Sarah Sternlieb, a current internal medicine resident, had a circuitous routeto medicine, but gained a great deal of insight with the aid of mentors and the disability community. In this interview, Dr. Sternlieb recounts her positive experiences in medical education, the difficulty with assumptions and stereotypesin medicine, and provides advice for learners with disabilities.
Sarah Sternlieb, MD, FIrst-Year Internal Medicine resident Ochsner Clinic Foundation
Episode 10, Transcript
DocsWithDisabilities Podcast #10
Dr. Sarah Sternlieb
Introduction: Lisa Meeks
Doctors with disabilities exist in small but measurable numbers. How did they navigate their journey? What were the challenges? What are the benefits to patients and to their peers? What can we learn from their experiences? My name is Lisa Meeks and I am thrilled to bring you the Docs with Disabilities podcast.
Join me as I interview Docs, Nurses, Psychologists, OT’s, PT’s, Pharmacists, Dentists, and the list goes on. I’ll also be interviewing researchers and policy makers that ensure medicine remains an equal opportunity profession.
Welcome to the Docs With Disabilities podcast -- our 10th episode! In this episode, I was so lucky to be able to chat with Dr. Sarah Sternlieb, an internal medicine resident with a passion for maternal-fetal medicine and disability inclusion. Let’s listen or read along as Sarah shares her experiences as a person with a disability and tells us about her journey to becoming a doctor with a disability.
I was born with an unknown neuromuscular disability. So I wear leg braces on both legs and use crutches to walk. I have a little bit of hand weakness in certain muscle groups in my hands that I compensate for by holding things slightly different at times.
I always knew I wanted to be a doctor. I didn't get in right out of college, so I went to graduate school. When I started meeting with some deans of admissions of different medical schools, that's really when I started to realize that there were going to be barriers that I didn't anticipate. Some deans would comment that they were unsure that I could meet the technical standards and that I really needed to read through technical standards and think again before I applied to medical school. And that's really when I realized, okay, this is not going to be as easy as I thought it was going to be.
You walk into a room of co-residents, of attendings, physicians in general, and I definitely feel like everyone is staring at me and I'm very much different than everybody else. However, I have not once walked into a patient room and felt that at all. I don't ever feel that sense of shock from a patient. Sometimes there's a little bit of, you know, a patient at the end of our interaction will say, “I don't mean to be rude, but do you mind me asking what happened,” things like that. But I've never felt that same amount of judgment or assumption from a patient, just from other colleagues.
Given Sarah’s encounters with admissions deans, and their assumptions that she might not meet technical standards, I asked her, had she ever been concerned about meeting these entry and promotion criteria? I also asked Sara about her experiences with receiving accommodations in medical school.
I had never even looked into the technical standards before these people said that to me and pulled it up and thought, well, this is not that intense. You know, medical students are not expected to really do that much in terms of physical labor.
Ultimately, where I went was to Tulane University in New Orleans. And in terms of their support, it was very clear that they were very much there to support me from the beginning, which is why I ultimately chose that school. They had previous medical students with physical disabilities and really demonstrated the commitment they had to supporting students with and without disabilities.
Dr. Mark Cahn:
My name is Dr. Mark Cahn, and I'm the senior associate Dean for admissions and student affairs at Tulane University School of Medicine. Over the years, we have accepted a number of students and graduated a number of students with physical disabilities. Students with disabilities really add greatly to a medical school class. Diversity is important, and folks with disabilities certainly provide a unique perspective. Sarah's really a self-starter and somebody whose drive is almost unparalleled and knew she was destined to be successful.
When students with physical disabilities are in a class with students without physical disabilities, I think in many ways teaches them to be more empathetic. I think that they also see that these students at the end of the day have a physical disability but aren't much different than they are.
It was hard to make the determination of what accommodations I would need beforehand. So it was a constant open line of communication that I had with the rotation clerkship directors of each specialty, but also the dean of my school. I really had to begin their rotation with an open mind and understand that there were going to be things that would be difficult for me, and I would have to figure out is this something that I can modify myself or is this something I need to talk to the program clerkship director about. But it was, I think just not being afraid to speak up if my team was walking too quickly on rounds. So something like that can be very intimidating as a medical student when you feel like you're really just following everybody and not an essential team member. To say, you know what, y'all are walking a little bit fast for me. I can't really keep up. So you know, things like that. But in general, I think that I was able to keep up with the rest of my class and kind of stay right in the middle of my class.
