Transcription of Caring for Community, #81
Speaker 1: You’re listening to the Dr. Lisa Radio Hour & Podcast, recorded at the studios of Maine Magazine in Portland, Maine. Summaries of all our past shows can be found at doctorlisa.org. Become a subscriber of Dr. Lisa Belisle on iTunes, see the Dr. Lisa website or Facebook page for details.
Speaker 1: The Dr. Lisa Radio Hour & Podcast is made possible with the support of the following generous sponsors, Maine Magazine, Mike LePage and Beth Franklin at ReMax Heritage, Dr. John Herzog of Orthopedic Specialists, Booth Maine, Tom Shepard of Shepard Financial, Apothecary by Design, and The Body Architect.
Lisa: This is Dr. Lisa Belisle, and you are listening to the Dr. Lisa Radio Hour & Podcast show number 81, Caring for Community airing for the first time on March 31st 2013. From raising readers to raising awareness for colorectal cancer, Maine has many innovative wellness programs created with the health of the community in mind. Learn more through our discussion with Deborah Deatrick, Senior Vice President of Community Health Education at MaineHealth and Dr. Kathleen Fairfield of the Maine Medical Center Shared Decision Making Program.
When I began Family Medicine training at the Maine Medical Center in 1996, our patient information was kept in paper charts. Finding information in these charts was challenging to say the least. Many of our patients have been coming to the family medicine clinic for many, many years. Valiant efforts were made to keep medications, vital statistics, and history up to date but the system had multiple failings. This contributed to a less than optimal patient care strength. Fortunately, we moved into the modern age and electronic patient information is now readily available at the Maine Medical Center and at most medical settings across the state.
I’ve always liked the idea of systems. Medicine is a challenging field requiring thoughtfulness and tenacity on the part of its practitioners. We are called upon to create individualized plans for our patients while simultaneously understanding the health of the family, community, and population. Having systems in place enables us to practice medicine more efficiently. I admit, systems can sometimes have their pitfalls. Patients are, after all, individuals. There is no one-size-fits-all when it comes to patients but systems provide us with a start. They are foundation upon which we can build a better patient experience.
This week on the Dr. Lisa Radio Hour, we speak with Deb Deatrick and with Dr. Kathleen Fairfield. These individuals have been practicing public health in Maine for many years and are doing so on a very innovative way. Practitioners like these enable us to put to put better systems in place from encouraging pediatric patients to read, to championing shared decision making about colon cancer between patients and their providers. Practitioners like Deb Deatrick and Dr. Kathleen Fairfield help us improve the care of patients in Maine. We’ve come a long way since my experience with paper charts in 1996. It’s an exciting time to be caring for our community. Thank you for joining us today.
As a Family Physician and Traditional Chinese Medicine practitioner for many years, I’ve learned a few things along the way and I have to write about these on a regular basis. If you’re a radio listener, you can read some of my weekly readings on bountiful-blog.com and read some of the blog post in between and let me know what you think. I think we can start a conversation that could be helpful for building a better world. That’s bountiful-blog.com.
Lisa: When life and work intersect, I believe there’s one way we can get with the greatest amount of energy behind our efforts in this world. Deb Deatrick is an example of how my life and my work intersect. Deb and I are good friends and also have worked together, worked together for more than a decade in fact at MaineHealth. Debra is the Senior Vice President of Community Health at MaineHealth and also a founding member of the Maine Public Health Association. How are you?
Deborah: I’m great. How are you?
Lisa: Very good. You are actually one of the people who got me into public health. I remember as a young resident in Family Medicine, I’m in Medical Center coming to talk to you. You have this thing called an MPH which at that time wasn’t really a degree that a lot of people were thinking about, at least not doctors, at that time. Why did you decide to go into public health?
Deborah: I think because I wanted to make a difference. Before I went into public health, I had a totally different career that just wasn’t as satisfying from perspective of important social issues. I was always very active on political issues in college, even in high school. Public health just interested me. I thought about medicine for a while but it seemed too focused. I wanted to work on a grander scale I think. I was very interested in the big issues, helping people get healthier.
Lisa: Arguably, you’re not from Maine?
Deborah: I’m not from Maine. I am from away, I’m actually from Michigan and grew up there as the daughter of a pediatrician, moved to Houston after graduate school. I was there for a couple of years and had an opportunity to move to Maine, a place that I had been exactly for one day before. I got a job offer to come here. The one day I had been here, I thought it was the most beautiful place in the world. I have never been in a place that was more beautiful than this than I thought. If I had the chance to live there someday, I would take it in a minute. I actually got a job offer and moved here in 1980, long time ago.
