Doctor, Mother, and SMILE Score Creator

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Interview with Dr. Laura Vater, resident physician and SMILE Score creator [Show Summary]

Dr. Laura Vater is a current resident in internal medicine, future hematologist/oncologist, mom, and inventor of The SMILE Score, a tool to help patients and health care providers simplify and prioritize health in their lives. She is also the mother of a beautiful little girl. How does an MD/MPH, resident and mom have the time to develop useful tool for measuring how well we are prioritizing our own health? Let’s find out in the interview with Dr. Laura Vater.

Life as a doctor and mom and how the SMILE Score helps [Show Notes]

Our guest today is Dr. Laura Vater. Dr. Vater did her undergrad at Notre Dame, majoring in Biological Sciences and Poverty Studies. She earned her MPH from the University of Pittsburgh and her MD at Indiana University School of Medicine, where she is currently a resident in internal medicine. She is also the developer of The SMILE Score, which we will learn about in just a few minutes.

Can you tell us about your background outside of medicine? Where you grew up? What you like to do for fun? [2:11]

All of my family is from Minnesota. We moved to Indiana when I was a child for my dad’s job. We planned to move back, but then my mom decided she wanted to go to graduate school and then medical school, enrolling at age 37 when I was 9. Today all of my family still live in Indiana.

In terms of what I like to do for fun, I have an almost three-year-old daughter and I’m a resident so I don’t have lots of time, but I love to be outside. I worked at Rocky Mountain State Park and just overall I love to hike and travel to national parks. I also love to read.

How did you know you wanted to be a doctor? [4:36]

My mom says I knew I wanted to be a doctor before her. I had a coach diagnosed with metastatic cancer when I was very young. I went with her to treatments and was with her when she passed away. This experience was very meaningful to me and I realized, that I wanted to be that person that helps someone navigate a serious illness – who lets them know they are not alone in that.

What was the hardest part of the med school application process for you? [6:42]

I went to Notre Dame and pursued a science degree. I had a lot of experience in global and public health so I took three years between graduation and medical school – I took a gap year and then got my MPH. I took the MCAT a few years after taking the rigorous courses, and I wish I had taken it when I was fresh.

Why did you decide to do a gap year between undergrad and your MPH? [8:06]

I had watched my mother go through the rigors of medical school and medical training. She started when I was 9 and started practicing medicine when I was 16 so I had grown up watching her go through it. All along I knew medicine was the right field for me, but I knew how challenging it would be. I was very interested in global and public health so decided to spend a year teaching in Haiti first. At Notre Dame they have a career fair and a service fair, where they actively encourage graduates to pursue service, and there was an opportunity to serve in Haiti after the earthquake in 2010. They needed help with teachers and community health, and it seemed like a great way to pursue something different.

Why did you choose to do the MPH? [10:41]

My advisor in college was an expert in public health, and he exposed me to concepts in public health I hadn’t been exposed to elsewhere in science. It was really interesting to me to think about prevention. In the public health field we refer to a model where people are falling into the river, and the hospital/ICU is downstream pulling people out. But who is walking upstream to understand why people are falling into the river in the first place? That is what public health and prevention experts do – they look at the socio-economic determinants of health, and ways to make people healthier and happier through behavior change and social justice initiatives. I wanted that experience to frame the rest of my medical experience.

What did you like best about your medical school experience at Indiana University School of Medicine? [12:43]

The school has nine regional campuses across the state, and I was able to do my first two years with a very small class at Notre Dame, which was great since my husband was getting his MBA there at the time. I had all Notre Dame professors, some of whom had taught me in undergrad. I had great personalized help and access to resources there. When I transitioned to Indianapolis for the second two years I was able to be integrated into the academic medical center, so I was able to get an understanding of hierarchy staff, residents, and medical students. I had a wonderful experience there, and felt so supported and empowered.

What could be improved? [14:22]

The curriculum has changed subsequently in response to this, but when I was a first and second year we had an exam every three days, and we did not have a weekend off until Christmas break, which was really challenging for one’s mental and physical health. It would have been better to have a balance to ensure students had enough time to take care of loved ones and their health.

Was there ever a time either in medical school or since when you really wondered if you had made a mistake and thought about leaving medicine? [15:26]

I just finished a 28 hour call last night, and there have been times throughout residency when I’ve had those calls and have a viral infection. At 3am you are trying to lay down and you keep getting paged so you can’t get any rest, and then I can feel how hard I am pushing myself. It’s times like that I have asked myself if I made the right choice, and my colleagues agree with that. We have found strategies to rest, and to refocus thinking to make healthy choices in a rational way to feel better. There is never a lasting sentiment to quit.

What is The SMILE Score? [19:11]

I was taught to use memory devices to learn important information, but we have no memory tool to help us prioritize our health, which was striking to me. I know what behaviors make me healthy, but at times I am inconsistent. When I am very tired – it can be hard to recall what I need to do to make myself feel better. In response I created a very simple tool to support my health. It is a daily self-assessment and takes less than a minute to do:

S = Sleep. Am I getting the 7-8 hours I need?

M = Movement. Have I been active today?

I = Inhale and Exhale. Did I take a few moments to do deep breathing/meditation/de-stressing?

L = Love/Connect. Did I meaningfully connect with another human being?

E = Eat to Nourish. Did I choose the donut after call or get a meal that could nourish my body?

I give myself a score between 0-5 and am very gentle with myself. When my score is low, my mood and energy level are lower, so it is a tangible way to take care of myself and take steps to make healthier choices. After encouragement I trademarked and copyrighted the idea, and it is being integrated into the wellness curriculum at Indiana. What is fascinating is there has been an interest in the SMILE Score from many others I did not anticipate. Physicians in California have included it in the health program for youth, and with patients to encourage a healthier lifestyle. As a clinician I plan to use this with my patients as a tool.

We’ve discussed your education and your full-time and part-time work, what about your family. When the show airs it will be a few days before Mother’s Day. You have a beautiful family. How do you fit them in? [27:44]

I have been married for six years and my daughter is nearly three. I have the most supportive husband. I tell my single friends to find a partner who is an advocate for you and really supports you. He believes more in my success than his own. He works fulltime from home with a flexible schedule in data analytics, so is able to drop our daughter off at day care and pick her up. Because of his support it allows me to be fully present when I am home. There are days when I don’t get to see my family as much as I like but we have found ways to make it work. On easier months we spend lots of time together. We do lots of pretend play with my daughter’s favorite characters, and it’s easier to balance than I thought because I watched my mom do it.

How do you see your career evolving after residency? [29:29]

I am in my second year of internal medicine residency. I will be applying for a fellowship this summer and plan to become an oncologist, most likely focused on breast or lung cancer. I see my career as a cancer doctor who cares about the complete quality of life and wellbeing of the patient. I anticipate my research will be focused on early detection and screening for cancer as well as quality of life. It is really important that we empower patients to be healthy from the very beginning – from diagnosis to the very end. How can we let them have the best life possible with what we can do in medicine?

What would you have liked me to ask you? [30:50]

A lot of my friends who don’t have children ask me this – “When is the best time to have a child in medicine/medical training.” I asked my research mentor this very same question several years ago, and she told me to have a child when you are ready, because there is never a great time. So for us, we had our daughter during the fourth year of medical school, and I was able to spend eight months home with her. Others say during fellowship is a good time, but it really is when you and your partner are ready.