Season 3 Episode 4: Rooted in Purpose

Dr Abrahram (00:02)
Reliably Well brings you thoughtful conversations from those who are shaping the future of healthcare, focusing not just on the technical side of the industry, but on the human element, the stories, the struggles, and triumphs of individuals who are driving change.

Dr Johnsey (00:20)
Join us for candid discussions that highlight both the challenges and rewards of working in a field where humanity and healthcare intersect.

Dr Abrahram (00:32)
Originally from the Dominican Republic, Dr. Liu’s journey has taken her from medical training and chief residency in New York City to leading one of Mississippi’s fastest growing behavioral health practices. Along the way, she’s remained passionate about expanding access to quality mental health care, supporting her fellow clinicians, and helping reduce the stigma that often surrounds mental health and illness. Dr. Liu’s spoken

At and with the United Nations, presented at professional conferences, and remains committed to advancing behavioral health through clinical excellence, education, and advocacy. From innovative treatments for depression to physician leadership, Dr. Liu brings a wealth of experience and perspective to today’s conversation. And I can personally say, having known people that have benefited from Dr. Liu’s work, she is sometimes referred to as a wizard.

Dr Lu (01:28)
Yeah.

Dr Abrahram (01:28)
⁓ and her ability to help patients and their families. And so Doctor Liu, we’re really excited to have you on the Reliably Well podcast today.

Dr Lu (01:37)
Thank you for having me. I’ve been very excited as well because I wanted to be part of this. ⁓ I believe a hundred percent in what you’re trying to convey with this podcast. So I’m excited to be here. Thank you for inviting me.

Dr Johnsey (01:53)
Yeah, thanks for taking some time out of your schedule. It’s it’s hard to get in to see you because as Sumner was saying, folks when they when they know that they can get in to see you, it’s it’s precious time. And so thanks for for sparing a little bit of it with us today. That was a lot of impressive stuff to say from a bio standpoint, but fill in the gaps in your story for us or tell us the the the the things that don’t fit on the bio that

that make Joanna Lou Joanna Lou, that turn you into that master of of taking care of ⁓ of people with with sort of damaged lives and help them to regain who they are or what makes you the the the mom to your to your family? Tell us that story that makes Joanna Lou Joanna Lou.

Dr Lu (02:45)
Think that what is missing there is I’m half Chinese, even though I come from the Dominican Republic, I’m also like half Chinese, so I have this Chinese influence. and I had to uproot everything. So when that when the fact that it says, let’s say, hey, she’s from Dominican Republic and then studied New York City.

I really literally, me and my husband uprooted and started over in a totally different country. Different in some ways, right? But different than what where we grew up. Different language, different cultures, different expectations. A social security number was new to me. Taxes is new. It’s not new, but the way that you manage taxes and those forms and stuff, it was totally new. So it was a lot of learning.

after medical school. I think that that’s something that shaped me and actually me and my husband, the uprooting everything, starting over, learning and then new residency at the same time. So on call, you know, working and then being a mom. Looking back at it, I don’t now thinking through it and looking at that and how much effort it took from us.

And how much sacrifice he also took because I’m away from my family, like my family. I have my husband. Wow. It shaped me. It hel it helped me adapt, maybe. That’s a first that’s something that I’ve learned. ⁓ I am adaptable, resilient. I am that’s a part of me that ⁓ people could see sometimes. It was funny when Dr. Sumner said the wizard, I’m like, my goodness. Yeah, that’s ⁓

impressive a an impressive word but it sort of is in one way one way and we made it work and we then uprooted again and moved to Mississippi totally different culture. I had to even learn how to understand people and they’re like lingo and I was joking with my husband because this is something that makes me me is actually obviously our my family. But

I was joking to my husband when we moved, I’m like, do you really understand what they’re saying? ‘Cause a when when we when a patient would talk, I was trying to like catch up, right? But they they talk fast. I don’t know if in Mississippi you’ve noticed. I don’t know if you’ve noticed, but and there’s like a fixing, I’m fixing to go somewhere. I I was like, fixing what? What are they fixing? And it w it took me a while. So again, a rooting, adapting again.

But at that point it was more of following something that I f because I wanted to follow that passion, right? So at that point it was less stressful, I guess. And that’s a part of me that really shaped me, uprooting everything.