Lisa: Actually, that was three years after I moved here in ’77. It feels like it was just yesterday. Now, you’re raising your son.
Deborah: Yup. I have a 15-year-old son who is adopted. He is in high school now obviously. It’s a great place, obviously, to raise a family and just to live.
Lisa: What was your career path before you went into public health?
Deborah: Actually, I was in advertising. I was an art director. I have spent many years as a professional illustrator. I thought about going into medical illustration. Actually got into one of the two programs at that time at the University of Michigan and then decided that that just wasn’t for me. It wasn’t working on that grand scale. I envisioned my life sitting over a board illustrating hearts, and lungs, and sort of thing. It just didn’t have quite the appeal the public health had.
Lisa: It looks to me as though some of this work that you did in advertising and also with visual arts could have an impact on your ability to communicate effectively some of the public health messages that you have approached in the last few decades.
Deborah: That is hitting the nail on the head. That’s precisely why I went into public health because I think there are ways of communicating with people that are better than others. I think having a sense of how you message, how you approach people, even what kinds of images and approaches that you take are really, really important. A lot of the work that I have done over the years has really been to try to combine all of these elements both visual, sort of thematic elements, engaging messages, etc., to move health behavior often times at an individual level or at a community level.
Lisa: We’ve talked about public health before with some of our other guess but for people who are listening who may not be familiar with the idea of public health, can you describe it for us?
Deborah: The best that describe public health is a little story that I actually heard in graduate school. It goes like this, there once was a river, a very busy river with a lot of rocks and torrents etc. There are a lot of people in the river who are drowning, thrashing about, just were being carried down the river and couldn’t seem to save themselves. The ambulances came, the doctors came, the nurses came to the bottom of the river and they were incredibly busy trying to pull people out. A lot of people died. Some people were pulled out and resuscitated on the shore. The point of the story is that they were so busy pulling people out of the river, they never had time to go upstream to see who was putting them in in the first place.
In public health, it’s all about going upstream. It’s all about making sure that people don’t fall into that river. That they have medical care, they have primary care, they have ways of taking care of themselves and their families, they have clean air, clean water, good education, etc., immunizations, all the things that prevent people from getting into that river in the first place.
Lisa: My experience with public health is that it can be somewhat thankless at times because we have right now such a financially driven and probably always have to some extent, financially-driven healthcare system and people will say, when you know that if you can prevent a second heart attack, you’re going to save X dollars. Sometimes it can be difficult to quantify the upstream medicine. What are your thoughts on that?
Deborah: It can be. There’s no doubt about that. But we do know that prevention works. There have been lots and lots of studies that document if you stop smoking you’re going to live a longer life. If you eat a better diet, you’re going to be healthier and hopefully have less chronic disease etc. but what happens is that public health, I think one of the problems here, is that public health is largely invisible to most people. You go to your faucet in the morning, you turn on the tap, you get a glass of water and you just think that that water is going to be free from carcinogens, is going to be, you can drink it. It’s going to be safe. When you go to a supermarket, and you buy fruits and vegetables, or food, you think that that food is going to be safe and somebody has inspected it.
Those are the kinds of things, frankly, that public health does. We do things that keep people safe, that protect people, etc., but it is largely invisible. The extent of which people want to pay for those kinds of things I think is diminished.
Lisa: In such a sense right now, we seem to be a sort of an employer insurance payment situation. If you have an employee who may or may not be with you for a very long time, it’s possible you don’t want to pay for things that are going to happen once they stopped working for you. How do you approach that issue?
Deborah: I think for all of us, we need to work together and agree upon the things that really do keep people healthy. Employers for the most part, I think, now agree that things like helping their employees stop smoking or to exercise on a regular basis is actually a good thing for society in addition to their own employees. Many more employers are investing in these kinds of things. If you work for one company and you go to work for another company, those kinds of things are still going to be available to the vast majority of the population. It’s also one of the reasons that we need to invest in public policies that can help everyone.
Things like smoking bans. Things like efforts to keep the air clean or the water clean etc. Everyone needs to invest in those. They float everyone’s boat so to speak and keep everyone healthy. It’s one of the reasons that in public health, we work at a policy level, we work in an individual level, and we work at a community level. All those things really have to be knitted together.
Lisa: What are some of the initiatives that you’ve been involved in through MaineHealth or through some of the work that you’ve done and other public health spheres in Maine?
Deborah: The two big ones and the two big predictors of whether or not we’re going to be sick or have chronic disease etc. are tobacco and obesity. Those are the two areas that I think everyone agrees. We do have problems here in Maine with both of these issues. We’ve done a lot of work on both of them but we have a long way to go. If we can stop people from smoking in the first place, we know they’re going to live healthier lives. Certainly for someone who does smoke, helping them to quit and giving them the tools and the resources they need to do that is incredibly important.
