Learning from my Irish Heritage

Today is the Christian Feast of Saint Patrick, one of Ireland’s patron saints who lived during the fifth century. Celebrated today around the world as St. Patrick’s Day, this observance has evolved into a celebration of Irish culture and is a day of fun and family for those who are Irish or wish they were! As one of the 70 to 80 million people around the world who claim Irish roots, this celebration offers a chance for me to reflect on my own Irish heritage and what I have learned from it. And as those who have read this blog before know, family is of preeminent importance to me as a source of joy, strength, and comfort — all of which I have drawn on throughout my life.

Ireland is best known for its music and mythology, sports, scholars, and, most relevant to me, deep allegiance to kin groups. I can’t claim any skill on the feadan (tin whistle) or the cláirseach (the 30 string harp), although I enjoy a céilí (a celebration), and I do have some familiarity with the mythology, particularly the Morrígan, the Celtic triple war goddess of old, Queen Maeve, the strong-willed, ambitious, and fearless legend, and the warrior queens of the North. In terms of sports, I’ve learned enough to enjoy a hurling match and can follow Gaelic football. Ireland is known as ‘the land of saints and scholars,’ and my Irish heritage has provided me with a genuine and deep-seated love of learning that has been integral in my life.

Valuing my Irish heritage means also looking clearly at what makes Ireland what it is today.

The response to oppression gave rise to nationalism and a drive to be an independent sovereign state, leading to independence in 1921 (only 100 years ago!) and militance with sometimes tragic results advanced in the name of freedom. The Good Friday Agreement of 1998 brought about the end to one kind of violence. The Good Friday Agreement brought a measure of quietude to the challenges of expressing different views, yet more than twenty years later, differences still persist. And the recent investigations into mother and baby homes engendered an awareness of the need for the apologies to survivors of this awful period in Irish history.

Some believe the “Irish temperament” is a mixture of stubbornness, personal warmth, and a wit that shines through adversity. I certainly hope I have all three of these, perhaps a bit more of the latter two than the first. However, having a bit of stubbornness is important, particularly as the director of NLM, which serves as NIH’s center for biomedical informatics research and the world’s largest biomedical library. Being stubborn, coupled with warmth and wit, has helped me guide the NLM as it approaches its 3rd century in existence. It has helped me serve as an advocate for the technical infrastructure necessary to secure our resources and to make them permanently available around the world. It has provided me with the tenacity needed to hold firm to the values of what libraries mean to society – institutions rooted in collecting and disseminating the literature of the world with integrity and without censorship.

What this means to NLM is that we must continue to hold to our enabling legislation of 1956, to acquire, preserve … materials pertinent to medicine and … make available… materials in the library. As Joyce Backus, our former Associate Director of Library Operations, was fond of saying, “science is self-correcting,” meaning that we don’t need to exclude materials that are no longer aligned with our global perspectives, but we do need to continue to gather and make available the full range of information.  

So, I hope you join in the celebration of all that is Irish on this St Patrick’s Day and remember that history is complex — and the purpose of libraries, including the National Library of Medicine, is to reflect the progress and perspectives across time, rather than a snapshot of a particular point in time.

How can we help you in this celebration?

10 Tips After 10 Months of Video Calls

Like most of the world, staff at NLM has been engaging with others through various technologies – video conferencing, virtual daily work huddles, and conference-inspired meetings that require screen sharing, virtual breakout rooms, chat features and instant messaging. I’ve gone from a 30-minute commute, including a short walk and a metro ride, to a 3-minute walk from my bedroom to my home office. Those lovely, long walks across the NIH campus that formed the bridges between meetings three or four times a day are now replaced by 60-second coffee refills between almost-non-stop video calls between 8 a.m. and 6 p.m. And where before I only had to make sure that I looked professional and polished, I must now make sure that there’s no clutter or distracting pictures or items in the background – the camera sees everything!

Fortunately for me, I regard meetings as a high art. For the past 15 years, meetings have been one of the main mechanisms through which I work. Early on I learned two great tips from a great biomedical informatics guru, John Glaser

Never walk out of a meeting with more to do than you came in with, and never close a meeting without knowing who is taking the next steps on every item.

This comes in handy when your days are lived on camera! I can’t match the wisdom of John, but I can share some ideas that are proving helpful to me as I (virtually) meet with NIH colleagues, the NLM leadership team, individuals with whom I’m collaborating, and NLM staff through “brown bag” lunch sessions.

