Dr Monique S Nugent : 5 Things I Wish Someone Told Me When I First Became A Doctor and Scientist
An Interview With Jake Frankel
Advocating for patients means thinking big
As part of my series about healthcare leaders, I had the pleasure of interviewing Dr. Monique Nugent.
Monique S. Nugent, MD, MPH, is a practicing hospitalist and physician leader in the Boston metro area. She has dedicated her career to improving the care of hospitalized patients, focusing on safety, quality, equity, and experience. Dr. Nugent completed her medical school and residency training at Loma Linda University Medical Center before becoming a Commonwealth Fund Fellow and receiving her Master of Public Health at Harvard.
Thank you so much for joining us in this interview series! What is your “backstory”?
My name is Monique Nugent, and I’m a physician living and practicing in the Boston area. I grew up outside of the Bronx in Yonkers, New York, attended college in Atlanta at Emory University, completed my medical training in southern California at Loma Loma University, and finally moved back east to get my Master of Public Health degree at Harvard. I jokingly say I’m an academic nomad because my studies allowed me to move around the country. But, no matter where I go, I carry the lessons of hard work and grit I learned growing up in New York.
Can you share the most interesting story that happened to you since you started your career?
I’ve had a few patients with rare diagnoses that are always great stories for impressing other doctors. But my favorite story is about when I got called for an emergency on an airplane when I was an intern in residency. The person who needed help was a very intoxicated young man who was vomiting and panicking. I didn’t do anything impressive; I just gave him some water and reassurance. He eventually calmed down and fell asleep. What was interesting to me was that it was up to me to decide if the plane needed to make an emergency landing. As an intern, I wasn’t allowed to make any major decisions at the hospital, yet suddenly, I was in charge of a plane full of people. Ultimately, I decided it was safe to continue the flight, and EMS should be waiting at the airport to help the young man deplane. It’s a bit of an anticlimactic story. Still, I remember feeling the gravity of my profession very differently than when I was back home with the safety of having senior physicians overseeing my every move.
Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?
In my second year of residency, during an overnight shift at the county hospital, I was woken up by a nurse calling for assistance with a patient who was having trouble breathing. I gave a few orders over the phone, got dressed, and went to the bedside. Except, there was no patient in respiratory distress in the room that I went to. So, I searched my pager for information about the patient, but I couldn’t find any information about that patient. I then went to every floor in the hospital looking for a patient in respiratory distress and found nothing. It turned out that I had dreamt the whole conversation with the nurse. The entire hospital got a chuckle from watching me run around in a panic, looking for a patient who did not exist.
Are you working on any new or exciting projects now?
I’m excited about some big projects I will be working on over the next few months. My website will soon include educational streaming content and videos of my community events. I’m also planning the first season of my podcast, where I will talk to patients, caretakers, and healthcare providers about all things hospital. In addition to all this, I will add more regularly to my blog and map out my upcoming books.
I understand that hospital care isn’t a topic most people jump up and down in excitement to discuss, yet we will spend some time in a hospital during our lives. I want to help relieve some of the anxiety that comes along with hospitalizations.
None of us are able to achieve success without some help along the way. Is there a particular person who you are grateful towards who helped get you to where you are? Can you share a story about that?
I wouldn’t have achieved anything I’ve done without my mother’s support. My gratitude to her is something that takes effort to put into words. My mother is a Jamaican immigrant who worked as a critical care nurse in the Bronx through the 1980s, 90s, 2000s, and 2010s while raising her three children. To say she is a tough lady is an understatement. She constantly told me I was the brightest and most capable kid in the class, so doubting myself wasn’t an option. As a child, nothing seemed impossible because she never put a limit on me; she let me try everything I wanted to do.
My mother always found a way to put me in the room with the right people to open doors. In college, I called home crying that I didn’t get a research position for which I had applied. So, my mother asked every doctor and researcher at her hospital if they needed a research assistant. Eventually, she got me a job doing neuroscience research for the summers back in New York. That job gave me skills and led to other opportunities that helped me get into and complete medical school. I have many supporters in life, but only one person was consistently behind me, pushing me to the top: my mother.
Is there a particular book that made an impact on you? Can you share a story?
“An Unquiet Mind” by Kay Jamison is the first book I immediately re-read after finishing it. Jamison is a clinical psychologist who has bipolar disorder and writes about how the condition shapes her life and career. She struggles with loving the feeling of invincibility during her manic episodes and then the blowback from the things she did while in that state and the limits on her life that her treatments cause. Jamison describes her desire to have a child and the doctor’s stark warnings about what that could mean for her mental health. It made me understand that having an illness doesn’t erase a person’s desire for all the usual things in life, particularly the desire to love and be loved.
