Communication is Medicine: A Conversation with Dr. Jeffrey Barkin

I'm assuming you love it, I do love it. Okay, Good. I consider myself a practicing psychiatrist, a physician, but also a multimedia journalist. Well this is Dr. Jeffrey Barkin who has many talents, not the least of which is being on air. And here we are today. So I want to start with, let's go back to your past. You're a psychiatrist, so you must love stories about how things link back to our childhoods. Tell me how your experience with radio began. So we'll go all Yes, we are. We're going to go deep. Yeah. First, thank you for having me here. Of course. So my story goes back to when I was first sent, probably like age four or five, and I had a stuffed animal and in the stuffed animal was a little transistor radio. So I was able as a little kid who really didn't sleep very well to listen to the radio and it got me into music. And later on talk long before there was anything contentious and talk radio, a lot of storytelling, Jean Shepherd, people who were consummate raconteurs and storytellers and that were engaging even to a 5-year-old. And then as I grew up in high school, I got involved in radio in New York City and that was a hoot. And then ultimately went off to college and medical school and in college was both pre-med and really into communications and ran the campus radio station at Swarthmore College, which was a hoot. And then after I finished my residency in psychiatry at Yale, I had my first job and I did Sunday nights at Rock 102 in Springfield, Massachusett. Springfield's classic rock block party station. And that gave us enough money for babysitting at the time and it was a nice departure from the stress of clinical medicine and then raising the family, you sort of go quiescent. But those radio days, we would be lent out to the PBS station to do the fundraising. So I found myself doing these long form breaks of talking about the Grateful Dead and Led Zeppelin and it was all very natural. So come to the present, a lot of things changed with covid and the accidental tourist part of me was reactivated again. And about five years ago I found myself back in the journalism world. And you currently work with WGAN, which is a Portland-based organization and you are the co-host of a healthy conversation. So you now have your own whole thing that you show up with and you interview people to talk about health in the state of Maine and beyond actually. So our show is really founded by Steve Woods and I came on the first time about four years ago during Covid and it was really to talk about how we can cope about with covid, the circumstances, our families, the biology, a lot of it I had in my day job been working for a large company where I suddenly found myself thrust into doing live telecasts to help the employees, 15,000, stay sane during covid come up with coping strategies. So effectively if you were an infectious disease doctor or a psychiatrist, all of a sudden you were needed all hands on deck kind of thinking. And I realized that I can explain things in a way that kind of makes sense. I was a guest on Steve Woods, a healthy conversation and one thing leads to another, he asked me to be co-host. So for the past four plus years, that's what I've been doing and it's been great. First of all, I want to just reflect back to you, and you probably already know this, but you have a great radio voice. Thank you. I appreciate that. I mean, it's very kind of soothing, but it's got just enough kind of confidence, a quiet confidence. And I think during covid that is something that probably people really needed because there was this sense of uncertainty. There was a sense of sort of impending doom and fearfulness. And I think that if you're a physician and you're called to speak about medical things during a very difficult time, you can only know so much about the things that are still evolving. But what people really want to know is how do I deal with how I'm feeling inside? And I believe that's probably the benefit that you brought to the work that you were doing that started then Initially. Absolutely. And it was two things. One is content, which was truthful and acknowledging what we didn't know. US doctors were trained not to be communicators at large. We're trained to be communicators intimately with our patients, with their families. I remember in my training the difficult conversations with families about their loved one in the ICU and code status and do not resuscitate. So we're really good for those difficult conversations, but to all of a sudden be foisted into the big world, we're not trained in broadcasting. So it was very helpful to turn to people who are in broadcasting who have been very generous with their time to mentor me. And I would really encourage anybody who's sort of finding themselves at a point of a pivot where you're going into something that's professional, where they're radio ratings, advertising, whatever, do it right, whatever it is, have a mentor have somebody who can make sure that your cognitive biases are minimized and that you're aware of them. And you're absolutely right. During covid, the cognitive bias that people were feeling was all about catastrophe, catastrophic thinking. So anything that we could do to get people focused away from the catastrophe and into more adaptive ways made sense, that's content. But then there's process, which is how things are being said. And I realized that as a psychiatrist, that's what I do every day with my patients, their families. I consult to businesses and do corporate consultations. It's to provide a process that's calm and not contentious. You are also the past president of the Maine Medical Association, so you have an experience with speaking to broader audiences. Although the main medical association is largely physicians, there are also nurse practitioner, PA affiliated medical people, but it's largely physicians and even that is a very different audience and a very different probably content and process around the conversations back and forth. Do you find it in any way challenging to kind of move through and across different types of conversational