Welcome to Pediatric Voices, Duke Children's podcast about kids healthcare. Now here's our host, Dr. Richard Chung.

Richard J. Chung, MD (Host): Hello, and welcome to Pediatric Voices, expert insights about timely topics in children's health, brought to you by Duke Children's Hospital and the Department of Pediatrics at the Duke University Medical Center. My name is Dr. Richard Chung, a physician at Duke Children's and a co-host of this show.

Today, we have a very special guest with us, Dr. Ann Reed. Dr. Reed is the Samuel Katz Professor of Pediatrics, Chair of the Department of Pediatrics here at Duke, and Physician in Chief of Duke Children's. She is also, oh by the way, a Pediatric Rheumatologist and a Physician Scientist. She cares for children with autoimmune disorders and immune dysfunction; in particular those with juvenile dermatomyositis and autoinflammatory disorders.

Her research explores the genetics and causes of human autoimmune disease with the goal of developing new biomarkers to identify those predisposed to develop disease, as well as to monitor disease activity and response to treatment. Welcome to the show, Ann.

Ann Reed, MD: Thank you, Richard. I'm excited to be here.

Host: Very glad that we could find time in your very busy schedule for this conversation. I've really been looking forward to this. In contrast to most of our prior episodes, today's conversation won't focus on just a single topic area. With Dr. Reed here in the studio, we have to go above and beyond. I'd like to spend some time introducing our leaders to Ann Reed, the person, the physician, and the leader, and also take a sort of guided tour of all things Duke Children's with Dr. Reed as our tour guide. Ann, how does that sound?

Ann Reed, MD: I think it sounds great. I'm looking forward to it.

Host: All right, perfect. Well, let's dive in more on kind of the personal side. We usually start these episodes trying to understand how people first started to get into children's health. And so tell us a little bit about how that happened for you.

Ann Reed, MD: When I think back on it, I'm not sure how I got into children's health, except I think throughout my life, when I was growing up, when there were some very impressionable times in my life, I always remember that I wanted to do something with children. I thought children and adolescents, they just wanted to be happy.

They just wanted to be like everyone else. And I loved doing things with them. And so, as I started to go through school, and I started to think about what I wanted to do, I was drawn towards science, loved science, and thought, what could I do to help children in whatever sphere that I made the decision to be part of. And medicine seemed like the one that I thought I could actually use my skills best at.

Host: Wonderful. Now, that's great to hear. And I think as we've talked to different guests, sometimes they have kind of a light bulb moment. For others, it's sort of a process over time. And so it's really great to kind of hear, especially as one of our key leaders here in children's health in the triangle and nationally, to kind of hear how you came about this particular interest. Can you share a little bit more about your personal and family background in addition to all of your roles here at Duke, I know that you have a full life well beyond as well. And so tell us a little bit about your family.

Ann Reed, MD: So, presently, I am the proud mother of three adult children. Got a wonderful spouse. Two of my children are themselves married and love spending time with them. They all are in many different areas, none of them are in healthcare, whatsoever, but are in very varied areas. And I really enjoy every minute I get to spend with all of them.

 But I grew up as the middle child of seven. So I had a little family growing up and my family was not in healthcare. They were in business. My father was in business. My mom actually was a chemist. But after she started having children, stayed home with the children. So, grew up in a large family, and I think there were some very impressionable times growing up.

You know, I found that I was the middle child trying to make peace, between the older ones and the younger ones, trying to stay out of trouble. And so, I think it did impress upon me, some of what I do today. Because of that role that I took. I also, growing up, one of my older siblings passed away when I was growing up, of cancer.

And it was back in the time when there was really no treatment for cancer. And that really did influence me wanting to try and help figure out how to help children. Because I do remember him and what he had to go through, and I remember what it did to our family and my parents. And so that, I think, was quite impressionable to me as well.

Host: Thank you for sharing that. That's really meaningful. And I think it's quite telling as to the motivations that bring you to this work. Even many years ago, thinking back to how impactful that was for you, your family, and now sort of drawing that into your day to day currently. And also just a quick shout out to middle children. I think middle children make the world go round. A shout out to my wife, who's actually a middle child as well. So I'm sure that really taught you a lot about navigating complex politics and also maybe fed into you as a leader, which we'll talk about later in the episode.

