Imagine walking into a clinic feeling anxious about a possible cancer diagnosis and leaving with all your concerns addressed, feeling genuinely cared for and understood. 

Unfortunately, for too many patients today, that’s simply not the case. The pressure of production goals, burned out and short-handed physicians, and an increase in administrative load are a few of the challenges that doctors and medical staff face day-to-day.   

As a result, patients who are awaited results from diagnostic tests like mammograms have their anxiety rise and are left feeling like a number.

In this illuminating episode of The Delighted Customers Podcast, we dive deep into the art and science of patient communication with Rachel Hitt, MD. 

As the medical director of patient experience at Tufts Medicine Integrated Network, Dr. Rachel sheds light on the pivotal role of efficient care and effective communication in enhancing patient interactions. Discover how active listening, empathy, and breaking down complex medical jargon into digestible information can transform a patient’s experience. 

1. Why are effective communication and efficient care essential in patient interactions?

2. How do empathy, active listening, and partnership with the patient contribute to communication in healthcare?

3. What are some strategies for breaking down medical information into understandable chunks for patients?

4. How can meeting patients where they are, including considering language barriers and providing interpreter services, improve patient experience?

The lessons that Dr. Hitt shares on this episode aren’t limited to healthcare – after all, humans have the same needs regardless of the environment.

Transcript

Note: This was AI-generated and only lightly edited

Mark Slatin:
Well, I can’t wait to get started with this episode of the Delighted Customers Podcast. I have a very special guest, Rachel Hitt, M.D. is the Medical Director of Patient Experience for the Tufts Medicine Integrated Network and Division Chief of Breast Imaging for Tufts Medical Center. And before that, she was the Physician Leader of UNC, University of North Carolina, Office of Patient Experience and Employee Engagement at the UNC Hospital at Chapel Hill. Rachel, welcome to the show.

Rachel Hitt: Well, thanks so much for having me. Delighted to be here.

Mark Slatin: So excited to have a true medical professional, a doctor on the show who is directly involved in patient experience at, to me, one of the premier hospitals in the country over there in Boston, where there is so much good medical care. And you’re leading this. You came up recently, didn’t you, from North Carolina?

Rachel Hitt: Yes, I did. And precisely in part, well, precisely because I could have the opportunity to do patient experience while also doing clinical work at a high level. So there’s a real partnership with the leadership of Tufts to make this happen and recognizing how important it is. So I’m really excited to be here. And I just started. So off to the races.

Mark Slatin: You know, in our conversations, you hit on something that I think is critical for leaders. And I’m gonna use the word, we’ll define the difference between patient experience and customer experience as it relates to impact in the healthcare. I do wanna talk about that in the healthcare world, but you and I talked about the financial impact of communication in patient or customer experience in healthcare. And that’s just so critical in the corporate world as well, in business, all sorts of manufacturing technology, whatever. But it’s interesting that you are onto this as something that’s critical in healthcare as well. Do you want to say more about that?

Rachel Hitt: Sure. I think everyone who goes into healthcare has a mission to help people. And we went through all the training, at least as physicians. And even anyone who goes to work at a hospital, they could choose to work elsewhere, but they choose to work at the hospital in whatever capacity they’re in. And it’s because they want to really help people. And so that’s the basics of everything. But sometimes I think what happens is through our training, through all the work and the stress, we lose sight of why we’re there again. And just trying to bring back to the importance of communication that you’re there to serve the patient. and to serve each other and to work with each other and to support one another. And so I think it’s a really, it’s a valuable, it’s the human connections, the basic basis of all our relationships. And I think it’s just a reminder that I can tell you to have this particular breast biopsy or have this kind of follow up, but unless you understand what I’m saying to you in a way that makes sense to you, will you actually be doing that? So for all the training that we have, if we don’t have that background and be able to convey our knowledge to people, it won’t happen. And then you, you’re missing a big opportunity and it’s, it’s free. I mean, it’s free to do once you get trained and do it properly, but the, the payback for the institution, for the patients, for the clinicians is immense.

Mark Slatin: And tell me how you got, you know, your career evolved from, I know you got your medical degree from Harvard Medical School. And from there, how did you get into the world of patient experience from practicing medicine?

