The EthnoMed Podcast

Provider Pulse Episode 9: Dr. Noga Rogel

• Dr. Duncan Reid, MD @ EthnoMed.org • Season 1 • Episode 9

Share episode

Send us a text

The next installment of the Provider Pulse interview series where we elevate diverse voices from across healthcare fields to learn the paths people took to their current roles.

On this episode, we speak with Dr. Noga Rogel, an internal medicine resident at the University of Washington who is preparing to start a fellowship in rheumatology.

 Dr. Rogel reflects on how her childhood illness inspired her pursuit of a career in medicine, her decision to attend a medical school abroad, and how her experiences in cross-cultural care have helped shaped her practice of medicine.

She shares how negative experiences with the medical system as a child have inspired her to provide more patient-centered care. She also reflects on her experiences with cross-cultural care while in medical school in Israel as well as her experiences providing care to refugee and immigrant patients.

Visit EthnoMed.org for additional resources. Follow us on YouTube and Instagram @EthnoMedUW

Duncan: Welcome to the EthnoMed Podcast, a community voice in the clinic. My name is Dr. Duncan Reed, a physician in the International Medicine Clinic at Harborview Medical Center and medical director of EthnoMed, a web resource for providers and patients with information for cross-cultural care.

Today we are continuing our interview series called Provider Pulse, where we elevate diverse voices from across healthcare fields to learn the paths people took to their current roles in healthcare, and how their cross-cultural experiences have helped them provide more informed care to a diverse patient population.

Whether you are an undergraduate student considering a career in healthcare, a practicing health professional, or a member of the community, these conversations are for you.

Noga: I was intermittently sick throughout my childhood. I think I was still pretty good at school, but I felt pretty far behind to the point where I almost didn't think I would graduate high school. growing up, I feel like I was told a lot that everything was in my head or I, should go see a [00:01:00] psychiatrist. And that was what the issue was. And doctors are pretty dismissive and wouldn't see me for very long in the appointment. And I would have to remind myself I felt these symptoms in kindergarten, like that's too early to be making it up 

Duncan: On today's episode, we speak with Dr. Noga Rogel, an internal medicine resident completing her training at the University of Washington in Seattle as she was applying to rheumatology fellowship programs. Dr. Rogel reflects on how her childhood illness inspired her pursuit of a career in medicine, her decision to attend a medical school abroad, and how her experiences in cross-cultural care have helped shaped her practice of medicine.

 

Noga: I'm Noga Rogel. I'm a third year resident in the internal medicine program at the University of Washington and I'm applying to Fellowship right now. My continuity clinic is at the International Medicine Clinic.

I'm originally from Israel. I moved to America when I was around three years old. My mom is originally from there. My dad is from the U.S. And he moved there. So they met,

 I grew up near Boston, [00:02:00] Massachusetts.

Duncan: how was school growing up?

Noga: School was good. Academics was definitely enforced in my household growing up. I really enjoyed science and math. I did not really enjoy English, reading and writing. Overall it was a good experience, but

I was intermittently sick throughout my childhood.

Duncan: Can you tell me more?

 Yeah, so I had postural orthostatic tachycardia syndrome or pots, and the first time that happened was in kindergarten and I just had a headache and I was dizzy for like three months at a time, and they did not know what it was until fifth grade.

And how did your parents respond to these episodes?

Noga: My mom was very worried all the time. anytime I'd have a headache, like not within those episodes, she would get worried that I was gonna be sick for three months. Again,

Duncan: And how did you deal with all of that?

Noga: It's difficult being sick not able to get out of bed. Not able to do things for a significant amount of time. But I don't think at the time I really realized so [00:03:00] much what was happening.

Duncan: And do you feel like when you were in school you, did you feel like a label of the sick one or the one that was not well, 

Noga: definitely sometimes for sure. I don't know that I shared so much about it with my friends, not my close friends, but my like more extended friends. But I definitely felt that label.

Duncan: And were you absent for long periods of time?