I’d like to share a few of my own tips garnered from my years of in-person and virtual meetings.

Call people by name, often.

This is particularly helpful if you are leading a meeting, for it acknowledges people and engages them in the moment. It is also important when you are a participant. Using names helps compensate for the lack of communication cues in video calls, such as eye contact and head nodding, and fosters engagement and stimulates participation.

Start on time and end on time.

I know I’m not the only one whose days are lived through conference calls and video chat. By starting and ending on time, you demonstrate respect for everyone on the call, as well as those in the prior and subsequent calls. In addition, it saves you from having to start every next call with the “sorry I was finishing up a previous call” apology.

Allow for pauses.

This is important for the leader of the meeting and is also equally relevant for participants. It can be difficult to pick up on visual and audio cues, gestures, and conversational threads, such as someone leaning back, leaning in, shifting their gaze, or changing their tone of voice. So, it becomes particularly important to let pauses stand an extra second or two to allow someone to come off mute or organize their thoughts.

Keep your camera on when possible.

Keeping your camera on provides visual evidence that you are present and attentive during the conversation and meeting discourse. It’s courteous to others, and yes, it does mean that you have to attend to the image being displayed, but it allows your colleagues to see that you’re not reading email or distracted by other issues. It also reinforces the connection between the speaker and the audience and enhances a sense of group engagement. Although some may worry about excessive bandwidth consumption, the social value is worth it!

Keep your microphone off unless speaking!

Visual cues are important; auditory cues are distracting. Until technology advances, microphones (mics) often create distortion, pick up background noise, contribute to audio feedback, and generally degrade the conversational experience. Remaining on mute signals respect for the speaker and gives them a non-competitive platform for discussion. It helps to learn the steps of muting and un-muting to keep up with the rhythm of the conversation.

Check your mic often and use a headset with a good mic.

Get to know your mic, how it works, and the indicators that it’s live. Poor audio quality can affect the experience of the video call for everyone. Many of us forget that the mic is on our laptop and the further away we are from the mic, the poorer the audio. I’ve found that using a headset helps because it puts the mic close to your mouth and will help minimize background noise. It is key to your personal happiness and professional survival that you make sure you know how to troubleshoot basic mic issues, particularly knowing when your mic is on, when it’s NOT on, and to stay alert so it’s never on when you don’t realize it! 

Use chat features judiciously.

Most video conferencing software has some type of text support, usually called “chat.” I find this feature to be very useful when I’m NOT the speaker and very annoying when I am. Sometimes, in a big and exciting meeting, sidebar conversations held through the chat feature can provide clarification and enhance the shared experience. However, every thought appears on the screen and it can be distracting to the speaker. If you really want to chat your way through a video call, consider setting up a parallel channel in a different platform for that purpose or consult with your speaker beforehand. Your speakers will thank you!

Watch your backgrounds!

Video conferences introduce us to the private lives of our colleagues in ways never before anticipated, often by having the opportunity to look over the shoulder of your colleague and into their background. Some video conferencing platforms allow you to customize the image projected on your screen – a blessing and a bane. Remember that some backgrounds may best be left for personal calls with friends or family, and professional engagements do best with a more subdued background where the interest can focus on the person, not the background.

Take notes.

Many of the mental mechanisms we use in human discourse add meaning and interpretation to the words that are exchanged. We remember how a colleague smiled when bringing up a new idea, or the worried look when your words weren’t well understood. Note taking (I use a fountain pen and write in long hand) helps keep me focused during video calls, aids me in organizing thoughts, and often provides a reminder for the next meeting or conversation.

Take a break!

This tip is for you; not about using the technology. Technology is unrelenting and always demanding. The immediacy of work, the pull of people waiting for a meeting to begin, and our tendency to overschedule can lead to very packed days. As an industrial engineer with human factors training, I know that performance degrades over time and short breaks help! Schedule breaks – at least every two hours – even if only for five minutes. Take a walk, hug your child or someone you love, or start a load of laundry. The goal is to refocus and refresh!

What have you learned from 10 months of video conferencing? Please share your tips and ideas here – we are all in this together.

Building Bridges Throughout My Career

Last month, I had the pleasure of hosting a fireside chat with Anthony S. Fauci, MD, director of the National Institute of Allergy and Infectious Diseases (NIAID) at NIH and our nation’s top infectious disease expert. This event took place as part of the American Medical Informatics Association (AMIA) 2020 Virtual Annual Symposium and was shared with almost 1,000 AMIA attendees.

