Transcription of Dr. Lisa Ryan for the show Maine Wellness 2015 #173
Dr. Belisle: This is Dr. Lisa Belisle and you’re listening to Love Maine Radio, show number 173 airing for the first time on Sunday, January 4th, 2015. Today’s theme is Maine Wellness 2015. Maine Magazine begins each New Year with focus on wellness. We know that health and happiness are interwoven and we wish both for our readers. Today we speak with Dr. Lisa Ryan, pediatrician and president of the Maine Medical Association and Mercy Hospital head cardiologist Dr. Craig Brett about the ways in which they approach wellness with patients. Jump start your health in 2015 by listening in to our inspiring conversations. Thank you so much for joining us.
It’s fun for me to spend time talking with other Dr. Lisas as Dr. Lisa Belisle. I get to interview today Dr. Lisa Ryan who is a pediatrician at Bridgton Hospital which is part of central Maine Medical, Central Maine healthcare family but also she is the President of the Maine Medical Association and the mother of 2 children. She’s a busy woman but we’re really privileged to have her to talk to us today about some of the issues that I know that she and I both find fascinating and important as to the state of medicine today. Thanks for coming in.
Dr. Ryan: Thank you for having me.
Dr. Belisle: Lisa, you’ve been doing a lot of work with what we call organized medicine for quite a while. In our days medicine is going beyond clinical practice where you’re seeing patients and it is spending time, meeting with other doctors, meeting with administrators, trying to understand what patient needs are, trying to really reach out into the community and into the medical system at large and influence change.
Dr. Ryan: When I was in my residency I got interested in working with the American Academy of Pediatrics and was able to take a leadership role within our state chapter and then within our district area which was all of New England and I really got to see a little bit more about how organized medicine works and it was a great experience. I loved it. I made a lot of connections in New England so after my residency, I moved to New Hampshire. I did my residence in Burlington, Beaumont and in New Hampshire was able to really get involved with New Hampshire Pediatric Society with doing some legislative work and sitting on their legislative committee.
I was there for few years and then sort of migrated to Maine and once again continued to be involved with the state chapter of the American Academy of Pediatrics and then became involved with the Maine Medical Association. It’s been a continuum really since residency training and I find it fascinating and interesting and really an important part of medicine aside from just patient care. It’s been a wonderful experience and it takes time and it’s worthwhile. It’s definitely worth it.
Dr. Belisle: Having gone from the specialty organized medicine which was the American Academy of Pediatrics to the Maine Medical Association which was basically the American Medical Association which is more generalized representing physicians and healthcare providers, what are you seeing as the differences?
Dr. Ryan: There’s not really a lot of difference. I think in general, a lot of these organizations both on a state level or on a national level really have the same goals in terms of supporting physicians, supporting their members, improving quality, and improving health of patients. I think, I find the similarities are much more common than the dissimilarities really.
Dr. Belisle: As a doctor I understand why it would be important to have these groups. As a patient why is it important to know that our doctors are working in an organized way towards bettering medicine?
Dr. Ryan: Well I think that he organizations hold a certain level of accountability for the profession and most of the organizations look to policy, look at research, really try to guide medicine in terms of best principles and best practices and I think it’s important for physicians to be involved with organized medicine. It’s sort of the mother ship if you will that really is out therefore our profession and I think as an individual and I hear this a lot in my experience with organized medicine, individuals will say well what do they do for me? How do they know what I want? I think it’s important that my sense is that the leaders in these organizations really want to know what the individual physicians are struggling with and dealing with and how the organizations can help them.
I see it really as a 2-way street and I see it important to really make those connections and there are people in every community that are involved in some degree with organized medicine and I would encourage physicians to really think about touching base with those physicians that are involved to get their word known.
Dr. Belisle: Patients benefit from having providers part of organized medicine because it creates a higher quality of care, it creates sort of an oversight of the profession and it really … I guess the term organized really is a good one because I think for many years were able to all act independently as they cared for their communities and increasingly we are connected and to have some sense that what you call best practices or best principles. If I come in to see you as a pediatrician and my child has some sort of a respiratory illness you can see to me, “Well your child probably doesn’t need antibiotics. The best practices are that we actually give your child some supportive care and not go to antibiotics.”