On the obesity side, I think we’ve learned that it’s not just about obesity and overweight. It’s really about healthy eating and active living. Eating a healthy diet and getting enough exercise. Again, there is a lot of resource on both of these issues. There’s no question that they both have a lot to do with our overall health. One of the other things that I often talk about frankly in addition to these issues that are everybody knows are related to health are issues that may not be quite so apparent but have a lot to do with how healthy we are. Those are things like poverty and education. Those are the two strongest predictors of how healthy we are going to be.
Whether we have a job, whether we have sufficient income, and also to a certain, to a large extent, how much education we have, people who finished high school are much likely to be healthier than people who have only finished sixth grade. People who live below the poverty line are much likely, more likely, to be unhealthy than people who have, who live, who have a living wage. All of these things are important predictors of health. In public health, we have a very, very broad view of what it takes to be healthy. It’s not just about doctors and hospitals although that’s really important to have a place to go when we’re sick. It’s also about our behavior whether we smoke or whether we eat junk food or fresh fruits and vegetables and also continuing education and supporting that and also supporting programs that can help those people out of poverty.
Lisa: When you and I met not so long ago, you are telling me an interesting and startling statistic about the number of children that now are throwing within the Maine Care system and how that’s risen over the last few years. Talk to me about that.
Deborah: It is a real statistic. It’s a very troubling statistic. We are, we, being MaineHealth are doing a lot in the area of early childhood health education etc. as our many other organization around the state. These are children or kids between the ages of birth and five. Last year, 2012 in Maine, almost three-quarters of children in that age range between birth and five were enrolled in the Maine Care Program which is a very, in my view, startling statistic as you just mentioned. Basically, it says that these are kids who are living in low-income households who may not have access to healthy food, who may not have access to clean air, who may have not access to all of the things that are needed to create healthy kids and kids who are ready to go to kindergarten etc.
It’s one of the reasons that there is now a lot of focus here in Maine on that particular age group in providing child care, high-quality child care to kids, in providing oral health education, and providing health education, making sure the kids get a healthy diet, have clean water to drink etc.
Lisa: We’ll return to our interview at a moment. We are in the Dr. Lisa Radio Hour & Podcast. Hoped that our listeners enjoy their own work lives to the same extent we do and fully embrace every day. As a physician and a small business owner, I rely on Marci Booth from Booth Maine to help me with my own business and to help me with my own life fully. Here are a few thoughts from Marci.
Marci: So many times we get stuck into routines and schedules and we forget that each day is truly a fresh start. You just ended a dismal day at the office and can’t imagine having to do it all over again. Stop, change your perspective. Tomorrow is a brand-new day. It’s an opportunity to do things differently, to get to the things you may have been putting off for weeks. Each day gives us the ability to see things differently and open up our minds to new possibilities. It’s a chance to discover something new or find an approach to make an old way of doing something better, more efficient.
It doesn’t have to be a profound change each day. Incremental changes or discoveries are all you need to make an impact. Maybe today, you decide to run instead of walk or drink water instead of soda, or finish that project instead of pushing it down the list. All small changes are events but all have an impact. Each day is an opportunity to grow and learn, to change and to create, to make an impact. What is your fresh start today? Let’s get that fresh start today. Contact Booth Maine at 774-4030.
Speaker 1: This segment of the Dr. Lisa Radio Hour & Podcast is brought to you by the following generous sponsors Mike LePage and Beth Franklin of ReMax Heritage in Yarmouth, Maine. Honesty and Integrity can take you home. With ReMax Heritage, it’s your move. Learn more at rheritage.com.
Lisa: In Maine, we have an issue with access to dental care. From The First Tooth is a program that MaineHealth has gotten behind to address that issue from early on. Why does it matter that we have good dental care from our earliest years?
Deborah: The simple answer for that question is that baby teeth are taking the place of permanent teeth. It’s really important for parents and even small children to learn how to take care of their baby teeth because they’re place holders for those permanent teeth. Decay, abscesses, other problems, can really affect oral health in later years not only as kids but as adults. It’s really important to prevent, again, going upstream, that concept, baby teeth from the time a child has his or her first tooth. This is another initiative where a very forward-thinking foundation came to us and said we know this is a huge problem in the state of Maine and we’d like to do something about it.
Several years ago, a program was developed that is now called, From The First Tooth which is really about taking your child again to that well-child visit at your doctor’s office. The doctor, or the nurse, or another person on the team will look at the child’s teeth very quickly and no pain, no instruments being used, and then apply something called a fluoride varnish to the child’s teeth which really does a very thin protective coating of fluoride. It’s colorless, it’s odorless, it doesn’t hurt the child, but it puts a protective shield around that child’s teeth whether it’s one tooth or more baby teeth.
