2024: Dr. Mandy Cohen

Well, good morning. Thank you, President Wente for that lovely introduction and for inviting me here to celebrate Wake Forest University’s Class of 2024. Graduates, I am so pleased to be here with you, your family, your, friends and the faculty.

Preparing for today, I received a lot of great advice about what to share for today. Don’t talk about COVID. Do talk about COVID. Talk about the CDC. Don’t talk about the CDC. Look forward. Look back. Talk about your experience. Make it about their experience. But above all, be inspirational.

All right. I’ll try for that. 

While I do hope to inspire you today, you have already inspired me, and it shaped the focus of my remarks today. It’s the Wake Forest motto that you already heard, Pro Humanitate. For humanity. And what I love most about your motto is that it feels very much alive on this campus.

So, before I share my words, I want to share some of your words. These are just a few ways in which Wake Forest University students describe what Pro Humanitate means to them. Pulled, of course, from Instagram. 

“It’s about openness to exploration, and willingness to step out of your comfort zone.”

“It means learning about just who the other person in front of us is. Or beside us. Or behind us.”

“It means being in community with people, thinking about what people need, and creating the ideas and the answers to meet those needs.”

These are powerful words to live by. But look; let’s be real. It’s not always easy to actually do it. It can be really hard to live Pro Humanitate. We see evidence of that all over world right now. Having good intentions doesn’t mean much without action.

To bring this home, I’m going to tell you a story … a story about a time when I failed. A time that I had the right intentions, but my actions and the system I worked in didn’t hit the mark. I didn’t do a good enough job learning about the person in front of me. It’s a story about a patient I met when I was nearly done with my training as a primary care physician at Massachusetts General Hospital in Boston.

For today, let’s call my patient Jennifer. Jennifer was a full-time grad student – just like some of you here today. She came in because she was losing her hair and feeling tired.

Pretty standard. My mind immediately sprung to the possible causes: A thyroid issue. Or maybe anemia. Low blood counts. Or maybe she had some sort of autoimmune disease that was flaring up for the first time. 

I asked her a couple of very personal questions – standard medical questions – about things like her menstruation cycle and her family history of disease. Yep, I said menstrual at graduation. Yep.

I did a quick exam and then I did what I did best:  I ordered blood tests to try to get to the bottom of it.

When all the tests came back normal, I spoke to her on the phone, and she told me that she thought she had lost some weight. Maybe her stomach felt bloated.

Ah ha. OK. I know how to investigate that. I ordered a CAT scan of her abdomen. That also came back normal.

Now, about eight weeks had passed, and she is back in the office. And I’m stumped. I asked my supervising doctor (because I was still a trainee) for advice. I showed her all of Jennifer’s lab tests, and we were discussing which specialist should we send Jennifer to next.

About that time my nurse tech – let’s call him John – came over. John had checked Jennifer in and taken her blood pressure and her weight and such. And he said to me, “I think you should ask your patient if she has enough to eat. I think you should ask your patient if she has enough to eat.”

I had an out-of-body experience. Actually at first, I was super defensive. In my mind I was thinking, “No, no, no. She isn’t hungry; she’s a grad student. She has insurance. She has cute clothes.”

Then I was horrified. I didn’t ask Jennifer about a fundamental, core aspect of her health: whether or not she had enough to eat. For eight weeks, she had gone on being hungry because of me.

So I pulled it back together and I went into the room. I asked the hard questions. But more importantly, I listened. 

Jennifer was living out of her car because she had left a relationship that suddenly turned abusive, and she didn’t want to tell her family or friends about it because she was ashamed. 

Now once I understood the core of the issue, we were able to get Jennifer connected to resources to help her. But for eight weeks, Jennifer had gone on being hungry and in unstable housing because of me. 

Now, my intentions from the outset here were good. I wanted to help Jennifer.  I wanted her to be healthy. I wanted her to thrive at school. I also think I’m a pretty smart person. (You heard. I certainly got a very pricey education.) But what if I had fully understood that my experience was not her experience? I might not have created a story of who she was based on her cute clothes and her status as a student.

And importantly, the system I worked in made it super easy for me to miss the person in front of me. It was really easy to spend money on the wrong things – ordering blood tests, CAT scans – but it was actually really hard to connect her to the housing, counseling, and food resources that she really needed to keep her healthy and thriving.

I share this story with you today because it’s become fundamental to who I am and how I show up – both professionally and in my personal life. And it’s one that I hope will inform how you show up as well.

That experience with Jennifer informed how I think about reshaping the system of delivering health in a way that puts people and their health at the center.

In North Carolina, under my tenure, we launched a ground-breaking program called Healthy Opportunities. Instead of just paying for traditional blood tests and doctor’s visits with our Medicaid program, we also used it to pay for things like food, or helping someone to move into stable housing, or even replacing carpet in the home of a kid with asthma.

And guess what. It works! It kept people healthy and out of the emergency room, which actually also saves money overall. We made the system work for people; we kept them healthy. And North Carolina is spending about $1,000 less per person per year in medical costs if they were in the Healthy Opportunities program. That means a lot of Jennifers are getting what they actually need to be healthy. This is what it can look like when our actions match Wake Forest’s motto, Pro Humanitate.

Now, look. The line from those early days as a new doctor taking care of Jennifer to implementing the Healthy Opportunities program in North Carolina was not a straight one. It was a collection of experiences that time and again reinforced how I want to show up in the world. Some of those experiences were big and highly visible – like leading through the COVID crisis – and others were personal and private.

But here are some practical things I have learned along the way about how to strive for Pro Humanitate.

The first is to actually show up. Get away from those screens screen and look people in the eye. Meet people where they are.

And when you show up, listen. I mean really listen. Not listening for how you can make your point, but listening for you can make a difference. To truly understand someone else’s experience – their why – find the common ground. It’s there.

Next: be authentic. Now look. Being authentic doesn’t mean sharing every opinion and thought you have the minute you have it, but It does means bringing your full self to the table: the things that make you, you. And for me, that means showing up as doctor and a public servant but also as a mom, a wife and a daughter. All of those things make me who I am and importantly, these things can connect you to others in meaningful ways.

And then lastly, do what you say you are going to do. Pretty basic but absolutely critical. This is how you build trust with actions, not just words. And that’s important. Trust is how you make things happen.

So in this increasingly complex world that makes it too easy to believe the illusion that we live in a binary world of us and them, I hope you will recommit to the school’s motto as you leave your college days behind. 

Show up and see people. All people.

Listen. 

Seek understanding. And not just with those who think like you.

Take the time to understand other the other person’s why. 

And focus on making a difference, not just making a point. 

And build trust by demonstrating your trustworthiness.

So as I wrap up, rather than ending with my own words, again I’ll end with yours here at Wake Forest. Use your ideas, knowledge, talents and compassion on behalf of humanity in all its difference and diversity. Pro Humanitate. 

Congratulations Class of 2024!