It’s that sort of thing that we’re actually paying attention on a bigger level to the types of things that influence not only our patients and our families but also the communities in public health.
Dr. Ryan: Definitely.
Dr. Belisle: It’s an interesting thing to see how physicians respond to what has happened in medicine and I think it would have been easy for you as a doctor to just hunker down, do your work. You have children who are in high school now so get your job done, put them through college. It’s just a job but instead you’ve really continued to look at this as a profession and one that you have a lot of … you’re very gratified by. What keeps you excited and motivated to be in medicine and to work at a much higher level?
Dr. Ryan: I think that’s a great point and something I’ve really thought about as I assumed this role of President for the Maine Medical Association. I had mentioned … I came across a document several months ago that really I’ve embraced, it’s really influenced me in my thought process and it’s very along the lines of what you were talking about in terms of the profession and finding some excitement and some passion and some energy. My sense is as I travel around, as I meet with fellow physicians, I am sensing a lot of dissatisfaction I think. A lot of physicians are frustrated by what’s happening with healthcare and all the changes that are happening and the onus that they feel is put upon them, not only to take care of patients which I think all of us feel like we’ve always done a good job at that but now there’s much more accountability along those lines.
This document I came across was actually published in the annals of internal medicine 12 years ago and I find it so relevant today and wonder why I haven’t seen it for the past 12 years. It’s called Medical Professionalism in the New Millennium, A Physician Charter and it really looks to all of the changes and understanding the pressures that are going on right now with healthcare and trying to step back and remember 3 basic principles involved. The first principle is patient welfare and that’s really I think what we all went into medicine for is that we wanted to take good care of our patients. The second principle on the charter is looking at patient autonomy and I think that’s a relatively new phenomenon in medicine away from the days that the doctor tells the patient what to do and the patient says okay and does it.
I think we much more want to engage patients now in their healthcare. It’s their healthcare. They need to be engaged. They need to be a part of that. We as healthcare providers need to talk to them about what their disease process is, how to maintain wellness, talk about options that are out there and really engage them to be partners in that healthcare. The third principle of this charter is really social justice. I think I hadn’t necessarily thought about that a lot in the past but it really is an obligation I think of our profession and of ourselves individually to make sure that there’s equity in healthcare and that everyone is getting the same quality and the same level of healthcare.
This document has really in essence re-energized me and my passion for medicine and made me take a step back and say wait a second. This is why I’m doing what I’m doing. This is what brings me passion, and take that step back and say, “Okay. Refocus and re-energize” because we all fall under the pressures sometimes when we’re over tired and we’ve stressors in our lives and stressors in our work that it’s hard to remember. I found this … I carry it around with me everywhere.
Dr. Belisle: I think that’s really important is to know what some of your core values are because this is something that we can get very distracted away from. We can get so focused on “I have 20 patients to see today, 30 patients to see today. How do I just make it through the list to get everybody happy and try to move them towards health?” Instead if you can really be thinking in the bigger, in the grander scheme of things, is what I’m doing actually heading in the direction of social justice, making patients more autonomous and the third one.
Dr. Ryan: It’s basically just patient welfare.
Dr. Belisle: Patient welfare.
Dr. Ryan: Health and wellbeing.
Dr. Belisle: Yeah, if you can be thinking on all of those things then it gives a bigger purpose to the work that you’re doing. Isn’t that really what all of us need is some bigger purpose to the work that we do in our lives. As a patient, what types of things can I do to create a better relationship with my physician? If I’m looking to change providers for example or establish care with a new doctor, or in your case, as a pediatrician, you interact a lot with parents. What are some of the things that I can do to create a good relationship with my provider who might be a nurse practitioner, who might be a physician assistant? What are some of the questions I can ask and how can patients from their standpoint foster that all of those principles that you just mentioned?
Dr. Ryan: I think it’s really important for parents and for patients to feel that they can talk to their provider. As I’ve been around to different practices in different practice settings I hear a lot from physicians that they don’t feel like their patients talk to them and tell them about their concerns but I think on the same foot side is we as physicians need to change our mindset and change our thoughts with how we walk into a practice and how we walk into an office visit. I think for us to take the time and just say which I’ve started to do even more so in my practice, what’s really … what are you worried about? What’s really bothering you? We have to engage in those conversations and I would hope that patients take more of that responsibility for themselves to feel that they can talk to their physician or their healthcare provider about what they’re really worried about.
