Transcription of Doctors with Heart #127
Dr. Lisa: This is Dr. Lisa Belisle, and you’re listening to the Dr. Lisa Radio Hour and Podcast, show number 127, Doctors with Heart, aired for the first time on Sunday, February 16, 2014. We’re at interesting crossroads in medicine. Doctors and other healthcare providers are being asked to adjust their way of practice significantly in order to address the increase in healthcare costs and other demands on their relationship with patients. Yet, doctors continue to show up and attempt to practice with great heart and compassion.
Today, we interview two sets of physicians, Dr. David Loxtercamp, Belfast Family Physician and author of A Measure of My Days, and What Matters in Medicine, and Dr. Rick Marden, family physician with Brunswick Family Medicine, and member of numerous international medical mission trips. We hope you enjoy our conversations with these very heartfelt doctors. Thank you for joining us.
Dr. Lisa: It’s always a pleasure to sit across a microphone from a fellow physician and especially a fellow physician who has had a hand in my own professional education. Today, I’m speaking with Dr. David Loxtercamp, who is a family physician residing in Belfast with his wife and two children. Dr. Loxtercamp’s expertise is in addiction medicine, and group visits narrative medicine, and practice transformation. He’s a founding member of the Seaport Community Health Center, and in 2012 was named Best of the Best in Medical Practice and Physician in Waldo County, Maine.
David’s most recent book, What Matters in Medicine is an exploration of the patient-doctor relationship and what really needs to come out of that relationship to insure wellness in a person’ health and in our healthcare system. Thanks for coming in and talking with us today, Dr. Loxtercamp.
Dr. Loxtercamp: It’s great to be here. Thank you Lisa.
Dr. Lisa: I remember first reading something you had written although I know you’ve been writing a long time but the first thing I read of yours was from A Measure of My Days: The Journal of a Country Doctor which was written back in, I believe, 1992.
Dr. Loxtercamp: The writing began in 1992 and it was published ’97.
Dr. Lisa: At this time, I was in my own medical training and I thought, “Wow, a doctor who writes. Somebody like me. I can relate to this guy.” Not only that but you also are a doctor with a strong Catholic faith, and you’re also a runner. There are a lot of things that you and I related, a lot of levels that I related to you on.
This is one of these levels. This is from A Measure of My Days. “I cannot dispense happiness any more than a parent can hand it down but I give to my patients a replenished heart and ears that will listen. I can hold up their fears, and doubts, and dispirited dreams as we strive toward that mutual goal, happiness. This does not deny medical science and its death-defying feats, but physicians realize that the hardest work begins when the cure is evasive and ‘the plan’ is our only defense – plans fabricated countless times over countless days by doctors and patients who infuse a diagnosis with different meanings in order to disperse the unknown and light the trail to their recovery; plans to create order; plans to sustain hope.”
When I was reading this book, this was something that I could really relate to because I think being a physician is so much more complex than many people realize.
Dr. Loxtercamp: Yes. It’s being a different kind of person, I think, to every patient that walks in the room. Some are looking for advice and some are looking for paternalism, some need encouragement, some are there just to argue with you, and to question the value of your work; that is medicine. Within a few minutes, try to figure out why the person has come to you today with this question or this problem. It’s always the most interesting issue.
The ability to adjust your expectations to those or the patients in the course of a very brief time is, I think, what defines the maturing position, the person was able to discard one’s agenda in favor of something more important on the patient’s mind.
Dr. Lisa: Which is a difficult thing to do because as we’re trained early on in medical school, we’re supposed to be eliciting the right answers to the right questions so we can create the right plan, we can come up with the right diagnosis. Many of us going in, we want to do it right. We’re perfectionist, and work a little bit competitive in our minds, I think. We want to do the right thing but the right thing doesn’t always end up being what we thought it was.
Dr. Loxtercamp: Yeah, that’s right. I certainly wanted to be an expert when I left medical school and residency. I wanted to have all the right answers, and I wanted to make sure that I wasn’t seeming – I don’t know – phony to my patients or to my colleagues maybe even more importantly, but the word that comes to mind, I think, best for me now is notion of helpfulness, not patients that or this which I stepped away from but helpfulness. How can I be helpful to this patient today?
The truth is, most of the answers that are important lie within the patient. If we can just elicit those answers, if we can just bring out and support those answers to their own questions, I think we make more headway for them. I do like certain things in medicine. I do like procedures, and I do like the occasion to be the medical detective but even more importantly, I really enjoy conversation and spending time with people who are interested in learning something about themselves, and maybe adjusting to change their life.
