5 - How to Handle Conflict in Advocacy with Dr. Nicole Carter

In every operating room, in every ward, in every clinic, and every team meeting, a silent battle brews. Conflict, negotiation, identity. Welcome to the Scalpel and Sword podcast, where I, Dr. Lee Sharma, physician and conflict analyst, Explore the hidden negotiations behind modern medicine. Let's trade burnout for boundaries and learn the art of healing with precision and power. Welcome, my peaceful warriors. Welcome to the Scalpel and Sword podcast. I am your host, Dr. Lee Sharma, physician and conflict analyst, and I am so excited to have on the podcast today my dear friend, Dr. Nicole Carter. Dr. Carter is a native of Michigan. She did her undergraduate at Albion College and she did medical school at Northwestern. She did her pediatrics residency at Duke University, and she and her husband Matt, who is also a pediatrician, have been local to the Auburn area for the last 20 years. She is currently in practice at WellStar in LaGrange. She is an advocate. She is an amazing doctor. She's an amazing mom. She is a triathlete. She is an ultra runner, and it is a pleasure to have you on the podcast. Welcome, Nicole.

Thank you for having me. I'm really excited to be here. And I have one of my children coming in behind.

Okay, cool. I had one of the first ones I did, my dog barked like through the first 5 minutes. And I was so embarrassed because it was actually a guest that I had not met, like formally, wasn't a friend. It was actually somebody that I met at a meeting. I said, be on my podcast. And she was so gracious and said, sure. And like the first 5 minutes, Ryker will not stop barking. I'm like, I am so sorry. And she's like, no, no, no, I've been on so many podcasts, it actually becomes more real. Because people's like, oh yeah, my dog does That too. So we totally get that. So welcome. I'm so happy to have you here. One of the things that we both did within the last month is we participated in one of the hands-off protests outside of the federal building in Opelika, Alabama. And one of the things that I admire about you is that not only have you been a vocal advocate for your patients, but you have shared your advocacy efforts with those of us who also want to participate. And I wouldn't have been at that protest if it hadn't been for you. So that meant a lot to me that you shared that with me. When did you really discover that incorporating advocacy was a very important part of your work as a doctor?

I think it's been always something that I wanted to incorporate. It somewhat naturally, I think, falls into the life of a pediatrician. You have some portion of the children you take care of who can't advocate for themselves. And that's part of my job and our job as physicians and pediatricians to advocate for someone who doesn't have a voice. I think 10 years ago, 11 years ago, if you asked me what would I want to be advocating for, Probably larger topics that would come to mind would be childhood obesity, common sense gun control laws. And then our world changed in March of 2020. And with the pandemic, found myself minding the gap. At the early stages of COVID I think for almost all of us, we were lost without direction. For those of us in healthcare and medicine, there wasn't much guidance from a state level, from a federal level, from a national organization level. We didn't get any guidance from the AAP. I don't know that they had it to give. Each practitioner, each practice was finding its own way. At least for me, I felt like there was a huge gap, whether it be knowledge or understanding or just the unknown of what was going on and how to translate it or what it meant for us in our daily lives. And in our community, we had a couple folks in our local hospital That I think definitely were trying to get some of that information out, one of our infectious disease physicians and one of the chief medical officers. But I'm not sure there was a lot of other information coming out, maybe a little from our state health department. And I felt like I could be helpful, that I could be someone maybe who could take some of the medical, some of the science.