I get the sense that that’s a different mind shift for a lot of patients. I think it’s so important. I think it’s so important to have a conversation. Not somebody telling you what to do and what’s going on. I think when you walk in to meet someone, you’re interviewing someone as a patient, I really believe in that gut sense of your feeling and your [inaudible 00:14:50] for a person is really important. We’ve all had those experiences in different aspects where you reflect and say something just didn’t fit well with me and I should have gone with that. I think that’s really important, your level of comfort, your level of ease with not only the healthcare provider but really the setting therein, the environment therein, how their staff seems and that’s all important to say is this a place I feel welcome? Is this a place I feel safe? Is this a place I feel comfortable.
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Dr. Belisle: What about cost? I know that quality has been an important piece for you and that you’ve done a project with Maine Quality Counts and I believe consumers reports has somehow gotten involved in questions that we should be all … patients should be asking their doctors really. What’s your take on these things?
Dr. Ryan: There are 5 questions is the consumer reports quality counts message about do you really need a test or procedure. Are there other alternatives, other options? What happens if I don’t do that test or take that medicine or do that procedure? What are complications and side effects if I do and how much does that cost? I think cost is important. We’ve all sort of shied away from cost over the years but we know in this country our healthcare costs are astronomical. It really can’t continue the way it has. I think it’s important. Those are important questions and I work for a system. It’s difficult to get the answers. I know they’re looking at finding the answers and I’m hoping to at least get some of that paperwork to start to begin to look at it. I don’t have the answers all the time for patients when they come in the office right now but I think it’s my job to be able to guide them and steer them to the places that they could get the answers to those questions and it’s important. A lot of families have very high deductible insurance plans now and cost is a huge issue.
Dr. Belisle: I agree and I … when I was in private practice, I knew how much I charged for patient visit, I knew how much we billed to the insurance, I knew how much we were like to get back from an insurance plan and I had a sense from having investigated this how much it will cost, order a cholesterol test drawn, x-ray or an MRI. I think it’s gotten more and more cloudy as time has gone on and especially working within a healthcare system, it can be very confusing. There are different things called facility charges which are now added into patient visits and the clearer we can be to ourselves as to how much things are going to cost, the better off everybody is going to be because there’s nothing worse than being a patient who gets a bill for a test that they really weren’t sure they needed to have in the first place and have it be so high that they never want to go back and see their doctor again because that trust is broken.
Dr. Ryan: I think in all the changes in medicine that we’ve had to embrace and all the … actually all the good things that have come out of things like technology and electronic medical records and really this idea of justice and part of justice is public health. It’s the ability to care for people as part of a population. Make sure that people are immunized against measles, mumps, and rubella and make sure that people aren’t being exposed to other infectious problems. Proper public health.
Dr. Belisle: Tell me how you feel about what we’ve been doing in public health over the last 10 to 15 years.
Dr. Ryan: I agree wholeheartedly and I think the healthier an individual is and you had mentioned communities, I think it’s so important. Public health is so important and I think that we as healthcare providers are really at the forefront to help educate our families and our patients about the important of public health and we can certainly see over time the amazing advancements and things like infectious disease for example. I think right now everyone’s really worried about Ebola and worried about the enterovirus. There are things like that that catch our awareness and our attention in a much more acute situation and I think that I talked of patients in the office that there are hundreds of enteroviruses.
When we talk about the risk and what we look for is not any different for this particular virus. It’s the things that we always look for with respiratory infections and things that you’re worried about and things that I’m worried about. I’ve been involved with the school health program in my school district and really looking at population health. I think we don’t always think of that on an individual provider level. I think we all probably contribute to it without really realizing how much we can contribute to it. I know the public health committee of the Maine Medical Association is probably one of the most active committees within our organization who really embraced public health and looking at all aspects and how that affects Maine citizens. I think we all do it. We don’t always consciously understand how much of role we have in that.
Dr. Belisle: We had Gordon Smith on the show, I think a couple of years ago. Now, he’s the executive director of the Maine Medical Association. I was impressed with how the medical association has needed to change its focus, change the way that it outreaches. What are some of the things that the medical association has asked you to champion as the President this next year?
