that really sparked me. This resident said, “Well, I’m doing a general internal medicine fellowship,” and I said, “There is such a thing?” [chuckles] “What do you do in a general internal medicine fellowship?” He said, “Oh, you learn about research. You learn about public health. You learn how to teach medical residents. It depends on where you want to focus, whether you want to focus on research, teaching or public health practice, but you use your clinical background to inform what you want to do.”

I thought, “Well, that’s fascinating.” It sounded a lot like another program I had heard about in medical school called the Robert Wood Johnson Clinical Scholars Program. By this time, I was in Maryland and was getting married. I didn’t really want to leave the area, and there was no Robert Wood Johnson Clinical Scholars Program in Maryland. Then I found out that there was a general internal medicine fellowship here at Hopkins, which was tied to the School of Public Health. So I thought, “That sounds fantastic. I think that’s what I’m going to do.” When I came to Hopkins, I was interested in public health and internal medicine. I still wasn’t convinced that I was interested in research.

Interviewer: How did that evolve, then?

Lisa: I started out doing the master’s program in the School of Public Health. I started to make connections in my head that, if you want to make a difference with some of these other things that happen outside of health care or even within health care, you really need some of these tools where you can measure and quantify what we’re doing, what people are exposed to, and then how they actually end up faring in terms of their health. I started to see the importance of having the research training and skills in order to be effective at making change.

Interviewer: I know that you started looking at disparities relatively early on in your career. How did you settle on that as your starting point?

Lisa: I think I started there because I felt a connection with the people that belonged to disparity populations. I connected a lot of what I saw in those communities with what I had seen growing up in Africa. I felt like this was a problem that was at the core of who I am and where I wanted to make a difference. That’s really what drew me to it.

Interviewer: Can you tell me about your first few research efforts on disparity?

Lisa: OK. I’ll tell you about some of my missteps and, then, how I got to where I went. I knew that I was interested in understanding how people change their behaviors, so I thought maybe I was interested in weight loss programs. I went around talking to a bunch of faculty who did studies looking at weight loss. I got assigned to this project with one of the faculty members that was looking at the different micronutrients in this food supplement bar and looking at how that related to weight loss. After reviewing some of the literature on that and trying to work on the study protocol for about a month or two, it became clear to me that this was not what I wanted to do [chuckles].

I went back to the faculty member and I was like, “You know what? I like the idea of weight loss, but this is not the part of it that interests me. I don’t really want to focus that much on the molecular mechanisms or the micronutrients that contribute to the fat content in the body or anything like that. What really interests me is more how people think and how they make decisions to change behaviors.”

Then I got connected with another faculty member who is actually now vice dean for clinical research, Dan Ford. He was looking at how depression gets treated in primary care settings. That was a perfect disease or condition for me to get started in because it has a lot of behavioral aspects to it. Depression is influenced a lot by how people think, and there are all these different cultural beliefs that play into whether or not people accept the diagnosis or the treatment, so I liked the idea of working on depression.

I was particularly interested in learning more about how African-Americans saw depression compared to Caucasian Americans, because my clinical experience had shown me that, a lot of times, when I introduced the idea of depression to my African-American patients, they said, “Oh, no. I don’t get depressed.” We had to go through this whole thing where they just didn’t think of what they were experiencing as something that would be related to a mental health problem.

Interviewer: When you started looking at these issues, did you feel that you had support from people around you? Did people understand the direction that you were heading in?

Lisa: I think some people did. I think a lot of people didn’t. I think a lot of people thought that what I was interested in was interesting but too limited in scope. That was a lot of the advice that I got at that point. I was told, “It’s not of general interest. You need to think of something that’s of more general interest across the entire population.” I kept saying, “I think it’s important to understand how something like this, something like culture and race, affects human behavior and influences treatment.”

Interviewer: Did you see these criticisms and concerns as real obstacles at the time?

Lisa: No. I questioned that maybe I won’t be successful or as successful as some of the other people I saw because I’m focusing on this area that seems to be narrow in scope and different. Yet, I felt like it was really who I was and what I wanted to do. I thought, “If I can’t be successful doing that, then maybe this isn’t the place for me,” and then I would make a different decision at that point. It really felt like something that I had to do.

Interviewer: When did you feel like others started to recognize the value in your approach?

Lisa: I think it took a while. I came on faculty in 1994, and initially I focused on the general area of patient attitudes and preferences for treatment of depression, as well as patient acceptance of treatment. I didn’t focus only on minority populations. I studied everyone and then I would compare what I saw in minority populations to what I saw in majority populations.

That’s how I was guided—to keep things broad. I started out that way so a lot of my initial work was just in the area of what became known as patient-centered care. I read about it. It was in a program announcement that came out from the Commonwealth saying we’re looking to train scholars in this new area of health care called patient-centered care. It encompassed things like patient attitudes, patient preferences, satisfaction with care, relationships with physicians, all those kinds of things that I was interested in. My area was patient-centered care applied to minority populations and compared across different ethnic and cultural groups.

