Heidi Gullett, MD, MPH

headshot of heidi gullett

Home Institution: Case Western Reserve University

Field: Family Medicine and Community Health

Current Positions:

My Driving Question

What is the role of primary care in cultivating social capital to support a patient’s movement out of poverty?

Fellow Project 

Upstream determinants of health, such as poverty, cause inequities in health outcomes for individuals and populations. Poverty remains one of the most recalcitrant determinants of health, often layered with the complicated effects of systems and structures that perpetuate inequities around race, gender, sexual orientation, class and religion. Clinicians, working in a health system that increasingly commodifies care and actively discourages integrating functions, see the results of these upstream health determinants, but are not supported to meaningfully address them. As a family and public health physician, Dr. Gullett believes that it is vitally important to understand the root causes of the current fragmented system and to address the identified opportunities for integration of care to reduce the health effects of poverty. 

To that end, Dr. Gullett has been piloting a pragmatic program to address the conditions of both individual and community poverty known as Getting Ahead in a Just-Gettin’-By-World with patients in her clinical practiceThis program is built on the framework of Bridges Out of Poverty, which enables people living in all 3 economic classes (poverty, middle class and wealth) to work together toward solving poverty through shared understanding. Getting Ahead consists of 16 three-hour sessions in which participating “investigators” – people living in poverty – simultaneously examine their own and their community’s experience of poverty while developing their own future story. Structured discussions consider historical and contemporary conditions, causes of poverty (individual behavior/choices, community conditions, exploitation and systems/structures), language, resources, and the hidden rules of class, among other topics.

During this ongoing research, Dr. Gullett has observed that Getting Ahead investigators frequently identify their primary care team as their (often sole) source of bridging social capital. Bridging social capital is a critical resource necessary for moving out of poverty. As a Nova Institute Fellow, Dr. Gullett is systematically building on this observation, using methods that enable understanding of Getting Ahead investigators’ life-course trajectories, to inform understanding of how individuals move out of poverty, and how primary care can be better understood and supported to serve as an impetus for movement out of poverty through bridging social capital. Elucidating the value of primary care in cultivating social capital as a means for movement out of poverty has the potential to serve as a key element of broadly characterizing and redesigning the role of primary care as a force for integration in the US health system.

Biography 

Heidi Gullett, MD, MPH, was born and raised in Youngstown, Ohio. She completed her undergraduate degree in Biochemistry and Sociology/Anthropology at Denison University in Granville, Ohio, her MD at Wright State University in Dayton, and her MPH in Health Policy at Portland State University. She completed a combined residency in Family Medicine, Public Health, and General Preventive Medicine at Oregon Health and Science University in Portland, Oregon, and is boarded in both specialties. Following residency, she served in the National Health Service Corps in rural Jellico, Tennessee, and in her hometown of Youngstown.

She has worked at community health centers for most of her career, including currently practicing at Neighborhood Family Practice on the west side of Cleveland. In her clinical practice, she provides family medicine care, including inpatient medicine, with an emphasis on women’s health services and previously spent ten years providing full scope maternity care services. Dr. Gullett is an assistant professor in the Center for Community Health Integration at Case Western Reserve University to promote research and development for community health and integrated, personalized care.
Education and Training
  • Diplomate, American Board of Family Medicine
  • Diplomate, American Board of Preventive Medicine
  • MD, Wright State University
  • MPH, Portland State University
  • BS, Denison University
Selected Honors
  • Community Health Hero Award, Neighborhood Family Practice, 2018
  • Alpha Omega Alpha Honor Medical Society, 2018
  • Tom Mettee, MD, Foundations of Clinical Medicine Teaching Award, 2018
  • Charles Kent Smith, MD and Patricia Hughes Moor, MD Professorship in Medical Student Education in Family Medicine, 2017
  • Partners in Education, Evaluation, and Research (PEER) Faculty Partner Recognition, 2015
  • Kenneth G. Reeb, MD Family Medicine Residency Award for Excellence in Teaching, 2013
  • CWRU SOM Medical Student Family Medicine Mentorship Award, 2013
  • Academy for Healthcare Improvement Second Place Award for Curricular Innovation, 2012
  • Jack H. Medalie, MD Family Medicine Residency Enhancement Award, 2012
  • OHSU Family Medicine Merle Pennington, MD Outstanding Resident Achievement Award, 2007
  • National Health Service Corps Scholar, 2001-04
  • Dension Excellence in Service Volunteer of the Year, 1999
  • Granville Kussmaul Service Award, 1999
Selected Publications

Peer Reviewed Articles

Op-Eds

Developing safety, persistence, trust

Healing is facilitated through safety, persistence, and trust.