Dr Abrahram (05:51)
Yeah,

and thanks for sharing that. I that’s kind of quite the triad of or maybe a square of some Chinese roots, Dominican Republic, New York City, Tupelo, Mississippi. It’s kind of like I don’t know where the Venn diagram is there, but maybe it’s healthcare, right? ⁓ it’s amazing when healthcare can kind of create some commonality between some disparaging, seemingly different places. I’m

I’m very curious about kind of all of us were drawn to the work that we do sometimes at a young age. And it’s always so interesting talking to our guests about what drew them to the work. Or was it something that you fell into? I I’m a big Wendell Berry person, and he’s got this book called Jaber Crow. And there’s this amazing passage that I’ve referenced on the podcast before, where he talks about how the main protagonist of the story.

reflects that somehow I feel like I’ve been led. I’d be curious about what drew you to the work that you’re doing today as a psychiatrist.

Dr Lu (07:00)
So in the Dominican Republic, after you do medical school, you are required to get your medical license there. You’re required to do like one year of service, of medical service in an underserved community. and one thing that is also not in the bio is that I worked that that year and how I stayed a little bit longer. I worked at a center for HIV patients. and it was ⁓

funded by the Clinton Foundation. So we also have did a lot of research for HIV medicines, the Johnson and Johnson, things like that. So we we were a part of that. When I saw those patients, yes, yes, yes. We all know that all doctors want to help in some way, shape, or form. We all do that. And I’m gonna also add something there. I heard yesterday from someone that said, I wanna see a some someone else because doctors treat symptoms. I’m like, no.

We don’t treat symptoms. I’m sorry. You know, that that that it I sort it sort of offended me. We don’t treat symptoms. We see all. We we combine all of it. We are we see a person and we try to find the root cause. But what seeing and working with the TV community, we were we would give them the pills. So it was a free center. The patients will come in and we’ll give them pills.

So we would have them like 30 days and stuff, and then they would come back and we would follow them up. So we’re talking that we would see these patients twice twice in a month, for example, because if we didn’t have enough medicine, they’d have to come. So we followed through, I followed through all of them for a year and a half, seeing them back and back and back and back and seeing their progress, hearing their stories. I had a child. I see the child right now. Look at that, that child has already won.

a that human connection part of it was something that sparked it at that clinic. Plus the underserved that if there’s stigma some around somewhere at that time, HIV was one of them, right? So they were the they they came with their health like they their head like this, you know, embarrassed, and helping them feel

supported and understood was something and seeing their faces when they said, wow, you really, I don’t know if it was you really listen or you really care. That was something that really ⁓ stuck with me. So at that point I said, okay, which career path would lead me to combine science? Of course I’m in medical I already completed medical school, but combined science and medicine and human connection the most, right? Because all of all of the medical ⁓ specialties do that.

But which ones follow stories? And that’s what led me into psychiatry. I’m fascinated by people’s stories, how life experiences shape us, how people can overcome adversity, how resilient the human mind can be. Psychiatry allows me to build that relationship with patients and often walk with them through even during their hardest times or challenges, challenges, most challenging times in their lives.

I also enjoy like that every day is very different. You’ve you experienced that too. Every day, every patient is different, every story is different. And no two patients are alike at all. Like at all. You can have depression in patient A, you can have depression in patient B, but it looks totally different because their story the story and their background is different. There’s always something new to learn every day. So that’s fascinating.

Dr Johnsey (10:39)
I l I love that that background of of your path and and how it sort of sets you on the trajectory that you’re that you’re in today. I I’ve of often wondered the way I see my my job in the ED is dealing with people’s either perceived or real worst day of their life and just trying to be maybe the best part of that worst experience that they’re gonna have. And you know.

If it’s a broken leg or if it’s a more broken life, when it happens right there in that instance, it will get better, whatever happens, you know, we’ll set the bone or we’ll we’ll we’ll start to recover from the stroke or from the heart attack and things will get better from that that that kind of really ⁓ negative event. so we’ll have recovery. So I’ve I’ve often wondered how when you’re dealing with something more.