Dr. Lisa: Some of the things that you’re interested in are things that have come over time. Your interest in addiction medicine is something that you didn’t start out with necessarily.
Dr. Loxtercamp: That’s right, yeah. Living in a community and practicing in that community over time, I think, draws you to the problems of the community. It was probably ten years ago now that I first began to realize how much addiction was shaping a part of my community that I didn’t even know was there. Probably – I don’t know – over nine years ago, I was called to see a patient in the emergency department and he was daughter of longstanding patients of mine. I came to see her, and she was wrenching and quite sick, and had been so for two or three days.
I soon realized that she was withdrawing from heroine, actually by her own admission. Something I had no concept of and her parents who had asked me to come see her had no awareness of or explanation for it. This was a very, very bright young woman going to college, the first in her family to go to college. That drew me in because she was only a few years older than my daughter. I knew nothing about this. I thought if I can’t or my colleagues can’t respond to a problem like this, who will be there for my daughter if she gets into trouble? or my son as he could get in with the wrong crowd and make some bad choices?
I needed to learn about this, and over really the last five or six years, we’ve developed a program in our practice to help people with addiction to narcotics, narcotic abuse. It’s been a fascinating journey. First, believing all that came out in the medical literature about addiction, and its treatment basically with substituting one drug, Buprenorphine, for another. That is whatever the patient was, their drug of choice was whether it would be methadone, or heroine, or prescription painkillers.
What I learned over time was how people change and why, and of what help I can be in that process. We’ve gone from one-on-one doctor-patient care and prescribing Subaxone really indefinitely to now, hosting groups and letting these individuals teach each other and me about what is most helpful for them in their recovery. It’s been fascinating, and you develop very close relationships with these people because you see them weekly and really hear about the intimate moments in their life and the struggles they’re going through. Really, the enormous challenges they’ve had to overcome to get to this point.
The other thing you realize is that since virtually all of them have children, that if you don’t help this generation, another generation is lost. It’s an enormous challenge. It draws me out of my comfort zone and working with people in a way where I am not the expert. I’m certainly not the expert on all of the legal issues they’ve gotten themselves into, and the shame they deal with, in early life experiences that are so different from mine. It’s been a huge learning experience.
I think what probably I have to give them more than anything else is an adult presence. An adult who believes in them. An adult who imagines a future for them. An adult who cares about the outcome of their struggle, maybe more so and probably in many cases much more so than their parents or the adults that they’ve had in their life up to that point.
Dr. Lisa: This sort of work is requiring something different than what being traditional medical practice requires of us these days. A lot of what we do these days has something called metrics associated with it. It’s about getting patients in, and seeing them in a timely way, having quality, meeting quality goals like every woman over 40 gets a mammogram and things like that. Sometimes these two things can be in contrast and in conflict. You wrote about this in the BMJ which used to be the British Medical Journal, this idea of humanism and the agent metrics.
Dr. Loxtercamp: That’s right. I really have no quibble with metrics. It’s just the choice of what we choose to measure. I think we’ve stopped the agenda, that is the medical association has set an agenda that can be quite different from what practicing physicians need in their office every day.
The other thing about metrics is that when you’re focused on one thing, it takes your eye off another. Sometimes, when you come in to a room with a patient, say, a diabetic, and you have in many cases, six, or seven or eight metrics to meet on that patient that day, you almost forget to ask what’s going on in their life or why are they there, and what’s troubling them. You have your agenda, they have theirs, and again, I come back to that. Our job is really to be helpful to them.
I think the opportunity for conversation, the opportunity to explore the sources of their unhappiness, these special moments which is many, many times why they’re there that day can be trampled under by our urge, by our strong performance desire to meet these metrics that have been laid out for us by others. I think metrics are important, and I think the challenge for primary care physicians is to take the lead in choosing what are the most important things to observe ourselves, observe in our patients overtime, rather than rely upon maybe the agenda of an urban medical center and their research topics or their research grant goals.
What we think is important, how can we measure that? One of the things that I think is very important is face time. How much time do we spend looking at a patient and listening to them? I think that makes a huge difference in outcomes, a huge difference in cost savings, and it’s really not been measured.
Another really important thing is to measure the power of relationships. I tried to explore that in my book, and what I discovered was there’s really not very much evidence for or against the power of relationships and moving people to a more healthy place in their lives. I really think that’s an important topic for primary care to take up. How does establishing a sense that you care about a person, that you want to listen to their concerns, that you really want to get to know them, and that you want to be with them over time help whatever struggles they’re going through?