Rachel Hitt: That’s a great question. I think, you know, I started out really being very interested. I was going to be a geriatrician. I loved working with older people, and that was my game plan. And I had wonderful mentors. Both my father and my grandfather were physicians, and they practiced sort of old-time medicine, what you would think. My grandfather was one of the only OBGYNs in a small town in Maine, and he delivered so many people. And whenever we would go out to dinner or whatever, someone would always say, oh, you delivered my son, or here he is. And things of that sort, everyone knew him. And then my dad practiced at a large institution in Boston. But he always had the patients come in, sit across from his desk, give their history, talk about their families, talk about life while they’re fully dressed. And then they’d go into the exam room and then do the medical exam. And so that’s what I was trained on. And I just thought that’s what medicine is. And I loved that, getting to know the people. I when I decided to go to medical school I tried a lot of different things that I I worked with a doctor on an island in Maine for two different times and just love the connection with people so I think that’s so important and then prior to medical school I got my master’s in public health and health education. I should say I wasn’t quite Rushing to medical school, I want to make sure it’s what I want to do. And I, I taught high school and I did a lot of education, things of that sort. So health education and teaching. And I think being a doctor is being a teacher. I’m going on and on, but At the same time, I fell into radiology because I just loved it. I love the opportunity to interact with my patients and really change their lives and help change their lives for better and explain things to them. So it’s not just looking at the mammogram or whatever imaging you’re looking at. You’re also perhaps doing their biopsy, explaining to them. They’re all very scared when they come in. They all think they have cancer, telling them this is cancer. I mean, excuse me, this is not cancer. Or if it possibly is cancer, we’re here to take care of you and help guide them through the process. So it’s just a wonderful opportunity to interact with patients. And in terms of the patient experience, I got involved with Schwartz rounds at one of my jobs, which is a wonderful way of helping understand what people are going through on the clinical side to support each other. And I went to one of their conferences and I said, oh my gosh, these are my people. I just loved it. And I learned about the healthcare communication. And through that, this just sort of evolved. And I recognize this is the other element of medicine that I absolutely love. and sort of codifies it and how to, I’m just so interested in spreading the word to other people.

Mark Slatin: Well, interesting background. And what was that group that you said, what was the definition of that group?

Rachel Hitt: The Schwartz Center Compassion and Action, or Compassionate Care, and their conference is Compassion in Action. It’s wonderful. It’s based out of Boston. And Kenneth Schwartz was a lawyer actually who was diagnosed with lung cancer back in the 80s, I believe. And he was really interested in taking care of the people who took care of him, the physicians and the nurses and all the staff and how to support them. And so it’s really developed into an international group and it’s wonderful.

Mark Slatin: Excellent, excellent. Okay, so you had shared with me the reference to a book called Compassionomics, and a really interesting book. If you’re a CX leader, customer experience leader, or PX leader, you definitely want to make sure you read this book. Steve Trezyak and Anthony Mazzarelli who wrote it and Steven will be on the show here shortly. So stay tuned, subscribe if you’re not already. But I wanna talk about a couple of things that they said in the book and why patient care is maybe at risk in healthcare in general, in hospitals and other places, where they point out there is a, three hallmarks identified, burnout, emotional exhaustion, a lack of personal accomplishment, and what they call depersonalization in healthcare. And that’s affecting the patient experience. So could you say more about this and kind of what’s causing the problem?

Rachel Hitt: Yeah, I think it goes back to what I was talking about before, that we’ve moved away from what brought us to medicine in the first place, with all the stresses of just getting through the day, RVUs, overburdened with scheduling, short-staffed. especially after COVID, and it’s just really wearing us and you’re just trying to survive the day. And so you kind of forget what it’s like to be on the patient side of things, because we’re on the other side now. And that totally makes sense. You know, you’re just very stressed out. So that’s where the communication piece comes into it. Because if you can, again, stop, just remember, you’re talking to another human on the other side and find out what’s important to them. It helps reinvigorate you as well as a clinician to remind you why you’re there. So it’s just a lot of stress going on and we’re trying to do anything we can to help people remind them why they went into healthcare.

Mark Slatin: And the book also pointed out that there were 6,880 US physicians found in this study by the Mayo Clinic, that 35% of them were sober now that they’re manifesting high levels of depersonalization. So can you say more about how that shows up

Rachel Hitt: Well, in my line of work, it’s, it’s, um, you know, you might rush through reading a study, you might miss something. Um, you might not like, if you’re in primary care, you might not follow up on a phone call as quickly as you should, or a result as quickly as you should. So it’s, it’s a real finding because people can have difficulties, um, focusing on what they need to do if they’re distracted by so many other things.