Ann Reed, MD: Absolutely.

Host: One last question before we kind of launch into more discussion of Duke Children's more generally. What would you say is the most rewarding part of your job and what's the hardest part? You do a lot day to day, you're in a lot of meetings and making a lot of decisions, but what's most rewarding day to day and then what's the most challenging piece?

Ann Reed, MD: I think the most rewarding thing that I look forward to every day are the people I get to work with. It really, truly, means everything. I think that people are just dynamic, they want to do what's right, they're innovative, they're hardworking, and it really is a joy to work with the people around me. And to me, that's the most exciting part of it.

And then you say, what's the most challenging? I'd say the people. When you see people who are struggling, you see people who aren't really happy with the choices that they've made; to me, that's the hardest part .To see how can you help them? How can you help them get on track? And sometimes what they're doing isn't the track they need to be on.

Sometimes you need to help people realize there's other things that probably would make them happier. Bring more joy.

Host: Really interesting. So the most rewarding part, as well as the most challenging, both have to do with the people with whom you work and the ones who you lead as well. And so that actually makes sense, if you think about it, people are complicated and things go up and down. I would think that maybe with some of those difficult moments, there's light on the sort of other side of that, right, if you can kind of navigate some of those challenges.

Ann Reed, MD: I think, you know, when you find someone who's struggling and you help them understand that maybe the path they've chosen isn't the right one and watch them come out the other side, smile on their face and feeling satisfied. That really does make you feel good that you've done something positive.

Host: That's really great. We'll come back to that a little bit as we, wrap up maybe at the end about leadership and some of the lessons you've learned through your experiences. But first, let's talk a little bit about Duke Children's. So Dr. Ann Reed, as Physician in Chief and Chair here at Duke, is the best tour guide we can have for Duke Children's. So let's start with this, Ann. What is the core mission of Duke Children's?

Ann Reed, MD: So I think Duke Children's is here to deliver the exceptional care for patients and for our community. And we do this through excellent clinical care, but also through discoveries and innovation. That's a key part of our mission, is how to promote care for the future, how to train people for the future to really be the ones that are making these discoveries to help children's health.

Host: That's great. So it all comes back to the health of children, both today as well as into the future. We had a conversation a few weeks ago with Dr. Kyle Rader, who talked a little bit about the role of academic medical centers and teaching hospitals and how that sort of inquiry and learning really feeds into highest quality care. And so that sounds like it's really core to the ethos of Duke Children's.

Ann Reed, MD: Well, and if you think about it, the children are the future, and we can make a greater impact for long term health and well-being, I think, if we do that when they're young. So really trying to figure out how do you do that, and how do you make that impact early, is just key to me. It's so important.

Host: That's right. And I think I always think of that as the real privilege of pediatrics, right? Everything we do is a benefit today, but it's also an investment that kind of accrues and bears interest over time, so to speak. And so it's really fun to think of it in those terms. What is one specialty area here at Duke Children's that you'd like to highlight?

Ann Reed, MD: Well, that's a hard one, Richard. Being the Chair, there's so many things I'd like to highlight, but let me take advantage and talk about two. First is the area that I work in, Rheumatology, Immunology. It's quite a unique area, and I think throughout, when I started to train, it was an area where people didn't know a whole lot about the patient and what was going on, and definitely we didn't have a lot of options in terms of treatments. You had steroids, or you had some other drugs that aren't even in existence anymore. And so, we've watched the field really evolve to where it is really a puzzle. Every patient is unique. And you have to put the information together, whether it's clinical symptoms or laboratory tests, and come up with what is happening with the patient.

And with the discovery of so many of the new therapeutics, the drugs that we use today; we're able to intervene and actually help people in ways we never could have before. So I find it very exciting going from when I started training where we didn't know any of these things and it was a group of patients no one knew what to do with, to now where we're actually doing things that we're impacting.

