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Changing the Landscape of Medicine through Innovation and Design

Dr. Chethan Sarabu is a pediatrician and landscape architect and currently a fellow in clinical informatics at Stanford University. Dr. Sarabu double majored in Biology and Landscape Architecture at the University of Cornell. After completing his undergraduate studies, he then completed medical school at SUNY Upstate University Medical School and his pediatric residency at Rutgers Robert Wood Johnson Medical School.

CO: How did you become interested in medicine?

Dr. Sarabu: I grew up within a family of doctors, and this was part of my introduction to medicine. I was also a patient as a child, and through all of my healthcare experiences, I always thought that things could be better. I had two lenses through which I saw that. I was interested in how children’s experiences could be better and how design could be used to improve the current state of medicine. That was what initially drew me into medicine.

CO: How was your undergraduate experience given your interests in both medicine and design?

Dr. Sarabu: In my transition from high school to college, I knew I had both interests, but I was not aware of the interdisciplinary fields. But I was very curious and explored. So, I started off undergrad as a biology major. Simultaneously, I was looking at courses in design due to  my interest in architecture. One day, I very serendipitously stumbled upon the Department of Landscape Architecture. As soon as I walked in, I realized that this was what all of my creative juices were seeking. It was an amazing space where everyone was drawing and building models and there was a lot of greenery. I later asked if I could take a class, without knowing what I was getting myself into. Because of my experience in this class, I ended up double majoring in landscape architecture and biology.

CO: How have you addressed needs within the medical field through your interdisciplinary work?

Dr. Sarabu: There are indirect and direct ways in which my work has addressed needs in medicine.If we look back at the history of landscape architecture, we can see its direct application to the field of medicine. One of the quintessential examples of this is Central Park in New York City. Central park in New York was designed by Frederick L. Olmsted, who is considered the father of landscape architecture.But before he created this field he was considered a public health official for NYC. His purpose in  designing the park was to improve mental health and prevent the spread of infectious disease. He conceptualized that green space is important in very urban areas and allows for rest and reprieve from the hustle of the city while also controlling rodent infestations in rapidly developing cities.

More indirectly, the overlap between the two fields gave me a way of thinking and looking at problems though a unique lens that I was able to apply to healthcare in and out of the hospital. . Within multi-scalar design thinking, we are looking at the same place but zooming in and out at different scales. This idea of thinking at different scales has played an important role in different aspects of healthcare. For example, the landscape architect of Central Park has to look at the whole 800 acre park as well as  city streets and the flow of traffic. They also have to zoom to one particular corner of the park in order to establish how trees, a pond, and a bench are all laid out next to each other. Redesigning systems in healthcare requires looking at systems from different scales. For example, if you are addressing obesity, you could start with what happens in an office encounter and how a pediatrician talks to a child and a mother about diet and exercise. This is a smaller scale. But you also need to zoom out to what is going on at the level of the city in terms of access to healthy food and places to play. We can also  look at state and national policy around this issue. Landscape architecture taught me to think at different scales,, and it has really helped me approach problems in healthcare that seem difficult to tackle.

CO: Can you tell me about your project ‘Drawing Play’?

Dr. Sarabu: ‘Drawing Play’ is a project that I spearheaded and helped conduct during my residency at Rutgers. It was inspired by my initial experiences in the pediatric clinic in downtown New Brunswick that served a primarily lower-income Hispanic population. When I started to work in the clinic, I noticed that there was a really long waiting room experience for patients,and I started wondering how we could improve that. I noticed that when we were talking to patients, we weren’t doing a great job at giving children enough time to talk about what mattered to them. As a result, we were not doing a good job of understanding the child’s environment, what they are thinking, and what they wanted. This issue combined with the issue of the waiting room experience are addressed simultaneously through ‘Drawing Play’.

‘Drawing Play’ is a way of making the time spent in the waiting room an extension of the visit and engaging patients and their families.  I was inspired by how we might to a better job of engaging children. I started to do more research and found that children often gravitate towards using their perceptive senses more than their semantic senses. I settled on drawing as a way of engaging  children through their perceptive senses. We asked children to draw where they like to play as well as what they like to eat while waiting for their appointment. When they come in to see the doctor, the child will show the doctor the drawing and a dialogue will be initiated. What this did was welcome the child into the visit in a way that was more tangible for them. Also, it was a way to get more actual information about what the child is thinking, which is a very rich source of information that we might not otherwise consider.

CO: What impact do you hope to make on the medical field using your interdisciplinary training?

Dr. Sarabu: I hope to address how we can engage landscape architecture and city planners to design healthier cities, whether through promoting walking or access to healthier food. My second goal entails how I can apply my interdisciplinary training in a way that has the most impact on technology in healthcare. Technology in healthcare is still really broken. We have come a long way but there is still more to do. As a country, we have spent about 30-40 billion dollars to create electronic health record systems within the hospital, but we are still using fax machines and pagers to communicate, and there are gaps of knowledge in how information flows across hospitals. The systems that healthcare providers use on a day-to-day basis don’t have that modern user interface that we experience with other software. So I am currently working on addressing the technology challenges through means of clinic informatics, which is not just about the technology itself but rather about how people use technology. This is where I see my greatest impact.

CO: Do you think the future of medicine will call for more interdisciplinary physicians?

Dr. Sarabu: Absolutely. Everything that I have experienced in my own personal journey has suggested that this is how medicine is progressing. Medicine is a science and an art, but ultimately it is truly about the human experience. It is about the full human experience. Different fields of studies, that may or may not be directly related to healthcare as a whole, deal with different aspects of this human experience. Every discipline has something unique to offer, and I think that they contribute critical pieces to moving healthcare forward by including more dimensions of the human experience that we don’t necessarily incorporate right now.

CO: Do you have any advice you would like to give those who are pursuing medicine?

Dr. Sarabu: Our medical education system is designed in a very traditional way. Medical school tends to reward the people who come from traditional science backgrounds. I know many people who come from interdisciplinary backgrounds and look for avenues to express such interests in medical school. These activities are truly enriching in medical school, but at the same time there is this immense pressure that doing these things might come at the expense of grades in more traditional testing. However, it is important to continue these interdisciplinary pursuits within medical school. Towards the end of medical school and residency, you start to differentiate yourself and reintegrate your passions.Transitioning from residency to a fellowship, there is more emphasis on people who bring unique backgrounds and experiences. So, ultimately these passions will be rewarded.