  • Persistence: “People did not simply progress through this sequence and experience healing. The healing journey was a recursive, back and forth process. They found helpers, used the skills/resources that those helpers provided, found other helpers that provided more resources and used those skills and resources. As this process continued, people experienced a gradual amelioration of their suffering. Although many despaired at times, all demonstrated the quality of persistence—they refused to give up.”
  • Safety & Trust: “To connect to helpers, it was essential for people to feel safe in those relationships and able to trust that the person would be a helper and not a barrier to healing. Persons whose wounds included a violation of trust were especially careful about testing the safety of new relationships.”

Acquiring Resources

Resources support us as we heal. They include reframing, responsibility, and positivity. “Making connections enabled participants to acquire and refine resources and skills that were essential in their healing journey. People also brought their own personal strengths to the journey.”

  • Reframing: “A particularly important skill was the ability to reframe—that is to look at suffering through a different lens.” This does NOT mean minimizing trauma or pain, but rather it often means the opposite: understanding what happened was wrong, unfair, or uncontrollable and that we are not to blame for it.
    • “I think I kept trying to convince him I was crazy. And he kept saying, ‘No, you’re not crazy.’ […] You wouldn’t necessarily say a Vietnam Vet was crazy. You’d say they are responding like you’d expect to extraordinary circumstances.”
    • “I’m not the only one who have [sic] this problem. A lots, millions of people, you know. […] They don’t have nothing to do with that. I guess I have to live.”
  • Responsibility: While we don’t have control over what happened to us, we are the only ones who can help ourselves heal. “A third essential resource that people acquired or refined was the ability to take an appropriate amount of responsibility for their healing journeys. They participated actively in the process of healing. Once again, some participants already had developed this skill, and some acquired or refined it from their helpers.”
    “You need a lot of energy and a lot of work … it takes a lot of work. It doesn’t just happen. It’s not like a magic wand.” This patient understood that they had to actively participate in the healing process.
  • Positivity: “Another resource that people acquired or refined during their healing journey was choose to be positive—that is to have some optimism about their situation.” People have varying predispositions to positivity. In the study, positivity was important in helping people heal. This doesn’t mean a toxic positivity, but rather simply finding some good in life and feeling hopeful about our situations.

Helping Relationships

“Connection to others was an essential part of all the healing journeys.” Humans are social creatures, and even the most introverted of us need close relationships. Friends and family add meaning and value to life and help support us, in good times and bad. When we experience relational trauma, relationships can feel scary, but reestablishing safety and trust in relationships is where the healing happens. (To be clear, we do not mean reestablishing safety and trust with abusers, but rather finding other healing relationships.) “When safety and trust had been established, people were able to connect with helpers. The nature of the behaviours of helpers that fostered healing ranged from small acts of kindness to unconditional love.”

  • “Moving from being wounded, through suffering to healing, is possible. It is facilitated by developing safe, trusting relationships and by positive reframing that moves through the weight of responsibility to the ability to respond.”
  • “Relationships with health professionals were among these but were not necessarily any more important to the healing journey than other kinds of helpers, which included family members, friends, spirituality and their God, pets, support groups, administrators, case workers and supervisors.”

Healing

Healing probably means different things to different people, but one definition that emerged from the study is: “The re-establishment of a sense of integrity and wholeness.” Healing was an emergent property that resulted from each individuals’ complex healing journey, a result of bridged connections between resources and relationships. Healing, in this sense, does not mean cured—none of the study participants were cured of their ailments—”but all developed a sense of integrity and wholeness despite ongoing pain or other symptoms.” In varying degrees, “they were able to transcend their suffering and in some sense to flourish.” When we begin to heal, we find increased capacity for hope, renewed motivation to help others, and are more able to accept ourselves as we are.

Suffering

Suffering is the ongoing pain from wounding. There is debate about whether or not one actually needs to experience suffering on the path to healing.

Wounding

Wounding happens when we experience physical or emotional harm. It can stem from chronic illness or by physical or psychological trauma for which we do not have the tools to cope, or a combination of those factors. “The degree and quality of suffering experienced by each individual is framed by contextual factors that include personal characteristics, timing of their initial or ongoing wounding in the developmental life cycle and prior and current relationships.”