chronic, something that’s more ongoing, how how how you how you see that. But I think seeing that story and seeing that whole what what you were explaining there, seeing that whole ⁓ whole person and and getting involved in in that life and helping them to not see themselves as something broken and and wrong. That that that’s that’s the reason why when I tell people, yeah, I I I I I I partner in in a clinic with

with Dr. Lou, people are like, you do? Can you help me to get ⁓ get an appointment with her? I mean, it’s like it’s like I get I get some huge street cred because I know you. ⁓ and so, you know, they’re amazed by by that fact that ⁓ that I know you. You’re like, you know, you’re you’re you’re the star. And so I I get that now by hearing how you see the patients that you deal with. So so thanks for for giving us that.

that insight into what shaped you into the the incredible clinician ⁓ that you are. You you may have told it, but but is there a is there a professional influence or personal influence, somebody who, you know, put their arm around you, somebody who mentored you along the way, somebody who you lean on when you don’t know the answer or you’re looking for, you know, that.

What do I do with this really difficult case out there? Or or the, you know, the the the personal issue. You know, my I I I can’t get my kid to listen to me. What do I do now in the parenting issue? Who who’s that person you go to?

Dr Lu (13:21)
It’s my husband, has always been my husband. Met went to medical school together, worked at the HIV clinic together, did psychiatry together. So literally, personal and professionally, he’s someone, his take on things, or he’s someone that ⁓ we we understand each other from all perspectives. Does that make sense? Like I can talk to him about a patient and hey, that’s my experience. Well, well, wait.

I’m stuck here. And he would say he can follow through and actually tell me, wait, have you thought about this or how you thought about that? So professionally and personally, it’s him. It always has been him. I don’t know. It’s when I say I don’t know when I when I say, like, he’s also a psychiatrist. People laugh, not laugh, but laugh in a good way. Like, my goodness, really. my gosh, that’s exciting. Two psychiatrists together. ⁓

And it really is exciting when you come home and ⁓ I’ve had something lingering and did I do right? Did I do right? Did I do right? I can talk to him and say, hey, I did this, or he does that too with me. So it’s give and take. We both do the same thing. Kids also, right? It’s our kids. So you know, did I parent right? Did I do that right? And he’s ⁓ he’s the calm in the middle of a storm to me.

Dr Abrahram (14:46)
It’s a beautiful thing and certainly rare to have, you know, sometimes you’ll have spouses that maybe are both physicians, but they’re in pediatrician and internal medicine or family medicine and general surgery or something. But certainly cool to do you think that any of your children will be psychiatrists?

Dr Lu (15:09)
You know what? My daughter, my son said, nope, no medicine. Nope. You work too hard. You’re, you know, some I thought it was gonna be something science-y because he’s amazing at it, but he said no. But my daughter actually something sparked in her the other day and she said, What did she say? Something like, I actually think that I can connect to also. So I actually like what you do.

And she looked at me and said, because she’s been she’s gone to the clinic, you know, like I don’t know if I have to pick her up, she goes to a clinic and sometimes sees people, not the patients, but like the staff. So she likes like the camaraderie. And she’s like, I think I can I like it. So I but I’m not sure. I can see her doing that, but I’m not sure. Hey, I hope, I wish that someone can take over.

Dr Abrahram (16:01)
That’s right. So there so whether or not it’s your daughter or the current clinicians, people coming out of training or people that have been in training for a while, they’re the the the challenges that are facing clinicians today, maybe they’re perhaps a little bit different than they were like a generation ago. Or ⁓ the clinicians that are approaching the ability to retire, the challenges when they first started are different than

what they are today. I’d love to hear from your perspective, both as a clinician and as a practicing psychiatrist. What’s the biggest challenge that clinicians face today? And perhaps if we can identify what that challenge is, what do you what do we do about it?

Dr Lu (16:45)
Oof. I think the biggest challenge for me is balancing the human side of what we practice, which is medicine, and with the growing complexity of what healthcare has become. Patients need more support than ever, but clinicians like we now are having to navigate through documentation requirements, insurance regulations, staffing shortages.

And the increasing demand. So in psychiatry, even more. I think many can many doctors entered healthcare to help people, and you know, literally help people. And sometimes the administrative burden can take it like can make it very hard to focus on that original mission, which is that patient in front of you, and still connect. So I think that

And you are to answer the second part of your question, finding ways to preserve that human connection is one of the most important things that for me we challenge today.