So I want to start there and then as my Chair hat on, thinking about the area that does not get recognized much is infectious disease. And I'm going to mention it probably because we are coming out of or still in the middle of having a lot of infections, respiratory infections particularly, thinking about how that's an under recognized area in medicine.

You know, they're often the ones behind the scenes that are supporting many of the things that go on, whether you have a well child, you're trying to figure out how not to use too many antibiotics with them, or you're thinking about a sick child in the hospital, or you're thinking about epidemics or pandemics like COVID, or last year, RSV, and the flu season that was so significant.

They're behind the scenes really trying to help keep us all healthy and safe, and they don't get a lot of recognition. It's not a glamorous specialty, so to speak, right? And so I think often they're the unrecognized heroes behind the scenes, if I was to mention one.

Host: Ann, I really appreciate you mentioning the infectious disease team. I think as you look back on the pandemic, they were really at the front lines, both clinically taking care of patients, as well as really translating, interpreting the complexities of the pandemic for the public and infectious disease doctors and other clinicians really have a knack for taking very complicated, technically nuanced challenges and making it something we can all understand and wrap our minds around.

And I think that's an invaluable trait. And certainly your mention of rheumatology makes a lot of sense as well. You know, there are many fields in which there's been such advancements in the technology and treatment available to patients. And certainly rheumatology is right at the forefront of those advancements.

Ann Reed, MD: Well, you know, I have to say when I was in medical school, I think we had two to three days of immunology. And now it's a year long course, if not a couple year long course, right? So it just tells you the progress we've made as a society understanding some of the basic phenomenas.

Host: That's a great point. On that point about research and innovation and kind of the leading edge of where things are evolving, is there a particular accomplishment or some other advancement that Duke has really been at the forefront of that you'd like to just kind of shine a light on?

Ann Reed, MD: I would like to say I think some of the most significant advancements that we have made at Duke Children's is a lot to do with drug therapeutics. And this starts with discovery of actually mechanisms that people have been able to develop new drugs.

Such as for Pompe's disease, right? Being able to figure out that mechanism and come up with a therapeutic, an intervention that can help the children. But it also expands into the work that's done in our Vaccine Institute for Children. To me that's a therapeutic too.

It's like, how do we improve protecting our children from all kinds of infections? And then we think about the work that's done to make sure that the drugs that are developed for adults are appropriately able to be used in children. Like really looking at those advancements and getting the needed studies in those different subsets of children.

And sometimes they're very small subsets that sometimes are very hard to do a true trial on. But we have got some amazing investigators who have developed models to be able to improve the care that we give children, newborns, babies that weigh a pound. How do they do that? And I think, to me, if I was to really look at that, that to me, the therapeutic side of it, has been a really huge strength of Duke Children's over the years.

Host: That's very well said. I do think that Duke is flush with such inventive and creative and passionate researchers who really are at the leading edge of their fields and are paving the way for how care is going to be a year from now, five years from now, 10 years from now. It's going to be very different practicing and it's because of work that's being done today here at Duke.

Another aspect that we focused in on in the podcast is related to the community around us. I talked with Dr. Gabriella Moradiaga a few weeks ago about issues around health equity. I know that Duke Children's has many involvements in our local community and more regionally. Is there an example of community impact that you'd like to share?

Ann Reed, MD: As I said, I think one of our missions is caring for our community. And we have a very diverse community. And you can define that in any way you want. And we have it here. I want to give a shout out to our primary care group, that really takes it as part of their mission is to help our community. And that really is involvement in all aspects of the community. And again, one of the highlights would be thinking about COVID and how that team took it upon themselves to make sure that they had providers who could care for children and families who maybe were sick with COVID or were questioning whether they were ill or were afraid to go out to the public, afraid that they were going to get sick. The things that they did were extraordinary to really come through for the community. They also worked really hard, that the same primary care team to be able to deliver vaccines and get into the community in Durham particularly, and in this area of the state to deliver the vaccines to patients who maybe otherwise would not be able to come in and get those vaccines.

