Q&A with Lara Michal Skarf, MD
July 10th, 2020
Lara Michal Skarf, MD is Chief of the Section of Geriatrics and Palliative Care at the VA Boston Health System and Palliative Care Lead for the VA New England Health Care System. She is also an Assistant Professor at Brigham & Women's Hospital and Harvard Medical School.
Why did you decide to work in palliative care?
It feels more like palliative care chose me. In retrospect it makes sense. My father is a physician and my mother is a social worker and both are very spiritual. I loved medical school, particularly patient-doctor interviewing, but struggled in residency. Inpatient medicine was very fast paced and patients did not stay long in the hospital. I gravitated toward the ICU and oncology wards because patients stayed longer. When I met Mary Buss and Janet Abrahm I was amazed to discover that palliative care existed as a field. I felt like the ugly duckling who found her swans. I cannot imagine practicing in any other field. The ability to practice patient centered medicine on a team with nurses, chaplains, mental health providers, social workers, and more is very gratifying. I feel challenged every day to improve my communication skills and abilities. Three elements really stand out: lifelong communication skills learning (not textbook learning), team-work, and being present for someone else’s experience no matter what it is.
Tell us about your research. What drew you to this?
Currently I’m excited about an integrated palliative care-pulmonary clinic that I’m running at the VA. We partnered with the pulmonary department to see patients with advanced COPD. These patients experience poor quality of life for many years before they die, and prognosis is unpredictable. The clinic includes providers from pulmonary, palliative, psychiatry and pharmacy. We are able to do a lot of work with goals of care and planning for the future. We are also working on guidelines for managing dyspnea with opioids in patients with end stage COPD and a prognosis > 6 months which takes into account multiple opioid risk factors including risks for addiction, mortality, respiratory depression, falls and confusion. We have noted that our population is mostly older, multi-morbid and has a high level of co-existing mental health and substance use disorders.
What’s your favorite part of your job?
This has probably been the case since second semester "Patient-Doctor II" at Tufts. In that course we interviewed patients and then debriefed word by word. The best part of my current job is going into a room with a fellow, resident, or colleague, taking notes, often word for word, and then reviewing sentence by sentence. The hardest part is not giving too many teaching points at the same time. I really enjoy talking, listening, and choosing words carefully.
Tell us more about yourself.
I was born in Montreal, when my father was a second-year medical student. My mother worked as a school social worker until I was born. I am the oldest of four children and we moved a lot: Montreal, Toronto (residency), San Francisco (fellowship), Boston (research fellowship), Toronto and then to Detroit. Six schools before fifth grade. I was a serious student and not good at sports. I used to go with my father to the hospital and walk around with him on rounds. I grew up as a modern Orthodox Jew. I went to Hebrew School from pre-K to 12th grade and then spent a year in seminary in Israel. I am fluent in Biblical Hebrew and love old testament trivia! As a child we went to temple every Saturday morning; we did not use electricity on Saturday—no cars, phones, or TV. Everyone in my high school went to University of Michigan, but I insisted on going to New York City to Barnard. While there I met my current husband. He moved to Boston after school so I went to Tufts Medical School which was outstanding.
What is the most helpful advice that you have received?
I am fortunate to have had many strong mentors along the way. I’m going to take the liberty to give two answers. “Do what you love” and “it’s a marathon not a sprint”. When we were discussing careers and I was hung up on what I “should” do many years ago, Dr. Tamara Vesel, one of my mentors and a remarkable palliative care physician said, “do what you love.” It seems so obvious and simple, but it really isn’t. The first question is how do I know if I love it? I’m the kind of person who sort of loves everything. I can say it has taken me several years to figure that out and here is what I can tell you now: after two weeks of managing my department, advocating for improved palliative care access, working on quality improvement and research I feel really good. After two weeks of working with fellows and patients I feel great.
“It’s a marathon not a sprint.” Countless women have told me this including Dr. Susan Block, Dr. Joanne Nowak, and Dr. Kalpana Gupta. Having my third child was a very hard decision. I am not a super-woman. Having a newborn would mean putting some of my goals on hold or at least going slower. It introduced uncertainty. Everyone’s decisions are individual but what I can tell you about mine is I was supported by confident women who told me that I will get to the same destination as the men, as others, just maybe on a different timeline. It was enormously validating and reassuring. And they were right.
In your spare time, what do you do for fun?
I have three children, aged 19, 13 and 8. Most of the time, for fun I play with the 8 year old. We read books, play soccer, football, board games. We do art projects. Most of my time out of the hospital is spent with him. I also enjoy swimming, reading, watching foreign films with my husband, going to art museums, running and kayaking with my whole family. On Saturdays our family goes to Temple from 9-12, then comes home, eats lunch and then we play board games all afternoon until it gets dark.