Michael Argenyi, MD MPH MSW, is a physician specializing in the intersection between clinical medicine and public health, furthering HIV/STD prevention and treatment. He aims to infuse evidence-informed practice with an anti-oppressive social justice framework. The second part of this interview will be released in January 2020.
Dr. Michael Argenyi, MD, MPH, MSW, Preventive Medicine Resident, University of Massachusetts
Episode 6, Transcript
DocsWithDisabilities Podcast #6
Dr. Michael Argenyi
Part 1: Testing Resilience
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.
This past summer I had the privilege of meeting up with one of my favorite people and my friend, Dr. Michael Argenyi. We met in Boston, and during our 3 hour conversation, we talked about everything from medical education, to clinical practice, to the impact of being a physician with a disability on the healthcare system at large. Our conversation was so rich in information that you, the audience, will hear it in two parts. This portion of the interview focuses on Michael’s path to medicine and his experience so far. In this portion, Michael also offers sage advice to students in the pipeline.
Let’s talk about your educational experience across the continuum. I'm curious as a person that has hearing loss, when you thought about applying to medical school, did it ever seem like there would be complications, like this wasn't possible?
When I was applying to medical school, no, I never really thought that it wouldn't be possible. It's funny because I had a conversation with other people that I was going to apply, and my father said, "Do you think you can do that?” And I just looked at him. And I said, "Yeah, I think I could do it. I don't know that I have all the answers for everything, but I think I can figure out how to do it."
Part of the reason I think I was so optimistic is because I had already connected with the Association of Medical Professionals with Hearing Loss, and I had met Chris Moreland and several other physicians at that time, so I knew that they were going through residency and fellowship, and some were even practicing. I saw that they were in different specialties, so if they had done it, why couldn't I? So I didn't really see it as a challenge. I just didn't necessarily know what the answers were going to be for accommodations at every step of the way.
So, you apply to medical school, get in, and disclose that you're deaf, or that you have hearing loss.
At the time, I called myself hearing impaired, yes.
Okay, tell me about your experiences. What did you expect? What did you not expect?
Medical school for me ended up being, rather, a journey. The institution and I disagreed about the types of accommodations I needed, so I ended up having a seven year process instead of a four year process through medical school so that in and of itself created some barriers to my experience. The beginning, things were, kind of, as expected. I figured, you know, I'd sit in a lecture room, I'd listen to lectures all day long, you know, they'll show the slides, they'll talk about things.
One of the challenges that I encountered almost immediately was anatomy. That was a challenge on two levels. One, they would teach us different things about the anatomy while showing a slide.
So they would point at a structure, usually with a laser pointer, and this while I'm reading a captionist transcription meant that I didn't necessarily see the pointer in time to make the connection between the information. So, those lectures in particular were a little bit more challenging. I had to figure out strategies, which basically meant a lot more time with Netter's anatomy book.
The other challenge that I didn't quite expect was the anatomy dissection lab. And this is just an environmental set up that just happened to be really unconducive to a student with hearing loss. We went down to the lab room, and it ended up being a concrete basement room with about 20 different bodies and about four to five students per body. So, the space in between bodies is probably five feet, at the most, and we've got scalpels going, we've got bone saws going, we've got all kinds of conversation going.
I mean 20-30 different conversations in the same room, and it was so difficult to understand anything going on. Add that to the expectation that we'd be identifying these, new to us, anatomical structures during the process of it. You're trying to balance the attention to the educational process that's going on, but also pay attention to the communication that's forming the social bonding of what medical school is supposed to look like.
Most people, by the time they leave medical school, have these incredible friends that they will follow. No matter where they end up for residency, they'll keep in touch 20 years later. Because I didn't necessarily always have accommodation, I think I missed out on some of that social bonding that happened during the first few weeks of medical school,    and also because I had a longer journey, I didn't graduate with the same students that I started with.
I'm so glad you said that, because I see that across the board, no matter what category of disability that's happening, a student misses out on the social experience. A student with a learning disability is at home reading, it's taking twice as long to prepare their notes. They can’t go out for that beer or social hour with friends. The individual that has a chronic health condition is trying desperately to avoid a flare, and so, you know, this regimented sleep pattern, they have to go to sleep at eight o'clock ,they have to get all their work done before they go to sleep.