And so I think we do believe the community, that's our home, we're responsible for that community. We take that very seriously. And you talked about what Gabby talked about, and that's another aspect of our community. Getting into our Latinx community and supporting them again, through COVID, with whether it's interventions, treatment, with vaccines. We believe that's really part of our mission here, and we need to do that strong. I could go on, I have multiple other examples of things that people have done, but that to me is probably the most recent large example of the impact that I feel like we made.

Host: I appreciate you sharing that and looking back again on the COVID pandemic and talking about the importance not only of the infectious disease teams, as we mentioned before, but the primary care teams out in the community really being kind of the first people contacting some of these families when the pandemic was evolving. I think that's really important to highlight. It also strikes me that it, as we were talking about research and innovation and advancements of different tools available to us, some of this work in the community and really understanding how social factors and community factors impact the health of individuals and populations is another area of sort of innovation, right?

Where we're learning more as we go and it's changing the core fabric of how we practice. And so it's really great that here at Duke Children's, we have colleagues who are really doing all of the work on both ends of that spectrum. Another aspect I wanted to highlight with you, Ann, is just the opportunity for individuals, families, other entities in our community to partner with Duke Children's. Now Duke Children's certainly does a lot on its own, but key partnerships have been critical in a variety of different ways. Is there a particular partnership that you'd like to mention or highlight that you feel like has been particularly impactful for the kids that Duke Children's cares for?

Ann Reed, MD: I think there's a couple of things that I'd like to say. One has been the program that has been our Healthy Lifestyles Program, right? Bull City Fit has been a partnership of Parks and Recreation for multiple years. And that program really tries to offer opportunities to help families that need the opportunity to learn about healthy eating, about healthy activities, really has been so strong and has now been replicated throughout this area and throughout the state and even the country because of the success that they've had. I think that is a wonderful partnership that's gone on.

The other one that I want to mention is something that we're really trying to build upon today, and that's actually partnering with our local colleges. And being able to introduce potential healthcare opportunities for them as they think about their career choices. Where sometimes people might have never thought about or ever saw somebody who, know, they interacted with that was in the healthcare field.

And we are now going to be partnering with them and holding opportunities for them to come see what it would be like, to experience what it would be like to work with children. And it could be in many, many different aspects, in science and healthcare, but to introduce those opportunities, give them experiences.

We've done a little bit of that with some of the work, um, that has gone on, uh, some of our faculty have worked in our community about bringing high school students in, in the summer to give them experiences and exposure to certain aspects of healthcare, and this is actually going to be much more expanded, and and even deliver more opportunities, so I'm very excited about that.

Host: Those two are really great examples of partnerships. First, you mentioned Bull City Fit, a partnership between Duke as well as the local government and community partners to really bring science based care to where the community is. And so it kind of draws in the latest evidence from a healthcare medical standpoint. And also that important community engagement, really to bring best support and care for the kids involved in that program. That's a wonderful example.

And then your mention of working with local educational institutions to really bring healthcare careers into the attention of people who might otherwise not know about these opportunities. We in healthcare are always trying to make ourselves more representative of the people we're caring for. We know that that improves care and this sort of partnership with local educational institutions is a great opportunity and I'm really glad to hear that we're involved in that. My last question on this tour of Duke Children's is, what does the future hold for Duke Children's?

Certainly, my guess is much of your day to day is dealing with the tyranny of the urgent. Today issues, what needs to be dealt with, but what about the future? Part of your purview is sort of thinking about where we're headed. And so how would you answer that?

Ann Reed, MD: I think we always have to be thinking ahead, thinking about where do we want to be next year, in five years and ten years. And to me, Duke Children's really is a very special place, caring for and trying to answer and bring solutions around complex problems, right? How do we think about health equity, as you mentioned earlier, and how do we really try to set ourselves up to study, pilot and then figure out maybe some solutions to help with certain areas of equity?

How do we look at some very major scientific question, and how do we invest in really thinking about in the future? How do we impact that in them? And so I believe the future of Duke Children's is continuing to do this outstanding care. We take care of some of the most complex patients that are around, but also training the next generation of scientists and physicians who want to ask questions.