How does that change outcomes, and in what way can we develop these relationships better to achieve those outcomes? Maybe in the next ten years as I slow down from the busy pace of medical practice, I’ll make contributions in those areas of research into primary care and what is most important not just to the doctors who care for the patients but the patients themselves.
Dr. Lisa: You’re on the Dr. Lisa Radio Hour and Podcast. We’ve long recognized the link between health and wealth. Here to speak more on the topic is Tom Shepherd of Shepherd Financial.
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Dr. Lisa: I’m fascinated by your practice, at least in part because one colleague that you worked with is one that I helped educate at Maine Medical Center, Dr. Megan Britton. Another colleague is one that I went through medical school and residency with, Dr. Carol Kim.
Your practice seems to have the ability to work together well enough to make fairly big and interesting decisions. You’re talking about changing the way that you see patients so that you maybe see patients for six hours a day but then you do administrative work for the remaining hours of the day so you get today’s work done today. That’s something that you actually need to have a lot of buying in for. How do you keep everybody in your practice sort of roughly on the same page so you can move forward?
Dr. Loxtercamp: Some days, it happens more easily than others but I think a couple of things. I’m not sure I’m the best leader for this practice but what I’ve been able to do is choose, I think, the right people which is the big head start in trying to get a practice to function as a team. First of all, I made an effort to find the right people and be choosy about that. I think that’s been a big help for our practice.
Another is the commitment we’ve all made to what we call, what has been called for the last 22 years now, that there is a morning meeting. 23 years ago, my then only partner, Tim Hughes and I went out and recruited Mary Beth Leone, a social worker, licensed clinical social worker, to come be in our practice one day a week because we saw the absolute need for behavioral health in our practice, and because we wanted her to help us work better as a team.
The way I knew to do that was to host a conversation every Thursday morning for an hour, what we call a “check-in”, where I learned about what was going on in the personal life and sometimes, the clinical life of my colleagues. I think physicians for a long time have been very good at parallel play. That is working exam room to exam room right next to others with lots going on in their personal lives, and maybe some troubling medical issues that they’re facing or mistakes that they’ve made, or concerns that they have about certain patients.
We gave voice every Thursday morning and have for 22 years, as I’ve said, to those kinds of questions and conversations from 8:00 to 9:00 every Thursday morning. Building that kind of trust and that kind of concern for one another, I think, also goes a long way to creating a team environment.
I think, lastly, people who have come to work for us have, some more reluctantly than others but have, all bought in to this notion that change is important. That we can’t do things the same way we’ve always done them, and that we need to try new things because maybe the old ways are not as effective or not as good as we thought they would be or because new challenges are confronting us, not just our patients at our practice but primary care more generally.
I think they’ve all bought in fairly freely to the notion of joining, in 2006, the National Demonstration Project. We were one of 36 practices in the country to look at practice transformation and see how we could promote it in our own practice. In 2010, to join the Maine Patient-Centered Medical Home Pilot. Right now, so many things are going on and it’s really such an exciting time. Very soon, we’re going to have a psychiatrist be consultant in our office which is really unusual but in many ways, absolutely necessary for the kinds of people we take care of.
We become a federally-qualified health center to expand our reach to the people of Waldo County and make more patients available for the kinds of sliding scales and other financial supports that an FQIC can bring. Even more importantly for me now is this notion of colocation which is the idea of bringing the essential ingredient of a primary care practice together. Certainly, integrative behavioral health is a big part of that, but also pharmacy, and lab, and imaging, and physical therapy, and dietary education.
All these things are absolutely important not just to have in the same place which is maybe kind of the mole mentality of medicine but actually working as a team, talking about the same page and at the same time about what we might really benefit from or how we can help them move forward in their lives. I think my job has always been to bring the right people together in the right circumstance.
That is in a place where we can have real conversation and make joint decisions together and also to push them to take tiny risks and sometimes major risks out of their comfort zone, trying new things with the hope, with the possibility that this could actually make their life better, and even more importantly, further the mission that we all agree upon which is taking care of patients where they are.
Dr. Lisa: Dr. Loxtercamp, how can people find out about the books that you have written? A Measure of My Days: A Journal of a Country Doctor and What Matters in Medicine: Lessons from a Life in Primary Care.
Dr. Loxtercamp: Probably the easiest way is to drive to Belfast and go to my wife’s bookstore where these are prominently displayed. I think another easier way probably for most people would be to go to my website. I have a website in part to introduce my newest book but also to collect all the things that I’ve been writing about really the last 20 years.