A student with a psychological disability, maybe anxiety, is working hard to manage the anxiety that comes along, to some extent, with a lot of medical students, but more so for this person. So in an effort to manage their anxiety, they might be going to extra therapy sessions at the beginning of medical school, or running.
They're making sure that they mitigate the effects of their disability, and that takes time usually. Time is kind of the constant in all of these categories, but they're missing that social interaction.
But for you, you could be missing that social interaction even if you went to the event, right, because you're in a noisy establishment, or you're doing an activity where there's lots of competing sounds. So even if it's not particularly noisy, it's still hard to differentiate, you know, the voices. So you're missing the opportunity to connect on that level.
But now, you're in a classroom where it should be an easy bonding experience, and you're still missing the opportunity to bond because of the multiple conversations that are happening around you. W hat could have happened differently that would have allowed you to engage with your colleagues?
I did bond with my anatomy group, I think some of those things just may happen more slowly. It would have been a challenge for an interpreter too, because even in that situation it's noisy, and they would have trouble hearing as well. Honestly, in that specific situation, I think the best answer would have been a completely rebuilt, state of the art anatomy lab. Not likely to happen.
I’m thinking about schools that have state of the art, new anatomy labs. I know a lot of the anatomy labs have screens over each cadaver with an adjustable magnifier perhaps, that would then project onto the screen so that you can see things more clearly.
Yeah, we didn’t have that.
What I’m wondering is if you had captioning, if that would have assisted. I’m thinking maybe for instruction, but when you have multiple conversations going, that would be difficult.
I think some situations are inherently difficult. And ultimately a lot of that goes to the fact of, are you willing to speak up to your colleagues and your classmates when you miss out on things? Are you willing to be vulnerable? That's hard when you're in a new situation, and you're around new people, and you don't necessarily know their level of receptiveness, or you don't know whether the institution as a whole is inclusive and open-minded. If you're in an institution that has made it a priority to open doors for you, then I think people with disabilities, or even just anybody who is marginalized for whatever reason, are more likely to be open about their needs to feel included. Maybe I would have been more willing to have spoken up to my classmates and say, "Oh, what was that joke again?" et cetera. Again, we did bond, but how much I felt empowered to speak up, I'm not sure.
The transition for anyone from UME to GME. If they say UME is like trying to drink water out of a fire hose. I don't know what the equivalent metaphor would be for intern year. I don't know anyone who would describe their intern year as well balanced and delightful. I think most people survive intern year. It's a time of a lot of growth. You're learning a lot. You're experiencing a lot. At the same time, it's hard. It's hard on the body, it's hard on the mind. Then when you add disability to the top of it, I think that in my experience, the people I’ve worked with have had to adjust. Even if the accommodations worked really well, there's a period of adjustment. And at times I have had learners who went into a specialty and said, "This is just not the right place for me." And I'm wondering how your experience was either parallel to that or not, and what you found most difficult about the transition to residency as a person with a disability.
I think I've always been kind of a different applicant in medical school than a lot of my peers. I enjoyed the bedside care that I did as a nursing assistant. But, I came into medicine already very public health oriented. I thought I was going to do global health to be honest. That in and of itself shifted over the years, but I have always, probably in part because of being both deaf and also queer and gay, I've always had kind of an eye on the social impact and social justice potential of medicine. I saw medical school as the ability to get a deep, broad understanding of clinical care, and then be able to use that in different modalities. So that's how I came into medical school.
My drive to find a specialty that tended to be social justice oriented, meant that I applied into family medicine, because that's where I could see LGBTQ people, that's where I could work in HIV, that's where I could see deaf and hard of hearing patients, and that's where I could move to an urban center where I think people still need providers. So I applied to mostly urban programs. I ended up at Erie, in Humboldt Park, which is affiliated with Northwestern University, and it's a wonderful program.
When I started residency, I carried over a lot of the same types of accommodation, mostly interpreters for me, and I had a wonderfully supportive program director who advocated for me to have the same access. They were one of the few programs that actually asked if I needed an interpreter for my interview during residency.
That's really nice.