Mark Slatin: And you can tell me about this, but I get the sense that there’s more and more pressure on medical care providers to be efficient with their day.

Rachel Hitt: Yes, there’s a huge amount of pressure for us for volume, increase your volume. At the same time, a lot of the administrative tasks have sort of transferred over to the clinician versus previously, you know, in an effort to streamline things. So putting in your own orders or things like that so you’re not necessarily just looking at the images or dealing with the patient, you’re doing a lot of other stuff in the background. So yes, it’s just, you know, we’re short-staffed, we’re trying to do things, and all these new computer systems can make it a little, they’re trying to streamline our life, but I think in many ways, some of the systems have so much information, it’s hard for us to know exactly where to go and are they, I mean, again, this isn’t my area of expertise, but just from experience, it just makes it a little bit harder to find the information we’re looking for sometimes. And so, and all the computer technology that you have to manage.

Mark Slatin: So to paint this picture here, we’ve got an evolution of how medical care gets practiced to where now it’s becoming more about production. more about hitting volume numbers. Physicians are, in some cases, shorthanded, they’re feeling burned out, and they don’t really feel like they have time to be empathetic, compassionate to patients, and there is some real financial impacts to missing out on that connection, right?

Rachel Hitt: Absolutely, absolutely. So anything we can do to help reinvigorate people, to remind them why they’re there. and to make their life easier is so important.

Mark Slatin: But is it one of the myths about correcting for this is that, look, I just don’t have the time. It’s just too, I’ve got to get these patients through. It’s just, I just don’t have the time. Is that a myth?

Rachel Hitt: I think so, because if you’re effective with your communication, you will be more efficient and you’ll understand the differential diagnosis much faster, understand the complexity of the case much faster. And the patient will give you the information you need as well. So it’s going from a monologue to a dialogue. You’ll extract the information that you need. You’ll also be able to… convey the information that you have to give them the instructions in a much more efficient way in a way that they can understand their little tricks, you can do it and like things like teach back and our loops and things of that sort of I’m happy to get into. So there are lots of little ways of doing that and some people think well it’s a. It’s a trait you should have. It’s not something I can learn, but it’s really something you can learn. I tell people if they can learn MR physics or organic chemistry, all those things you had to learn for medical school and radiology for my situation, you can certainly learn how to communicate with people more efficiently.

Mark Slatin: So it’s a myth, and so this idea of go slow to go faster, slow down a little bit so you can go faster in the long run, is what are, talk some more about, well, before we get into the benefits of this, I’d love to back up a little bit and say, you know, Tufts is probably not a whole lot different than other hospitals, hospital systems around the country who suffer from a burden on the physicians and other medical care providers and this goal to try and get financial results and the patients feeling the burden of that goal. And so what do you see as sort of your primary goals at Tufts Medical Center?

Rachel Hitt: I have to say at Tufts, I’ve been really amazed. And again, I’m newer there, but I’m amazed by the time people do take with the patients in the care and with each other. It’s really quite amazing and I’m loving it and enjoying it. I think the same recommendation I have for Tufts as I have for any other place in the country is the value of communication and giving people the space to do what needs to be done, and just the reminder of why we went into this in the first place. So what I would love to do, in part, one of my goals is to have teachings of communication skills for everybody, anyone on the patient journey from the valet person to the environmental services to all the clinicians and even the leaders. So if we create a culture, which is the most important thing of caring for each other and each other and for the patients, you’ll be much more successful.

Mark Slatin: Excellent, excellent. And so tell me about some of the strategies if someone was interested in impacting the culture in a positive way to, as we say, embed CX or embed PX into the culture of the organization rather than just bolted on as a next project du jour.

Rachel Hitt: Right. I think it really has to come from leadership, and that’s what I’ve noticed at Tufts, that they’re all in with patient experience. It has to come from the top, because they’re setting the tone for everything, and they’re putting what limited resources they have for the things that they think are important. So as we touched upon, good communication and good patient experience will save you millions and generate millions as well. You’ve got value-based purchasing, things of that sort, reimbursement from contracts. A lot of the surveys that the hospitals have to have done for their patients is based on patient experience and communication and things of that sort. So this is financially in their best interest as well, as well as it will help I always say it’s a win, win, win. It’s three wins. You’re going to increase patient outcomes, which is a great goal. We’re going to decrease clinician burnout and we’re going to increase the financial bottom line of an institution. And so, as you said, going slow to go fast. So take that time, invest in the people, listen to what people are saying and make a culture of it and offer it everywhere along the way of the patient’s journey.

