Dr. Chuck Radis: Maine's Renaissance Physician

It's my great pleasure to have in the studio with me, a fellow physician and author, Dr. Chuck Radus. Thanks for coming in today. Thank you for having me. Thank you. I know that you're a very busy individual. As you and I were talking before we started filming, you were talking about, so I'm on my way up to Ellsworth. I spend a week a month up at the Main Coast Hospital, and I do still practice rheumatology. You just told me you have four books that are out. I know you do a lot of social justice work, you have a lot going on. Always been kind of a restless soul I guess. So yeah, when I left full-time medical practice in 2015, I knew there were a lot of things that I really had been looking forward to doing. I'd have time to finally spend more time on them. One of the things that I'm interested in too is that my dad, long time and family practice doctor, it was in the same medical community that I know you were practicing in the Portland area for many, many years and he actually would never have stopped practicing. I think he still would be doing probably what you're doing now if he hadn't needed to step aside to manage his cancer, which now he's doing great. So that all works out well. But I love the fact that you still are really enjoying the practice of medicine. I'm not sure everybody can say that right now. I think that's true. You hear a lot of noise about that. I've always really enjoyed seeing patients and can put aside the other aggravations of medical practices, and I've also seen physicians who've completely stopped practicing and didn't have enough to fill their days. And so I'm in a nice niche going up to Main Coast a week, a month, and there's a history of that in rheumatology is that since there's so few rheumatologists in the state, every single rheumatologist I can think of in the last 30 years stopped full-time practice in their late sixties or seventies and then continued smaller practice in more rural areas of Maine. And so I'm actually just following in the footsteps of people who I knew who had retired before me from full-time practice. It's been kind of interesting how that all has and practicing into their eighties. So For those who may not know what rheumatology is, talk to me about that a little bit. Sure. The fellowship is actually usually rheumatology and clinical immunology. And so within that broad group of diseases, some of them people have arthritis, but a lot of them are really disorders of the immune system. Some of them are just special to rheumatology like lupus and rheumatoid arthritis, but we interact also with immune system disorders that say Crohn's disease that the GI people manage. Sometimes we become involved with that with pulmonary interstitial lung disease syndromes. So it's an area that luckily in the last 15, 20 years, it's just been an explosion of more effective medications and lesser reliance on prednisone, which is the big bugaboo. Yeah, you're right. I mean steroids like prednisone obviously great for inflammation, but also lots of side effects, very nonspecific doesn't do anything to actually get at the cause of the underlying process typically. Right. Yeah. Michelle Petri at Johns Hopkins who detests the long-term use of prednisone, she feels that the P in prednisone should stand for poison, which is hard because we still have diseases in which people have to be on some prednisone, particularly in the beginning. So I never try to poison the waters with that, but so much focuses on finding more effective treatments in which people are either briefly on prednisone or sometimes not at all. One of the reasons I'm teasing out what is it that you do now is because I want to kind jump back to what it was that you did before because you actually were what I think was considered family medicine in the day as opposed to primary care, which is what it is now. You were an island doctor, you wrote two books about being an nylon doctor and you made the choice to move into specialty medicine. So talk to me a little bit about that. Right, so I've always had an interest in immunology, and so going through college, I went to Bates College and my internal medicine residency, I did a lot of elective time or class time in immunology, but I knew I had a National Health Service Corps obligation to serve in primary medicine in a high need area, which I looked forward to. So I knew I wasn't going to be going into rheumatology right away or perhaps never. And so back in 1985, my area of service was the Bay Islands. So my wife Sandy and I moved out to Peaks Island. That's where we still live. And then I started a practice that actually served a clinic on Shabe Island and a clinic on Peaks Island. And then some other islands were serviced by house calls, but eventually I kept circling back to immunology and I had some other physicians who were in rheumatology who encouraged me even though I was getting a little older to go back and do a fellowship. And that transition happened a long time ago in 1991. So I've been in rheumatology a long time. And what were some of the lessons that you brought forward from family medicine, primary care medicine into your specialty practice? Yeah, that's a great question. In rheumatology many of our patients, particularly the younger patients, it's the only condition they have. So an 18 year old with lupus or a 25 year old with rheumatoid arthritis, and so in many ways we become their primary care doctor because a lot of the medicines we use increase the risk of infection. We make sure they get immunizations. A lot of our drugs may increase the risk of cardiovascular disease. And so having been in primary care, I like the idea of seeing people long-term and looking at kind of the total picture of how they're adjusting to a lifelong illness or not, and trying to approach that from primary care. And obviously many of them had primary care people in addition, but I just kind of was in sync with that to be able to see people with some of these long-term illnesses. When you were acting as an island doctor, I think one of the ways I became aware of the work that you did then I knew you as a rheumatologist for many years when I was in the Portland area practicing, and I had no idea that this was your background. You came to the Hanley Institute and you read from one of your books and you were really describing this interesting and very different island culture and very different and kind of unique negotiations that you ended up needing to go through with the community so that they were willing to accept you into their midst to practice medicine. And each of the islands is unique, and so you can't really compare long to peaks or long to shabi. So the culture of each of the islands was very different, which I had no idea and had to learn that on peaks where we lived, I was less of an outsider perhaps compared to the other islands. There was a lot more poverty on Peaks Island at that time. Peaks at one point was known as Poverty island, and so it hadn't been gentrified at all. There was really a culture of just managing things on island. Some people never left the island for anything. There was a grocery store on the island and some people didn't even leave their side of the island. And so when it came time to convincing people to get testing or to see a consult for say, gastroenterology or cardiology in