It was very nice. That kind of message to me, even if it's not necessarily necessary, just sends a very strong, positive message. Family medicine residency in a resource limited, heavily Spanish speaking program, ended up being challenging. I had a couple unanticipated challenges that year. The big one being that the two people I hired as my interpreters, who were hired specifically because they could provide bilingual access, i.e. they knew Spanish, or they were able to provide some kind of access in Spanish, both ended up being hospitalized in October of my intern year.
So I went from two to none. November, December, and January were three inpatient months back to back. I ultimately hit the point where I said, "This isn't working for me. This is not the right program, at the right time, in the right place for me," and I made the decision to leave.
My program offered me the idea of trying some elective months to see if I could reduce the level of, what I now recognize, was burnout and, probably depression. They offered the idea of extending residency and going part time, so they were actually very willing to do something different. I said no, because I had already had a delayed medical education, and I preferred not to delay even longer. The other major deciding factor for me is I also realized I did not want to be just an outpatient or inpatient clinician full time.
I had discovered preventive medicine when I was third year medical student, found a training curriculum, and I thought it was an incredible fit. So, when I decided to leave, I started looking at preventive medicine again, and I decided that that's what I would do and I would pursue that direction.
First of all Michael, you know, you are, to me, evidence of what resilience is. You are a very resilient person, you have had to shift, whether it be in your undergraduate medical education program or in residency. You've managed to pivot, and pivot beautifully. Now you're in a position where, despite all of the barriers that were presented to you, you are where you are supposed to be it sounds like. You seem very happy. You look very happy, and I’m so happy for you. I don’t know how many people could have met each roadblock with the grace that you have, and with the plan B. You had a plan B and a plan C, and along the way you’ve collected a few extra degrees which we didn’t get time to talk about. But you’ve done a great job, and I’m so happy that you are where you are.
And yet I'm thinking about the person at the beginning of the pipeline, maybe even in high school. Maybe they haven’t even gotten remotely close to the entrance of the pipeline for medical education, or nursing education, or really any health science education. And they have hearing loss and they're thinking, "Is it possible for me?" I’m sure, much like what you thought when you engaged with AMPHL and engaged with Chris and with Mike and with others to talk about their journeys. This new person that’s hoping to come to medical school is wondering, how can I avoid some of the landmines that were present for the people who went before me? How can I navigate more swiftly through the process? I know some of that has to do with where you land, and that’s not always up to you. Medical school is very competitive, and people are applying to multiple, multiple programs. So, part of it is something you can’t control. But for the things that you can control, what is your advice to this new person hoping to enter this profession and succeed?
I think there are a ton of things that one can do, and you're right some of it does depend on where you land, and it depends on what kind of community you come from. I have to confess my privilege every time. I have a great mother, and I identify her as a resource every single time I can. She's been behind me, but not only that, she has the income to be able to support me through much of this. She has the access to education that has supported me through much of this.
I think everybody should be able to identify a few people in their lives, or they should be able to go out of their way to find people. And for me that also became evident when I figured out I was gay. I had to figure out friends who were fine with me being gay. Because not everybody necessarily in my relatively conservative, suburban, Seattle neighborhood was all that great with gay people. Most of them were, but a few people weren't. The same kind of strategy that I figured out when I was just navigating, coming out as gay and queer, also applied to navigating a new space as a deaf person.
Who are my people? Who is willing to take the time to sit down and have a one on one conversation to me? Who is willing to repeat the joke when I missed it the first two times? Those kind of things. Who, even if they're not deaf and hard of hearing themselves, kind of gets it?
Are there organizations for deaf and hard of hearing people who get it? For me that was AMPHL, the Association of Medical Professionals with Hearing Loss. There have to be people who at the end of the day, or at the end of a long week, or after you just have a frustrating experience, maybe not even because of communication or hearing loss, you can open up to and talk to .
I  felt relatively isolated in my school because I didn't want my school to be my classmates' experience of medical school. I don't know if that was the right decision, but I didn't want it to be, which meant that I didn't open up to them about the challenges I was going through. And that meant I relied a lot on my original friends from Seattle, my outside friends in the gay community in Omaha, to talk about things that were going on. Not even necessarily related to school, but just emotional well-being in general. Ironically when I took time off from medical school and I pursued my other studies in Boston, I also realized what life was like on the other side of the medical curtain so to speak.