I would say it was not until around late ’90s, almost 2000, so maybe five or six years after being on faculty, that the whole focus on a national level began to shift to where people got more interested in understanding these differences in health outcomes and in health care across ethnic groups. The surgeon general actually declared elimination of health disparities as a national imperative.

Interviewer: Were you having a clinical practice at the same time?

Lisa: Part-time clinical practice.

Interviewer: How did you feel that your work in the research arena was influencing your clinical work?

Lisa: It influenced my clinical work, for the most part, just because I began to think more scientifically about the problems that I was seeing in my patients. For example, how would you categorize that kind of problem and how would that impact a patient’s adherence to treatment? What are the kinds of resources that we would need to address that particular problem?

I started thinking on a more broad scale, not just for this individual patient in front of me but for all the other people in the country who are like this. What kinds of things would we need to do? While always thinking about the individual patient in front of me, because that was my clinical training, my public health training made me constantly think more broadly. I thought, “How many people in Baltimore are dealing with this same problem? How would we address this or how do we know how important this might be in terms of depression outcomes in Baltimore?”

Interviewer: For you, it truly seems that clinical medicine and science are so carefully integrated that they really fuel one another. I would guess that you’re probably a better clinician because of the science you’re doing, you’re probably a better scientist because of the medicine you’re practicing.

Lisa: For sure. Almost all of my research questions are informed by something I’ve seen in the clinic or that my colleagues have raised.

Interviewer: As you and your work gained more prominence along the way, and this issue grew more national in scope, did you personally feel that you were being innovative?

Lisa: Not really. I never really saw myself as being particularly innovative. In fact, early in my career I was actually worried that I was not going to be able to carve out a niche for myself. I would read all these papers, all these journal articles, and it seemed like somebody had already thought of a lot of the things that I was thinking about. I wondered—what can I do that’s different or that hasn’t been done already?

I realized, over time, that even though people might have thought about similar things, they didn’t make the connections in the same way that I was making them. That was how I could contribute something new or different. Because of who they were and who I was, we would see the problem in a different way.

Interviewer: Now that you’ve been at Johns Hopkins since 1994, what would you say was the most important development in your career along the way that brought you to where you are now?

Lisa: It’s hard to pinpoint one particular thing. The first thing I would say is that the people that I got connected with, my colleagues and the scientific networks that I made here, were very important. I think that having the School of Public Health, which is very close to the School of Medicine, and having people with different kinds of expertise in behavioral science, health policy and systems research, epidemiology, and biostatistics really strengthened my ability to address the questions I was interested in.

I think one of the things that happened in late ’90s, right around the millennium, was there was an RFA that came out from NIH calling for large proposals that would create centers to study racial disparities and try to identify some promising solutions. I was really excited about this. I was still an assistant professor, so I couldn’t lead such an effort, but I could be involved in leading one of the smaller projects within it. It brought together people from all over the School of Medicine who had interest in this, as well as people from Public Health and Nursing. We all came together and crafted this proposal that had all these different pieces of these different populations that we were going to study, how these different problems affected minority populations.

Our proposal didn’t get funded. I was devastated because I felt like I was starting to be seen as a leader in the area, yet still my work didn’t get funded. Other centers and people actually got funded, and I was being asked to be a consultant on other people’s projects. I thought my career was over almost at that point. Fortunately, a few months later, there was another RFA that came out which was more focused on cardiovascular disease because of the huge burden on the population.

After thinking about it, I realized that a lot of the things that I had thought about in terms of depression could actually be framed differently and applied to hypertension because it wasn’t a disease-specific issue. The issue of attitudes towards treatment, preferences for treatment, communication with health professionals, and so forth, all of those things applied regardless of the specific condition. I reframed my study in terms of looking at people with hypertension, and applied to the National Heart, Lung and Blood Institute. It became funded! I think that was really when I felt like I could take a deep breath.

Finally it seemed like my peers on a national level understood the importance of what I was trying to do and that I was now going to have an opportunity to develop an intervention that could maybe identify some sort of a solution to part of the problem.

Interviewer: It is now more than a decade after that funding was granted to you. How do you feel that things have gone for you?

Lisa: I think things have gone phenomenally! I could not have anticipated the level of enthusiasm and focus on this particular area that has happened. I was blown away. At the time that I initially started doing this, it was called minority health. It wasn’t even really called disparities. Disparities research is so much of a national focus now. It not only applies to minorities but to other groups. Gender, geographic location, sexual orientation, income, health literacy, etc., are all topics included under the focus of disparities.

People are starting to see that this problem is something that cuts across so many different populations, and that there are so many common themes and things that we can learn from the way that we study these problems.

Interviewer: What role did creativity play for you in your work?