I think because I've come so far from the very timid first, second, third year medical student at this point. In the beginning, especially early third year when I'm just starting to be on rotations with residents and attendings, very often people just walk to the stairs without thinking about it. And initially I would follow and I would struggle and I would very slowly walk up or down the stairs just to stay with the team. But within a couple of months, probably of third year, I started to realize that there's nothing wrong with me saying, “Hey, I'm going to meet y'all on the third floor. I'm going to take the elevator.” And from that moment on, I really didn't have a hard time saying that. I did find that a lot of the teams, I would say that once or twice and that team would then remember themselves, and the next time we rounded, the attending would say we're all going to take the elevator. So it's become very much a non issue for me because I've just, I'm not gonna walk up and down the stairs if I don't have to. And you know, if that means I go to the elevator alone and meet my team on a different floor, then that's fine.
It definitely has been a process of not getting upset over little things like that. When I would try to keep up with the team that was walking too fast and I wouldn't say anything, I would be exhausted. I would be, you know, short of breath when we stopped to a room to present to the attending. I would be more likely to fall if I'm walking very quickly and not comfortable, and it would end up stressing me out. I was unable to present to the attending at the level that I knew I was capable of. So everything suffered when I wouldn't stand up for myself. So when I started to realize that I just need to do what's best for me and if that makes me stand out, so be it. My disability is not a secret. Everybody can see my braces and my crunches and if I take the elevator or if I take the stairs, that doesn't make it more or less visible to everybody. I'm just more likely to fall and hurt myself or really struggle if I don't do what I need to do.
The archetype of a physician is very well-ingrained and almost super human. For medical students with disabilities, it can be difficult to marry this identity as a person with a disability and that of a physician. Sarah and I discussed this disconnect and how she eventually embraced the intersection of these two sides to her identity and how it influences her relationships with her patients.
So, in terms of evolving into my own identity as a physician as well as physician with a disability, I think initially I was just trying to feel like I knew what I was talking about well enough to sound like, “Oh, I could be a sense of authority in terms of being a physician.” But what really helped me to develop my sense of being a physician with a disability is the patients. So once I started interacting with patients in my third and fourth year, I think a lot of things changed for me. The reaction patients had to me really helped me to realize that being a physician is great, but being a physician with a disability is really a spectacular thing that I really want to show patients that you can be a physician regardless of a disability or something that makes you different from other people.
Patients would stop me in the hallway and say such nice things to me about like, “Oh, I have a family member who's paralyzed and I'm going to go home and tell him that I met a doctor with braces and crutches today. And just the way that patients reacted to me and seemed to bond to me in a way that they didn't with a lot of my classmates and my attendings just because of that sense of the patient knew that I knew what it felt like to be a patient, whether or not we had anything similar medically. It was very obvious that I understand what it means to be a patient. And that connection with the patients is something that really allowed me to develop into a physician with a disability and that be who I am.
When I first started medical school, I was very interested in several areas of pediatrics and I thought nothing would change that for me. Not a chance. When it was time to start third year rotations, I put OBGYN is my very first rotation with the thought that I want to get over it, I want to get through it, I want it to be done and I want to do it at a point in the year where nobody expects me to know anything. Pretty quickly into the rotation, I realized how much I loved it. I really loved the obstetrics side of things. I love labor and delivery, but maternal fetal medicine stuff in terms of high risk pregnancies, managing those high risk pregnancies. That specialty I was really drawn to.
It's obviously one of the most physically demanding specialties. So it was a difficult, you know, third and fourth year of medical school really deciding is this something that I can and/or want to pursue was a very difficult decision.
All my mentors, very unsure if I would match into OBGYN. Nobody really had any experience with the situation of somebody with a disability really wanting to do a very demanding specialty. Definitely there were lots of physical challenges, many of which I was able to work around, come up with different ways of doing things, just getting used to a very busy schedule and being on my feet a lot more than I was used to. The program was unfamiliar with working with a resident with a disability, which I know that would have been true for all almost any residency program. But it wasn't a program that was really well-equipped to help me to come up with alternate ways of doing things along the way.
At the end of the day, my program director was very straightforward with me and our communication throughout my time in that residency. You know, he knew my long-term goal was maternal fetal medicine. Ultimately not really operating a lot, if at all in the future.