Mark Slatin:  So I want to go back to the myths, and I appreciate what you’re saying there. And one of the ones that you and I talked about beforehand is that it just takes too much of my darn time to talk to the patient. And in the book you shared with me, Compassionomics, they talk about the power of 40 seconds. Yeah, exactly. Tell the audience what they meant by that.

Rachel Hitt: So, in essence there was a in the book and you’re going to have the authors on so I’ll let them go into it but it’s just about efficient care so what can you say to a patient to make to show them that you’re on their side that you’re listening to them as part of a team, but yet, how to navigate the situation they’re in. So something as simple as saying, you know, okay, for example, with a, I don’t know the exact quote from the 42nd, but just sort of say, you’re in a very difficult situation here, this is a cancer patient, I’m sorry, you have to be here, acknowledging it, I’m here to take care of you, but I’m also here to answer any questions you may have. First, I need to go through some basic things with you, but then I want to come back and make sure I answer all your questions. So it’s just acknowledging that you’re on their team, and then at the end of the visit, for that 40-second situation, they just showed partnership with the patient. And that’s all this is. It’s sort of, I always, people will keep talking and until they feel heard. And so if you can make sure that it’s active listening, if you can listen to them and get from them what they need and but at the same time negotiate what I call negotiating your agenda, making sure you are telling them what needs to be done, there’s a balance that can be played in a very effective way. So yes, it’s going to save you time. It looks like to people who are new to it, it looks like it’s tacking on more time to the encounter, but it’s not. So in essence, the three elements, and this is based on the Academy of Communication Healthcare, their healthcare communication, which I’m a facilitator from, is you open up with introductions. And this is customer service, you know, starting with a smile. I always tell people your smile is your superpower.

Rachel Hitt: People make a determination about you within the first 30 seconds. Are you friendly? Are you helpful? Are you not? Are you on their side? It’s important to sit down when you talk to a patient. People feel that you’re listening to them more and less rushed, that you spend more time with them if you’re sitting versus standing. And these are legitimate things because you want to do it. And then I ask them, OK, why are you here? And they give me their list, and I hear their list, and I repeat it back to them. And then I tell them, OK, I hear this. And this is what I need to focus on. And for this other issue, I’m going to have you talk to x, y, and z. But I will be focusing on this. And then they tell me their story. And you just have to respond with empathy, both verbal and nonverbal ways of empathy. And there’s little skills you can do with that. And then once you’re done and you’ve formed your assessment of what needs to be done to help the patient, you want to, what they call, chunk and check. You want to divide up all that information, all that medical information, to a level they can understand. So, you know, don’t talk to people like they’re all doctors, right? Even to my doctor patients, I’ll say to them, I know you’re a doctor, but I’m going to treat you just like a patient, because that’s how I want to be treated, like a patient. Unless you tell me otherwise, I’ll talk to you like a patient. And 9.9 times out of 10, they’re like, yes, because they’re not for estimators. And they’re scared. And they might hear the word biopsy or something like that. They just want to get the basics. So then you do a chunk and check where you break it down into what we call ask, respond, and tell. So you can break down the information into these small things. And it’s more of a conversation versus what I call a download. And then you want to make sure they understand what you’ve said, and that would be the teach-back, which is something nurses have done for years, but it’s newer for doctors. And just to make sure, I’ll never say to someone, do you understand what I just said? But just rather say, I just gave you a lot of information. Please let me know that I did a good enough job explaining to you. Tell me your understanding of things. That was a lot of information, but that’s the general gist.