Writing has always been a way for me to collect my thoughts and to push away all of the ambiguity and uncertainty that a family and a family practice can bring to one’s life and organize it a little bit better. It’s been a recreation for me. It’s really been a part and parcel with my work that one really can’t perform well at one without the other.
On this website DavidLoxtercamp.com or WhatMattersInMedicine.com, both entries will bring you to the same site. I highlight the book. I highlight some of the articles that I’ve written over the last 20 years, and I talk a little bit about where I’ll be speaking or getting involved the next.
Dr. Lisa: Your wife Lindsay’s bookstore is Left Bank Books?
Dr. Loxtercamp: Exactly.
Dr. Lisa: People who happen to be up in the Belfast area, and I recommend that they go actually because it’s a really unique community and offers quite a lot beyond just the books and the good family medicine, and they can stop in at your wife’s bookstore.
Dr. Loxtercamp: Absolutely. Now, to further the advertisement by saying dogs are always welcome.
Dr. Lisa: Very good. I do thank you for taking the time write about your experiences as a family doctor and also, for helping educate me when I was a resident at the Maine Medical Center, for driving all the way down from Seaport to come participate to my education professionally, and for being so thoughtful as a family physician in a time of great transition.
We’ve been speaking with Dr. David Loxtercamp, author, father, runner, writer. Thanks for coming in today.
Dr. Loxtercamp: Thank you very much, Lisa.
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.
Marci: When I consider today’s show topic, I can’t help but acquaint it with what happened in my business. I have to remind myself and my team to consider what we do for our clients helps their business to stay healthy. We are often there to diagnose problems and prescribe solutions that ease business aches and pains. We have to do it with empathy, compassion, and heart. When we see result and our clients are happy and successful, that gives us the deepest sense of satisfaction and gratitude.
I’m Marci Booth. Let’s talk about the changes you need. BOOTHMaine.com.
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Dr. Lisa: In Medicine today, we’re all trying to find the thing that really keeps us motivated and about which we feel passionate. I was fortunate in the last few months to be in practice with Dr. Rick Marden who has indeed found things about which he feels passionate, and one of these is the work that he does in different and foreign countries.
Thanks for coming in and talking to me today about the work you’ve done elsewhere, and also the work that you do in your practice in Brunswick.
Dr. Rick Marden: Thanks for having me. It’s my pleasure to be here.
Dr. Lisa: Rick, you’re from Maine originally?
Dr. Rick Marden: I am. I’m a native, multigenerational.
Dr. Lisa: Yeah, so tell me about that. Where’s your family from?
Dr. Rick Marden: I grew up close to Bangor, outside of Bangor. My family has been there since I was born, within five to ten miles of Bangor. My family still lives there, my sister and my parents. Then, I went away for college, med school, and residency. I came back to raise my family here.
Dr. Lisa: You went to school right in Freeport?
Dr. Rick Marden: I went to high school in Freeport at Pine Tree Academy, right.
Dr. Lisa: It’s been interesting to be in practice with you, and noticed strong connections that you have created throughout the State of Maine really, but even going as far back as high school.
Dr. Rick Marden: My wife and I still have a lot of the people we went to school with who are still in the community, who we’re still really close friends with, and it is, it was great to come back home to Maine after being gone for 12 years and have really tight connections.
Dr. Lisa: After you went away to college, and medical school, and residency, you came back in your practice in little Maine. This was a big change for you after having gone out to California for medical school. Why did you make that decision?
Dr. Rick Marden: Right. After being in Southern California where it would take 40 minutes to get to my bank, three miles away to move to Rumford, Maine was quite a change. I knew I wanted to do rural medicine from the time I was a second or third year in residency, and prepared for that. Really, when I look at rural spots and of course, Maine has plenty of those to offer. Western Maine appealed to me because of the mountains, the lakes, the beauty of the area, and that took me to the Rumford area.
Dr. Lisa: You have patients who still travel down to see you in Brunswick, and you’ve been in Brunswick now for three years.
Dr. Rick Marden: It’s my third year in Brunswick, and there are patients who still come from the Rumford, Dixfield area. It’s a real privilege as a family practice doctor to be involved with the people, with the birth of their children, with the death of their parents or their spouse to be really allowed into the trust into their lives and those relationships are strong. An hour-and-a-half of driving often doesn’t stop them.
Dr. Lisa: You’re also somewhat of a rarity these days in that you’re a family practice doctor who still really enjoys delivering babies, and is continuing to seek ways to deliver babies. A lot of family practice doctors, although we like to deliver babies, it’s so challenging from a scheduling standpoint that we decide not to do it, but it’s important for you.