And then also some of the mom and the daughter of elderly parents and all of that. And at least put out how I saw things at the time, how I saw the science and the knowledge and how I was applying it in my own life. And I think overall, I think I helped our community. Not every single person would say that, like that. But even now, I still have people come up and introduce themselves. And they know my name because of information I tried to share, especially early on in 2020. Yeah, long answer. No, that's amazing. And that is, I think, for me especially, I think during the pandemic, most of us at that point were grasping for information. And I was part of groups of OB-GYNs on Facebook that were in epicenters like New York and Chicago. But because I think I was on social media a lot at that point, I saw a lot of what you were posting. And I think what I respected so much about what you were doing Was that you were giving a medical informational perspective, but you were doing that as a mom and you were doing that as a daughter. You were able to put it in that context for people who were also in that situation, and I think that's why that advocacy resonates—is because you weren't just a doctor laying out info. You were—I am in this too—and this is what I'm experiencing, and this is what I am doing, and this is how I'm trying to inform myself. And I think maybe this can help you. And I think that kind of perspective where you're not talking to people, but you're with them is what really allows you to advocate. So I loved how you handled that. I thought you were a very wise and very practical voice as well. You weren't asking people to do things that were outlandish. You were doing things you were doing yourself. And I think that really spoke to a lot of people, definitely spoke to me. But I also know that was not without its pushback.

Yeah.

That anytime I think you're trying to speak truth to power, you're going to have pushback. And especially in some of these situations where you're maybe advocating for things that people either don't understand. What was that like for you?

At times, really challenging. I'm lucky to have a really great core group of friends who I call them the inner circle. And they provided So much grounding, uh, protective boundary circle around me.

Yeah.

That I needed. But there definitely were a lot of hurtful comments. Folks definitely feel some freedom. And I think we're all aware of this on social media when using the keyboard to say things they may or may not say if you were talking in person. And I did get pretty skilled at responding to that. I also let sometimes other folks step in, so it wasn't always me responding. It was challenging and even challenging because my oldest, at the start of the pandemic, was a sophomore in high school.

Yeah.

And the first big social event was homecoming that was coming after this had all begun. And, you know, all the recommendations and what the school was doing and all was to not do large group events and having to parent him, trying to be, as I like to say, even now while he's 21 in college, safe and smart, safely and smartly, and protect my elderly parents as well.

Mm-hmm.

You know, we explained why all of this wasn't a good idea. large group of his friends did go ahead and have their own homecoming, right or wrong. And that created a lot of conflict between him and us, between us and some of his friends' parents, a lot of people we've known a long time. And that's really difficult when you have either friends or people you've had a lot of shared memories and time with, and something like this caused some division. Yeah. It was hard at times. Yeah.

Wow. You are so courageous. That— I know how much that wrenched at your heart to have to do that, but you knew it was the right thing to do. You were being safe and smart for your—

Yeah. And that's— I do think when you know it's right, it may be hard, But you still need to be doing the right thing, especially in a situation like that where lives are at stake.

Yeah.

I can sacrifice knowing hopefully that I kept some other people safe and healthy.

Absolutely. You were having to look at a big picture. You were having to keep the end in mind. Your motivation was sound. You knew why. And I think sometimes knowing the why can be the thing that saves us, especially if we're questioning, this is, I know this is the right thing to do. It's not going to be the popular thing to do, but popular isn't always right. And that is, I think, a very common example to get pushback and get into conflict is when you know you have a position that is the right thing to do medically, but also personally, and then you're having to stand behind it. It's so hard. You're just sitting there taking it, but at the core of it, your integrity knows that you're doing the right thing. I love it that you have an inner circle. I think that inner circle is— and one of the podcasts that hasn't yet to be dropped is with Dr. Risa Lewis, who is an emergency room physician out of Harvard who wrote a book called Microskills. I was so excited she was a guest on the podcast. But one of the things that she talks about in her book, Microskills, is about having a personal board of directors, having your own personal— this is Nichole Carter's board of directors. And I think it's so cool as I'm talking to more and more women. That the people who are in conflict situations that are having to navigate them, one of the common denominators to successfully navigating it is having that inner circle, having those people that you know will have your back no matter what, that will be honest with their opinions. It's like if you come to them and ask them an honest question, they're going to give you an honest answer. And I know that means the world when you are trying to advocate for yourself and for your patients.

It does.

I think also too recently, In this current climate, I think this need for advocacy is even more urgent. We're really having to step out as doctors for so many things. What have you— I know you do a lot of advocacy on social media, and we talked about being at the hands-off protest together. What other ways have you exercised your advocacy and your fight for your patients?

