Narjust Florez, MD, discusses importance of care equity, being ‘true self on social media’
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One recent evening, as Narjust Florez, MD, wondered about one of her patients, she decided to give her a call.
The patient greeted her by saying, “You’ve got to be kidding me.”
“She had just been typing me a message about her nausea,” Florez told Healio. “Something told me to give her a call. She said no doctor had ever called her because they were thinking of her.”
This patient-centered care and personal rapport has made Florez a beloved figure among patients, as well as a highly respected leader in her profession. On a larger scale, her relentless commitment to fighting for health care equity and her honest, disarming representation of herself as both an accomplished physician and a flawed human being have made her an agent for change in the medical profession.
Although Florez is no stranger to accolades, she said awards and achievements are not what drive her professionally.
“I can lose titles, I can lose any of that, but what I cannot lose is patient care,” said Florez, associate director of the Cancer Care Equity Program and thoracic medical oncologist at Lowe Center for Thoracic Oncology at Dana-Farber Cancer Institute, and member of the faculty at Harvard Medical School. “When I die, what is most important to me is that [on my grave] it says, ‘and she was a good doctor.’”
Florez spoke with Healio about how she seeks to nourish even her sickest patients, her struggles with impostor syndrome, and her pursuit of equity and inclusion in health care.
Healio: What inspired you to become an oncologist?
Florez: I’m the daughter of two doctors, and I always start by saying that because I know there are a lot of people who face a lot of hardships to get into medicine. For me, it was the natural selection — I was raised in hospitals. My mom was a single mother and would bring me to the post-acute care unit. I saw that when cancer comes, it disrupts not only the patient’s health, but also the family nucleus, the household finances — everything changes. I saw what a true privilege it is to be there for these patients at this time in their lives. I fell in love with the patients and I wanted to be there for their journey. I remember my surgery rotation: the expectations were super high because I am the daughter of two surgeons. Yet, I was thinking about the patients in the oncology ward. That was probably the calling.
Healio: What motivates you to get up and go to work every day?
Florez: There are two things. One is that I have a great rapport with my patients and I feel like I can make a difference every day. I don’t think you need to wait for systemic change to change how you treat patients. My care is patient-centered and that motivates me to make a difference. I have patients who are very sick when they meet me, and I am able to nourish them even if I don’t give them any treatment. I can nourish them to where they want to be.
Also, I am very involved in the Florez Lab — we are the largest lab dedicated to underrepresented groups in medicine and we’re very productive. Trainees I’ve been mentoring for 4 or 5 years are now becoming faculty, and they’re practicing the same type of medicine that I practice. That makes a big difference.
Healio: What career might you have pursued if you hadn’t become a physician?
Florez: I think I would have become a writer. I write a lot of short stories. Some of them are based on nonfiction, similar to the writing of Gabriel García Márquez. I write things that are happening in reality, but add the magical aspect. I’m writing a new story about a lady in a very small town in Latin America who can’t sleep. Because she can’t sleep, she knows all the gossip of the town. It’s a funny story.
Healio: What is the last book you enjoyed, and why?
Florez: The last book I read was Michelle Obama’s The Light We Carry. It’s a good follow-up to Becoming. It’s tailored to women and to women of color. It was very good for me, because I often don’t fit in. I’m very young for many of my titles. I like to break stereotypes around traditions in medicine because tradition is the obstacle of innovation. Michelle Obama broke so many stereotypes as the first Black first lady and in her many other accomplishments. It was good to read about how she dealt with her impostor syndrome. I learned a lot from that.
Healio: You struggle with impostor syndrome?
Florez: Oh, my imposter syndrome is crippling. My primary care doctor lists it as one of my conditions: asthma, impostor syndrome, reflux, etc. (just joking). As women, we have been told so many times what we are supposed to be, and when we break out of those gender stereotypes, we get punished. Then you’re always wondering, “Did they hire me because I’m a woman?” Women in medicine often deal with impostor syndrome because we continue to be excluded every day.
Healio: What are some of the biggest challenges you deal with in your work and how do you address those challenges?
Florez: One big challenge is setting and maintaining boundaries. When you set boundaries in medicine, people get shocked. They make you feel guilty sometimes.
After deleting an email from my cellphone not long ago, I emailed everyone to say, “After 6 p.m., no checking email. You have Voalte [a messaging app] and you can page me.” Some people pushed back, but you know what I did? I deleted the email and moved on with my life. Just because you don’t have a boundary doesn’t mean I can’t have a boundary. That’s part of the problem between baby boomers, Generations Z and X, and millennials, who are in the middle. I think there is this challenge to set up a boundary and stick to the boundary, because medicine has been built on the sacrifice of physicians. That’s why so many people are burned out.