Dr. Rick Marden: It is challenging from a scheduling standpoint especially when I was in my Rumford practice. It was very, very busy between my regular call and my OB patients. Again, what a privilege to be there at the birth of a child, to go through the journey of pregnancy, and all these ups and downs, and then to be there at the birth and to sometimes see the kid, see the babies, see the child grow overtime, it’s great. I really enjoy it.
Dr. Lisa: You have three daughters, and you and your wife have made very conscious decisions to do things professionally and personally that really focus on the family. You arrange your schedule around your children’s schedules to some extent. Both of you are very dedicated to your three kids. That’s another sort of rarity these days. A lot of families go in different directions, parents do one thing, the kids would do a different thing, and as a doctor, it would be very easy for you to say, well, my career takes precedence but you haven’t.
Dr. Rick Marden: We do try to do that I think. It’s important to make family a priority and I think we’re lucky enough to be able to do that, to have some flexibility. I’m lucky that people I work for allow me to have some flexibility in my schedule. It’s a privilege. It’s a responsibility. It’s a part of our role to each other, humans who take care of each other and who better to take care than our own children.
Growing up, my parents maybe didn’t have the same opportunity. My dad had to work ten, 12, 14 hours a day. He couldn’t adjust the schedule and I have that luxury, and so I choose to do that, and I enjoy going to my daughter’s basketball game at 4:00 in the afternoon even though I left the office early.
Dr. Lisa: You talked about this, so it’s a lucky thing. I know how many patients you see, and you’re definitely meeting all of what we call productivity standards, and in fact, surpassing them. You’re able to be incredibly efficient and effective, and offer a very compassionate care to your patients, and get enough of that done during the day but yet, the hospital recognizes that you’re a very valuable physician. Not every doctor is able to do that.
Dr. Rick Marden: Choices, it’s all about choices in what we do. Some of my choices are I do some of the computer part of work at 10:00 at night so I can be with the kids from 4:00 to bedtime. After they go to bed, I’ll do some of the work either early in the morning or late at night. I think that’s what we all do day-by-day is you make choices and what our priorities are, and making conscious decisions to make those choices and whether it’s to exercise, whether it’s to eat well, whether it’s to spend time with the people that matter.
Hopefully all those things or choices that people make day-by-day, not just let things happen but make conscious choices of where my priorities and what am I doing to reach those.
Dr. Lisa: You’ve also made conscious choices that have enabled you to travel widely, and as I’ve said earlier, do something that you feel passionate about and that is to offer care to people in other countries.
Dr. Rick Marden: It started when I was at Pine Tree in Freeport as a student. We did a mission trip to the Dominican Republic for our senior class trip. There were only 12 of us in the graduating class, and we raised a bunch of money, and we went, and did a building project in the Dominican, and I realized something that’s a real eye opener. It’s that a child who’s never left Maine, hardly to go to another country and just the poverty and just the wanting to realize how blessed you are here in our country.
From there, it’s been something we’ve done every couple of years. We’ve done a trip somewhere in the world to do either medical mission, or a building project, or something of that sort.
Dr. Lisa: You’ve also brought your children along and your wife.
Dr. Rick Marden: My wife went in college, before we were together, and spent a year at teaching school in the Marshall Island. She had a similar passion already in place. We’ve done three trips with the children, one to Africa and two trips to Guatemala. Our eldest is 12 and our youngest is seven. We started when our youngest was two doing trips. They love it. They think it’s the greatest time of the year.
Dr. Lisa: Describe this most recent trip to Guatemala. I was fortunate, I came into the practice just as you were getting ready to go. It was around Thanksgiving of 2013. It’s something that you planned for, as you said, for maybe a couple of years. What was this year’s trip like?
Dr. Rick Marden: First, thanks for covering the practice so I could go. That helped dramatically. This year, a friend of mine who organized this, he has a five-year plan for the region of Guatemala that we’ve gone to twice now. He’s gone the last few years and has two more years planned. This year, we went to do a medical mission. There was the building project to build these bathrooms for a dorm for a nursing school, and it’s going to be established in the area. We did a medical trip and saw probably 800 to 1000 patients in six days that we were on site.
Dr. Lisa: That’s a lot of patients just for a relatively short period of time. How many people were on this trip with you?
Dr. Rick Marden: Our medical team is about 25 people that’s composed of several nurse anesthetists, nurse practitioners. I was the only doctor. There were several high school students helping out which was great. My own children went with me a couple of times of the medical days and helped out. Total for the trip, we had about 85 people involved in the different parts of the trip mostly from the Tennessee area. We were the only group from Maine that went. Long days with a lot of traveling to remote villages and two hours on back rutted, muddy roads in minivans and with 25 people in a 17-passenger van sort of experience.