Noga: Yeah. In high school I was absent for three months, for two of the years.

Duncan: And how did that have an effect socially or academically? 

Noga: Socially, I don't think it had so much of an effect. I don't know that I talked about it so much with my friends at the time and then academically. 

I think I was still pretty good at school, but I felt pretty far behind and I was really bad asking for help. So I would like be outta school a long amount of time, to the point where I almost didn't think I would graduate high school.

Duncan: So that sounds like a very stressful and defining situation. And then, academically, I mean, looking at you now, you obviously did okay. how did you get through all of that? I.

Noga: yeah, I think, I just didn't really think about it that much. I [00:04:00] think my parents are both academics and I like generally did well in school. So I think just like kept going.

Duncan: What field are your parents in?

Noga: My dad does computer science and my mom used to do computer science and now she does neurofeedback.

I.

Duncan: What was your interaction like with the medical system during that time, ?

Noga: Yeah, not great. And it's interesting now being on the other side of it People talk about those patients a lot in a pretty negative light. so it's interesting being on the other side of things, but 

growing up, I feel like I was told a lot that everything was in my head or I, should go see a psychiatrist. And that was what the issue was. And doctors are pretty dismissive and wouldn't see me for very long in the appointment. And I would have to remind myself I felt these symptoms in kindergarten, like that's too early to be making it up 

or be too stressed, and I felt like I kept having to remind myself that


Duncan: When did you become cognizant of being dismissed or not being taken seriously,

Noga: I think in fifth grade was the first time that happened.

Duncan: [00:05:00] And how did you deal with that?

Noga: I think it, is a cycle that it makes things kind of worse 'cause it's like people are telling you that you're feeling this way 'cause you're anxious or stressed and then that in turn makes you feel more anxious and stressed, which doesn't help the diagnosis.

Duncan: Were there any particular care providers that you remember being particularly supportive or particularly harsh or that left an impression?

Noga: Yeah. I actually had a cardiologist who was very nice, very supportive and felt like he was listening to me and my parents. so he was definitely like a turning point. And then there was also a neurologist as well.

Duncan: And it sounds like what was important there was they were just taking the time to listen to you.

Noga: Yeah, and I think just believing also, I think there's a lot of doctors who didn't believe, what I was saying.

Duncan: And part of it might be just because of unfamiliarity with POTS as well.

Noga: Yeah. I think on the East coast it was definitely not familiar. I think at some point I was taking like 10 pills a day. steroids and other things. and I had a headache like 24 7 for three [00:06:00] months. So I was taking a lot of , pain medications. Also

Duncan: You were mentioning headaches. What were the other symptoms?

Noga: Just dizziness, feeling palpitations. I fainted a lot during that time 

Duncan: Really non-specific things, and I assume they did the full workup, couldn't find anything that they were looking for that was concerning.

Noga: Yeah, at some point they did a brain MRI and thought that maybe they saw something. that was when I was younger. but then, and I remember that being very hard for my mom. I don't think I totally understood what was going on, but then they were like, oh no, that was just an artifact.

Duncan: So then you graduated high school on time. Despite all these absences, your academic record was, was fairly okay at that time.

Noga: Yeah, not like, not as good as it could have been by no means, but it was, yeah.

Duncan: And then where did you go 

Noga: then I did a gap year in Israel. And that was doing classes and, traveling around and things like that. And then, I went to undergrad at SUNY Binghamton in New York.

Duncan: I think a lot of people are thinking about doing gap [00:07:00] years more now. Is it something where you already applied to undergrad before you went on your gap year, so you had a plan set out, or did you go to your gap year thinking that things were kind of open-ended? I.

Noga: Yeah, I knew what I was gonna do afterwards. I had already applied to undergrad, in high school. but I did really enjoy taking a gap year. I think it's very beneficial to be able to take some time to think about what you wanna do and experience new things. And I think you can have some different lens going into the next stage of your life.

Duncan: And what were you thinking of doing then after your gap year? Did you have a good idea of what you wanted to do?

