Ken Huey 0:00

Welcome to The Voice of Hope, where bold leaders and healers share how they're building hope, not just talking about it. I'm Dr. Ken Huey. Let's meet the changemakers transforming lives from the therapy room to the boardroom. Hello, today's guest on The Voice of Hope is Dr. Leslie R. Walker. She's a pediatric physician leader and chief academic officer who spent her career advancing child and adolescent health through clinical care, academic leadership, and national advocacy. She currently serves as chair of pediatrics and president of the Association of Medical School Pediatric Department chairs, shaping how future generations of physicians care for children and families. Dr. Leslie Walker, welcome.

Leslie Walker 0:44

Thank you. It's great to be here.

Ken Huey 0:47

So nice to have you. So I'm always fascinated to know how people land in the career they're in. What first drew you to pediatrics and working closely with children and families during these kinds of times?

Leslie Walker 0:56

Yeah, in med school, I actually said the last thing I was going to do was be a pediatrician. Um I thought, you know, that so many times people think, oh, you're a woman, you need to go into pediatrics, or, you know, so I wanted to explore everything. But when I actually got into our required pediatric rotation, it was just, it was just a joy. Every day was a joy. And what I realized is that so much effort has been spent in adult medicine that there was still so much to learn in pediatric medicine. And we could do so much to, you know, if you impact a kid, you impact their entire life, you impact the illness in adulthood. So I thought that's where I could make the biggest impact.

Ken Huey 1:37

Right. Early childhood and adolescent help. How does that shape long-term emotional and mental well-being?

Leslie Walker 1:44

Well, I mean, I think that's everything. Kids and who they are as adults are is dramatically impacted by from birth all the way through the time that their brains are being developed. If they don't get the right love, the right environment, they're not able to take good risks, and they don't have a feeling of belonging. And if they're not challenged with disappointment and failure, they're not going to be able to really negotiate adulthood well. And we see that play out over time when people aren't supported during their childhood. So wellness, emotional, mental well-being for adults and kids is really grounded in childhood and adolescence.

Ken Huey 2:24

Yeah. Dr. Water, you've led at some of the highest levels of academic medicine. How do you keep the human side front and center in large systems?

Leslie Walker 2:35

Yeah, on a system level, one of the most dramatic differences between, you know, an adult system and a children's system is all of us that really are practicing pediatric medicine, we have a mission. We're kind of mission-driven. Doctors get paid a reasonable amount of money, but you know, as doctors go, we get paid the least amount of money. Pharmaceutical companies have the least amount of interest in our medicine because children's disease is considered many times rare disease. We don't get as much attention and research. So when you decide you're going to be a pediatrician, it's because you love that work and you really are dedicated. And that's from the guy that's fixing the lights in your office or somebody that's cleaning in the rooms to doctors, to nurses, to the chief financial officer. We all could probably be somewhere else making more money, but we have chosen to be here. And so that's a difference that you feel in a children's hospital or people who work with kids. And it helps keep you grounded. I think personally, the other thing that keeps you grounded is even though I've moved into more leadership positions, I have kept seeing patients throughout that time so that you never forget why you came into medicine in the first place.

Ken Huey 3:48

What changes have you seen in how the profession treats trauma in children and adolescents over the last decade or so?

Leslie Walker 3:57

Yeah, I think quite a bit. I think that the most important thing is that we talk about it now. And that was always a taboo. Trauma, mental health issues, substance use, those have always been challenges for kids and adolescents and families. But we always hit those things and we try to push them under the rug. And now people definitely, I think, with the advent of social media, people realize they're not alone. There are many people out there who are experiencing some of their same challenges. And there's ways to address that and there's people to support them. So I think that we just have it much more transparent that these are things that can happen to people that can be helped. And in medicine, in pediatrics, in particular, over the last few years, it's a requirement to learn how to manage behavioral mental health in training. That didn't used to be, but it's now a requirement. So what's a requirement? People get tested on, people have to master. So I think that's also good.

Ken Huey 4:57

The adverse childhood experience study, is that something talked about in your circles?

Leslie Walker 5:03

I think it has been probably a decade ago or so when it came out. It was a lot of interest in it. I think now people incorporate that when they think about social determinants of health. And most hospitals now, most programs ask those questions. They screen people for the social determinants of health. I think that's really good. One of the things that I would hope, though, is that we move more to thinking about the vital conditions necessary to produce flourishing. So not just identifying problems, but actually identifying how you prevent those problems is where I think we need to go. Really, again, iterating on some of the learnings and the research from the past that has really shined a light on what the majority of things that really hold our kids back is not the clinical space. It's in the environment, it's in where they're living and the kind of opportunities they have. And so really looking at the communities and trying to put the things in there that help kids flourish is what I'm focused on.

Ken Huey 6:03

So tell me a little bit about that. How can the pediatric care, how does it support not just the taught child, but the entire family system? You're talking about a larger social system too. But what about the family system? How do you support them in getting the changes and the healing that they need?