And in discussing this with the program director, he would say to me, “What do you think? Do you think that you're capable X, Y, Z?” And my response was always, “I don't know. I don't feel like I've been given much of a chance to learn X, Y, Z, or to actually do X, Y, Z. A lot of the attendings would not feel as comfortable with letting me do things in the operating room. And then I felt as if I was judged on doing something once or at times evaluations were written that said I couldn't do something that I was never given the opportunity to actually try. So I think it was just a discomfort in the operating room with my instructors. It was becoming more and more stressful for me every night to go to bed, preparing for a case the next day. It wasn't what I wanted to be doing. And ultimately, we decided another direction would have been a better choice for me with my long-term goal of managing high risk pregnancies.
I definitely felt like it was the end of the world when my program director and I sat down and made the decision that I would not go beyond the second year of residency in OBGYN. So I completed the first and second year. I couldn't imagine doing anything else. There were many months after that when it was probably the lowest time that I have had probably in my life. I really felt like I didn't want to be a doctor anymore if I couldn't do what I wanted to do. I don't want to be a doctor just to be a doctor. I want to do what I'm passionate about, which is high risk obstetrics, and I didn't know how I was going to do that if I couldn't get through the OBGYN residency.
So I had a mentor who was affiliated with the program I was at, also owned her own private practice, maternal fetal medicine group in the city where I was living, who really took me under her wing and reminded me every day that I still have the potential to be very involved in maternal medicine and that OBGYN is not the only way to get there.
Dr. Cornelia Grave:
My name is Dr. Cornelia Grave, and I'm the director of perinatal services for St. Thomas Hospital. I first met Sarah when she came as a first year resident. She was part of our first class of residents at St. Thomas Midtown. The thing that really struck me about Sarah immediately was her intellect. She was always very inquisitive and thoughtful about taking care of patients. She automatically drew herself to the maternal fetal medicine practice and expressed that she wanted to be a maternal fetal medicine specialist.
There are many obstacles that we have to overcome in life, so I immediately took Sarah by the hands and said, absolutely not. You've gone to medical school. What do you mean you don't want to be a doctor? And there are plenty of other ways to serve women. And so we began to look at other options. Okay. As I said before, I've always admired that Sarah was really very bright. And so she began to round with us almost exclusively on the service. So over time, I began to map out a plan for Sarah to still be able to do maternal medicine because I felt like that that's what she really loved.
It was really this mentor who pulled me up off the ground and said to me to stop feeling sorry for myself and to come up with another plan. She found for me a fellowship program in obstetric medicine and I had never heard of that before. It's not very common. It's not a boarded fellowship. It's an internal medicine fellowship. So you would do three years of internal medicine and then a two year obstetric medicine fellowship. There's only one program like it in the country. But when I went to the website and looked at the description of the program, it's exactly what I want to do in every way. If I had written down my exact career goals and long-term plan, this fellowship matched it perfectly.
So finding that fellowship really helped me to pull myself off the ground, stop feeling sorry for myself and reminded me that I do want to be a doctor. I don't just want to stop because I can't do what I want to do right now. By that point, I had spent so long trying to decide my next step, I didn't want to jump into it. So I reapplied in internal medicine and ended up matching at an internal medicine residency program.
I reached out to the fellowship director of the obstetric medicine program right away when I first learned of the program and spoke to that fellowship director. And he said to me, “You know, Sarah, this sounds like a perfect, perfect program for you and you will be the only internist who has also been in the shoes of an OBGYN.” He said, “the other fellows we have don't understand what it is to think like an OBGYN, but you'll have an experience that many of them will have.” So those two years, while they were two of the most trying years of my life, ended up being extremely valuable to my career.
Mentorship has been probably the most important thing in my life. Every step of the way. So medical school, I still am extremely close with maternal fetal medicine physician, Dr. Gambala, who really had a big influence on my life at a time when I was deciding, do I want to apply to these OBGYN? Is it something I can do or not? And she's been an incredible source of support. When I moved on to my OBGYN residency, there were several of the MFM physicians within one practice. So, you know, certainly Dr. Connie Graves, who was the person who really helped me to map out the path that I was going to take after I left OBGYN residency. And then of course, Dr. Hilary Tindle in research. So having a really solid mentor at every single step along the way has been something that really meant a lot to me, which is why at this point, if there's any way that I can mentor or help guide or even just be there to support a student going through any of the things that I went through, I am very excited to do that.