Dr. Lisa: What types of things were your daughters able to do?
Dr. Rick Marden: They sat beside me and if I needed a medicine, I sent them to the guy who was running this pharmacy side and would tell them what to get. If I needed bandage, if I needed them to ask for one of the nurses to come and do something, I would ask my daughter to run and do it. I had them take a few pictures. I was doing a procedure on a young one who had spine bifida and had an infected wound on his back, and my nine-year-old was with me. I asked her to take a picture and she looked at me and said, “Dad, I don’t think I am going to do that.” That was a pretty funny moment. She just looked away and didn’t want to see the procedure.
Dr. Lisa: It is interesting that your daughters would be so wanting to take part in the work that you do because I know a lot of kids these days don’t really have a sense as to what their parents do.
Dr. Rick Marden: I’m always happy to have them come. This is the first time I’d have them come on a mission part with me. My 11-year-old, she’s almost 12, really enjoyed the medical part this time and seeing what I do. Previously, she thought that medicine was a terrible thing to do, it was too bloody, it was too awful. Last month, she informed me that she’s going to be a doctor. Let’s see how she changes her mind over time but I think the experience is good for her. I think she realizes this. Medicine provides us a way to help people. That’s really easy. People have tons of physical, mental, spiritual needs, and they let us help them. It’s a real privilege, and I think she saw that, and was excited about it.
Recording: The goal of the Dr. Lisa Radio Hour is to help make connections between the health of the individual and the health of the community. The goal of Ted Carter Inspired Landscapes is to deepen our appreciation for the natural world. Here to speak with us today is Ted Carter.
Ted: In 2009, I just come out of moving through a great recession, I guess you might say. Most of us were concerned of getting our bearings after the debacle on Wall Street and the economic collapse. I remember, I started that spring. My business went down by 40% in one year, and I was rumbling. I put this exhibit together for the Rockport Show at Maine Home Design Magazine, and I pretty much did it solo by myself, and I found it very healing. It was all working with this sacred feminine. I was very interested back then in nature.
One of the things I realized when I worked with the elemental forces is that metal does not bend. It’s stiff, it’s unyielding, it snaps, it cracks. Wood tends to be more supple, it bends, it moves, it expands and contracts. Even the wood on your house expands in wet season and contracts during the dry cold season. These are things to remember in life that try to b supple. Try to move with the energy. Try to move with the flow. Don’t become too rigid. Virginity is good but it needs to be balanced with the supple flow of the wood energy.
I’m Ted Carter. If you’d like to contact me, I can be reached at TedCarterDesign.com.
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Dr. Lisa: Were the problems that you saw in Guatemala very different than the problems that you see on day-to-day basis here in Maine?
Dr. Rick Marden: Yeah, we don’t see a lot of parasites in Maine. In the villages where we went, pretty much everyone had some sort of parasite illness, and they didn’t even complain about it. You just happen to ask the questions that would lead you to that diagnosis, “Yeah, I have that.” You figure out very soon that when the latrine is ten feet from the river that everyone that uses the water supply, that everyone is going to have similar issues.
They just thought that they were supposed to be fatigued, and having fevers, and body aches, and that’s just how life is. Then, they would come in for bad wounds from working in the fields, agricultural accidents with machetes, and burns, and of course, the usual aches and pains from doing manual labor, the usual respiratory infections. They cook inside their huts without chimneys, without ventilations. There’s a lot of upper respiratory symptoms.
Dr. Lisa: We know that in some countries, we’ve imported western problems. Did this occur back at Guatemala?
Dr. Rick Marden: We did two sort of medical days. We would do one where we would go out to a Mayan village where the people are not exposed much to western influence, and then some, we’d do closer to towns where Coca Cola and Doritos and the usual vices are present, and there is a lot of diabetes, a lot of blood pressure issues in those settings versus the Mayan villages which is more of the parasitic infections.
Dr. Lisa: What about smoking, was there any role that that play?
Dr. Rick Marden: There was a fair amount of smoking in the more city-like setting, not so much in the Mayan villages.
Dr. Lisa: You described yourself as getting interested in this when you went to Pine Tree Academy as a senior. The Pine Tree Academy is a Seventh Day Adventist. What is it about being a Seventh Day Adventist that causes the sort of interest in helping people?