Leslie Walker 6:18

Yeah, I think we're really privileged, and sometimes it's so humbling that people will tell you things that maybe they won't even tell their husband. They won't tell the other kids, the kids won't tell their parents, things that are critical that to their health and mental well-being, things about trauma, good things too, but we're really privileged to hear that information. It's our duty to really think about okay, what can I do? I can listen for a lot of people, that's real important, but I also can understand what's happening in the community and help people to get to spaces where they can get even more care than coming to the pediatric office. I think that's important. We can do things like treat people initially for opioid use. We can begin to treat people for depression while they're waiting. There's a lot we could do medically as well to help kids when they're challenged. And I think when I started medicine, pediatricians weren't necessarily comfortable doing that. But now they're, I mean, we have to. That's a mental health and self-district crisis. We have to be more able to help our kids and the families. And the other thing I would say is it's really important that we listen and we understand who we are with. We understand the communities that we're in and the cultures and the different people and what they expect. That's really important because we still need to do a really good job of helping all children be healthy and flourish.

Ken Huey 7:40

Talk to me about the idea of hope. So it's the voice of hope is is the podcast name. Where does hope show up in pediatric and adolescent care?

Leslie Walker 7:49

I think it naturally is pediatric and adolescent care. I mean, when we have a child, we have an infant, we have an adolescent, everything we're doing is based on trying to fulfill the hopes and dreams of that child, of that family, of looking to see how we can help prevent things that will be barriers to that hope. I mean, we go into this because we have hope that children will develop perfectly and beautifully to the best of their ability. So I'd say when you go walk into a room of pediatricians or pediatric nurses, you see a kind of a different attitude. We're okay to, you know, wear purple shoes and red hair and have a funny tie and get down on the ground with the kid. We really are are motivated by the hope that we have in children and their families.

Ken Huey 8:40

How do you think medical education needs to evolve in order to better prepare physicians to address the trauma and emotional health?

Leslie Walker 8:49

Yeah. Like I said, for pediatrics, it's now a requirement to learn something about this. Some places before across the country that train, they were doing that, but it wasn't uniform, and now it is. And you have to show that you're doing that in order to remain accredited to teach pediatrics. I think that's good. I also think we have to recruit the kind of people who are have emotional intelligence, people who are interested in understanding how to work with people and not everything's in a book. That's really important. You can have great grades and great test scores and have no emotional intelligence. So we have to have really people that are complete people that are whole that can come in and help other people. So I think that's another thing we can do and continue to do better.

Ken Huey 9:35

What gives you today the most optism, optimism about the future of child and adolescent health care?

Leslie Walker 9:41

Um mainly the kids on the teenagers. When you hear their solutions to problems, I wish you wish you they they just had the agency to act on them. So many things that they think about and do. And through the course of history, right? We change our whole societies, and a lot of it is based on adolescence. And when you look back in history and see how old people actually were when they drove change, they were young. They were young adults, their adolescent age. And so that gives me a lot of hope for the future because kids are and adolescents have amazing ability to get things done, to think through things, and really cut through a lot of assumptions that you begin to have as adults. So that's one thing. I also think right now, the system of health care, the system of education, this Medicare, you know, 50% of kids are on Medicaid in this country. We're getting ready to cut Medicaid. So that's dramatically going to impact kids. And so in medicine, we're really having an earth-shattering change right now. It's and with that, we have the ability to make real change that we haven't been able to do in 100 years. And so I have hope that many bright minds and many people that care about kids will have this opening to actually do things that can prioritize children's health in a way our country never has. So I have a lot of hope about that. And a hope and belief that does humans really see the need to have children be healthy. And now we have the opportunity to try to do that.

Ken Huey 11:13

If you could change one thing about how our system supports children in crisis, what would it be?

Leslie Walker 11:20

To have communities. One of my dreams was if you could, just like how we have 911 and we have Medic One, and people are trained in CPR. And so in Seattle, if you walk down the street and you fall, there will be before you hit the ground, there will be four or five people running up to you to see if you need CPR. Because the whole town has they're known for that, too, has learned how to do first aid, how to do CPR. And so I think we need that for mental health, not just the doctors, not just the parents, but the grandparents, the coaches, the store owner down the street. Everybody, the guy walking down the street, everybody needs to know what it means to be healthy and what it means when kids are being stressed and challenged, and not see them as, you know, oh, we need to call the police or oh, you know, this kid is a delinquent, but see it for what it is and immediately do some mental health first aid and address it. That would be my dream is for the community to be able to come around their kids, know when there's a problem, know how to address it themselves in the moment, and know where to send them later.

Ken Huey 12:27

Dr. Leslie Walker, you have a passion for those you serve that is really enjoyable to engage. Thank you very much for spending a little bit of time with us.

Leslie Walker 12:38

Ah, well, thank you. It's been fun talking.

Ken Huey 12:42

Thanks for joining us on The Voice of Hope. If you were inspired, share the light. And remember, hope's not just a feeling, it's a force. We'll see you next time.