I’m trying to set boundaries so I can do burnout recovery. My burnout recovery looks like writing, it looks like baking, and it looks like setting boundaries.
Healio: What is your “must-watch” TV show?
Florez: My favorite show is “The Great British Bake Off.” Everyone should watch it. To me, all the drama in some of these cooking shows makes them less appealing. You know, “I need to win this award so I can help my mother with cancer,” or things like that. With “The Great British Bake Off,” they’re baking. That’s it. Also, compared with other competitions, the people on this show help each other. I love that.
Healio: What do you like to do when you’re not working?
Florez: I enjoy baking and cooking. When I see a recipe in a video, I try to make it without looking at the recipe. When I’m very stressed out, my therapy is to cook. Some people get a runner’s high — I have what I guess you’d call a chef’s high. My significant other just loves seeing me cook, because it makes me so happy.
Healio: What is your favorite travel destination and why?
Florez: My grandmother’s house in the Dominican Republic. It has the best food in the world and the best advice that you cannot buy anywhere.
Healio: What do you think will be the next big breakthrough in oncology in general or in your subspecialty?
Florez: We need to learn how to de-escalate treatment. Not everyone needs the same level of treatment, and we need to stop picking arbitrary numbers. I think the next step to precision oncology is individualized care. Your genomic profile is only 30% of you. What about the patient’s wishes and goals? I have a patient right now who is in New Zealand, and that was her goal. So, we powered through everything to get her to New Zealand. That, to me, is precision oncology — individualized care for the patient’s goals, not my goals.
Healio: You are very active on Twitter, with more than 20,000 followers. Why do you value being a voice in the medical community?
Florez: I value two things about social media. One is that it breaks down geographic barriers. I have been able to collaborate with people from all around the world with whom I connected first on social media. Another thing I value is serving as a role model. There aren’t many Latina assistant professors at Harvard Medical School. I’m one of them. I believe in role modeling through social media, but I also believe it’s important to be my true self on social media. When I have a bad day, I acknowledge that. Trainees are so used to seeing these people on a pedestal, and that feeds into the impostor syndrome, which in turn feeds a sense of anxiety and depression.
Healio: What is the best advice you’ve ever been given?
Florez: About 5 years ago, when I first got on social media, Jack West, MD, said, “Don’t compare your insides with other people’s outsides.” I repeat that advice to myself at least three times a week. People have become very focused on presenting an idealized image of themselves to get likes. I’m in social media to communicate and be real.
Healio: In a previous Healio story , you shared an anecdote about an older male colleague who told you thoracic oncology was “still a man’s world.” Has this changed, and how much change is still needed?
Florez: It has changed, and I think this is largely because the International Association for the Study of Lung Cancer has its first female CEO, Karen Kelly, MD, and Heather Wakelee, MD, as its president. So, I think the change in leadership has helped significantly. Older men might have outdated ideas about women in medicine, but it’s no longer a man’s world. That has to do with the leadership of Drs. Kelly and Wakelee and many senior women in thoracic oncology .
Healio: You’ve been quoted as saying that during your residency, you felt a sense of not belonging because you are a Latina, and you went on to co-found a Latinas in Medicine group. Why is it important to you to create a place of belonging and inclusion for Latina physicians and providers?
Florez: Because when I die, I want to be sure I left this place better than I found it. Otherwise, did I just come to occupy space? The Latinas in Medicine community now has 9,000 members. We have a grant. Two years ago, we created and funded ASCO’s Young Investigators Award for Latinas. At that time, we didn’t know that Latinas in Medicine would become what it is.
Healio: Your lab is nicknamed the Social Justice League, and you’ve established yourself as a champion of equity in cancer care and in the workforce. Why are these issues important to you?
Florez: Equity is everybody’s responsibility. When you have your white coat ceremony, you say the Hippocratic Oath and vow to do no harm. If you don’t create equity in your work, you’re harming other people. Also, my own family has faced disparities in this country. I have faced disparities. This country was built on immigrants — we were all immigrants once. I think it’s just a matter of principle. If I have privilege, it’s like power. When you have a superpower, you can either be a supervillain or a superhero. It is our superpower to create equity, and that’s what we strive to do.
For more information:
Narjust Florez, MD, can be reached at Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215.
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