And you know what's funny is we had a simulation the other day to learn how to place a central line. And when it was my turn to go through the steps with the mannequin, I felt like I was fumbling a lot and just felt like I really wasn't doing a great job. And I left feeling like, ah, I was okay, but I just don't feel like I did a great job. And you know, at lunch that day, my chief resident came up to me and said, “Sarah, you really did a great job today with that simulation.” And I left work that day and called my mom and I said, it's just funny because I'm so used to being evaluated from the standpoint of a surgeon. I'm just very hard on myself because of those two years. So to feel like I didn't do great, and then that chief resident to come up to me and say, “You did a great job,” it was very strange to me. It's still something that is not settling with me because I can't imagine that that is considered a good job.
As we concluded our interview, I asked Sarah what advice she would give a learner in the pipeline hoping to enter medicine with a disability?
I would definitely say… so it's scary, right? You don't know, especially with any sort of limitation, how things are going t o be different for you than they will be for other people. I think it's important to keep your mind on what you want at the end of the day. Going after something, even if that goal seems to be unreasonable. I think if I hadn't have attempted OBGYN, I would have always regretted it. Right? I would have always thought, man, I really loved it. What would've happened if I had tried? So I think that anybody, and this applies to someone with or without a disability, especially in medicine, you have to go towards what you love, what you're drawn to, and once you're in the clinical world of medicine, something will likely speak to you. And I think it's important to continue to really go after that goal, but then also to realize that when things happen unexpectedly, when it doesn't go as you had planned, it doesn't mean you can't get to that same end goal. You have to take a step back and really think about, well, this is not what I wanted, but how can I go about this in a different way to get where I wanted to be still. It's easy to be angry that it didn't work out, but that really doesn't help me in any way. And that doesn't help any student or person get where they are going. In terms of resources, I think it's critical to align yourself with really solid mentors and sources of support at every step along the way. The people in my life that mentored me, that I mentioned already, I don't think I would have gotten through everything. I don't think I would be where I am right now without each and every one of those people that really had a huge influence in my life. So I think that that is one of the most important things, is having people in your corner, but also speaking up for yourself and telling people when you need something, when something is hard, when you need help with something. There's no shame in that. I just think you have to be very upfront about what you want and what it's going to take for you to get there.
If you don't ask, you're not hurting anybody else. You're just lessening the potential that you have to become better. Right? So if I don't ask people just slow down the rounds. I don't hear when people are presenting, I'm not paying attention because I'm too out of breath. I'm not learning, right? And that doesn't hurt anyone other than me. So asking for accommodations is ultimately for the sake of making you better. So I think it's so important, and that's not something that I realized right away at all. It's hard with the imbalance in power, especially in medicine where you know, as a premed and then as a med student, even as an intern, you just feel like you are on the very bottom and who are you to ask for anything. Right? But if you know you've gotten to that point, you deserve to be there and you deserve every opportunity to be successful. If that means accommodations, then that's fine. That's what you need to be your best. And when it's hard to ask for those things directly, right, you need to have a person that you can go to that can help advocate for you if you don't feel like you can advocate for yourself. And that's often very easy to do. You know, when I interviewed for med school, the person who interviewed me at Tulane became one of my biggest advocates for all four years in med school. She expressed to me how it was important to her to have more disability representation within medical school. So right away I knew that I could go to her if I needed to and she could advocate for me. And I think finding that person, whatever stage you're at to help you advocate for yourself is so important. And there will always be someone, even in a situation where it seems like there's nobody there will be. You just have to look for it and ask people, ask them to help you.
We would like to thank Dr. Sternlieb for sharing her journey and to all of you for listening and reading today’s episode of Docs With Disabilities. Stay tuned as we ring in the New Year with our next episode, coming out in January 2020. From the Docs With Disabilities team, we wish you a wonderful holiday season and a happy New Year!
This podcast is a production of the University of Michigan Medical School, Department of Family Medicine, MDisability initiative. The opinions expressed in this podcast do not necessarily reflect those of the University of Michigan Medical School. It is released under a creative commons, attribution noncommerical, nonderivative license. This podcast was produced by Lisa Meeks and Kate Panzer.
*This podcast was created using excerpts from the actual interview and is representative of the entire conversation. Interviewees are given the transcript prior to airing. Some edits may reflect grammatical and syntax adjustments for transcription purposes only.