Dr Johnsey (17:52)
So I I don’t disagree with with sort of the the other side of medicine that that that creeps in more. I I I remember hearing Dick White talk about the the old days whenever you just said, Hey, this is my fee schedule, Blue Cross, and next year we’re gonna add 10% to it. And Blue Cross just said sure and paid it. And and and that those days are long, long past, never to return.

and the game changes every year and all those sorts of things and and and everything else that we think about on patient experience side and every all the other things that that that come into play. So we do have all of those different that noise that’s out there that that gets in the way and and we’ve seen the pictures of the of the clinician who’s who’s

paying no attention to the patient. They’re over there looking at the screen instead of looking at the patient because we’re I I I do see a little bit of the the now the artificial intelligence, the the the scribes, the electronic scribes that can maybe help us to start looking at the patient more instead of looking at the screen. But if there’s if there’s those negatives that are out there, what what and I I certainly

May maybe maybe I’m looking at the or thinking of the wrong cases that that I get to see in the emergency room from your area of of specialty, but I certainly think of some of those that that maybe are or seem hopeless sometimes. What gives you energy? What gives you hope for your specialty, for medicine, for the next generation, for your daughter who may follow in your footsteps? What are the things that that we can look forward to to say?

Th there is something that that will be better tomorrow. There is there are those things that that we do get up tomorrow and say, I’ve done something good. This is positive out here. What what do we what do we tell tell the next generation ⁓ about?

Dr Lu (19:56)
I that’s a very because there’s so many elements that give me hope. I think the one that one because it just lifts there. you know when you see that patient coming back, and that’s something that you probably in the EED don’t see. Well, you probably see the ⁓ you see a lot, but you see them in pain, you see them at the worst. When I see that person say, Thank you for giving me my life back, or

I’m able to go to work. I’m able to take care of my child now. And and I said something, this happened recently. One person said, You don’t know what my le you don’t know how much you mean to me. And I’m like, Thank I don’t know how to take that. Like, I don’t, you know, like I don’t know. I’m not good with traces. So I don’t know. And I’m like, ⁓ okay. Hey, well, thank you. Cause I’m just doing my job, right? But sh that person mentioned, like, no, no, no, you don’t get it. You don’t get it. You

I would not be here if it wasn’t for you. I take that home because obviously, you know, and then I it it it it ponder. I ponder and it stays and it stays here in your heart. Wow, you know, that’s the impact. That’s what’s make makes it worth it. How much how much I changed that life and that person changes someone else, right? So it’s it’s a it’s a connection. And when I am part of that also training.

my my team, right? Training people, mentoring that younger clinician, mentoring that nurse practitioner, you know, nurse, whoever, so they can also do the same. So not not only could you say something about like, how can I get in to see Dr. Lu, I feel bad when they cannot see me quicker or soon enough, right? But I just am one person. So if I care and mentor others to see things the same

Not the same because I don’t expect that, but like similarly treat the patient as a human, right? See them as they are, not as the diagnosis, and this is the next step, is what is the root cause, then that’s gonna also continue providing roots and continue making dramatic impact. So knowing that people are getting better and that we are part of that makes me.

gives me that passion to go back and continue doing it, even though things got stressful today because the insurance denied something.

Dr Abrahram (22:32)
Yeah. Yeah. Amen. I do feel like there’s kind of we’ve had this cultural shift of historically this medical paternalism or maternalism of the doctor’s always right and he or she’s riding in on the white horse to save the day. We’ve kind of shifted away from that to where kind of like the patient’s always right. And so it feels like it sometimes it is harder to

accept that gratitude because of kind of this historical shift of how that’s happened. We could go on and on, Dr. Liu, and and I’m gonna go a little bit off script here because one of my favorite writers is a psychiatrist named Kirk Thompson. And he practices in Northern Virginia. And one of the things that he talks a lot about is that you can’t change and I think this applies to the earlier question about

The struggle for clinicians today. And I think it applies to all of the patients we encounter, irrespective of specialty. But Dr. Thompson loves to say that you can’t change the events of your story, but you can change how you experience them. ⁓ I can’t help but think that as a clinician today or as a patient, you really can’t change what’s happened. But if you start to talk about

How you feel or what has happened with somebody that’s incredibly empathic, like yourself and hopefully other clinicians that are not just psychiatrists, your your brain changes, right? I’d love to hear you unpack that a little bit of maybe that one of the antidotes to our current predicament as providers is what if we just talked about what we experience, right?