I will share a few key points of wisdom that Tony provided a little later in this post, but first I want to share the experience of bridging my life-long affiliation with a dynamic professional society and my current responsibilities as NLM director.

Making Connections

As NLM director, I support the work of the 1,700 women and men who conduct research, enable access to the vast biomedical literature, and accelerate data-driven discovery. I understand the importance of professional societies, like AMIA, that advance the field by nurturing and supporting health information professionals, providing platforms for sharing research findings, and creating spaces that inspire discoveries and improve health through information technologies. Rarely has the critical importance of the field of biomedical informatics been more sharply focused than during the COVID-19 pandemic.

Moments of joy with Dr. Fauci during our fireside chat.
AMIA Fireside Chat
Top row (L to R): Dr. Anthony Fauci, Dr. Patricia Flatley Brennan
Bottom row: Dr. Eneida Mendonça, Chair of the AMIA 2020 Scientific Program Committee

During the hour spent with Tony, I was reminded that engaging with domain experts can elevate awareness of where biomedical informatics challenges exist and the potential solutions that could have a broad impact. Taking part in this event with a giant in the field, like Dr. Fauci, was like taking a tour through the fields of microbiology, immunology, chemistry, pharmaceutical development, public health, and science education, highlighting the many points of impact open to biomedical informatics interventions.

It was wonderful to be able to introduce AMIA to Dr. Fauci, and vice versa. Tony spoke passionately about the importance of data sharing — emphasizing that peer review brings trust to data, and that data should be shared in ways that people can easily access and use. In his closing remarks, Tony expressed his appreciation for the opportunity to talk with the biomedical informatics community and acknowledged the benefits of building bridges to learn from each other.

Sharing What We Learned Together

Shared with permission: evan.william.orenstein@emory.edu

Through this interaction with Tony, I developed a deeper sense of his passion for science as well as his confidence in science. In considering how to best understand the long-term effects of COVID-19, Tony advocated for the effective use of patient registries – an area where biomedical informatics could make considerable contributions. When asked about how to better infuse science into our educational system, he enthusiastically responded that introducing children to science and scientific concepts in early childhood can foster a lifelong love of science, adding that “science can be love at first sight!”

I learned that preparedness is more important than prevention when it comes to pandemics. I was inspired by many of his views, including that supporting local public health authorities is the best first step to strengthening the national public health infrastructure. Finally, I developed a new perspective on the importance of scientific communications during emergencies and the challenges that can emerge when mixed messages and differing perspectives create confusion and uncertainty. 

The AMIA audience also shared what they learned from this session. Dr. Fauci’s clear explanation of the current trend that 75 percent of emerging infections originate through zoonotic transmission (i.e., disease that is passed from animals to humans) put into perspective his advice to prepare for — not try to prevent future pandemics. As one AMIA attendee offered, “It takes everyone to beat back this pandemic, and informatics has a role to play.” Another attendee shared of learning about new opportunities for biomedical informatics in global health.

As two of the 27 Institute and Center Directors at NIH, Tony and I share many responsibilities and have many opportunities to collaborate. Certainly, our mutual regard provides a strong platform for a discussion. What I didn’t expect from this discussion was to walk away with new insights about the importance of NLM’s support for open data, data sharing, and outreach to the public through our highly trusted information resources. I am delighted that we may have inspired AMIA attendees to answer some of the many challenges Tony described in guiding science and society through this pandemic.

Bridges are built by the concerted efforts of many people.

For this event, the AMIA Board of Directors brainstormed to come up with a set of questions that allowed for a lively discussion. AMIA members posed additional questions through a crowdsourcing strategy. Staff from NLM, NIAID, and AMIA collaborated to coordinate logistics, technology, messaging, and outreach to support the success of this conversation between two colleagues.

Did you attend the fireside chat at AMIA with Dr. Fauci? If so, what new planks on the bridge of your life did you discover?

Didn’t you used to be a nurse?

Didn’t you used to be a nurse?

I get this question more often than you might expect—and frankly, a little more often than I would expect.

I am a nurse who presently serves as the director of the National Library of Medicine. I’m the first nurse to direct the Library but not the first licensed health professional to do so. In fact, all of my predecessors have been licensed health professionals—specifically, physicians. I wonder how many of them were asked, “Didn’t you used to be a physician?”

The answer to the nurse question, by the way, is, “No.”