That fluoride application will actually protect the child’s tooth for many months. The ideal is to have two of those fluoride applications every year during a well-child visit or other visit to the child’s physician. Again, we also recommend a child see a dentist hopefully by age one if that’s possible but as you just mentioned, Dr. Lisa, in some areas of the state, we don’t have dentists who are able to see, first of all, we may not have dentists at all in certain areas of the state. Secondly, not all dentists will see children at the age of one or even two. This is a compromise. We’re trying to provide some protection for these child’s teeth, for these children so that when they do get to their first dental visit, they don’t have decay and they don’t have dental problems.
Lisa: You’ve also worked with an organization that is associated with Maine but does work outside of Maine called Konbit Sante. What’s that all about and why?
Lisa: Great question, Konbit Sante …
Deborah: I’m sorry, Sante.
Lisa: … is an amazing organization headed by an amazing person, Dr. Nate Nickerson. The focus of Konbit Sante is to help rebuild and strengthen the healthcare system in Northern Haiti, in particular, in a community called Cap Haitien. Many people from Maine and actually other parts of the country, physicians, nurses, not only healthcare workers but other to volunteer their time to go to Cap as it’s referred to and actually teach some of the physicians, the nurses, the people who work in the public health system there.
The public health system in Haiti is run by the government and there is a public hospital in Cap Haitien where many of the folks from here go to work for a period of time. I’ve had the honor of going to Cap on a couple of occasions. It’s quite an amazing place. The people who are working in the healthcare system there are incredibly committed, working under the most challenging conditions that you could ever imagine. It’s quite an organization and I would certainly commend all of your listeners that there’s a website www.konbitsante.org to hear and see more about it. It’s a fantastic investment. Again, in global health in one of the most impoverished nations in the world.
Lisa: Why did people from Maine decide that they cared about people from Haiti?
Deborah: I think there’s some affinity. Maine is a very poor rural state. We have limited access to resources. Until the last several years, we haven’t had a public health school here. We do now have two public health programs in Maine. I think there was a recognition that, by the way, there were some individuals here going back many years, Dr. Mike Taylor being one of those who got connected to Cap and some of the folks there. That has been built upon over the years. Now, there ‘s a very strong relationship. Many physicians here travel to Cap maybe a couple of times of year engaged in projects etc. It has simply built up, there’s a relationship between the city of Portland and Cap Haitien. I think a recognition to that, we need to lift ourselves out of poverty that no one is going to do that for us.
Lisa: How can people find out about the work that MaineHealth is doing in the area of community health?
Deborah: Probably, the best thing is to go to our website, www.mainehealth.org. There is information and link to the Raising Readers Program, the From The First Tooth Program and our work in tobacco which again, focuses on helping people to quit smoking for the most part and obesity. Actually each of these initiatives have their own websites. I don’t know if you want me to go through all of those but one of the programs that we’ve talked about a little bit before on obesity prevention that really going upstream is called Let’s Go, that also has its own website at www.letsgo.org. The now famous 5-2-1-0 mantra and you’ll find lots more information there.
Lisa: For our listeners who are with us in a regular basis, our interview with Dr. Michael Dedekian actually is all about Let’s Go. You can go back to the Podcast on iTunes and listen to that show if you haven’t had the chance. I really want to thank you for, first of all for being my friend, for inspiring me to go into public health and for being a mentor when I worked at MaineHealth for all those years but also for the work that you’ve done for the state of Maine over the last there I say, decades.
Deborah: Decades, with an S. That would be appropriate.
Lisa: Most recently as the Senior Vice President of Community Health at MaineHealth. Thank you for joining us today.
Deborah: Thank you Dr. Lisa, and I will say that you too have been an inspiration just in terms of your career over the years becoming a much more highly-skilled communicator about health and medical issues. Kudos to you.
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Lisa: In the studio with us today, we have Dr. Kathleen Fairfield who’s not only a medical doctor but also has a doctorate in public health and the Associate Chief of Medicine and a Clinical Investigator at Maine Medical Center. Thanks for joining us today.
Kathleen: Thank you for having me.
Lisa: Kathleen, you and I have known each other for a while. We’ve been sort of following each other as we have gone through our medical education. I also have a background in public health but you got a doctorate in public health. Why did you do that?
Kathleen: The group I was working with at that time, I was working at nurse’s health study. We were doing a lot of quantitative work and I felt like I wanted to make sure I really understood the methods. Also, there was other work that was going on around me and it allowed me more time to explore some of the other dimensions of public health. At that time, I actually was thinking more about research than public health practice but I do a little of both now in some ways.