Let me preface just a little with I think a lot of us in healthcare had hoped that after the pandemic, the once in a century event, we could return to just the struggles of regular life. And then the last 3 or 4 months, and I'm tired a little just from life. I would like to just be at my boys' soccer games. And spend some extra time with my mom and all of that. Except sometimes if maybe it's your skillset or maybe it's even not, sometimes you have to use your voice.

Yeah.

And like you just said, we are in a very dangerous position as a country and there's obviously so many issues, but one of the large areas being attacked is both science and healthcare. And I guess I'd even say women. Yeah. And I didn't feel like I could sit on the sidelines. So the other things that I've done, I did go ahead, now that I'm working in Georgia, I did go ahead and join the Georgia AP Legislative Committee.

Awesome.

And they actually go to the Capitol and have certain days you can go and you can meet with Some of the representatives, you can stand with signs. I joined the Georgia chapter of the Gun Control Committee. I haven't been able to take part in any of their activities, but I've definitely been a part of some of their webinars, which again has just been really good to be surrounded by like-minded people and talk to other folks who have the same worries and concerns. And then I somehow got myself involved And I'm grateful, but with one of our local Indivisible groups. I'd heard about Indivisible. It started in 2017 as a nonpartisan national group with local chapters. Their main focus is to build community, to address community issues, and then things that may be on the state or federal level, and to focus efforts. So there was a group of folks that were just talking about what can we do? Because I think that feeling of helplessness, feeling of aloneness is what sinks you right now. So a group of 8 of us met at Town Creek Park about 6 weeks ago. And all of a sudden I was on the steering committee for the local Indivisible group. But through that, There's 5 of us. I've met 4 other really incredible people and then just made lots of connections along the way. And we're finding our way as we go. So the Hands Off event was a national one and just worked out really well. There's been a lot of the local town halls and districts all over the country. And we had a town hall in the 3rd Congressional District in Alabama actually last night. We had hoped that Congressman Mike Rogers would attend. We reached out to him about 6 weeks ago. We sent him a certified letter, then called and emailed, and then eventually spoke with his office about 2 weeks ago, and he declined our offer to attend. But we still had our town hall, and I actually spoke at it about public health and about a lot of the dismantling and harmful actions that have happened. With our current administration.

Mm-hmm.

And then we had an open forum for community members to ask questions. And that was really what we wanted and why we wanted Congressman Rogers to come, was to let him hear the concerns that we have, the real concerns that we have, see what his answers and how he would address those concerns. So those are the primary things. And then On social media, try to mostly stay in the health and public health lane. Although every so often I feel like there's important things like the SAVE Act, which I believe disenfranchises voters and other things I'll hit on, but primarily trying to, again, connect people from either the science or what's happening to how it applies in their lives. Or our daily world, not just all this stuff that's happening in DC. Right.

Wow. You're amazing. I love it that you have literally put yourself out there. And by putting yourself out there, you have put yourself in a position to be part of these larger organizations. And because there's strength in numbers, your voice now gets amplified and you also get More ways to get your voice out there. You spoke at this thing last night, so other people got the opportunity to hear your perspective on what the current policy means for them practically. And I think that's such a big thing with health policy is it's hard for people who don't delve into that, maybe not in that world as much, understand what this type of legislation and what this means on the daily. And if you can put it in a perspective of this is how this will affect you, I think you can really get people to understand why it's so important for not just doctors to advocate, but to get as many people, as many patients as possible to advocate with us. And I think that's one of the great things about you not being afraid to put yourself in a place where you can share that knowledge, because it just gets more people to advocate with you. It's just increasing the strength of that number. And I also think that you can change minds. I think when you start to logically— so everybody's got their own different way of looking at things, and there are some people you're never going to change. This is the nature of conflict. This is the nature of advocacy. There are some people that are never going to have that perspective. And on some level, I think this is one of those things, and I'm not going to speak for Mike Rogers— how— I'm not. But if you're afraid of conflict, if you're afraid of engaging on that level, change will never occur.

Yeah.