Dr. Ryan: I think there’s not the issue of championing anything that I get from the medical association and from the leadership. I think it’s more on an individual basis sort of what you’re passionate about and what your vision and what your hope is for your term as President. I really feel strongly about physician wellness, physician burnout, physician dissatisfaction and I think as a medical association, we really need to remember that what we do is taking care of our physicians and our health care providers and the quality piece and the patient improving the health of Maine citizens. We have to remember my goal, my vision is to really hear from members to try to re-energize members who are feeling dissatisfaction and frustration.
I think part of that comes from education in looking at how we have to function now within all these changes in terms of quality documentation, in terms of accountability, in terms of continuing medical education. I think as an organization we need to be able to support physicians and have answers and resources for them. We are trying to get out. We’ve done a couple of what we call listening sessions. We’ve done one in the Portland area, and one in the Bangor area where it’s a social event and we invite physicians and healthcare providers in the community. I’ve been to the one in the Portland area. We have one coming up next week in the [inaudible 00:24:49] area. Its’ been … it’s been grate. We’ve just started this but I see physicians that I would never see.
They don’t come to meetings. They’re not allowed committees. These were physicians out there in the trenches taking care of patents and we really get to interaction as leadership of the organization to see what concerns they have, what things they’re worried about , what they’re wondering about and my hope is to really get out there and be out there for physicians to really get a handle on what’s going on, what their concerns are, what their joys and what their satisfactions and their accomplishments are also and really try to energize the healthcare providers.
Because you had mentioned that you were faced with an onslaught of requirements and boxes to check and different things like that to hold accountable for but I think at the end of the day we have to remember we’re there to really take care of our patients and give them the best quality care and make them as healthy as we can be. We can’t get too wrapped and too focused in clicking the right boxes and get disengaged from that.
Dr. Belisle: Something that keeps coming up from me that I think comes up in many of the shows that we do and that in the end there is really is all about relationships and when I’m sitting with a patient I want to be able to work with that person and really in a team as you’ve suggested not just me but the other people who work in my office and this patient and this patient’s family and I want to have a positive relationship. I don’t want a patient to come in and feel like they have to be defensive. That seems like a harsh term but sometimes I know that when I’m sitting with people I am getting the entire medical … I am representative of all of the doctors that had ever done poorly for the patients that come through the door and that’s a heavy burden for me to lift.
I would prefer to have somebody come through the door and sit with them and say, “I’m on your side. Let’s see if we can build this relationship together. I can clearly understand that you’ve had difficulties in the past with the medical system at large or may be a particular doctor but let’s see where we can start as human beings and start with the human level and really understand it that way.” It sounds like this is something that you encourage as well.
Dr. Ryan: Definitely. I get to do that. It’s the nice thing about being a pediatrician because I just often times especially with newborn babies I’m starting that relationship for the first time with families and with children. I’ve been there long enough now that I’m starting to see the children of the children. It’s great to be in a community. It’s great to have that relationship. I don’t always make people happy. I understand that and that’s part of human nature but I think really having that conversation and not feeling like you as a healthcare provider have to justify the system or justify what’s happened to somebody in the past but with knowledge that there were issues and there were problems and things that you weren’t happy with and how can we move forward and make this a better relationship than what you had in the past. I think that’s crucial.
Dr. Belisle: Lisa, how can people find out about the Maine Medical Association?
Dr. Ryan: We have a wonderful website MaineMedical.com. You can Google it and there’s lots of information about the medical association, about all the different committees and all the activities and all the things that are going on within the medical association. Their office is located in Manchester and I certainly as President this year encourage anyone to really reach out to me. I want to hear from the members, I want to hear from healthcare providers.
Dr. Belisle: I do encourage people to find out what the medical association is doing if you are a healthcare provider or a patient. It’s a very worthwhile organization. Also reach out to Dr. Lisa Ryan who is a pediatrician at Bridgton Hospital and the President of the Maine Medical Association. Thanks so much for coming in and talking to us about what’s going on in healthcare and for being part of Love Maine Radio.
Dr. Ryan: Well thank you so much. It’s been a pleasure and it’s always a pleasure to meet with you and talk to you about things again. I’m thrilled to be here and thank you so much.
Dr. Belisle: As a physician and 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.