Mark Slatin: Yeah, look, this is a huge deal. And, you know, start off with the medical example you’re sharing. And then I just, it’s clear to me that these methods and these principles apply outside of the medical world as well, because we’re all humans. It’s just that for most people, their own health is the highest stakes you can have. So there’s a lot of, a lot of emotions connected to all of this. And a lot of you mentioned the word fear, you know, can you imagine, you’re in the world of, of diagnostic and met and imagery and the world of oncology and radiology. And, you know, people are getting potentially some really, even if it’s, you know, bad news, but it could even be like, we don’t know it all the picture yet, we’re still we need to do more tests. That’s scary as hell. Right? So, so if I’m the patient, And I feel like you’re just trying to get to the next patient. as a doctor and get me off. Then I’m going to go back to the sterile world of the patient portal and the phone calls with administrators who may or may not be English as a first language. I’m sorry to say that, but, you know, they may be overseas, you know, and you’re talking about my health and I’m leaving the hospital. First of all, I’m in a state of shock with whatever’s going on. I’m incredibly, so I’m not functioning at the highest level and I’m not going to remember Odds are I’m not going to remember things, especially if I’m a senior citizen, I already have trouble trying to keep track of everything. And you’re telling me this really, you know, important information. And if you start using words like jargon, I mean, I just get more nervous, right?

Rachel Hitt: Yep, so you have to break it down, you have to meet the patient where they are, that’s what I always say, and exactly English as a second language or even if you have interpreters you just have to meet them where they are make them comfortable, make sure they that they have the interpreter services they need. And again, in the new world of things, some people will get their biopsy results. They do get their results the exact same time I do because it gets announced on the portal, their healthcare portal. So they’re gonna see the words cancer by themselves potentially. So I always have to warn people, you’re gonna get the results. You’re welcome to look at them, but don’t be surprised by what you see and we will be calling you. I just can’t get to you at the exact same time. And then I even tell them, even if it’s not cancer benign, that can look scary as well, because it’s all medical jargon. So there’s a lot of communication in that regard that you have to educate them of what to expect. And I always like to tell people ahead of time what I’m thinking, for example, what the biopsy might be. If I think it’s probably not cancer, if I do think it is cancer, I try to meet them where they are ready to hear, but I also don’t want them to be surprised by themselves. If there’s something I’m worried about, but they don’t want to ask us, I’ll just sort of say, I’m actually a little worried about this. So I’ve got all these little ways of communicating as best I can, but to a level that the patients want to hear it. I’m not going to tell them more or less than they don’t want to hear, but I’ll answer any question honestly that they have. ask me. And I just also want to bring up one other point. I think a lot of doctors also don’t know about the financial aspect of health care communication and the value of it. And I think with value-based purchasing and things of that sort, it’s important for us to teach clinicians about it. Because we’re so focused just on the clinical part, but I think it’s important as leaders to teach them about the financial ramifications of health care communication and the patient experience.

Mark Slatin: So some of the things, and help me fill out this list, some of the things in terms of the financial implications. So we’re talking about what seems paradoxical that you’re investing 40 seconds, according to the studies, in spending time getting to know, empathizing, showing compassion to the patient on the front end can actually save you a ton of time with the patient, and then some of the things that I’m gonna toss out, but please add, is one, they’re more likely to, number one, have less anxiety, which can help combat their disease or their issue, right, just to not deal with all the stress while you’re trying to deal with the disease or whatever the medical concern is, and less likely to keep calling back to try and get information because they’re confused.

Rachel Hitt: because they got their questions answered, and they feel heard, and they absolutely. I mean, just think of it for yourself. When you go to the doctor, if you feel like, I’ve got all these questions saved, but I didn’t have a chance to ask these questions, you leave dissatisfied. You feel like, oh, I wanted to get this. Now, you might go down the rabbit hole, and you might go on the internet and get your answers that way. And that’s not necessarily every case. Every case is their own case, and it’s all personal. So, and I it’s just so important for to get those questions answered but also be offered the opportunity to ask the questions, and to get the support, even if you can’t come up with the question sometimes people just can’t come up the questions, but if you can help guide them say you know. We’re here for you. This is, of course, a cancer situation. We’re here for you and we’ll guide you through it. But even for non-cancer things, people are very fearful of non-cancerous things. So if someone can explain things to them in a way that they understand that they don’t need to worry about this, that’s really important as well.

Mark Slatin: What other benefits, you know, if I’m the CEO of the hospital or the hospital system, what other benefits are of this, of this idea of really being in tune with communication with patients?

Rachel Hitt: I think you’re going to have a happier, as I said, those three groups will be very happy. You’re going to have a happier patient population. You’re going to have increased patient loyalty. You’ll have happier clinicians, you’ll have less disgruntled clinicians. I mean, even talking to ourselves, this communication skill can help in terms of interacting with disgruntled clinicians and things of that sort. You’re going to have decreased risk for malpractice and you’re going to have increased financial bottom line because with increased patient loyalty and increased patient experience scores, that generates revenue.