Lisa: You also do clinical medicine?
Kathleen: Yeah.
Lisa: What do you do for clinical medicine?
Kathleen: I’m doing primary care, general internist at Maine Medical Center in the clinics. I have small-patient panel. I also supervise residents in international clinic.
Lisa: What does international clinic look like?
Kathleen: This is a once a week clinic where we do new intake for new refugees who are entering our system of healthcare in Portland. We link with Catholic charities in the public health system. Public health nurses brings the patients in and we do comprehensive new intake visits and I try to assess their health needs and get them established in care in the medical clinic with partnering with our residency program.
Lisa: You’ve been able to marry what I think most people be considered two very different world, research and also clinical practice or taking care of patients. How does that work in your own life?
Kathleen: It gets busy. Like a lot of people who, like you, a lot of people who do multiple things to inform each other. So I think being a researcher makes me a better doctor and being a physician makes me a better researcher. Sometimes I feel a little bit more of one or a little bit more of another. Patient care always takes precedence, as you know, if somebody needs something. That’s the great part about the research that I do. It doesn’t usually involve human subjects that are sitting in front of me. I could set it down when I need to.
Lisa: What is your research right now?
Kathleen: There are two major tracks, one has to do with the shared decision-making and using tools to help patients make better decisions that are aligned with their own preferences and values and also fully informed about the risk and the benefits. The other piece is using large data sets including SEER-Medicare which is the nationally available cancer data set to look at patterns of care. This is a field of health services research where we’re trying to make sure that people are getting care that is consistent across systems and minimizing disparities and difference in health care by region, and race, and ethnicity, and gender.
Lisa: For people who are listening who don’t have much of a background in research or statistics or some of the things that you’re talking about but they do of course have health needs. How would the research that you’re doing be relevant to them?
Kathleen: The research that we do in shared decision making probably feels the most proximal for patients. It actually really crosses over into quality improvement as well where for example we currently have a grant from Maine Cancer Foundation to do work with shared decision making around colorectal cancer screening choices. In the practices, some people have done work with shared decision making and asking patients about their preferences and values mostly at the point of care when the patient is sitting in front of you which is a really nice way to do it because that can be a nice back and forth.
As you know, time directly with the patient in the office is really tight already. There’s so much you counsel them about in terms of prevention, and their current medications, and other things they question that they have that we often run out of time and it gets deferred to the next visit. The model that we’re trying out is to look at our patients when they’re not sitting in front of us, to identify the patients who have need, for example, are unscreened for colorectal cancer screening or overdue, and to some of the decision aid which is a video tool and a booklet so that they can think about their choices for colorectal cancer screening including being … in an informed way to not pursue screening or to pursue one type of screening over another.
Then we have someone from our office or one of the officers with working with call them, so an RN or a medical assistant call them and do decision support to help them understand, answer questions, help them understand their options and then refer them for screening as appropriate. It actually, for patients, they have a chance to look at decision aids, process them, think about them with their healthcare team and then make better decisions. It’s pretty direct in that way.
Lisa: The idea of shared decision making is kind of counter to the way medicine has been for quite a long time where it’s a bit more top down where somebody would come in and say, this is what I think, this is what I think you should do. Now we’re saying, here some information, this is how these impacts your quality of life, and you’re really attempting as a physician or a healthcare provider to have a dialogue with the patient and make this decision together.
Kathleen: Yes, I think it is a little bit of a paradigm shifting. I think a lot of excellent providers, physicians, and other caregivers have been doing it for a long time. It’s a little bit more explicit I think in some ways of saying to the patient, we really want to know what you value. Do you really value avoiding getting on an additional medication or do you value avoiding surgery or procedure and help them reflect on their own values and their preferences. Some situations are very clear. The patient can pursue surgery say, for a knee replacement, or spend more energy doing physical therapy and be willing to take anti-inflammatory medications for example.
Other decisions might be something like screening where you revisit it annually for example or every 10 years in the case of some colorectal cancer screening choices but it is a little bit of a change. I think some patients might not be comfortable with it but what we’re finding in general is that most people really want to participate and be fully informed and have, in fact, strong feelings that they might not have shared with their provider had they not been invited to do so.
Lisa: Why colorectal cancer?
Kathleen: Colorectal cancer we chose because it’s a good example of, it’s a malignancy that we can screen for and make a difference. We can reduce colorectal cancer death by screening for it and taking up polyps that might later transform into malignancy. We have one of the lower rates of colorectal cancer screening compared with some other screening test like mammography or cervical cancer screening probably because the test are unacceptable to a lot of patients. They’re not willing to undergo a colonoscopy, as you know the prep and the procedure itself are, feel more invasive, for example, to a patient. We thought there was an opportunity there to provide education to patients about what the test are, why we’re recommending them, why they might choose one over the other, and to be more informed particularly about that choice.