Noga: I always liked science, and I was at that point even thinking about medicine, but I didn't really have any. No one in my family was a doctor or in the medical field at all, so I don't think I like totally knew what that meant. but I did ride in the ambulances during that gap year, which was great fun.

Duncan: And then how was, SUNY Binghamton?

Noga: It was great. I did all of the pre-med classes to potentially apply to medical school. I did research, and actually also was on the, student run [00:08:00] EMT. club service that they had.

Duncan: Binghamton's pretty far north, like upstate New

Noga: Mm-hmm.

Duncan: Mm-hmm. How was that? Did it feel isolated? You're from the big city, in Boston.

Noga: it didn't feel very isolated to me. I like being in nature. I like, kind of all different types of places to live, whether it's rural or urban or suburban. So I, for me, it wasn't that bad. I feel like in college you're kind of with your friends in, in a bubble. Anyways,

Duncan: . You did all your pre-reqs for medicine and so you were thinking medicine at that point, or were you still open-ended

Noga: I was still open-ended, but I was thinking that. I would probably want to apply to medical school, but I wasn't totally sure. And actually the last year I did start the application and then, then I withdrew my application 'cause I wasn't sure.

Duncan: What did you do after graduating?

Noga: And then I did research for three years in Boston

Duncan: So you had a degree in,

Noga: Neuroscience. And then I joined a lab that was doing primarily genomics. my project was on the small intestine.

We were doing a lot of [00:09:00] single cell RNA sequencing.

Duncan: And how was that experience? So three years there you got pretty involved. Did you feel like it helped you decide what you wanted to do? How did your thinking of your career evolve during that time?

Noga: Yeah, I really liked it a lot. I think, I was around a people who were working a lot, very dedicated to working. And they were in the lab all the time. I think there is not a single day where you could go in at any time basically of day and someone wouldn't be there. but I was on a project that I really enjoyed and so I also dedicated a lot of time.

I think a lot of weekends I went in, a lot of vacations I went in. and I really enjoyed it a lot and I think that was kind of also difficult knowing then if I wanted to go to medical school or pursue more of a science PhD route.

Duncan: So how did you make that decision?

Noga: I think I had a meeting with the PI who was quite busy in the lab and so I didn't meet with her very often.

But I set up a meeting to talk that through. And she really simply was just like, do you want to be able to see patients? And I was like, [00:10:00] yes. And she was like, okay, you should go to medical school. but I think part of it is the growing up aspect of it and having negative interactions in the healthcare field and kind of thinking about the doctors who did really make a difference, a positive difference in wanting to be like that.

Duncan: So that's coming from a very optimistic point of view. It sounds like. ' cause you had so many negative experiences, 

Noga: Mm-hmm.

Duncan: At the end, you're like, I wanna see patients. And Is it part because you were just thinking about your own experience as a patient? Is it that kind of interaction that you were looking for

Noga: I think there is definitely a component of that. Yeah. 'cause I think I did have some good interactions and I think that really helped a lot to have those interactions.

Duncan: Were you doing any other shadowing or any other pre-med things while you were in this, research role? I. No, just research. So you're just doing all this research, but you had enough things that you did with the EMT in undergrad and in your gap year. Mm-hmm. So you had this meeting and it sounds like, did you have any other important mentorship during this time?

It sounds like this PI is very, high [00:11:00] powered,

Noga: Yeah.

Duncan: didn't have a lot of face time with them, which is I think, common.

Noga: Yeah.

Duncan: Were there o other people that you were talking to that were helping with advice or just figuring out what you wanted to do?

Noga: I think people in the lab some of them were MD-PhDs, so I talked to them a little bit. Um, actually I did, I forgot about this, but I did shadow actually the cardiologist, one or two days, who had made a positive impact and that was actually really great I did it during that time.

