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Breaking Down Barriers
Medicine for the Greater Good takes internal medicine residents out of the clinic to educate, advocate and build trust.
When the Doctors Go to the Patients
Since the launch of Medicine for the Greater Good in 2013, Johns Hopkins University medical trainees and students have brought asthma education to local schools, operated blood pressure cuffs at health fairs, and challenged churchgoers to eat more fruits and vegetables.
Panagis Galiatsatos roams the cavernous community room of Poe Homes, a public housing complex in West Baltimore. A couple of months ago, he was here with advice about heart health. Now, he’s explaining how to treat sprains and concussions.
His audience, again, is about 25 children and teens, the drummers and dancers of the Christian Warriors Marching Band. Again, they sit on folding chairs arranged in a circle around Galiatsatos, a pulmonary and critical care fellow in the Johns Hopkins University School of Medicine. Galiatsatos has about 20 minutes before the marchers resume their twice-weekly practice.
“Do you remember me?” he asks.
“Yeeesss,” comes the drawn-out chorus of a reply.
“Do you remember my name?”
Galiatsatos chuckles, tells his young audience to call him Dr. G. He knows his name is hard to remember. He also knows he’s forming relationships, even as the marchers shift and whisper in their seats. Maybe some of the young people in this room will remember his advice for treating a sprain. Or maybe they’ll remember, next time they visit a doctor, that this doctor made them smile.
“The main thing is connecting with and loving the community,” says Ernest King, the marching band’s longtime director.
That connection is the reason Galiatsatos helped found and still directs Medicine for the Greater Good (MGG), a program lauded by U.S. Rep. Elijah Cummings and featured in the Baltimore Sun and New England Journal of Medicine.
MGG began in 2011 as a series of workshops that encouraged trainees and experts to discuss nonclinical topics, like health policy, behavioral counseling and social determinants of health. In 2013, it expanded to include a requirement that all internal medicine residents at Johns Hopkins Bayview Medical Center complete at least one project that benefits the community. Many do more.
The program also attracts undergraduate and graduate students from across Johns Hopkins, even though they are not required to participate. Accompanying Galiatsatos at Poe Homes, for example, are nursing student Kathleen Littleton and Siddhi Sundar, a postbaccaulaureate premed student in the Krieger School of Arts and Sciences.
Together, 82 trainees and students have launched, led and learned in nearly 300 programs. They bring asthma education to local schools, operate blood pressure cuffs at health fairs, and challenge churchgoers to eat more fruits and vegetables. They attend palliative care workshops and push policy changes to benefit lesbian, gay, bisexual and transgender people.
MGG’s directors are Galiatsatos; Colleen Christmas, director of the Primary Care Leadership Track; and Erica Johnson, program director for the Johns Hopkins Bayview Internal Medicine Residency Program. Participants learn from each other through collaborations and presentations.
“More than 50 percent of what we do when we’re taking care of patients is not strictly medical,” says geriatrician Ariel Green, who started the workshop series when she was an internal medicine resident. “It’s confronting other issues, like poverty. That’s why it’s important for doctors to get beyond the walls of the hospital.”
A few weeks into his residency, Christopher Hesh does just that, leaving Johns Hopkins Bayview on a summer Friday to attend a Caregiver Café held at the Southeast Anchor Library in Highlandtown.
The cafes provide support and resources to people taking care of loved ones. Trainees like Hesh often participate. He sits at a table with Johns Hopkins Bayview social workers, chaplains and others. He listens as a man talks about his sister with stage 4 cancer. He listens as a woman describes the sparkle that still animates her 90-year-old mother.
Galiatsatos is there. So is W. Daniel Hale, founder of, the Lay Health Educators Program (LHEP), the largest Medicine for the Greater Good initiative. Hale started LHEP in the 1990s, when he was a psychology professor at Stetson University in DeLand, Florida.
At the time, Hale wanted to bring health information to the older adults in that Florida city. For help, he contacted Johns Hopkins Bayview geriatric experts John Burton and Richard Bennett, who is now Johns Hopkins Bayview’s president. The three decided to work together.
“We proposed that the best way was to go through houses of worship, the only places where older adults gather on a regular basis,” Hale says. Hale, Burton and Bennett created a curriculum of relevant topics, including diabetes, depression, medication management and heart disease. In Florida, Hale recruited local physicians, who taught dozens of faith leaders how to bring health information to their congregations.
When Hale joined Johns Hopkins Bayview in 2011 as director of the Healthy Community Partnership, he brought the LHEP model with him. The twist, suggested by Bennett, was that the instructors would be Johns Hopkins Bayview residents, not local physicians.
The congregants in Baltimore were younger, on average, than those in Florida, but just as thirsty for health information they could use, such as how to read nutrition labels or recognize depression.
The first Baltimore training session attracted leaders of St. Matthews United Methodist Church in Turner Station, a historically African-American neighborhood in Baltimore County. Armed with new wellness knowledge, participants created a weight loss challenge that inspired congregants in the 150-member church to drop a collective 1,000 pounds in 2013.
LHEP succeeds because the church and medical communities work together, says Dred Scott, who retired in June after 18 years as the pastor of St. Matthews. Hale visits the church often, he says, and worked with Scott to choose topics meaningful to congregants: hypertension, diabetes, heart disease, depression and violence.
Galiatsatos learned the power of medical-religious partnerships through his own ties to the St. Nicholas Greek Orthodox Church in Highlandtown. In 2010, he stood in the pulpit and spoke about cancer screenings to the Greek families he had known all his life. The advice was mundane to him but startling to congregants with little knowledge of routine prevention, he recalls.
“That’s when I noticed the disconnect between the community and the hospital,” Galiatsatos says. “Unless we go out and talk to people, they won’t know the value of these screenings.”
At Poe Homes, Galiatsatos is once again in the community, once again doing what he can to improve health. He winds down his talk by asking the young musicians and marchers what they want to learn next. One teen suggests CPR. “Great idea,” says Galiatsatos. “Maybe one day you’ll save somebody’s life.”