Lisa: How big a problem is colorectal cancer?
Kathleen: Colorectal cancer is the third most common malignancy for both men and women.
Lisa: Is this something that we’ve seen rising, the rate of colorectal cancer, over time?
Kathleen: I actually think it’s been fairly constant.
Lisa: But it’s something clearly that we need to be paying attention to because it causes death.
Kathleen: Yes. It’s an important malignancy, again, it’s the third most common. We also have an opportunity because if we diagnosed polyps we can take them on to prevent them from actually getting the malignancy or if we diagnosed it at an early stage, it’s curable through treatment versus later stage, tumors are much harder to cure and it becomes a disease management situation.
Lisa: What are some of the responses that people have had when asked to participate on these shared decision-making project?
Kathleen: We have a whole range of responses and some patients haven’t wanted to look at the materials that we’ve sent them. They would rather get information directly from their physician. We’ve had some people look at it and say, they really appreciate it and they had some questions when they get the phone call. They have, in fact, chosen to be screened when before they were reluctant to be screened. We’ve had patients choose simpler stool test that they can do at home and mail in called high-sensitivity stool testing and try to not realizing that that was an option, they had only been offered colonoscopy before.
They do have to understand that if the stool test is positive, they need to go on to colonoscopy. We are making sure that people are well informed about their choices. We’ve had, a lot of peoples say, they really appreciate the information and the chance to participate in that care.
Lisa: As a primary care provider yourself, have you been able to use this information on shared decision making in your own practice?
Kathleen: Yes. We’ve done … MaineHealth has been part of a grant that Dr. Neil Korsen and myself have had and working on throughout the MaineHealth system with many practices trying to engage primary care practices and shared decision making along with their patients. We’ve been working on this where we can refer patients, for example, to the MaineHealth Learning Resource Centers to view what are the decision aids about variety of conditions and then they come back to the next appointment and talk about it. That’s different than the way I described that we’re doing now, through the Maine Cancer Foundation Grant, where we’re mailing out materials.
We’re also doing a pilot in medical clinic at Maine Medical Center where we’re using an iPad and doing some point of care decision aids where physicians or a nurse practitioner during the office visit can say, hey would you like to look at a decision aid right now after your visit? We’re trying to make it accessible to patients in a lot of different ways. I’ve referred my patients to all three of those ways of trying to get the materials to patients when they need it and when they’re ready for it.
Lisa: We’ll return to our interview in a minute. First, let’s take some time to explore the connection between health and wealth, something that I firmly believe in and have tried to promote on the show. Joining us is my friend and personal financial advisor, Tom Shepard.
Tom: The healthiest communities are the ones that has figured out how to develop new and unique structures to support needs and wants at many different levels. When we look at a healthy school, it supports the needs of the individual, the classroom, the building, the district, the community and therefore, the family as a whole. Building a plan for financial health and well-being is the same. What we can learn from managing our portfolio of assets, is that sometimes one part of the plan needs to address the risk that allows another part to pursue opportunity. These three step dance of preserve, manage, and pursue is the core of good design. If you’re a part of an organization that is struggling with how best to evolve to a better place, we can help. Send us an e-mail to [email protected] and we’ll help your organization learn how to evolve.
Speaker 1: Securities offered through LPL Financial. Member of FINRA/SIPC. Investment advice offered through Flagship Harbor Advisors, a registered investment advisor. Flagship Harbor Advisors and Shepard Financial are separate entities from LPL Financial.
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Lisa: You described this decision aids. So what would that look like to a patient?
Kathleen: Decisions can take a lot of different forms. They can be pencil and paper, they can be something that they read on the computer for example. The ones that we’re using are created by the Informed Medical Decisions Foundation in Boston. It’s a foundation I’ve been working with as a medical editor for many years. They are very high-quality decision aids. They are balanced. They have a lot of patient vignette. They have a lot of pictograms to show patients about risks, using images to help them better understand how what their benefits and risk are. They also have a booklet with them. Patients who have low literacy can actually watch the video instead of looking at a booklet, some patients prefer to read to get information and some would do both.
Lisa: Has literacy been a barrier that has been recognized?
Kathleen: Yes, great question. Literacy is a huge barrier. Health literacy in the United States is very low in general and is certainly low in Maine. Having materials that are at the right reading level such as about sixth grade is I think what the materials that we have. That’s important but also health literacy in general is low and I think there’s a lot of myths in general too out there and not everyone has access to high-quality health information. We think it’s completely important that it’s unbiased. It doesn’t feel like they’re being, the patients are being sold anything or that anybody has any financial benefit from using these tools really to get the patient to make the very vest decision for them.
