Q&A with Richard Leiter, MD, MA
May 15th, 2020
Richard Leiter, MD, MA is an attending physician and researcher in the Department of Psychosocial Oncology and Palliative Care at Dana-Farber Cancer Institute and Brigham and Women's Hospital. He is also an Instructor in Medicine at Harvard Medical School.
Why did you decide to work in palliative care?
I have always been humanities minded and never thought I would go into medicine. My father is a doctor and I could never see myself doing what he does. One summer in college, I fell into a clinical research job and found that I actually really liked the environment of the hospital and an academic medical center. Fast forward to my senior year and, for all intents and purposes, I was on the track to becoming a lawyer. I took the LSAT and downloaded the law school application, but couldn’t bring myself to fill it out. I was having a sort of existential crisis. I decided that I wanted to go to medical school, so I did a post-bac pre-med program, took a year to do research while applying, and then started medical school.
When I got to medical school, I had no idea really what I was getting myself into and I was really worried that I would lose that part of my brain that wrote and thought critically about the humanities. In order to keep the humanities side of my brain going, I signed up for a dual degree. In addition to my MD, I completed a Masters in Medical Humanities and Bioethics. It was mixed course work in philosophy, law, history, literature and sociology and focused on how we can look at medicine through all of those interdisciplinary angles, which I loved. I wanted to find a way to integrate that into whatever career I ended up pursuing, though I wasn’t sure how.
As a first-year medical student at Northwestern, I was also in a program called “Patient Perspectives,” where students would sit with hospitalized patients and talk to them about non-medical subjects to better understand their lives and what it’s like to be a patient in the hospital with a variety of illnesses. The group I was in was oncology and palliative care, and I found myself drawn to that patient population and talking with them about their serious illness in a meaningful way.
Two years later, as a third-year medical student, I did a clinical rotation in palliative care and everything clicked. It was a patient population I knew I was drawn to already and the palliative care clinicians were using the skills that I was studying in my Masters, thinking about larger societal questions related to medicine, but at the bedside with individual patients.
I decided to pursue residency in internal medicine and did a rotation in palliative care as an intern and that sealed the deal. It just felt like palliative care clinicians were my people – they thought the way that I thought, they cared for patients the way that I wanted to care for patients, and they were the type of doctors I always saw myself becoming. I decided at that point to go into palliative care and haven’t looked back since.
Tell us about your research. What drew you to this?
My research primarily focuses on models of palliative care for cross-cultural populations, specifically international patients with cancer who come to the United States for advanced treatment. A few things drew me to this patient population.
When I was a clinical fellow in the Harvard program, we were seeing international patients and it was a uniquely challenging patient population. It didn’t feel like we could approach them in the same way as we could approach our domestic patients. There were not only language barriers and cultural barriers, but it also felt like our standard tools weren’t effective in the same way. My co-fellows were finding the same thing. One day I did a literature search to see what people understood about this patient population and I found next to nothing, which was really interesting.
As I was preparing for my research fellowship at Dana-Farber, I was brainstorming with Dr. Tulsky and he asked me what bugged me when I’m working clinically – what questions did I have that couldn’t I answer when going to the literature? I thought of international patients and the fact that no one has really studied that population before, and decided I would be the one to do it.
Because of my background in ethics and humanities and trying to understand medicine in its wider societal context, this is the perfect patient population to study. By understanding international patients, we will gain critical insights into larger questions facing palliative care, for instance: Do our interventions work and how do they work in diverse patient populations? If they don’t, how do we adapt them? Working in the United States, which is steeped in a western bioethical framework, how do we understand and care for patients from a very different ethical milieu? For patients coming abroad that see us as their last beacon of hope, how do we manage that hope in a compassionate, honest, and ethical way?
These patients are, in many ways, vulnerable. They are coming thousands of miles, often with only a few family members, and they are incredibly sick. I want to figure out how my colleagues and I can provide them with the best care possible, and I think that by doing research we can really understand that.
What’s your favorite part of your job?
There are a few of them, but if I had to pick one it would be that, because I do a lot of different things, my days are often so different.