If you're in DC and you're trying to represent for me, but you're not afraid to engage in a conflict where somehow, some way, maybe we can find a path forward together. If you're afraid of that, you're never going to see positive change. And this is one of my biggest— I don't want to say beef, but it is— with legislators all over the country. When people are having these empty chair town halls, that these legislators are not showing up. It's like, on some level, you have to be unafraid of the conflict to see change happen. And that's so hard. And you have found so many ways. You are smart about your topic. You have your inner circle. You have found so many ways To give yourself that strength to engage. And that's what I love so much about what you're doing is that it's hard. What you're doing is hard. And I think you got to touch on that. When I listen to what you're doing and I've seen what you're doing, it's not easy. It takes a lot of courage to do what you do, but where you're coming from, the space that you're coming from, you care for your patients, you believe in what you're saying, you understand the science. It gives you a solid place to come from. And I think that is where you help people. And unfortunately, and I think we've had this conversation personally, it's going to get worse before it gets better. And I think we all recognize that. And I think sometimes that can be a little bit discouraging, but it doesn't stop us from fighting. I think in the women's health space, I'm kind of trying to do what you're doing a little bit. I'll get in with organizations that I actually took a role in ACOG and my whole career, I've never actually taken an active role in ACOG, but ACOG is so persistently advocating for women's rights, for contraceptive access, and all these things that are so important to our women that heck, I gotta, I can't. And when you said at a certain point, you can't sit on the sidelines. You can't in good conscience, knowing what's happening, just to sit on your hands and do nothing just feels wrong. And you know, at some point I'm going to get people that are not going to agree with me. I actually have a sticker in my planner that says. Not everyone is going to like you. You're not tequila. I think I'm going to have to find you that sticker. But it is that reminder that if you're out there, you're doing the right thing, you're going to have that pushback. You're going to have conflict and you just have to know where you're coming from to handle that.

Yeah. And you have to believe in yourself too, I think. Like, I am okay if some people don't like me, if I know that I am doing the right thing for myself, my family. And my cute little patients. Yeah, that's okay.

I think that's easier for some of us than others. I know for me that's really hard getting that headspace, but I will say, as I have gotten older and as I have gotten more into health policy, I am less concerned about it. And I would say in the last year, I've gotten from less concerned about it to let's ride at dawn, baby. We know we got work to do. I think as I've gotten older and I see what Yeah. I think I'm less afraid of that. And that comes naturally to different people. And some people like me may have to work at it a little bit more, but it still comes back to know why, you know what your why is. And it does make it much easier to engage knowing that. I think that's really cool. Have you ever had the experience where maybe somebody shared with you that initially they didn't agree with you and then after a while, as they saw and heard what you were putting out there, they maybe came around and maybe shared that with you? Have you ever had that happen?

I'm sure it has. This isn't necessarily applicable to COVID or to our current world.

Yeah.

As a pediatrician, it happens all the time with vaccinations.

Oh, wow.

I'd say that's a fairly common occurrence when you're a pediatrician to spend time trying to answer questions or reassure, remove anxiety and fear. And sometimes that takes a number of visits, but being willing to sit there and listen, to be nonjudgmental, and to try to provide good information and good resources for families that have concerns and questions as well. I've spent hours making sure I'm providing info about aluminum in vaccines because that was one family's concern. I think as a pediatrician, how have I either changed minds or helped guide someone towards a good medical decision? That's a fairly common one in our world.

Wow. I love how you talk about what you invest in that process. That it wasn't one of those things where you sat down, and it may happen, but it sounds like it's more of you even built a relationship with these families. And as you build that relationship and you build that trust, but you're also willing to listen to the other side of what they're bringing you. You're not just rote saying, I'm right, you're wrong. And I think that's something, unfortunately, if we really feel passionate about something, we— and we don't mean to do it, but I think it can happen. But I love the perspective of I had to invest in this relationship. And I had to be open to what was being said. And as I was open, and as we engaged in this conversation, that we actually got to a point that we both agreed. And what a beautiful way of describing how we get to a place of resolution with conflict. That's such a common— some of that's, I think, media. Some of that, it's just not having a conflict experience, because a lot of us don't have experience dealing with conflict. But it's that idea of it's going to take time and investment and an actual relationship to get to the point that you can share a perspective. But how beautiful is it that you spent that time, that you actually were open, that you actually listened to concerns, you spent time researching those concerns. I know that meant a lot to those families, and I'm sure that was part of their decision. Okay, we trust this doctor. She's really listened to us and she's evaluated our concerns. And I'm sure that was huge for them too.