Lisa: What is the response from physicians has been?
Kathleen: The physician response has been great including, again, we work in teams generally now. I think the teams have enjoyed the process of learning about shared decision making. We have especially found that our process of mailing the decision aids outside of the office visit has been well received by the teams because that way when the provider sits down with the patient next time, the patient has already seen the material and processed it and they can have a better discussion about the choices that the patient has at that time. It’s hard to find the right time to give the information to the patient ideally might be right before the office visit but as you can imagine, there are a lot of logistics that make that very hard to do.
Lisa: Does it enable patients to also spend more time researching a given topic before they go in with a visit with their doctor?
Kathleen: I think so. I think so. I think a lot of patients have been coming more informed with the materials they may be found on the internet about certain things they might want to try that they’re thinking about. This is a chance I think to help patients prepare particularly around things like screening that they might not have realized the physician was going to bring up during the visit or particularly in the case of colorectal cancer as we were saying, the screening test seems unacceptable to some patients. It gives them a chance to think more about what that might be like and then ask questions that are a little bit more targeted for their provider.
Lisa: The type of medicine that you’ve gone into where you’re doing clinical medicine or seeing patients and also research-based medicine and public health related. It isn’t the type of medicine that most little kids think about when they’re thinking, what do I want to be when I grow up. When you were younger did you have any sense that this might be the direction you’re going?
Kathleen: No. I didn’t. In fact, I wanted to be a veterinarian and I started thinking about medicine as a career. I think, I thought about primary care family medicine because I really want to be the regular physician that had a long-standing relationship with patients. I could get to know them and take care of them over time and have a trusting relationship. That has been great. As you know, face-to-face patient care is wonderful and very rewarding but sometimes you wish that you had better information for patients or that some of the barriers in getting care done would go away. That’s the wonderful thing about doing research too is that sometimes you feel like you can solve problems that come up in everyday patient care and maybe make things a little bit better.
Lisa: You can get a little bit of distance from some of the in-the-trenches work that you’re doing?
Kathleen: Yes. Yeah, it’s rewarding to do both. I knew the challenge in research always is feeling like it’s quite slow and sometimes translating findings into actual clinical practice takes much longer than anyone would ever think.
Lisa: Kathleen, you and I have been in medicine for roughly the same amount of time and we’ve seen a lot of changes. I think when I first came into medicine, there are a lot more independent physicians and a lot fewer that were employed by health care organizations. I think people are really seriously considering whether medicine is a good career path for them. What would you say to somebody who is thinking about going into medical school?
Kathleen: I think medicine is still a wonderful career path and that most people work hard in their jobs regardless of what they do. It’s nice to go home at the end of the day and think that you helped people even if you provided someone with some comfort and not necessarily a big cure which, as you know, doesn’t happen that often frequently in primary care. I think that a lot of the changes in medicine have to do with standardization which is a really good thing because we don’t want to be practicing the kind of medicine that feels too artful and too unique. I think it’s good and comforting for patients to get the same answer from one provider that they would get from the other provider.
I think that we’re doing also doing a better job with integration where all members of the care team are participating, communicating with each other not just primary care and specialist either but our nursing colleagues, and physical therapy, and mental health etc. I feel like we’re moving toward a more cohesive model that makes a lot of sense. I think somebody … I hope that patients perceive that as well.
Lisa: You have a daughter who’s the same age as my daughter, Sophie, 12. Would you suggest that she’d be a doctor if she wanted to?
Kathleen: It turns out she wants to be a veterinarian. I do think for women in medicine, it’s a really interesting question about the balance of that with work, and life, and caring for kids, or parents, or to participate in other things in the community. It’s a difficult career. As you know, it’s very time consuming. The field of medicine for women has been much more open in terms of specialties accepting women I think among their ranks. People beyond adjust job descriptions and tailor their profession to something they need at home as you know. However, I think it’s still hard.
I think there’s still a lot of bias there. For example, a year ago, I was actually on a show, the On Point show. It’s part of an NPR show about that woman anesthesiologist who try to have part-time careers in medicine for women and how she thought that that was very negative and that it was a waste of resources to train women and then allow them to go part time. It’s very controversial and made a huge splash. it was an up ed in The New York Times. It’s nice to have a chance to talk about that again. I think that women are at a great dimension in medicine, of warmth and understanding where patients are in their lives, in their journeys.