Years ago, I treated a woman with bipolar disorder who wanted to become pregnant, and I felt that I was watching the pages of that book come to life. I was careful not to be brusque like the doctor in the book, and I listened to my patient as she struggled with her decision to stop taking her psychiatric medications. Eventually, I lost track of that patient, but she comes to my mind often.
How have you used your success to bring goodness to the world?
I sincerely hope I have been helpful to every patient I’ve treated. I can’t make every patient 100% happy, but I can make some positive changes happen and help guide them through their hospitalization. I wrote my book, Prescription for Admission: A Doctor’s Guide to Navigating the Hospital, Advocating for Yourself and Having a Better Hospitalization, so that everyone can benefit from my insights and guidance during a hospital stay. I also teach senior citizens how to prepare for a possible hospitalization and streamline communication with their medical team. Improving the public’s knowledge about our healthcare system and ways to advocate and protect themselves while seeking care is vital to improving healthcare outcomes, and that is my ultimate goal.
Can you please give us your favorite “Life Lesson Quote”? Can you share a story about how that was relevant to you in your own life?
One of the phrases that my father repeated to my brothers and me, over and over again, is “Two wrongs don’t make one right,” and it’s a life lesson that I live by and now pass down to my children. When someone has done something hurtful to you, it is natural to feel the need to retaliate. I’ve been in some challenging situations where I could feel my blood boiling, and I wanted to lash out. Still, I returned to that phrase and decided to try to navigate the situation and come up with a solution without responding in a hurtful manner. No matter how others behave towards me, I want to maintain my integrity and feel good about my actions.
Can you share your top three “lifestyle tweaks” that will help people feel great?
1- Eat more fiber: If there is a “miracle pill” for a lot of what ails us, it is fiber. Adding fiber to your diet will help lower cholesterol, stabilize blood sugar, help you lose weight, and improve the regularity and consistency of your bowel movements. Having regular bowel movements makes a big difference in how people feel. So eat more fiber!
2- Learn good sleep hygiene — Many people have bought into the idea that “sleep is for the weak,” which is untrue and quite the opposite. Poor sleep affects your mental and physical health. Conversely, untreated medical conditions can lead to disordered sleep. You can start improving your sleep by having good sleep hygiene, i.e., the things you do to help you fall asleep. Good sleep hygiene means having a consistent bedtime, keeping the room quiet, cool, and dark, and avoiding screen time an hour before bed. If these things don’t work, ask your doctor if you would benefit from a sleep study to learn more about the problems with your sleep.
3- Start with changing smaller habits to achieve significant and lasting changes in life.
Time and time again, I’ve seen how making small changes has more significant effects than I expected. I’m the kind of person prone to making big, drastic changes that are ultimately unsustainable. Then, I get discouraged when I’m not meeting the new standard I set. Over time, I’ve learned that if I make small changes and track how well I can stick to those small changes, I can eventually achieve the bigger goal. Using a journal to track how consistent you are with small changes helps to reinforce what you’re doing and serves as encouragement when you see how far you’ve come.
What are your “5 Things I Wish Someone Told Me Before I Started” and why. (Please share a story or example for each.)
1 — Social Determinants of Health have a much greater impact on individuals than anything I can do as a physician.
In medical school, we learn about different risk factors for diseases, and it seems so theoretical to think that simply because of who you are or where you live, you may be more prone to specific illnesses or injuries. Over the years, I’ve worked in various types of hospitals, serving different populations, and it is evident to me that our social structures, laws, educational, and economic policies determine who is healthy and who stays sick more than any prescription I can ever write. We need to recognize how much health is affected by the food we eat, the places we live, how we work, our physical safety, and so much more than pills and surgeries. I’m pleased to see medical schools teaching more about social determinants of health and encouraging students to see the bigger picture of their patient’s lives rather than just an acute illness. I’m hoping people other than healthcare providers will learn the same lessons and work to incorporate positive health outcomes across all the social structures that support our communities.
2- Setting boundaries at work is essential for longevity in my profession.
Medicine demands more and more of you as you progress in your career. When you’re a medical student, you look at attending physicians and think that they’ve figured out how to do life. However, burnout can occur at any point in your medical training and career, so learning coping mechanisms and boundaries builds resilience.