I hope so. I wouldn't tell any Family I see, if you're seeing a physician that's not willing to say, I don't know, I need to go ask some questions, or I need to go look this up, I think you need to find someone else to see because there's no physician that knows everything and things are constantly changing as well. So if they're not willing to tell you that or give you that response, I would be very hesitant.

I 100% agree with you. That is the essence of humility. And we can't do what we do without having that essence of humility. We have to have that. One of the things that we teach kids in martial arts when they're little and we have to have belt exams, they have to answer questions. And so they come up to the table and we ask them questions about what does the symbol mean or what does this mean in your form, whatever. We teach them to say, if you don't know the answer to the question, say, I don't know. I don't know, but I will find out. And that is a legitimate answer. And we will take that. Now, it's something that when we teach the kids that this is a life skill for you. I don't know, but I will find out. That is always a valid answer. And if that is the answer to a question, nobody on this planet, I don't think, I've never had the experience of saying to a patient, I don't know, but I'll find out and have somebody get mad at me. It's like, you didn't know that? I've never had that response.

Mm-hmm.

It's always, okay, cool. It's like, I'll research that and I'll get back to you when I have an answer, but I don't have one right now. And no patient, I don't think, ever gets upset about that.

Agreed.

Yeah. But that's also, I think, a very important part. If you have a conflict with a patient, I think that's part of it too, is that we have that humility and they feel that. And that answer, I don't know, is the essence of that. So I absolutely agree with you. So where is your advocacy? Like, what are you focused on right now before we close? What efforts do you have and where are you directing your efforts at the moment? I know we have a lot going on politically.

Yeah, primarily through the Indivisible group. Some of it as a mom and a physician and a daughter is balance. And it's a very weird world we live in right now where you're trying to live your life, have these amazing moments, be with your family. And then I may be saying this a little tongue in cheek, but in trying to save our country and our democracy all at the same time.

Yeah.

So some is finding that balance and having some of that margin. And then right now, primarily focusing efforts through Indivisible. And then I meet with a couple other groups in town. We're meeting Indivisible. We have a couple meetings coming up and we'll, I think right now, try to continue to do as much as we can with community protests. We have looked at a couple other town halls with other elected representatives. Potentially also bringing in some of the folks who are going to be running for some of the other, whether it be state or federal seats within the next election year. We're trying to get a little calendar in front of us for how do we want to focus our efforts. I also think we're going to do a food drive with the East Alabama Food Bank losing a lot of funding federally. They're really hurting right now. So I think that's one of the other Things that we'll be doing.

Awesome.

Yeah.

I am personally so grateful for your efforts. I know your patients are too. The community is blessed to have you and doing what you're doing, not just as a physician, but as an advocate. You're just doing the most amazing work. And I'm just so grateful that you were able to be on the podcast today. So thank you so much.

This was great. I always love talking to you, so I'm good.

Oh, I'm so glad. Hey, yeah, this was just an excuse for us to have a good long hangout.

Exactly.

Oh, I love it. Thank you again, Dr. Nicole Carter, for being on the podcast. So thank you, all of you peaceful warriors who have joined us today on The Scalpel and Sword. Please like and subscribe, and until next time, be at peace. Every episode is an invitation to speak To negotiate, to choose. I'm Dr. Lee Sharma. Join the dialogue by subscribing to Scalpel and Sword. Until next time, peaceful warriors, may your choices be sharp and your voice be even sharper. This podcast is a reflection of lived experience and research in conflict resolution. The Scalpel and The content of this episode is not intended as medical or legal guidance. For personal matters, please consult a qualified professional.