Dr. Rick Marden: I think there is the culture, or hopefully there is, a culture of service that’s not unique not Seventh Day Adventism but unique to people who care about others, people who wants to show the world that we care, that love exists, that there is goodness. I really hope that that’s where that comes from, it’s just if hopefully, as Christians if you claim the Love of God and you want to show that love to others, and if it’s physically helping them, if it’s making a building.
One trip I did, we just built restrooms for a maternal-child health clinic and whatever you can do to help others, then I think it’s whether it comes from your foundation in Christianity or not, I think our role as humans is to find ways to help others.
Dr. Lisa: You personally have helped people through these mission trips by using your own money to pay for medicines, and supplies, and gathering. It’s not some big corporation that’s coming in that’s funding you on these trips.
Dr. Rick Marden: Right. The last two trips we’ve done independent without any sort of affiliation at all. I’ve done a few trips that’s part of affiliations but most of those still you pay X amount for building supplies or pay X amount for the medical supplies, but the last three we’ve done have been independent and you figure out, “Well, I’m going to need this, this, and this. I better buy it and bring it with me.”
Dr. Lisa: This is something that gets budgeted into your household expenses over the course of two years. It’s something that you and your wife have to agree upon and as a family doctor in Brunswick, Maine, you make a certain amount of money and some of that money goes to this.
Dr. Rick Marden: It’s true, yes. The Africa trip from four years ago took a lot of budgeting and airfare and five people traveling to Africa, and leaving a practice for a month, and there was this significant commitment to make that happen. Otherwise, the Guatemala trip, we think of it more as our vacation. Instead of spending our vacation money on beach and restaurants, we went to Guatemala and stayed in a room with other people and gouging scorpions and spiders, and had an adventure.
Dr. Lisa: You described to me one trip in which you were in a one large room with families separated by sheets and you were on the floor, and it was difficult to sleep, and actually everybody else’s night time sitting and moving and coughing.
Dr. Rick Marden: Yes. That was two years ago in Guatemala. That was a challenge. There were six families in a room, and maybe 30 feet by 20 feet, and separated by sheets, and scorpions on the wall. Good for the kids to realize how nice their beds and bedrooms are here in Maine.
Dr. Lisa: That is an interesting contrast between what your kids have, what you have, what we have, and what you actually have to go through to help other people, and yet, you keep making that decision.
Dr. Rick Marden: The adventurous part of it and I think that you just have to look at it as an adventure. It’s great for the kids to see how the rest of the world lives and how privileged that we are day-to-day. Before the taping this morning, I had to choose whether to go to a coffee bar or Starbucks. That was my hardship this morning. It wasn’t where I’m going to find the rice to make tortillas for my supper tonight. It’s a very different world we live in in the US that we take for granted all too often.
Dr. Lisa: What are some of the similarities that you’ve seen in going to Africa and going to Guatemala, and maybe in taking care of your patients in Brunswick?
Dr. Rick Marden: People need help everywhere. I think that’s the most similarity. Working in Brunswick, Maine is a medical mission. Working anywhere you are is a medical mission. It’s taking the time to help people where they are and what their needs are, I think, is a crucial part.
The similarities from a medical perspective across the third world country is just the lack of resources, the lack of knowledge that drinking that water leads to parasites, it leads to me not knowing well. They don’t understand that. The village we’re in just didn’t get that which is difficult. You’re face with that challenge of how can I teach people? I can give them some pills to make them better but they’re going to get sick again in two weeks unless they understand this.
That same concept exists in the office here in in the States. You got to take care of yourself. You have diabetes, you have to make changes. If you don’t, bad things are going to happen. I think working with people to help themselves is probably the common thread between the different settings.
Dr. Lisa: Rick, you’re a young physician. You are relatively young. If you’re not in practice.
Dr. Rick Marden: Relatively young.
Dr. Lisa: You’re a little bit younger than I am so I think of you as young. You’ve been in practice for a while now and you’ve seen, I’m sure, great change as I have in the medical system. I think you and I both went into medicine when we were applying to medical school, we both knew of medicine and knew of doctors as being one way, and we’ve seen a lot of moving and shifting. What are some of the challenges that you’ve encountered and what are some of the opportunities that you see opening up?
Dr. Rick Marden: It has changed a lot. Somewhere in my third or fourth year, just a simple change from dictating our notes to now doing everything by electronic medical records and typing our notes, and their responsibilities from a clerical perspective, from a paperwork perspective are very different and take more time, and being pulled away from our patient encounter time to do more of that sort of thing. There’s pluses and minuses just to that and which is an example of all of medicine.
The electronic medical record is great for searching for data. It’s really great for that but it requires us sitting at the computer screen and typing, and having that barrier between us and the patient are perceived barrier which is a challenge to overcome day-by-day, and I’m sure patients understand that more and more as they continue to come in and see that computer as part of their visit.