And then another experience that actually forgot about what I shadowed, I think one of my parents', friends who, is an ophthalmologist, And, he was in the OR and it was really early in the morning and I went, to, shadow him in the morning. It was probably like five 30 or something in the morning. And I get into the operating room and I'm like seeing this really cool procedure and all of a sudden I start feeling very dizzy. and then I fainted in the operating room and it was very, very embarrassing.

 

Noga: They didn't call a code. I came too pretty quickly and he was [00:12:00] very nice about it.

I was so embarrassed and almost to the point where I was like, oh my gosh, I can't do medicine. but I think actually. I have been very worried throughout medical school and residency about being in the surgical position of standing on your feet for a really long time and then fainting.

Duncan: It sounds remarkable. So this was the same cardiologist that saw you as a child, and how did you get in contact with him to shadow? 

Noga: I think I found his email and I emailed and I said that you made a great impact on my life. I'm thinking about going to medical school. Would it be okay if I shadowed you? And I like saw him you know, talk to patients. Some of them were kind of in similar positions that I was, so that was very interesting to see.

Duncan: How did you decide where to apply to medical school

Noga: So once I decided that I wanted to go to medical school, I did not apply very broadly. I applied in the, vicinity of Boston and then I also applied to Israel. And the reason that I did that was because my grandparents lived there and, a lot of my, mom's family members [00:13:00] and I do enjoy , having finite amount of time in different countries and different places.

Duncan: Were you thinking about if it would be difficult to match later on if you were international student?

Noga: I don't think I totally knew that it would be as difficult as it's supposed to be to be an IMG. And I think it was because I had , talked to people who had gone through that path and seemed to be okay. but I don't know that I totally knew that it would be more difficult.

Duncan: So it wasn't even something that you were factoring in, you were thinking about this would be a good experience. I've spent time here before. I have family out there. Mm-hmm. And how was the medical school experience itself?

Noga: , I think in general it's very beneficial to go to see other healthcare systems and other types of relationships between doctors and patients. So I think in that, specific regard, it was very interesting. And I think that that culture there is quite different than the culture here.

So, relationships are gonna be different. And there's not as much of a hierarchy between the doctors and [00:14:00] patients, which I think was beneficial to be able to see that relationship. And then see a different type of a healthcare system where some things are not as relevant, like they have universal healthcare.

So kind of some of those things are not as in the forefront of doctor's minds as they are here. like when you're trying to discharge a patient. Anyone can get a helper at home or a caregiver at home, which makes things a lot easier. The other thing that I really enjoyed there was the refugee population there and we had a student run clinic that I was very active in.

Duncan: One of the things I'm curious about is that interaction between the doctors and the patients there. Mm-hmm. How is that different than what you see here? I.

Noga: I think, just the way that the culture is there, There's a lot less, rules and hierarchy. And so, I think just like it didn't feel as much of a power dynamic as it does here where like a lot of the patients here I think are scared to say something negative to a doctor or they know how much at the mercy, I [00:15:00] guess they are to doctors here.

It just felt a little bit more level, like a little bit, I think there's always gonna be a power dynamic, but it seemed like the patients didn't have, at least the ones I interacted with or saw, didn't have as much of a, like, filter, 

Duncan: So do you think it's like structural. What was causing those dynamics or structurally, here are the dynamics more hierarchical.

Noga: I think it's a little, it is structurally, and then I think it's also just like culture and just how interactions happen. I think especially in the Pacific Northwest, people are very polite is maybe the right word to say. Whereas they're not as polite in Israeli culture.

I think people are a little bit more blunt just in general. And that's not taken as a negative thing, like in that culture.

Duncan: And do you feel like just in culture in general, there's less of a hierarchy amongst people or was it just isolated to this medical realm?

Noga: Yeah, I think it was more isolated to that. I think in other ways there are a lot of hierarchies, but I think the [00:16:00] way that people talk to each other, I think people are a little bit more blunt and I think other people on the receiving end don't take that as like a negative thing as much.

Duncan: Then you were working in a clinic taking care of refugees or immigrants there. Kind of a parallel universe to what we have here in the international clinic, . What were the similarities or differences between how, care was done there with that population versus what we do here?