And when I say scientists, I think we're all scientists, if we're asking questions about improving um, the care in any way, whether it's in health equity, whether it's in drug development, whatever it is; we're all scientists because we're asking questions to improve health. And to me, that's what we are and that's who we are.

And I think that's what will have to continue and think forward. How do we set ourselves up to continue and lead in those areas?

Host: I love that. It strikes me that there's a sort of virtuous cycle that happens at places like Duke Children's, where we provide excellent care today. And that care is in the front of a learner who's just starting on their path towards the curious questions that they're going to be investigating in the future. And then in the future, they're sort of the ones rendering the care, while they answer these questions. And so I think that sort of inquiry piece and the academic aspect of Duke Children's really plays off of the care that we provide and creates again, this kind of virtuous cycle into the future. And so it's really great to hear you articulate that.

Ann Reed, MD: Well, it's exciting. It's exciting to think about that future, and I think now of these, whether they're high school students or undergraduate students or professional students, I think about what they're doing and the knowledge that they have and the technology that they bring that wasn't there when I trained.

I don't know about you, Richard, but it wasn't there when I was around, uh, when I was training. They bring this all together. I just feel like we can conquer so much more and we can do so much more. It's very exciting to think about.

Host: That's really great. Very exciting and hopeful really for the future. Ann, I'd like to sort of round out our conversation with just a couple questions about you as the leader. You are the head honcho, as we say, you are my boss. We should have maybe said that at the top as a disclosure, Ann is technically my boss.

And so, I have just a couple of questions for you as the leader of Duke Children's. What has been the secret of your success as a leader? If you had to point to one particular characteristic or habit that you have taken on, you know, what's the secret to your success?

Ann Reed, MD: When I interview people, I ask them what their secret sauce is or what they think their magic powers are. When I think about it, and I know, I'm not the smartest one in the room. I'm not the quickest one in the room. I'm, you know, not the most analytic one in the room.

I know that. But I feel like I have an ability to assess a situation and be able to do that rather quickly. Some of it's intuitive in nature, I would think. But some of it's really to be able to hear all the voices and to be able to make sure we're representing them. Equity is very important to me.

Equality and equity is very important. Not to leave someone's voice behind just because they're the quiet one or isn't the loudest, isn't the first to speak up. Making sure we're including everybody. Making sure everyone feels like they belong. So belonging is very important to me as well. And I feel like keeping that in mind, maybe it has to do with being the middle of seven kids that I feel like I need to do that all the time. But to me that's been really important and I feel like that's part of my success.

Host: My next question, Ann, is what is the best advice you've ever gotten from somebody who was a mentor or guide for you through your career?

Ann Reed, MD: Well, I would answer that in two different ways. One is in my own personal success in research. Very early people told me to stay focused. And I think, when you start in medicine, often, and particularly in science, you're almost like a kid in a candy shop. There's all these cool things going on and people are like, like, say squirrel, right? Squirrel. And you look over there and you think in a certain direction, like, that'd be fun to do. Or there's another one. Squirrel, I'm going this way. But you have to really stay focused to be able to actually find advancements and success in the research side. And so that to me is probably one of the biggest things people really need to think about.

 The other thing that someone taught me, this is an individual woman who actually led a huge health system. And she was more in the business side of things, but she, as a leader, was incredibly successful. People really highlighted a lot of her work and how she was able to engage people. And something she always says, make sure your door is always open.

Know you're never in a position where your door shouldn't be open. Now that doesn't mean anybody will ever walk in because they, they might not feel they need to, but them knowing that you're there and you're listening to them and you're willing to have a conversation, I think is really important.

Host: Those are some really great tips. As somebody who feels like he's perpetually in a squirrel phase of life, chasing after different things, it's really a good reminder. And then the open door policy is wonderful. I think even if nobody walks through the door, it speaks volumes as to who you are and how you want to relate to others.

And you mentioned at the top that the people are the most important. And so it's great to hear that. My last question, just from a leadership standpoint is what is your top tip for learners and trainees seeking to make a real impact in children's health?