The technology, I think, is one. The requirements for whatever, whether it’s getting a precertification for a CAT scan, it takes 25 minutes and two telephone calls. Those are the things that pull us away from our patient encounter time which is one of the things that I struggle with is wanting to spend more of my time with the patient and less time doing those things.
Dr. Lisa: Do you see that there are possible opportunities in what has been happening, the changes with ObamaCare and the requirements that were being asked to meet now?
Dr. Rick Marden: Yeah. I think we have to look for those opportunities. There’s pluses and minuses to those things. I won’t get into the politics of the Affordable Care Act but there’s pluses and minuses. It’s not all good. It’s not all bad. I think that’s how most things are, and you try to find what are the strengths. For example, a family whose 24-year-olds can get coverage now comes to see me and has coverage. Meanwhile, one of my fisherman patients now has to buy coverage and says he can’t afford it. Those are obstacles certainly.
I try not to get too excited about different changes and try to enjoy my time in the room with patients and see how things go before getting to worked up about it, but at the same time, you have some obligation to be aware of the current situation, and what is our role to change, or to endorse, or to help tweak whatever that is. I think it’s a challenge. I’m glad there are people who are more politically motivated, who are interested and who are trying to make those changes. It’s not my strength.
Dr. Lisa: How do the mission trips that you do every other year, how do these contrast to inform your medical practice on a day-to-day basis and looking forward into the future?
Dr. Rick Marden: It’s like hitting a reset button. You come back. I do feel charged up and ready to go, and excited to be back in my office too. I think, they’re helpful for that perspective. The patients in Brunswick, one of the response I got this time and they found out I was going, it’s so much support. People wanting to donate their medicines they didn’t use anymore. People wanting to give money to help sponsor the trip. People want to be part of something. They want to help other people.
I really discovered that on this trip in particular with the outpouring of support from my patients in Brunswick. I am not sure what our next adventure is. Let’s see when it comes.
Dr. Lisa: You work on a regular basis with the residency program at Central Maine Medical Center as one of the teachers up there. What advice do you have for our younger physicians whether they’re residents and who have already graduated from medical school or whether medical students who are still in the midst, or maybe they haven’t even gone to medical school yet?
Dr. Rick Marden: I do. I’d probably give my advice unsolicited a lot to the residents. I think the really important thing is to do what you love, to have passion about in the care. That’s what I try to tell them is don’t just take a job, find something that you love, make it yours so that you would want to go to work, so that you enjoy your work, so that you appreciate your opportunity. If that’s not happening, make it happen. Family medicine in particular, there are so many options available to us in how we practice and what we do. Find what you love and pursue it.
Dr. Lisa: Right. It’s a privilege to have you here with me today. I know that your patients think very highly of you having now helped take care of your patients for a few months. I think that’s it’s a wonderful practice to be a part of and I think that speaks volumes about your approach to medicine and about your approach to living. I think it also spills over to the work that you do in other countries. It’s great to know that there are people who are so passionate about the work that they do. Thank you for that and thank you for coming in.
We have been speaking with Dr. Rick Marden who is a family practice physician in Brunswick, and for those who would like to find out more, they can go to the Central Maine Medical Center website.
Thanks, Rick.
Dr. Rick Marden: Thanks for having me.
Dr. Lisa: You’ve been listening to the Dr. Lisa Radio Hour and Podcast, show number 127, Doctors with Heart. Our guests have included Dr. David Loxtercamp and Dr. Rick Marden. For more information on our guests and extended interviews, visit DoctorLisa.org. The Dr. Lisa Radio Hour and Podcast is downloadable for free on iTunes. For our preview of each week’s show, sign up for our e-newsletter and like Dr. Lisa Facebook page, follow me on Twitter and Pinterest, and read my take on health and wellbeing on the Bountiful Blog.
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This is Dr. Lisa Belisle. I hope that you’ve enjoyed that our Doctors with Heart Show. Thank you for allowing me to be a part of your day. You have a bountiful life.
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The Dr. Lisa Radio Hour is recorded in the studio of Maine Magazine at 75 Market Street, Portland, Maine. Our executive producers are Kevin Thomas and Dr. Lisa Belisle. Audio production and original music by John Dean McCain. Our assistant producer is Leanne Ouimet. Our online producer is Katy Kelleher. Become a subscriber of Dr. Lisa Belisle on iTunes. See the Dr. Lisa website or Facebook page for details. Summaries of all our past shows can be found at DoctorLisa.org.