spaces? It's been challenging and it's been something I've focused on, but what I've realized is, and it sounds cliche, if I can just be myself, it goes fine. And if you think about yourself as having an onstage persona and an offstage persona, the way you are with others and the way you are in private, the more you can align those things, the easier life gets. And in terms of a psychologic life hack, if you will, beginning to align your onstage persona to match your offstage persona, it makes it so easy. You just are who you are. I absolutely agree with that. And I also think it's been challenging for many people in medicine because you do have to leave yourself at the door quite a bit. You have to be able to show up and be fully present with the person in their space. And even though you obviously bring your own self into it and you want to be authentic, also the focus really has to be on the other person. So that's an interesting kind of balance point that you're always trying to achieve in medicine. At least that's my experience. I am wondering what your experience Is. Oh, absolutely. When you're practicing medicine, you're so focused on everything else. I mean you're blocking everything else. You're so focused on the patient, your formulation, their problem, what's going on, what are we going to do? And what I've always enjoyed is the patient-centered approach where it's shared decision making. I'm not acal, I don't like to tell people what to do and especially what not to do. That never works. And during covid, a lot of physicians were telling people what to do. They were telling people what not to do. Probably coming from a good place based upon what we believed at the time. You have to keep a six foot distance, you have to wear a mask. No, don't wear a mask. We really didn't acknowledge process-wise, our own uncertainty. And I think that as a communicator, you have to question and not know things. So you can ask questions. And what I find process-wise is if I'm interviewing a family, an individual patient or I'm on the radio or tv, it's exactly the same. I'm focused on what's being said, how it's being said, and how I can contribute hopefully in a positive way. There's so many things that are kind of bubbling up for me because I don't think in medicine, yes, we do focus on communication, but I think it's very goal oriented in a really different way. And especially in this day and age where we've got 10 minutes, 15 minutes with a patient, we know what we need to achieve, we hopefully get to what the patient needs to achieve. It's beginning to end. And I think that sometimes that causes us to shortcut things. And there aren't very many people who are physicians who are thinking, how does that ting negatively impact relationship and our ability to actually do our job well. But it sounds like you've thought about this. Yeah, a lot. I have to spend a lot of time thinking about this, and that's been advice that I've gotten because I find myself in a sometimes awkward place where as a physician who represents the physicians of Maine, which is what the Maine Medical Association does, I'm a subject matter expert, but I'm also a medical multimedia journalist where I like you towards the truth. So I have to straddle what's the facts versus what's my synthetic opinion, acknowledging the probability or possibility. I could be wrong, but always you to the facts. And I try to be mindful. And now we live in a world where we don't have shared facts. People have different facts based upon where they look. We used to have three networks, PBS, and if you were in a big place, maybe one or two independent stations, but now there are hundreds of thousands if not millions of outlets on the internet where people turn and they specifically turn to get what's called confirmation bias, ideas that support that, which they already believe. So they're deprived of alternative perspectives and that creates polarization. And I think as a doctor, when we treat a patient, we don't think of them as a political person. We think about them as an individual and come up with a patient-centered care plan. And I think if we could begin to approach society in that which way, we would do a much better job communicating. So yes, being president of the Maine Medical Association is a bit like herding cats at times, but it's a group effort. So you're not just doing it alone. And one of the things that I've learned that I encourage others to really cogitate on is that any effort is a group effort and there's no I in team. Yes, I agree with that a hundred percent. And it's actually a very challenging thing sometimes to help physicians in particular. And I will call out physicians. I am one. I have been one a long time as you have. We are somewhat independent minded. I think that our training kind of forces us to, we understand that we're accepting risk, we're accepting responsibility. There's a very good reason why we end up being called as individuals. We end up being subject matter experts. We spend a lot of time investing in our educations and our subject matter expertise. And so as a result of that, I think we're kind of enculturated to move forward as individuals. So how to create a team, how to create a body that's actually working for together medically, I think can be very challenging. It's challenging, but it's where the goal is. So in mental health, we used to operate in a pure silo. People would have their psychiatrist or psychologist, and then they had their primary care doctor. Well, now we're moving more and more towards integration of care, where the behavioral health is part of is physically located in the practice setting of internal medicine, pediatrics, family practice. So we're integrated into that care team. The more we're integrated into teams, the less siloed we are, the better it is for our patients. Now you mentioned the short interaction time, the 10 to 15 minutes. I'm going to say something really provocative, and that is that physicians though we're very well trained and often very much in debt because of that training, more and more of us are institutionalized, meaning we're owned and operated and employed