I think a lot of men do that as well. I think that it’s a time of growth in medicine for women. We’re still trying to find our way in some ways. I think the most important thing is supporting each other in all of the different options that people choose including part-time work or full-time work or shared practices, every other model that you can think of. That’s one of the most important things they’re thinking no woman succeeding in medicine as it being allowed to change their direction as they need to to care for their families.
Lisa: What challenges have you had in being a mother of two, a 12 year old and a 10 year old and also a doctor?
Kathleen: I think, you know it’s always deciding how long to stay at work and how much more you can get done for the day or what’s for next year or five years away. If I had worked harder, I could have published a lot more papers by now for example. I get that very big patient panel. There’s a lot more that you could always do. I think being able to feel comfortable with what you’re doing and not look back and say, I wish this or that. There will always be opportunities, I think, to work and do more professionally but when your kids are younger, it’s also really nice to be there and be able to participate in the things that they’re going through. Getting home at the end of the day is in a way … and feeling not completely overwhelmed by work is one of the most important pieces.
Lisa: Did you take into consideration the fact that you wanted to have children when you did this research track and when you got a doctor in public health?
Kathleen: No. I think my plans were all a little unclear then. I was thinking about my education and making sure that I took the time to finish all the education that I thought I needed at that time. I was fortunate that I could get that all done before I had kids. A lot of other people do it the other way really successfully where they start having kids in residency and find a way to make that balance work. I think that would have been harder for me because I’m not sure. It’s just the kind of person I am but everybody, I think, needs to take into account how much time they have for family planning and what they want to accomplish in their careers. Again, it’s not a race. There’s plenty of time and everyone have their own path I think.
Lisa: You have a medical degree and a doctorate in public health. Arguably, you could be employed anywhere at any of the big medical centers or training institutions in the country. Why choose Maine?
Kathleen: I grew up in Hallowell, Maine. It was coming home for me. About 10 years ago, my husband and I were both in Boston in medicine and decided that we wanted to raise our family here. The Maine health system has been fantastic for me to be able to practice and do research. Maine Medical Center and Maine Medical Center Research Institute has been very supportive of my research and has allowed me to do everything part time. Just take care of patients and do teaching and do research. That’s a wonderful thing. I think it might be harder at a major academic center where I think a lot of people are forced to pick their path and spend the majority of their time as a clinician or maybe in education or in research. It’s very hard to strike that balance, I think.
Lisa: Does your husband also feel as if, also being in the medical field, as if he’s being able to strike a balance?
Kathleen: I think so. Yeah. I think he works full time as an endocrinologist. He’s very busy but I think being in Maine allows us to be home at the end of the day with our families and feel like we’re accomplishing all our goals personally and professionally.
Lisa: How can people find out about the shared decision making program that you’re doing or the work that you’re doing with colorectal cancer specifically?
Kathleen: They can visit the MaineHealth website which has a lot of materials about the things that we’re doing with shared decision making and links to other places including some decision aids are available online. Also the Informed Medical Decisions Foundation which has funded some of the work at MaineHealth. It has an excellent web site and it’s Shared Decision Making Month, the month of March 2013. There are links to other materials there as well including some Podcasting.
Lisa: It’s also, I believe, Colorectal Cancer Awareness Month too.
Kathleen: Yeah.
Lisa: It’s appropriate for two you’re talking to us about that …
Kathleen: Good alignment. Yes, it’s Colorectal Cancer Awareness Month. It’s a great opportunity for people to think about their screening options whether they might want to be screened and to find out about the choices. The Maine CDC has a program for low-income patients to get screening which is wonderful. It used to be only breast and cervical cancer screening. Through a lot of workup by others, it was extended to include colorectal cancer screening. We’ve been fortunate in Maine to be able to have good access to a lot of colorectal cancer screening options.
Lisa: I’m very pleased that you took the time out of your busy schedule to sit in here and have this conversation with me today. I think it’s been a while since I’ve seen you. To know that you’ve gotten your doctorate in public health and you’re a successful medical doctor and Associate Chief of Medicine and Clinical Investigator at Maine Medical Center, it’s very gratifying to spend this time with you and thank you for joining us.
Kathleen: Thank you so much for having me, Lisa.
Lisa: You have been listening to the Dr. Lisa Radio Hour & Podcast show number 81, Caring for Community. Our guest have included Deborah Deatrick and Dr. Kathleen Fairfield. For more information on these guests, visit doctorlisa.org. The Dr. Lisa Radio Hour & Podcast is downloadable for free on iTunes. For a preview of each week’s show, signup for our e-newsletter and like our Dr. Lisa Facebook page. You can also follow me on Twitter and Pinterest, doctorlisa and read my take on health and well-being on the bountiful blog, bountiful-blog.com.
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