Noga: Yeah, I think, some of the similarities was using the interpreters. we had a few in-person interpreters, and. we put on some workshops for pregnant women. 

 We would choose a topic like lactation, for example, and try to get an interpreter to come in and like a lactation specialist and gathered people together who spoke the same language. So I think the importance of the interpreters was very apparent. I think just understanding people's cultures and where they come from and the need to understand their [00:17:00] backgrounds.

Duncan: And you were saying there's less of a hierarchy in the hospital when you're talking to Israeli patients with the Israeli doctors, do you feel like that extended over to this immigrant population, or was there more of a hierarchy there? I.

Noga: I think from the patient's perspectives, patients who are refugees, I think that because of the way that they communicate and in their culture, they don't talk the same way that the Israeli people do. I think that there probably was still that hierarchy, and also because it's difficult for them to navigate the healthcare system and speak the language.

Then I think, yeah, the hierarchy comes back.

Duncan: And what countries were people from that you can recall?

Noga: There's a lot of , Ethiopian, Eritrea kind of that area.

Duncan: So similar population to who we see here.

Noga: Yeah. Somali. Yeah.

Duncan: So when you came to clinic here in the international clinic, did it remind you of your experience in that other clinic or was it quite different? 

Noga: I think in this clinic we have a lot more resources to try to help, these patients. So I think it was [00:18:00] really nice to come here, but I think that there's definitely aspects of it that mimicked, there, and that was like one of my favorite parts about medical school was being able to work with that population.

And so it was really nice to be able to kind of continue that over here.

Duncan: And in school there were most people from Israel or is there a lot of foreign students there as well?

Noga: They were all in my program. They were all either American or Canadian.

Duncan: And no Israelis in that particular program? Yeah, they

Noga: Yeah. They had others that were Israeli.

Duncan: And is it training different if you're coming from abroad versus if you're from the country?

Noga: Yes. So the program I was in was for, coming back to the US so it's like has the kind of requirements that you would need to come back.

Duncan: And then how about matching to residency? Where were you thinking about, sounds like you're on the west coast now. You're originally from the east coast. Was that intentional? .

Noga: Yeah. It was actually. I had never been to Seattle before or Washington. I had visited Oregon once and I think I really, liked the idea to be in the Pacific Northwest [00:19:00] specifically. So I really wanted to come here. I really liked the nature and, people who also enjoy being in nature that I think I was like missing in some of my past places that I lived in.

I think, the healthcare system at UW was also treating a lot of underserved patients was very important to me. and what I had heard is that the, kind of the hierarchy again in Pacific Northwest is not the same in the healthcare system as it is in the East coast.

Duncan: And how has residency been your third year? You're almost finished.

Noga: Yeah.

Duncan: now? I guess looking back on residency, how was it?

Noga: It's been lots of ups and downs. I think there are times where things feel very difficult. The times that have been hardest for me is when, you realize that your decisions can impact, patients' lives. And I think those really stay with you for a long time. So I think those have been like when a patient doesn't have a good outcome, that that's definitely been like a low, but I think overall it's been a great experience. in the hospital, how much I've learned and [00:20:00] how much more competent I feel compared to when I first started at least.

And then being in the international medicine clinic. I think we learn like very different skills in a lot of the other continuity clinics. And I can see how things that I've learned here can extend to other places . In fellowship for example i'm applying to rheumatology and just being able to take the time to be patient with the telephonic interpreter or figuring out what medicines people are taking. I think that patience has been a really valuable lesson to learn from moving forward.

Duncan: And now thinking about your own past. You had a lot of interactions with the healthcare system, some of them very negative, some of them positive, and then you went to medical school where you mentioned that this lack of hierarchy was very important. How does all of that impact the way that you're seeing patients, or how was your experience of hierarchy and residency here compared to kind of what your idealized [00:21:00] version had been?