by somebody else. And that means that our voices are squelched. When you're an employed physician, what you can say is limited. So your beliefs and what you want to say have to be channeled through appropriate channels, if you will. I have zero dependencies. I am self-employed. I see patients for 50, not 15 minutes, five oh minutes. And there is a big movement across the country called direct primary care. And what that is is basically a subscription based model where patients choose their doctor and their doctor have fewer patients, which is a problem. It does mean less access, but it allows the doctor to spend time with the patient and see the patient when they can. The doctor doesn't have a staff, the doctor doesn't have a billing staff. The doctor doesn't waste their time on all that paperwork nonsense. The doctor spends their time with their patient and my doctor makes house calls. So I think that as we adopt these alternative models and doctors become less institutionalized, more free thinkers, we can unshackle our creative powers, You're preaching to the choir. I mean, I absolutely am a fan of direct primary care and I have my own medical practice for 10 years in which I did that sort of work. It was not subscription based at the time, but I definitely understand that it's a great direction that we're moving in. And also because we still have people who for whatever reason are in institutionalized medicine, maybe they're getting loan repayment or maybe they're just newly out in practice and they still need kind of that collaborating academic kind of setting. We still have that. That's 80%. Yes, exactly. It's not just have it that four and five doctors are employed, so their wings are clipped. They don't have to worry about a paycheck. That's great. Yes. So I think what I hear you saying is it's not possible to more effectively have your voice in that setting. You said you were going to be provocative, so I guess I'll ask you that question Back. If you are a doctor employed by a physician and you get into trouble, you're on your own kid. If you're sued and there's a malpractice action and the doctor is sued and the hospital is sued, you're on your own kid and I'm a forensic psychiatrist, I do these cases. So though the hospital employs you as a doctor, you are perceived as a potential liability. So if there is an adverse action, the hospital has their own lawyer and you have your own lawyer. Another thing for doctors to understand is those non-compete clauses, which mean that if our relationship as an employee doctor and as the hospital doesn't work out, you can't work for a year within a 25 mile geography. And we're at a point where we have healthcare access crisis happening, inland hospital closed, Maine general just terminated over a hundred employees. Our services are literally crashing. We have to find ways to increase our ability to see patients not restricted. It's great. The hospital systems are wonderful. Employers can be wonderful, but I think that they have to do a better job of allowing the doctors to speak otherwise as you out, our voices will be squelched. And we're not stupid people. We have a lot to contribute. Yes, you and I can agree on that. And I don't disagree with you. I mean broadly I do believe that our voices are squelched because when you are employed, your time belongs to somebody else and there's still a number. I think there's still some need to kind of operate within that space. And yet you yourself found the opportunity to move in your own direction. So what was the turning point for you? Well, for me, the turning point was when I was no longer employed by hospitals, and that was in 1999, so I've had 26 years of doing it on my own. And you can do it. You don't have to feel that you need to be owned. You don't have to give up control. And now with so many layoffs, physicians and other healthcare providers are going to be forced to realize that people are reaching out to me. I'm a past president of the Maine Medical Association. People are losing their jobs. They need plan Bs or plan Cs. And when you lose your job, perhaps you're a little bit more cynical or skeptical that if you take the next job, that you're secure. And if you have a family, if you have massive medical school debt, there is an important role for some degree of security to place. And us physicians have enjoyed having basically secure jobs essentially forever. So in this environment, we're threatened. Now, let's not just be physician focused. Let's think about what those job losses of doctors mean for their communities. It means that healthcare access goes down. There are a lot of people interestingly who don't understand what that means. It's just big words. Healthcare access goes down, right? Wow. What that means is if you're having a baby, you may not have a place to have a baby. This morning, driving to your beautiful studio, I learned that Holton is no longer the hospital there delivering babies. So if you live in Holton, Maine, you have a very long drive. We lost inland hospital. We're losing vast swaths of the healthcare things that we take for granted. And when people don't remember that thing of every second counts, if you're having a stroke or heart attack, a 90 or 120 minute drive means that you or your family member have a real risk of complications or death. So I'm going to pivot us because now I want to really pick your brain. This is so intriguing to me. So a year ago, my position was eliminated from Maine General. So I have a very, I think, pretty significant understanding of the Waterville Augusta area. And I was in the C-suite at Maine General. And this isn't something that I have talked about actually publicly on air at all. But I went through this experience of having the position eliminated, having lost my job, I'm now with a digital startup. What I firmly believe is that we need to be more innovative in the healthcare space and what you're describing where they can no longer deliver babies in healthcare. It can't be solved by virtual care, which is MySpace. But there are probably ways that we can be innovative. But this is a very deeply entrenched field that we're