Ann Reed, MD: I think it's beautiful that many of our learners today are really great advocates. They want to do something to make an impact. And I would say with them, is that really think about what you want that to be. You really find the right people to work with and engage with on that focused area. You have to really be the one to perpetuate it and push it.

You know, don't expect someone to do it for you, but come up with a thought and a plan, and please don't ever miss an opportunity to take the advantage of getting yourself exposed to something. Take an opportunity to be able to go to the government and advocate for child health. You know, take the opportunity to be able to work with somebody.

You know, don't be afraid because to me, when you're in that learning phase, we're always learning, but when you're in that official learning phase of your career, take every opportunity you can. You never know which opportunity might be the one in the path that you want to go down. So don't close any doors, but keep them open and take those opportunities.

Host: That's really good advice. I think very often I worry a little bit, frankly, when learners feel like they've kind of narrowed things prematurely, because there's just so much to it. And I think for many, or most of us, we have taken left or right turns when we didn't anticipate it. And so when do you know when those turns might happen?

You really don't. And so really remaining open is key and for my part, I would say that learners often ask these curious questions and really push me as a faculty member in the direction that I didn't anticipate. And so it's really important for learners to not only perceive what they're interested and curious about, but really express that.

You never know what's going to happen if you ask for a meeting or have a conversation. Many of the best innovations and projects and sort of impacts on kids and families have come from those sort of happenstance moments.

Ann Reed, MD: And often the question will be and I don't mean this in a negative way, almost naive. And they're asking a question because they don't know. And often, I've lived in my siloed world for a long time. And they'll ask me a question, I'm like, that's a great question. I never thought about it that way, or I've never thought about that. And that then makes you think too. I think it's a beautiful experience.

Host: That's right. If only we could all be naive again.

Ann Reed, MD: I know, seriously.

Host: There's certainly wisdom, but then sometimes that wisdom can mimic as a blinder, right? And then kind of keep you from seeing things that you should be seeing. So that's a great point. My last question for you, Ann, is this. If you weren't a pediatrician, if you weren't Chair of Pediatrics, if you weren't Physician in Chief of Duke Children's, who would you be and what would you do?

Ann Reed, MD: You know, when I went into medicine, I always knew I wanted to do something with children, but I seriously thought about things like surgery and emergency medicine, instead of doing what I do today. Time and luck and just fate had it that that's not the way I went.

And I really became interested, like I said before, in being in rheumatology and immunology where you had all these unanswered questions. But if it was even before medicine, and if I were to think back, I always wanted to be a singer and dancer. I love to dance. I love music, but people would pay me not to sing. I will tell you that. But that's what I always wanted to do. And so when I started out, I wasn't for sure the one going to medical school. My path was never set for me. I actually was a designer shoe buyer for a couple of years too, in between there. My fetish was shoes. I do have a lot of shoes. I admit that. But that was the path. And then I realized that's probably not what I wanted. And I really started to focus in on medicine.

Host: Very interesting tidbits to kind of round out our episode. So singer and dancer, Dr. Ann Reed, I hope our medical students are taking note. They do have a show, certainly, and I'm sure they could put you to good use. Well, thank you to Dr. Ann Reed for joining me today to talk a bit about her own personal journey, her lessons in leadership. And also all things Duke Children's. I hope you all have learned something new, not only about Ann, but also about Duke Children's and all the wonderful things going on here each and every day.

Ann Reed, MD: Thanks, Richard.

Host: Thanks for being here. Pediatric Voices is produced by the team at Dr. Podcasting. The show has been developed by my co-hosts, Dr. Angelo Milazzo and me. Thanks to our administrative team at Duke Children's, particularly Dr. Ann Reed, Debbie Taylor, and Courtney Sparrow for their support. Find our show and hit the subscribe button wherever you find your favorite podcasts.

And we want to hear from you. You can connect with us at dukechildrens.org, Facebook, X and Instagram. Please send us your feedback about the show, including your suggestion for future topics. Thanks for being a part of the show. I look forward to talking with you again.