Mark Slatin: Rachel, what kinds of programs or training are you providing to the staff to help them, you know, do a better job at this?

Rachel Hitt: I’ve developed with the aid of the Academy of Communication Healthcare that I mentioned before, a modified version of training of the clinician or the healthcare worker. So I’ve got two forms of it. One is for clinicians who are interacting directly with patient care, and I modified that so it’s an interactive case where it’s both PowerPoint presentation with demonstrations, and then we do role-playing and interactive peer and peer and structure feedback as well. And then I also have the same type, of course, but modified for front desk people. And in this case, it was for mammography technologists. So but it can be expanded for any particular group. I’ve given it for ENT people. I’ve given it for all sorts of groups. And so it’s just, again, it’s practice. And I’m excited to say I’ll be giving a version of this at Michigan State. at the CX meeting as well in October. So I’ll modify that for the business world and just show that I’ve done research on it and statistically significant results have come back that you’ve improved your communication, understand better how to explain things to patients, and all the five elements that are important to patient communication that are outlined in my course.

Mark Slatin: So just to affirm what you’re saying and expand on it, in the world of CX, in the world of business, so what we’re talking here in doctor-patient terms is high stakes, frontline stage, but there are people at all levels of a customer’s journey, patient’s journey, that go beyond that direct high stage. You’ve got all these different touch points in the experience. And the communication is no less important at each one. It just happens to be very high stakes when you’re talking life and death. But in terms of the experience and what the customers remember from the experience, is really how they’re treated as they’re going through the process. We talk about peak and end rules. So really important at the peak of their experience, wherever you determine that is likely to be, and also the end of the experience. So you go through and you go to Disney and you go on an awesome ride at Space Mountain, but you remember that, but you also remember that it took me an hour to get out of the parking lot. if that’s the case. So I’m just trying to, I’m thinking about all the implications of this. If you’re a leader, a leader of change, the illustration that you’re sharing right on the front line there, it doesn’t just apply to the doctor-patient relationship, it really expands more, right?

Rachel Hitt: Exactly. I mean think about the prison had incredible cardiothoracic surgery done, had something very complicated done, and they’re asleep for the whole thing. What they might remember is the phlebotomist that wakes them up in the middle of the night and has to poke them five or ten times to get the blood. or something dirty on the floor. So you’ve had an incredible life-saving experience, but you can only remember things in terms that you can understand. You don’t understand what happened in the OR, because that’s just so far beyond what most of us can understand, but we understand how we were meant to feel. And that’s what Maya Angelou always says, is you won’t remember what people say to you, it’s how they made you feel. And this is just another example of that.

Mark Slatin: What, if I could ask a little bit more of a CXE question, which is how do you measure, how do you collect and measure the feedback of the patients at Tufts?

Rachel Hitt: Well, the government has, there’s inpatient and outpatient ambulatory ways of surveying patients. and caregivers. So there are HCAP scores, which is for inpatient, and then there are things like Preskeny and Qualtrics to find out about outpatient. So this is regulated, and many of the payers use these surveys for reimbursement. That’s where value-based purchasing comes into it. Again, this isn’t my area of expertise. I’m learning more and more about it every day. But a lot of contracts are based on, and reimbursements are, a portion of it is based on what the survey results are. So it’s a really important part, and I think a lot of clinicians don’t know about it. And I think that’s why we have to educate them about it. And I don’t want people just to learn these skills only for money, because that’s not the point. I think the surveys emphasize these questions because it is such an important aspect of patient care. So I want to we have to marry the two, but we have to understand the importance of it just as baseline. It’s just common sense, human health care that we’re trying to get back to the basic sort of what I was talking about in the very beginning, the kind of medicine my grandfather and my father practiced.

Mark Slatin: Hmm. Yeah. How wonderful. Well, it has been such a pleasure talking with you. We’re going to have to land the plane here, although I could talk to you all day. But I would like to end with the same question I ask all my guests, which is what advice would you give to your 20 year old self?

Rachel Hitt: I would say, make sure you take all the conversations and phone calls you possibly can, because you never know where something will lead you, a conversation will lead you and network as much as you can, because you’ll end up in a place that you’re not expecting and you’ll be happier for it. And I think just trust yourself and do what really motivates you, but follow through and investigate and look for things. Don’t wait for things to come to you.