Dr Lu (24:22)
⁓ You literally described what we do as a profession as a psych in psychiatry. My job, not our jobs is not only to treat, you know, depression anxiety, is to treat to change that actually a good clinician in any way, shape, or form is to re change the way that you’re seeing that, right? What I would say, and I think that us clinicians, we think because we we we

I I feel that if we I’m gonna describe a clinician, like if I in the in and and if I have an image of what like a a doctor or a clinician is, it’s like we’re in an island and we have to make it full function. The island is alone and I have to water the plants, I have to take the produce, you know, build the house. And I even though I know that there is someone else beside me, like there’s support, I function as an island because I’m used.

You we’re used to that. You see your patient in front of you, you know, leave and you okay, fix, gone, then see the other one. So you function like that on a daily reminding ourselves that I don’t know how to describe it, because I see like an island, like we’re all alone, but we’re not, because I can see the other island on the other side, and there’s a boat. So how can we get to that boat, right? How can I remind the other person in that island there is a boat, come right.

You’re not alone. We’re here. Changing that mindset, changing the yeah, we cannot change the facts. That’s true. We can’t. But we change the way that we see it. We can change that. Takes a lot, but we can do it.

Dr Abrahram (26:06)
Yeah. I I yeah, I love that idea of all these little islands that are out in the middle of the Atlantic Ocean and we’re actually all more connected, but we have to maybe get up above the clouds and have the perspective that it looks closer up there than it

Dr Lu (26:25)
Yes,

Baby Island. Yes.

Dr Abrahram (26:28)
So in season three of the Reliably Well podcast, we kind of every season we always want to have a signature question. And I would love to know, ⁓ there’s lots of talk about wellness in our current cultural moment. And I won’t ask a lead-in question, I’ll ask an open ended question. That’s what I’m supposed to do, right, Dr. Lewis. Open ended questions. What does what does being well mean to you? And has that changed over time?

Dr Lu (26:47)
That was another question.

Ooh, and being well is about finding balance for me. And now it has changed because we caught before being well was being with my family, you know, which is the same thing now, but the stress level changed over time. The demands changed over time. So for me it’s about that balance.

And I think we hear that all the time. Work life balance. That’s harder to find lately, I think. And with what we do, we’re trying to help people and hear their stories. Sometimes you also keep fit, you go home and you keep thinking about it. So you even though you’re home, work life, right? The balance going home means, you’re stress-free now. No, you’re not. You keep thinking.

And did I do right? Did I not? So for me, that wellness today, because it used to not be that way before, it was easier to disconnect years ago. ⁓ I don’t know, it was easier, I guess in New York, just like you know, train subway, boop, home. Like there’s literally things that happen in between from hospital or or clinic to home that you can stop. But now it’s

How do I really disconnect that part? Finding the way that I can, I can really let that go. Right. That is wellness. That’s what balance me to me is that letting that go, letting that stressful event or thing that is like ruminating, did I do right? Let it go and be present. That’s wellness to me. Present. Being here talking to you, not thinking about what I need to do next.

you two, right? ⁓ going home, being with your family, being with my family, right? Being present. That is what that means to me.

Dr Abrahram (28:59)
Amen. Well, thank you for a therapy session during the Roman podcast. And ⁓ you did this one pro bono, so we appreciate it. But we really respect

Dr Johnsey (29:12)
She might get us a bill later on, you know.

Dr Lu (29:14)
No, no, no, no. Never ever never. Thank you for having me.

Dr Abrahram (29:19)
And

thank you for all the great work you do, Doctor.

Dr Lu (29:22)
Thank you

so much.

Dr Johnsey (29:26)
Thank you for joining us on Reliably Well, where we explore the intersection of healthcare and humanity. We hope these conversations inspire you to see the people behind the policies, the passion behind the practice, and the purpose that drives innovation in healthcare.

Dr Abrahram (29:43)
If you enjoyed this episode, be sure to subscribe, rate, and review our podcast. Your support helps us to continue sharing these important stories. For more insights and updates about what we’re up to at Relias, visit us at reliashealthcare.com and follow us on your favorite podcasting platform.

Dr Johnsey (30:03)
And if you have any stories that help to demonstrate the humanity in healthcare, please let us know at reliablywell at reliashealthcare.com.

Dr Abrahram (30:14)
We look forward to hearing from you and telling your story. Until next time, stay well, stay inspired, and keep bringing humanity to healthcare.