Clinically, I work on the consult service, I'm on the intensive palliative care unit, and I’m one of the attending physicians on the KidneyPal team, which provides palliative care to patients with advanced kidney disease, both inpatient and outpatient. I love my clinical work. I find it exciting, challenging, and intellectually stimulating. I believe in what we do. I believe in helping patients, their families and our colleagues using all the skills and knowledge that we have in palliative care. The clinical parts of my day are always highlights even though it’s incredibly hard work.
I absolutely adore the opportunity to interact with learners at all levels. Working with the Harvard Interprofessional Palliative Care fellows is just incredible. I also work with research fellows, leading their journal club and teaching some of their curriculum, and I have a research mentee, Zhimeng Jia, who is doing incredible work to understand palliative care in patients of Chinese ethnicity. They bring an energy, passion and brilliance to their work as learners that always pushes me to become better at what I’m doing.
Digging into my own research and writing allows me to step back from all of that and try to ask and answer the deeper questions about our work. It allows me to scratch below the surface to understand where we’re at with palliative care, how we got here, and where we’re going.
Being a part of the palliative care community at Dana-Farber and across Boston and the Harvard system is just amazing. I always tell the palliative care fellows interviewing here that it’s like palliative care Disney World. There’s so much going on and the people here are so committed and intellectually engaged. There’s always someone who is an expert in a specific area or looking at things in a different way. I’m fortunate to be able to tap into that and we can cross-pollinate ideas.
It’s hard to say there’s a single favorite part of my day, but being in this environment where we can provide absolutely incredible clinical care, engage in cutting edge research on the science of caring, and teach the next generation of palliative care clinicians and leaders across all disciplines makes it an unbelievable place to be.
Are there any recent publications or projects that you’d like to highlight?
There are a few recent projects that I am particularly proud of:
I was the palliative care chapter editor for COVIDprotocols.org, which has been viewed hundreds of thousands of times since it was put up in March and has served as the online living resource for all things COVID. It’s been a remarkable effort led by the Critical Care group at Brigham and Women’s, but involving all specialties and people across different institutions. It has been a really important project given everything going on.
I was lucky enough to be on the GeriPal podcast a few weeks ago with my colleagues Rachelle Bernacki and Zara Cooper to discuss our experiences with COVID. It was a hard conversation because we’re all going through a lot, but I think it was important to be able to share what our experiences have been and the lessons that we’ve learned.
I’m currently working on finalizing a paper on a qualitative study of palliative care and oncology clinicians that care for international patients with cancer in order to better understand the clinician experience. We conducted focus groups and interviews with 30 clinicians from Brigham and Women’s and Dana-Farber and the results are just fascinating. The clinicians are really trying to provide the best care for these patients and there are a number of barriers to doing so. There are simpler challenges to talk about, such as language and incomplete records, but there are also deeper issues, for instance, challenges to clinician’s identity as professionals and difficulty connecting with patients because the patients don’t view them in the way they’re used to and aren’t expecting the same things. This work has been really fascinating for me and I’m excited to get it out there.
In my spare time, one of the things I really enjoy doing is writing for the lay press. I’ve had a couple articles published in the New York Times, one on international patients and one on what it means to die at home and how we think about that and the changing nature of the place of death in the United States. I’m really proud of both of them, but particularly the article about dying at home because I was able to share some of my emotions and my own family’s story on the subject. Most recently, I wrote a piece on palliative care and COVID that is available on STAT’s First Opinion. Writing for the lay press continues to be a source of great pride and pleasure for me. It’s also a way to advance the field and get ideas out there to a different audience and advocate for change.
Tell us about your background.
I grew up in Toronto, Canada and lived there until I was 18. I moved to the US to go to college at Yale, where I was a history major. I then bounced around: I lived outside Philadelphia, then moved to Toronto, went to medical school in Chicago, did my residency in New York, and now I live in Brookline.
My wife Stephanie is an attorney in the U.S. Deartment of Education’s Office for Civil Rights. We have two boys, who are 5 and 3, with a third son on the way. My sons are very into scooters, so they scoot around Brookline and I run after them. They’re also very musical, which has inspired me to pull my guitar out. We have a lot of fun playing music together, goofing around, and having family time.
Fun fact - I’ve been on two game shows: Cash Cab Canada, which I won, and Jeopardy, which I did not win, though it fulfilled a lifelong dream.