Lisa: I would like to think that it played some role. When I think about some of the things that I’ve done, I don’t feel that they were something completely brand new. But I think my work put together the pieces in a way that they hadn’t been put together before. For example, some of my mentors had studied a particular thing. One of my mentors is an expert in doctor-patient communication. But she hadn’t really been focused on how race, ethnicity, and culture affect doctor-patient relationships. I think I brought that lens to the problem for her. Some of my other colleagues had done work with community health workers in the inner city, going out to people’s homes and providing health education to them. Because of the interest that I had in improving doctor-patient relationships and improving health care quality for minorities, we thought that maybe we could bring these community health workers into the health care system and actually have them coach patients to be more effective at communicating what their concerns and needs are.

So we bring together different pieces of things in a new way. I don’t know if it’s completely brand new. I think creativity is actually increased by having diversity of perspectives. So the fact that we came from different backgrounds in terms of our training, where we grew up and things like that, people on our team could just contribute all these different ideas that actually would end up making the final product something that was completely new.

Interviewer: One form of creative thinking really centers on insight. There are a lot of pieces there, and it’s seeing the solution as to how to reorient the pieces so that clarity emerges out of confusion or something meaningful emerges from a jumble of information. It seems to me you had, and have, the insight to recognize exactly what’s in front of you. Do you feel that there’s been anything in terms of being at Hopkins that has made things more difficult?

Lisa: Because we have to work so hard to support the work we do, sometimes it is hard just to actually find the time and the space to think creatively or get together with other people to talk about ideas. We can just get caught up in having to do what we have to do to generate our grant funding or to get our work completed and our papers published. So I think it’s tough in that way, that there’s not a lot of support that is already there that you don’t have to be working for. Sometimes worrying about where the next funding is going to be coming from detracts from your ability to actually focus on the scientific things that are of interest and to follow up on those ideas.

Interviewer: I think a lot of faculty members share that sentiment. So where do you see your work headed next? Any new work that you find particularly exciting?

Lisa: Most of my work up until the last few years was really focused within the health care system. I had gotten very focused on the doctor-patient relationship. So I started out with this big public health perspective and then talked to patients and then found out what a lot of their concerns were. One of the really top concerns that people raised were relationships with health professionals. So then I dug really deep into studying the relationships and the communication on a visit-by-visit level, and I felt like I was on this microscopic level examining the doctor-patient encounter. Now I feel like I’m broadening back out again. Now that we’ve distilled what some of those problems are and tried to come up with some solutions for them, we realize that those visits take place in the context of this whole bigger system. We have to back up again and say, “Now why would doctors not spend as much time talking to minority patients?” or “Why would they dominate the conversation?” It could be something about that individual patient or a clinician, but it could also be something about the way the clinic is organized or the way the resources are allocated to certain types of services for the patient.

So now we’re looking more at systems-level interventions and then also working with communities and also with payers, more of what we call an ecological approach, because if you identify a solution that doesn’t resonate with the people who come from that community, how long can it possibly last? Or if the health system doesn’t really see the value of it and no one’s willing to pay for it, then you’ve done a great study and you’ve provided evidence, but in the real world it doesn’t serve any purpose. I’m excited about the fact that the work is hopefully having more of a translational component to it. Not just translation from bench to bedside per se, but from bedside to populations and to policy. If we show that something really works well within a health care system, will the policymakers then decide that this is something that is important enough that it should be either paid for or incentivized or rewarded in some way?

So that’s the kind of work I’m doing now, and then I’m also seeing how what we do here in Baltimore and in the United States relates to what I’ve seen in other countries. I’ve done more traveling and learning about health care systems in South Africa, for example, and in Cuba, learning about how the primary care delivery system actually works so well there. Hopefully this will also be a two-way learning process. Whereas, I’m learning about what works well in their settings and maybe applying some of that to our underserved settings here in the States, I would also like to share some of what we’ve learned here with people in those countries and maybe partner with them to do more international research.

Interviewer: That all sounds really ambitious, fascinating, and critically important. Have you been back home?

Lisa: I had not been back home for 25 years, until I went back three years ago for the first time. The reason I hadn’t been back home was because of a lot of the political unrest and the civil war there. But I did finally go back home and connected with some people there. I think it’s going to take some time for the country to come back from the war and the economic deprivation in order for us to really have an opportunity to make some changes there. But I’m hopeful that I’ll be able to go back and to contribute to some of those efforts.

Interviewer: Is there anything else that I haven’t asked you about or anything else that you’d like to add that we haven’t covered?

Lisa: I had been thinking a lot about how things like creativity and innovation are not always purposeful. A lot of times it seems to just be fortuitous, or it seems to be like serendipity that you just happened to be somewhere where you heard this little tidbit of information, and you made a connection with something else that you read or heard about. A lot of times it’s not even on a conscious level because sometimes it’s more like you just have an instinct. Something about it sounds interesting, sounds related to something else that you’ve wanted to know more about. You don’t really even know exactly what that is yet, but you just go with it. Then the ideas seem to crystallize over time.