I used to have a pretty “open door” policy at work, extending myself to patients and colleagues for anything they needed at any hour. This personality trait served me well in my career; others saw me as a problem solver and leader. However, a few years ago, I started resenting the people who needed me, feeling angry that I rarely had a moment when I wasn’t extending myself. Thankfully, I took time to reflect on what changes I could make to set boundaries with my time so that I wasn’t always available and that it was ok to direct people to other resources for their problems. I still struggle with the feeling that I should be doing more, but I’m more aware of my limits nowadays.
3- Advocating for patients means thinking big
“Every system is perfectly designed to get the result that it does.” — W. Edwards Deming
Engineers live by this quote, and it is very applicable to healthcare. The disparities and poor outcomes we see in healthcare result from how our healthcare system is designed. Once I understood this concept, I knew that I would have to think big to positively affect more patients than I could see in my day-to-day practice. I’ve purposefully sought positions where I can participate in designing and improving healthcare.
During the COVID pandemic, I was part of the medical leadership team at South Shore Hospital in Weymouth, Massachusetts. We met several times daily to plan how the hospital supported patients and to get physicians and nurses the newest information and supplies needed to care for patients and protect themselves. I’m proud to have been a part of the team that made sure our hospital rose to the occasion to support the community during that time.
Now, I’m focusing my efforts on giving patients and families the tools they need to understand the healthcare system so they can advocate for themselves. Improving healthcare requires all parties to be invested and involved in demanding better outcomes for all of us.
4- Patients may not always agree with my medical opinions and plans
One of the things I had to get used to as a physician is that people will do what they want, even if it is not what I feel is best for them. My medical training taught me how to assess a patient’s medical concerns, all the supporting labs and radiology findings, and then devise an appropriate action plan. However solid I may think my plan is, it is ultimately up to the patient to accept it or not. I now understand that my role is that of an advice giver; I tell patients what I think is going on and what I believe the best action plan is. After that, it is up to the patient whether or not they will accept my advice and agree to go through a plan. A person’s decision to take my advice hinges on various things: their hopes, fears, religious beliefs, prior experience, financial capabilities, and so on. There are many things outside of my control or knowledge of the person that will ultimately determine their decision. This realization allowed me to release myself from the feeling that I had to fix everything for everyone. Now, I know how to let go of my need to fix and control things and join the patient on their journey to what is acceptable and feels right to them.
5- Take things one step at a time
I was speaking with a medical student when he told me that he was concerned he wouldn’t be able to fit in time with his children and his clinical responsibilities. This young man had yet to graduate and didn’t have children or a spouse. He was feeling overwhelmed by the idea of all the things that lay ahead of him. I have known that feeling at various transition points in my life. The idea of all the things that lay ahead can become overwhelming and suck the joy out of the great things that are currently going on. Somewhere in life, somebody told me, “You don’t have to finish it all today; just finish today.” I took that lesson to heart, and now, it’s what I tell myself when I feel like there is too much to accomplish. Focusing on completing the immediate tasks in front of me and breaking down big tasks into smaller goals makes everything more manageable.
If you could start a movement that would bring the most amount of wellness to the most amount of people, what would that be?
I would create a movement focusing on social connectivity to improve the health and wellness of as many people as possible.
When we look at the health journey of people who live long and healthy lives, we see that they live in a very interconnected way. These people have lots of social support and are active members of their communities. Conversely, we know that loneliness can lead to poor mental and physical health. Too often, we focus on social isolation as a problem for older adults, but bringing people of all ages and abilities together improves wellness for everyone. I would work with architects and urban planners to create physical spaces encouraging intergenerational living, walking, socialization, and easy access to third spaces.
We are very blessed that some of the biggest names in Business, VC funding, Sports, and Entertainment read this column. Is there a person in the world, or in the US whom you would love to have a private breakfast or lunch with, and why? He or she might just see this if we tag them 🙂
Sally Sampson founded Chop Chop magazine, a publication aimed at improving children’s knowledge and experience of healthy foods. I would like to have dinner with her and learn about her experience creating and founding an organization to improve health through lived experience and education.
What is the best way our readers can follow you online
My website is the best place to find my book, blog, podcast spots, and upcoming projects.
Thank you so much for these wonderful insights!
Dr Monique S. Nugent : 5 Things I Wish Someone Told Me When I First Became A Doctor and Scientist was originally published in Authority Magazine on Medium, where people are continuing the conversation by highlighting and responding to this story.