Neha Nanda on standardizing the path and personalizing the care

What this conversation is about

Dr. Neha Nanda leads the preparation for and response to emerging infectious diseases at Keck Medicine of USC. Glenn Llopis calls her the paradigm disruptor, and she joined him and co-host Scott Lacy a year into the pandemic, when the data on who was dying was no longer arguable.

Glenn opened with the question that has followed healthcare for a decade: we have said we are patient centered for years, so why does it so rarely feel that way? Her answer starts with what the pandemic exposed:

"COVID really showed us our weaknesses as it relates to the potential gaps that we have when we are trying to be inclusive." — Dr. Neha Nanda · 00:01:48

Where the balance actually sits

Asked to define balance, Nanda gives the cleanest answer in this archive. Standardize everything involved in getting a patient to a caregiver, such as scheduling and waiting time. Then personalize what happens once the two of you are together:

"let's standardize the processes that are involved in getting the patient to the caregiver." — Dr. Neha Nanda · 00:05:19

Her example is the instruction everyone heard during the pandemic: go home and isolate for ten days, use a separate bathroom. It is easy to say and, for many households in her community, impossible to follow:

"very easy as a physician for me or a caregiver to tell the patient that, but what's personalization is asking him, are you really able to do that?" — Dr. Neha Nanda · 00:05:19

Words become actions, she says, when the clinician helps build a setup where the patient can actually do the thing. The same applies far beyond infection control. Telling someone which medications to take is the standardized part. Working out how to overcome the obstacles in their daily life, down to the reminders at noon and at six, is the personalized part.

What the patient is actually asking for

Nanda puts herself in the patient’s chair, and the answer is about power rather than manners:

"I want to have a shared decision-making and... the onus lies on my provider to have the cultural maturity, to understand where I'm coming from" — Dr. Neha Nanda · 00:03:06

Later, asked to define inclusion as a physician, she says it simply: whatever the patient’s educational, cultural or ethnic background, they are actively making decisions with her. Glenn named what that represents:

"what you just said is you've shifted the balance of power to the individual" — Glenn Llopis · 00:23:52

His point is that most conversations about inclusion are still stuck at permission rather than action, which is how the work slides into an initiative that comes and goes. Nanda had gone straight to decision-making.

Acknowledging history in the room

The most striking practice she describes is also the simplest. When there is a history between medicine and the community a patient comes from, she now names it out loud with them. That is the pull quote at the top of this page, and she is candid that she had never done it before. It is not only COVID, she adds; the same pattern shows up again and again if you look at the record, including the Tuskegee syphilis study, in which Black men were denied treatment that existed.

What follows that acknowledgment, in her experience, is openness: the barriers between the role of physician and the role of patient come down, and the conversation about something like vaccine hesitancy can finally start from an honest place.

She is equally frank about why this was not standard practice before. It took constant awareness, she says, and the discipline to keep that self-awareness alive. Co-host Scott Lacy heard an ecosystem in her answer: she began with the patient, but immediately included family members, colleagues and trainees. His observation that there is no such thing as an isolated individual is a nuance worth stating carefully, because Nanda’s point is not that the person matters less; it is that the person cannot be served without the relationships around them.

From the individual to the system

Individual awareness is where it starts, but Nanda does not leave it there. Hardwiring inclusion means changing what a system makes easy. Recruiting residents and fellows with this in mind, because that determines who is in the building a decade from now. Training that uses techniques such as practising with an avatar whose skin color is different from your own. Making a patient’s address and demographics visible at the top of the record rather than three clicks deep, so a clinician can ask the right questions before the visit ends. Tying preventive goals, such as mammography rates in a specific part of the county, to metrics and incentives.

Her care will be identical whichever neighborhood the patient comes from. What changes is the conversation she knows to have, because that patient becomes the messenger back to their own community.

And she is clear about what compliance can and cannot do:

"regulation should be something that, uh, allows us to reach the bare minimum standard." — Dr. Neha Nanda · 00:35:26

Going beyond the bare minimum requires cultural hardwiring, which takes time. Glenn tied the whole conversation back to his own argument:

"inclusion is a growth strategy. In other words, the broader and more interconnected our perspectives, the more confidently we can co-design the future together." — Glenn Llopis · 00:21:47