I am a nurse. I didn’t used to be a nurse.

I have an active license as a registered nurse. I am a member of the American Nurses Association. And though I might wait a beat to raise my hand when that call comes over the airline public address system—“Is there a health professional on board? We have an emergency.”—I sometimes do, doing what I can to help but always deferring to someone with more current clinical knowledge.

I don’t even think it’s possible to leave nursing behind. Nursing is as much a calling as a profession. The calling fuels the desire to be a professional with specialized knowledge, operating under a contract with society (Nursing’s Social Policy Statement: The Essence of the Profession, 2010).  One does not forget the knowledge, nor does one abandon the calling.

A commercial years ago used the slogan, “If caring was enough, anyone could be a nurse.” I care, but that does not make me a nurse. I’m a nurse because I possess specific, advanced knowledge about the diagnosis and treatment of the human response to disease, disability, and developmental challenges, and I apply that knowledge to caring for others.  Today, I demonstrate that caring and fulfill my contract with society as the director of the largest biomedical library in the world.

It takes 1,700 women and men to bring to society all the products and services NLM offers. But being a nurse gives me insights into and an understanding of health that help me channel their efforts in different ways. Being a nurse broadens my perspective on what constitutes relevant health information. Being a nurse drives me to connect the knowledge of how to manage a health problem with the skills needed to do it. It highlights that health is a team sport, not a solo pursuit, and that I must create the environment that lets all team members, including patients, their family, and friends, operate at the top of their skills. And as essential as trusted, quality health information is, being a nurse reminds me that information is only part of the equation. Personal motivation, a sense of self-efficacy, and the ability to act in accord with one’s values and outlook on life contribute mightily to someone’s willingness and ability to move toward health—and even how they define health.

Of course, I’m not the only nurse working outside a traditional clinical setting. Nurses do many things, but all fall under nursing’s contract with society: helping people, sick or well, by understanding their human responses to disease, disability, and development and partnering with them to move toward health informed by mutual respect and shaped by our combined talents and skills.

So, no, I didn’t used to be a nurse. I am a nurse. And my job as a nurse is to lead a library.

Come join me in my practice, add your skills and knowledge to the mix, and work with me toward the future of data-powered health.

With Gratitude

What is it like to be feted for a lifetime of work?

I never imagined I’d have the chance to answer that question, but I found out early last month when I received the Morris L. Collen Award from the American College of Medical Informatics at the annual AMIA meeting in San Francisco.

The accompanying celebration was full of the joy of family and friends. My sister Kathleen brought my almost 90-year-old mom out from Philadelphia, and my son, Conor, joined us from Seattle. As a result, my family got to meet my friends, and my friends met my family, creating a delirious mix of my professional, personal, and family lives over a three-day period. I soaked up the excitement, basking in the love and floating on people’s kind and generous words. The experience left me feeling complete and centered in a way I never had before, as if the intersection of these parts of my life simultaneously anchored and inspired me, reminding me where I’ve come from and the countless steps I’ve taken through a career in nursing, academia, and federal service and highlighting how these many threads have woven together to create the person I am and the work I’m doing today.

formal headshot of Dr. Patricia Flatley Brennan with the Collen Award medallion draped around her neck
Patricia Flatley Brennan, Collen Awardee

I also found tremendous joy and satisfaction in the attention the Collen Award brought to the work we do here at NLM and to the remarkable accomplishments of the Library’s previous Collen Award recipients: Don Lindberg, Betsy Humphreys, and Clem McDonald, all of whom were and are exceedingly dedicated to improving health care and biomedicine. Their contributions to the field have helped shape NLM into the trustable resource it is today, and I’m proud to stand in their company.

In fact, part of what drew me here for this phase of my career is to build upon their work providing outstanding, trustable health information in the service of patients and their families. After all, the most important person in the health care process is the patient. He or she is the reason for it all—the research, the training, the technology; the doctors, nurses, and orderlies; the biomedical engineers, informaticists, and medical librarians. We’re all here to improve the health and life of patients.

But there is more to be done.

I will be eternally grateful for the professional recognition I’ve received. The Collen Award is an honor I will treasure, and sharing that honor with my family and friends yielded memories I will cherish for a lifetime. But my work continues, and I’m thankful that it’s here, leading this amazing institution with its almost 1,700 women and men, each serving science and society in their own ways. Thank you all for being a part of my team. The world has never needed our efforts more than it does now.