Noga: It is very interesting being on the other side of things where we don't have a lot of time for appointments. There's a lot of people trying to come in. There's a lot of things that you're up against. So I think I can see how having enough time to explain things, I can see how that can get cut short or lost. But I think that overall, I felt that we see a lot of injustices and kind of times that that doesn't happen. But I do feel like a lot of the people, especially who work at Harborview have a similar mission of trying to treat underserved patients, in the way that can help them most.

Duncan: What are the things that, from your own experience as a patient do you use as a resident now?

Noga: I actually haven't had a lot of patients who have POTS. But I do know that a lot of my co-residents have. And I think for a long time it had a pretty bad and negative stigma to it. I've heard so many times that people will groan when they see a [00:22:00] patient who on their chart, who's like, has POTS. So I think one of the things that I do try to do is talk about it more. 'cause I think I spent a lot of time not talking about it. I think listening is, I think the best thing that we can do when patients and people talk about being in pain or things that are a little bit more subjective and harder to just quantify in a way that's like you could cath someone and see what's happening to their heart.

To just listen and acknowledge their symptoms.

Duncan: Here in the international clinic, we have a lot of patients have kind of poorly defined symptoms. Just based on how people report symptoms. A lot of overlap with pots. Are there things that, with your own experience that you see carry over with some of the patients we see?

Noga: Yeah, definitely. One of the patients that I had who came to me from multiple other primary care providers, I could see that she had changed a bunch of times and had mentioned every time it was some sort of pain or joint pain or [00:23:00] weakness.

Those were the chief complaints. And the approach that I took with that patient was also thinking about how I would've wanted to be listened to and heard. But I think just really acknowledging her symptoms and seeing her pretty consistently and pretty often.

Also seeing what she wants out of the visit and outta the appointment and keep trying new things. I think also providing some hope that one of these things that we're gonna try is gonna be helpful. I think even just acknowledging people's symptoms and that we're going to work together across multiple visits to try to figure out what we can do to help has seems that it helps.

Duncan: And you've lived through that experience.

Noga: Mm-hmm.

Duncan: What's next for you? 

Noga: I am now applying to rheumatology fellowship. I think rheumatology is another example of a lot of patients who have symptoms such as pain and it's very difficult sometimes to quantify that. Sometimes they have [00:24:00] active swelling or inflammatory markers or things like that.

One of the things that I enjoyed about rheumatology is that there's not a specific test or a specific thing that we can do to say , yes, you have this, or no, you don't. I think that working with patients to try to figure out their symptoms and listen to them, especially with diseases that are very debilitating in terms of their pain and joints is one of the reasons that I wanted to go into that field.

Thank you so much for your time joining us today. Noga, 

 

Duncan: We hope today's episode offered meaningful insight into the diverse paths that lead to a career in medicine.

Dr. Noga Rogel, an internal medicine resident at the University of Washington, shared how her own childhood illness sparked a passion for patient-centered care, the unique challenges and opportunities of attending medical school abroad. And how cross-cultural experiences have shaped the way she practices medicine.

 Here's a preview from Dr. Abdifitah Mohammed, our guest on the next episode of Provider Pulse.

Abdifitah Mohammed: I had one sister who is younger than me, but she passed due [00:25:00] to, diarrheal disease slash malnutrition slash dehydration. And I still remember the pain we felt in our family and how someone can pass from that preventable disease and still a big issue in Africa.

My first time applying for residency it was 2019. I applied 100 program and I got zero interview. I was shocked. I felt disappointed and I said what I'm missing?

So they always tell me, you are at United States the land of freedom. If you cannot success in USA, you will never gonna succeed anywhere else in the world.

Duncan: Thank you for listening. Be sure to visit our website@ethnomed.org for additional resources. Also follow us on YouTube and Instagram at EthnoMed uw and on LinkedIn. Do you have comments or suggestions? We would love to hear from you at [00:26:00] EthnoMed uw@uw.edu. That's EthnoMed uw@uw.edu. Thank you.