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Motherhood, medicine, and multiple sclerosis: a discussion with Lisa Doggett, M.D., MPH

September 27, 2023

Lisa Doggett is an Austin native and board-certified family physician who has dedicated her career to caring for communities that are historically marginalized. In 2009, after experiencing unexplained dizziness, taste changes, and vision issues, Lisa was diagnosed with multiple sclerosis (MS). During this time, she was also busy running a clinic for patients without private insurance and caring for her two small children. We sat down to discuss her new memoir, Up the Down Escalator: Medicine, Motherhood, and Multiple Sclerosis.

You were the clinic director for a nonprofit health care clinic for low-income, uninsured populations. What was your experience like managing a clinic while also practicing medicine?

Trying to run a clinic while providing patient care is really challenging! In some ways, patient care for me was the most stressful part of my job. But I also struggled with the challenges of managing a staff and making sure that we had a reasonable budget, consistent funding, and that we met the productivity goals.

What advice would you give to physicians looking to move into a similar role?

I think that it’s important to continue to provide some level of patient care when you’re in an administrator role. When you’re able to see patients yourself, you have a unique perspective that other administrators don’t have and a firsthand knowledge of some of the challenges encountered in day-to-day patient care. You’ll have more credibility with other physicians and staff. Even when I moved to a full-time roll outside of a medical practice setting, I found a great volunteer opportunity at a clinic for people experiencing homelessness that allowed me to keep seeing patients from time-to-time.

There are elements in your memoir that speak to physician burnout – dealing with subpar electronic medical record systems, the nearly impossible quota of patients that providers are expected to see in a day, the paperwork that remains after the day is over. You write about balancing all of that with your family responsibilities and the MS diagnosis you received during that time. What was that experience like for you?

It took a lot to balance work plus two kids under five and my MS diagnosis. Looking back, I don’t know how I did it at times. My job was fulfilling and depleting at the same time. My patients needed tests and medicines I couldn’t access. They faced innumerable barriers to care. I had a patient with bats in her apartment, immigrants who overcame serious trauma to get here, many people with serious mental health issues but no access to psychiatry. I would come home just depleted and have to summon all remaining energy and patience to take care of my kids. I would feel guilty because I couldn’t give them 100 percent. You know, I think that’s very common for parents – the guilt of not being able to give your kids everything you think they need.

What would you say to clinicians who are also struggling to manage it all?

I think that we as physicians need to not be afraid to ask for help. A lot of times we think we need to do it alone. We’re strong, we’re smart, we’re capable…. but we can all benefit from a support circle that we identify, nurture, and then call on when we need to.

My husband is a hospital-based pediatrician and was often gone in the evenings and weekends, so I would schedule friends to come over and help with dinner, bath time, and reading books to kids at bedtime.

It's also critical to prioritize self-care. My family knows that I need to exercise, at least for 30 minutes a day, to feel good. When my kids were young, we got an old-school, inexpensive Stairmaster that we put in the laundry room. I was able to use that while my kids were napping. I still use it now if it’s too hot or cold to go outside and run.

You weave anecdotes about the challenges you faced with the health care system throughout your memoir. How were your views shaped by your work with uninsured patients as well as your own experience as a patient with MS?

I’ve known for a long time that the system was a mess. I started caring for underserved populations right out of residency and every day we were running up against obstacles trying to get people the care that they needed.

The problems with the system, especially the inequities, became even more obvious after my diagnosis. Once I became a patient, I had to deal with long phone trees, medications not getting delivered on time and specialists losing my labs -- that kind of thing. All of that is ridiculous and frustrating, but compared to most of my patients, I was able to get the care I needed with great ease. When I had dizziness, I was able to talk to a neurologist in just a few days over her lunch hour. I was able to see an ENT specialist just a few days later and get an MRI right away. I got my MS diagnosis within nine days of my initial symptoms.

In the meantime, most of my patients who I referred to specialists had to wait months if not a year or more. That’s just unconscionable to me. We say we have the best health care system in the world and yet the people that need care the most are unable to access it. I think that’s a real driving reason behind why I wrote this book.

How did that juxtaposition inform your practice and how you cared for patients going forward?

I think it motivated me to work even harder on behalf of my patients because I knew it wasn’t fair. I wanted to do all that I could to give my patients the care they needed. Sometimes that meant working longer hours or being late to my next appointment. It might throw off my schedule, but I would stay in that room with them and make sure we dealt with any acute issues at hand. I think I was always a strong advocate for my patients, but my own diagnosis and experience made me an even stronger ally.

What are you working on now?

I have a background in public health as well as my medical degree. My MS diagnosis prompted me to think more about health care at a higher level. So, for the past eight years I’ve been working at a care management company that designs programs for people with Medicare and Medicaid. We focus on helping people stay out of the hospital and keeping them as healthy as possible.

While I plan to continue that work in a part-time capacity, I’m also getting board-certified in lifestyle medicine. I’m excited to share that I’ll be going back to part-time patient care next month at an MS clinic where I’ll provide care and coaching around healthy lifestyle and preventive care.

More from Lisa Doggett:

You can find Lisa's memoir at https://www.simonandschuster.com/books/Up-the-Down-Escalator/Lisa-Doggett/9780757324864.

You can also learn more about Lisa and her work at http://www.lisadoggett.com/.