in. We are in healthcare, there are regulations, there are payment structures, everything is so kind of locked down. How do we become more open, more creative, more innovative? How do we try to solve problems in a different way than how we've gotten to where we are? Great question. I think the reason that we got to where we are is that medicine went from a clinical focus and was co-opted into the political space. So large medical decisions went from between doctor and patient to doctor, patient and administrator. And this is before politics. So all of a sudden, your call schedule, your salary was determined by somebody else. We became more and more dependent upon the government and third party insurance payers for our salaries. And I think that the healthcare ecosystem, the whole big thing is so fragmented. You have Medicaid for poor people, Medicare for old people, Indian Health Service for indigenous or native people, the VA for veterans. So to have communications, healthcare systems, electronic records that are able to even talk to each other is a challenge. We have to do better. And it's not just doctors. Doctors are just part of it. And I apologize for your layoff, and that's another thing that we share. I too was laid off from corporate America, and I can't even speak about it publicly except to say it was a great job. It's nothing personal. I get it. We have to be adaptive and we have to adopt an adaptive and resilient mindset. And unfortunately, many of our colleagues feel demoralized and they feel fearful. And when you're in a position of feeling fear or demoralization, your ability to make positive directional decisions goes down. And we need to think different. We need to think better. I agree. And I think that one of the things that comes up for me is trying to be innovative within a space where you also are continually feeling fearful of losing your job or you're continually feeling like, I need to have this level of security because I need to feed my family, pay off my debt, have a mortgage. That's a really hard place to be in because you tend to hunker down when you're afraid and you don't tend to have an openness around change. Because also when you are innovative and other people are also fearful, then you become kind of the spotlighted person like, oh, that person wants to do things differently, but we all just want to hunker down. There's a huge dissonance there, and I think that's where we are right now. We're in this place of dissonance. How do we move through this? How do we become, you're talking about individual resilience. How do we become resilient as a society, as a culture? That's a great question and I have so much we can go on for weeks about this. I think one of the centerpiece, and there's so much experimental data to support this, is we need more contact time one-on-one time, not digital time, not that not a text message, not social media, not polarization. We need time with each other as healthcare providers, and we need time to connect with members of our community who are not healthcare providers, but depend upon us. And it's not just being doctor barking, it has to be Jeff or Dr. Jeff. So when somebody approaches me in the parking lot and says, yeah, I listened to your radio show and I agree with you on this, or I disagree with you on that, wonderful. We can now have a healthy dialogue. We have to begin to think of ourselves as ambassadors from the medical community. And in fact, all of us have to consider ourselves ambassadors from whatever community we come from. So to come out swinging, to come out telling people what to do, undermines resiliency. The other thing that physicians have to do, and this again sounds obvious, is take care of themselves. Because physician burnout from the stress that you outline is at record highs and you don't want to lose physicians to retirement. And what happened with psychiatrists is we had 110 actively practicing psychiatrists in the state of Maine five years ago. Now we're down to 60. And I've learned of layoffs. So we may be down much more at a time of mental health access crisis. We have to educate the public and we have to be together so we're not so anxious. Something when we're emotional, even positive emotions, we make bad decisions. Well, that kind of makes sense. So you're saying we have to bring ourselves back to a place of more sort of rationality and intellectual approach. Is that what you're suggesting? We have to bring ourselves to a point of kindness, being able to explain things. Doctors need to own our own uncertainties. Many of our treatments don't work as well as TV commercials would lead our patients to believe. We have to be more honest. We can't scald. The more we do that, we change ourselves away from being just telling you what to do with a prescription pad, to interacting with you in a way where we can be trusted. And if we bring down that volume, we bring down that anger and we engage the decision makers, the political people, to understand that when you lose your hospital, that's a big deal because then you're losing not only your medical access, but the access to get people to move or stay in that community. Because we know that meds and eds, the medical access and the educational access is what draws people to move and stay in communities. So we have to make sure that the people that are decision makers politically understand that if they don't support us, we won't be there because of the anxiety that you describe where people have to make ends meet. And the other point I'd make is being dependent upon somebody to pay you creates tremendous anxiety because what if they don't? As this happened over the past few weeks, and I have a boss, and I know sometimes my kids say he can be tough, but it'll never fire me and that boss is me. And that's a different model. That's a very different model. So 20% of doctors have that model, 80% don't. And the 80% that don't get 10 to 15 minutes with their patients and the 20% that do have as much time as they need with their patients. So I would suggest that thinking differently, even though it sounds like something from the past may be the way to go. And in