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Spotlight Storytelling as a Powerful Teaching Tool – An Interview With Dr. Shan Liu, MD, SD


An Interview With Geriatric EM Expert, Shan Liu, MD, SD

Shan Liu, MD, SD is an attending physician in the Department of Emergency Medicine at Massachusetts General Hospital (MGH). She received her medical degree from Harvard Medical School, her doctorate in science in health policy from Harvard School of Public Health and completed her residency at the Harvard Affiliated Emergency Medicine Residency Program. She is currently an associate professor of emergency medicine at Harvard Medical School and the MGH Geriatric Emergency Medicine Division Fellowship Director. She is past president of SAEM’s Academy of Geriatric Emergency Medicine (AGEM) and has served on the executive board of the American College of Emergency Physicians’ Geriatric Emergency Medicine Section and the International Federation of Emergency Medicine Geriatric Emergency Medicine Special Interest Group. She is considered the international expert in the emergency department (ED) management of fall patients and leads the Geriatric Emergency Medicine Guidelines group. She has authored publications in U.S. News and World Report, CNN, and the forthcoming book, Masked Hero: How WuLien Teh Invented the Mask and Ended an Epidemic (Publisher Candlewick Press/MIT kids).

Dr. Wu-Lien Teh: Inventor and "Plague Fighter"

During COVID lockdown Dr. Liu and her daughter, Kaili, wrote a book entitled, Masked Hero: How Wu Lien-teh Invented the Mask and Ended an Epidemic. The book tells the true story of a boy who loved science and when a deadly disease came to China in 1910, how he used his learning, courage, and quick thinking to invent a mask that quickly ended the outbreak, saving countless lives in China and around the world. That boy was Dr. Liu’s great-grandfather, a physician renowned for his work in public health and particularly, as the “Plague Fighter” who stamped out the Manchurian plague of 1910–11 using the same precautions (wearing masks and restricting travel) taken during the COVID-19 pandemic more than 100 years later. The mask he invented was the Wu mask, the precursor of today's N95 mask.

Dr. Wu-Lien Teh was also the first Malayan and the first Chinese-heritage person nominated to receive the Nobel Prize in Medicine in 1935.

“It is frustrating when we know how to stop the spread of a disease but struggle to persuade the public to act on that knowledge.”

In the 1990s you spent a year as a Fulbright Scholar conducting health policy research on AIDS education policy in Honduras. In your experience with COVID-19 and AIDS, what similarities and differences have you found, especially regarding attitudes, stigma, discrimination, fear, misinformation, and inequities among vulnerable groups?

There is always a lot of fear with the unknown. And an easy way to cope with that fear is to blame others – with both AIDS and COVID, it is all too easy for society to place blame on those who fall ill and thus stigmatize them. Unfortunately, both diseases, at least early on with COVID, were related to socioeconomic factors – front-line workers, multigenerational families living together, people not having access to health information or access to testing. With AIDS, in many low-resource countries, people may not be able to afford condoms. And misinformation is easily spread during epidemics and even more so in the age of social media. In terms of differences, I think it has been a miracle to have a COVID vaccine roll out within a year – a truly amazing testament to the power of science, research, and technology.

What lessons learned from studying AIDs helped you in dealing with COVID, both from a practical/professional and a personal standpoint?

It is frustrating when we know how to stop the spread of a disease but struggle to persuade the public to act on that knowledge. Changing peoples’ behavior is difficult and requires more than simply disseminating information. We must gain their trust and make it clear how change benefits them. Studying the AIDS epidemic provided me with insights into why people resist measures that could save their lives. That in turn helped me understand why some people refuse to be vaccinated against Covid-19. Unfortunately, that understanding doesn’t lessen my frustration.

When is the book you wrote with your daughter, Masked Hero: How Wu Lien-teh Invented the Mask and Ended an Epidemic, scheduled to publish? Did you learn anything new about your great-grandfather while writing the book? How important is “storytelling” when it comes to teaching? What is the most important message you would like this story to convey?

I am so excited to share that the book will be released in September 2023. Writing it taught me so much and working on it with my daughter made the experience all the more special. Because my great grandfather was an expert in infectious diseases, the Chinese government dispatched him to Northeast China, in 1910, to confront a plague that was rifling through the population, killing nearly everyone it infected. Foreign doctors who were already there thought it spread through rats, but, after conducting an autopsy, Dr. Wu discovered the real culprits were the respiratory droplets that spread through coughs. That led him to invent a mask that proved essential to ending the epidemic. But the plague wasn’t his only foe. He also faced racism, especially from a French doctor who couldn’t believe that a “Chinaman” had unraveled the mystery. He refused to wear Dr. Wu’s mask and died from the infection, days after visiting a patient ward.

Storytelling is a powerful weapon against hatred because it shows that people who appear different from us really aren’t so

different after all. I hope this story teaches children that people of any race or gender can be heroes. Telling Dr. Wu’s story is especially important now because of the pandemic and the racism and scapegoating Asian people have suffered because of it.

What have we learned — and not learned — about dealing with a pandemic in the 100 years since your great-grandfather eradicated the pneumonic plague in northern China?