Medical school and residency demand a lot of sacrifices, and after a few years away, I think I was maybe less willing than some of my peers to make those sacrifices. Which probably also influenced my decision to change to a residency program that was better suited to what I wanted in work life balance.
Even though my journey was longer, I credit that time away with teaching me a lot about being a working adult, about how to incorporate different aspects of my life into medicine, about what I wanted to do with my medical training, and I also credit the other people in my life. Other residents who have also been older, who have entered as a second career, with teaching me those kind of lessons.
Other things are to look back at your educational history and think about what has worked for you. Medical school and PA training and nursing school all present situations you may have never encountered before, and that's okay. You might not have all the answers. I didn't have all the answers. However, it goes a lot better when you can come to the table with some ideas about what might work for you.
If you come to the idea with some information, for example, of other people who have done it before, schools are less likely to see it as a challenge, and they're more likely to see it as an opportunity. They're also going to say, "Wow, this person is obviously prepared, is knowledgeable, has an understanding of what medicine looks like. Yeah we should accept them rather than another student, disability or no disability, who comes in and goes, 'Oh my dad was a doctor and that's what I want to do.'" It makes you look so much better.
Unfortunately we are subject to a double standard. We can't just be average, we tend to have to be better than average. And I mean average medical school matriculant. We have to be better than most of those often on paper or in interviews, because we have that additional subconscious judgment of what we are and what we do.
I wish we didn’t have to perpetuate that, but I think for a long time that’s going to be perpetuated, because the people who end up being accepted are more likely to be better than average, because they’re more likely to come to the table prepared. That means, take your classes seriously, shadow as much as you can, all of the typical things.
Shadowing is interesting. Who’s going to pay for an interpreter when you shadow? I didn’t get anyone to pay for mine. I doubt people are going to get their schools to help them. I would love it if medical schools or undergraduate programs, or even high school programs, would be willing to provide interpreters and captioning and other accommodations for all the volunteering that’s supposed to happen, all the shadowing that’s supposed to happen.
The other thing, a lot of people, they start becoming interested in medicine, or because they’re interested in medicine, they hear about undergraduate research opportunities. Those conversations in the hallways that we often are left out of. So it would be great if some of those could be formalized to give a somewhat more equitable opportunity for deaf and hard of hearing students.
I have definitely benefited from people who have been just key people. And these are the people that continue to open doors for me. They are everybody from the emergency department nursing manager at Seattle Children's Hospital when I applied there for my ER tech certified nursing assistant position. The program directors in both family medicine and preventive medicine who both said, "I don't care about the interpreters, we want you."
They are the supervisor at the Department of Public Health here in Massachusetts who said, "I think you add something." And when I asked, they said, "I can't describe it yet, but I can tell that you've changed this place."
I enjoy my time with you so much. I'm so glad you agreed to do this talk with me, and I know that somebody listening somewhere will be positively impacted by hearing your story. I know you have really knocked down some pretty big barriers for people, and I tell you this all the time, you're the Beyonce of my world. But you have done things that will make a difference for years and years to come. You've changed the trajectory of inclusion in medicine, and I am grateful for you.
Thank you. I hope I have, but thank you for inviting me. I feel like even though I do some disability work, sometimes I pull away from it, and then when I get to see you, I go to the conference like AMPHL and the coalition. It just always amazes me, the powerful work. And this is the work that's being done behind the scenes. It's not making it necessarily into the news. It might make it onto Twitter, but this is work that often we don't see as trainees in our programs. And it's just incredible the work that comes out of what you do, and it always inspires me to bridge what I do and what you do even more. So thank you again.
Great. Well if that leads to more time with you I'll take it.
Yes, I'm down. Slay.
Look for part 2 of our discussion with Dr. Argenyi in January, when we discuss the benefits of deaf or hard of hearing doctors and how a deaf or hard of hearing doctors doctor navigates the clinical space.
We look forward to bringing International Month to the DocsWithDisabilities podcast. Subscribe and join us in November when we talk to folks from the UK and India, leading the charge for inclusion!
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.