models like Direct Primary Care, we have numeric evidence that you can pay providers in advance for just taking care of patients. And it's more cost effective than the Byzantine insane system that we have now. I mean, no arguments here. I absolutely agree with you. And I think that the way that it used to be where people own their own practices, where they had responsibility for the people that they employed, if they employed any, where they were submitting their own paperwork, if there was paperwork to be submitted. I mean, I think that it's a very different feeling than waiting for somebody to offer you a paycheck. And so I see that there absolutely is a positive future for that. And we still have, we're still existing in the current structure. And so I like what you're saying about learning how to communicate, because I do think that oftentimes the scolding is one thing, and physicians, we do it well. And as a physician, I hope that I don't scold, but there is likelihood that I do because here's some information I'm going to tell you that you're probably doing something that's not aligned with your health and it's going to come across in a way that feels judgmental. But when we show up and we talk to people in the legislature with the general public in conversations like this, if we just bring ourselves in as know it alls, we know it all and we don't try to have a back and forth, that's going to go nowhere. And so how do we help people do that? How do we help people take a larger stage and hear at the same time that we're talking, Ask people questions and get them to tell you about themselves? Get to know them in a 10 to 15 minute encounter with a patient, not only is it short, but when the physician asks the patient, how are you doing? The patient will be interrupted on average within 15 to 20 seconds. We have to do a better job of listening. And only when we listen can we understand and we need more time to listen and hear more. It's like anything else, quantity or quality, pick one. And when we're interacting with patients, we see that when we're interacting with the public, we see that when we take a basic thing, how much do you drink? Or in Maine, do you use cannabis? The way you ask that question can sound skully or it can sound really open, right? I mean, what do you like to drink? I mean, Maine has a thriving microbrewery scene, thriving gin manufacturing scene, vodka scene. Actually a physician makes a top selling vodka and gin. It's really good. And I think when we engage people on that, rather than talk about only cancer risk associated with alcohol, which of course is a real thing, but only when we engage people on both of those thoughts, will we be taken seriously and not kind of perceived as skulls telling folks, don't do that. Don't do that. Which when you do that to patients, it's like dealing with teenagers. They shut out and they do the opposite. We saw that during Covid here you had vaccine access that most of us couldn't wait to get. And then you add another part of the population who absolutely refused vaccines and believe some things about those vaccines that they had 5G chips or whatever it was. There is nothing from focus groups that you or I can say to a patient that believes that those vaccines are effective. There's nothing that we can say. And if we don't understand that and own that, we lose. And that's a scary thought. But you get to know those people and when they begin to trust you, well maybe then their cognitive biases go down and at that point they may be open to more data and more information. And during Covid, I think I've had very positive relationships with people on both sides of the aisle. And some of the people that I would've thought may have been vaccine hesitant were not, they were really appreciative of my efforts to give them a ride, to get a shot. Simple things like that go so much further than a complicated scientific message that you need a graduate degree to even understand. I so relate to what you're saying, and I think it's, and what you're saying is really, really important. And I guess the challenge that I see is that I'm not sure yet that every, and I won't even say it's just physicians, like anybody who's interacting with people in the health space has quite the same understanding of the high level of importance of communications. And I do think that we have a bias around it, and it's really many people within healthcare, not everybody, many people within healthcare are showing up in these spaces with some sort of disconnect on what it means to connect with people on a human way. So trying to get people to that, how you're modeling it, you're modeling it through the work that you do in a healthy conversation. And through the conversation we're having here, you model it when you go out professionally, you model it when you write for the Portland Press Herald, which I know you did recently. And so in a similar way with our colleagues, without becoming scolds ourselves, without becoming the communications scolds, how do we move forward this idea that the way that we communicate is just as important as what we are communicating? I think the biggest message I could give people to answer that question is to really go back to basics, which is communications is content and process content or the facts and what's being said. Well, do you really remember what you had for lunch two weeks ago? Probably not. Process is how it's being said, how it's making you feel. If I asked you about lunch two weeks ago and you ate your lunch in a contentious meeting, there is a good chance you're going to remember that. I think we have to remember that we have to keep a process that's healthy. And our radio show a healthy conversation, kind of the name says it all, where we'll take on any topic. It could be the health impact of art. It could be any topic. It could be a really controversial topic. But the goal is, let's talk about it in a way that has a healthy process. I think, I hope I might be very wrong. I'm not seeing it now at large, but I hope we can get back to a place where it's normative to have a disagreement, but be able to agreeably disagree or agree,