Masking and social distancing are the best means of halting the spread of new respiratory infections, especially before vaccines and medications can be developed. Unpopular as these measures are, we have learned that people can endure them and that they do save lives. We also must invest in public health—today’s system suffers from underfunding and fragmentation that hamper rapid and effective responses to emerging threats. Finally, we need more global cooperation. Shortly after the Manchurian plague ended, Dr. Wu convened a conference where experts worldwide gathered to learn about masking and to share knowledge with each other. When the Influenza Pandemic broke out in 1918, masks were a vital part of the public-health response. Politics and nationalism will always exist, but if we learn one thing from the past, it should be that we can end disease outbreaks much faster when we put those things aside

Your great-grandfather was the first Malayan and the first Chinese-heritage person nominated to receive the Nobel Prize in Medicine in 1935. Google even dedicated a Doodle to him on what would have been his 142nd birthday! How has his story shaped your life? What is the greatest lesson and legacy he has passed along to you?

Growing up I always wanted to be a doctor and work in public health—largely because of the stories of my great grandfather. Even today, I can’t imagine the courage he must have summoned to confront an epidemic with a near-100% mortality rate. I certainly felt fear in the initial phase of the pandemic when so much about the virus was unknown. But in a crisis, we must put our fears aside and use our skills and gifts to help others. My great grandfather did just that, and his inspiration stays with me to this day.

“Genomics and personalized medicine will play an increasingly important role in patient care.”

Your great-grandfather was a devoted advocate and practitioner of medical advancement. In fact, he is known as the Father of Modern Medicine in China and is credited with establishing the standard for generations of doctors to follow. Looking back on your own career, what are some of the most significant changes or advances you’ve seen in emergency medicine since you started practicing medicine?

I am proud of the incredible growth of research in the emergency-medicine field. Technology has also made significant impact, but not always for the good. Early in my career, we wrote prescriptions and documented patient encounters on paper. Now we have electronic prescribing and electronic-medical records, which have reduced medication errors and sped up the process of obtaining records from other hospitals. But instead of finishing our paper documentation a few minutes after leaving the patient’s room, we now spend hours on electronic charting after our shift ends. That adds to the strain facing emergency physicians and contributes to burnout.

What do you think are the most urgent issues facing emergency medicine in the U.S. today?

My first publication, and later, my doctoral research, examined adverse events related to boarding in the emergency department. Crowding was bad back then, but it is even

worse today. We are seeing record numbers of patients coming into the emergency department, and it is taking a toll on staff who are still recovering from the shock of the pandemic. As a result, I see many talented and dedicated staff burn out and leave emergency medicine. It is a tragedy that we are losing so many amazing clinicians, and I fear that the high attrition rate will only worsen emergency department crowding.

In the coming years, what do you believe emergency medicine physicians will need to become experts at?

Genomics and personalized medicine will play an increasingly important role in patient care. For example, new blood tests promise to detect cancer earlier than conventional methods. As physicians we will have to learn how to interpret and utilize these and other emerging diagnostic and treatment technologies.

You are one of our specialty’s leading experts in geriatric emergency medicine…What inspired your interest and involvement in geriatric EM?

My first academic focus was on boarding and crowding, two issues that affect the geriatric population significantly. The geriatric emergency medicine specialty started about 10 to 15 years ago, and I found the pioneers of the field to be incredibly warm and inviting. It was also easy to get involved because there was, and still is, a tremendous need for more research to establish protocols to guide the care of the geriatric emergencymedicine patient.

What other research topics get you fired up and why?

I love to learn about other cultures and explore how cultural differences affect patients and the practice of emergency medicine. Quantitative research tells us what differences exist. Hearing people’s stories helps us understand why they occur.

What led you to choose emergency medicine as your specialty and, specifically, why academics?

I was initially drawn to family medicine and pediatrics, but I quickly learned that I didn’t like peering into kids’ ears. I didn’t know how to get parents to hold their children still. Fortunately, in my second week of medical school, my anatomy and small group leader invited us to shadow him during a shift at MGH. I took him up on his offer, and, three hours later, I was hooked on emergency medicine. I loved the adrenaline and sense of camaraderie in the emergency department, and the breadth of cases was energizing. Academic emergency medicine appealed to me because it allows for the most flexibility. If you have interests beyond patient care you can also do administration, education, research, and policy work during your career.

Up Close and Personal

1. You have a full day off work… what do you spend it doing?

Exercise, take a walk with a friend, pick up kiddos early and play at the park, and watch some true crime series with husband.

2. Name three people, living or deceased, whom you would invite to your dream dinner party.

What a great question – Bono, Dr. Martin Luther King, Jr., and President Barak Obama. Their words can make people soar. We are in desperate need of leaders who can inspire us to see past our differences so we can reach common goals.

3. What is your guiltiest pleasure (book, movie, music, show, food, etc.)?

Peanut butter and chocolate. Hands down the best comfort food ever. And the new Top Gun movie was actually really entertaining.

4. When you were a child, what did you aspire to become?

I loved the surgeon general C. Everett Koop. I thought he was the perfect blend of a kind and caring doctor who spoke scientific truth. He drew a huge amount of criticism because he was politically appointed for certain values, but he used science to prevent the spread of AIDS, despite garnering a lot of political backlash. I wanted to be the surgeon general in 6th grade. However, I don’t think I could stomach the political world as it is today.

5. If you weren’t doing what you are doing now, what would you be doing instead?

More direct public health work.

6. What is the most interesting/exciting/fun vacation you've ever taken?

One of my colleagues is connected with these amazing 2-3 week private jet tours. We get to be the private doctor for 60-80 people who literally jet set around the world. The best tour I had was called Great Faiths. We had two religious professors and one art expert give lectures while we visited Rome, Tibet, Jerusalem, the Ganges river and multiple other pilgrimage sites; it was a crash course in comparative religion and just was life changing.