Portland, sometimes that was a big negotiation and sometimes people certainly did not want to travel to Portland. Some people did. Obviously it wasn't a everyday occurrence, but there was a lot of negotiations going on in terms of getting people the care they needed in areas that I wasn't really well trained to take care of. And I think that is an interesting thing. I have also noticed about practicing in Maine when I was practicing in Brunswick and the institution moved our practice to topum, people said, oh no, I'm sorry. I really like you as a doctor, but I can't cross the river. It's too far away that people really are very tied to geography, many people. And So I guess if you're on an island, it kind of makes sense, right? You actually have a notion around you Even more. But I think in Maine that's true even for smaller communities. Yeah, so true. Part of what we do in medicine is building trust with patients, and you just said, when I lived on peaks, I lived there so people knew me. You're going to other places where people are very tied to their geography and very tied to their community. How does one kind of break into the island culture and maybe convince people that you actually could offer them something that would be worthwhile to them in the form of healthcare? I Don't think there's one pathway with that. And you can't try too hard. That doesn't seem to work. Sometimes it's just luck in that you treat a person early on who is influential in the community, they like you kind of quietly the word spreads that you're okay. I had an extra little bit of a challenge in that my training in primary care was as a do. And for some people back in the mid eighties that mattered. And so there were some people who needed additional reassurance that as a do back in the mid eighties that they were seeing the equivalent of an md. So there was a little bit of that back in the mid eighties. There was a lot of transition going on with that. But back in the mid eighties, we still had osteopathic hospitals and only dos were on staff there. And dos weren't on staff, say at Maine Medical Center. It was kind of separate but equal. So not on an everyday basis and actually much less on Peaks Island. There was a little bit of that do MD thing going on subliminally. Yeah, I mean, you're describing something that I think anybody who is, I don't know, maybe 40 and younger or maybe 30 and younger, certainly wouldn't really understand. I think the MDDO divide has largely been kind of erased, particularly in Maine, maybe other parts of the country. I don't really know. I've never practiced anywhere else but in Maine, I mean, we are all physicians. I agree. Agree. We Go to medical school and we come out doctors, but you are absolutely right. Historically there was a very big divide, and I was at Maine Med doing my family medicine residency when the first DO was brought in as I think a pediatrics resident. It was a big deal. This person had to be the best of all the best dos in order to make it into the residency at main me. That's right. And thinking back to it now, it's so strange. I don't think we approach it that way anymore. No, I mean the chief of the medical staff at Main Med eventually was a do. So once practices on the outside became blended and hospital staffs blended, then do hospitals merged. And so that all went away. And you're absolutely right. People from a certain age and younger really would be going, really. And the answer is yeah, still, well, not so much still, but certainly true for that time. And it feels like we're continuing to really try to figure this out. How do we actually offer care to patients? And it's still, it's a very hierarchical model. We still think a lot about doctors, but we also have nps, nurse practitioners and physician assistants who I think might be called physician associates now. But I mean there's different levels. We're asking our RNs to do more, our medical assistants to do more, but there's still this interesting thing. We're still, we don't have enough people to care for the patients in the state of Maine, arguably around the country, but definitely not in rural places like Maine. And yet there's still friction and strife. We still can't quite figure out how to make it all with the resources we have. It's evolved, but not always in a direction of better patient care. Some things that we've experimented in recent decades have worked well and others haven't. You even have that divide or option. Then used to be everyone was in private practice managing their own practice. Now most physicians in Maine are employees, and that model can work better in some ways, but maybe not as well in others. So it compared say to other countries that have a single healthcare system, I think it's very complicated. It's very complicated for patients to navigate, and I've been a proponent of not getting rid of private health insurance, but having a single payer system that people can opt out of, but that it's just a single system and that is also a very difficult thing to evolve into when you have this history of our for-profit system. So it's never easy. I found out a lot of that, more about that when I was in the Hanley program, which was a great experience. Well, I had no idea that, or maybe I just wasn't paying attention when you were introduced, so you actually also went through the Hanley Leadership Program. I did, and at the time I was in full-time practice, but it's still, I really look forward to the time there. It was such a different experience for me. I hadn't been involved very much at that point in public health or the bigger pictures in medicine. So I enjoyed that respite from full-time medical practice. I think it was on weekends maybe when you would do it, and they brought in a lot of interesting folks. As I'm hearing you talk and knowing your kind of broad range of interests, it strikes me that one of the things that we actually need in medicine is people who are interacting in spheres that are outside of medicine so that we are having different experiences that maybe we can learn from in other places. I mean, Hanley was certainly specific to medicine, healthcare leadership, but for example, you spent six years writing a book on the botany of Casco Bay plants with your brother. I understand. Yes. I mean, are there lessons that we who are kind working with the wellness and health of patients can get from non-healthcare settings? What can we learn? The healthcare system that part's complicated in that many healthcare providers feel that just doing what they're doing in medicine is all they can manage and that they have very little time for outside interests. Having said that, if I go back to the admission processes for medical school, still, there's some exceptions to this, particularly say at Columbia where they pick people who have broad backgrounds, but there's this arms race to have as good a record that is just focused on medicine and excel in your classes and do well on MCATs. And sometimes I feel that the people that are selected now are top heavy for people who have had to give up everything already just to enter the queue to enter medical school. And that then self-selects them for people then who maybe are struggling because they're engulfed in medicine and their careers and they don't have time they perceive for outside hobbies. So a little bit of it I think goes back to the selection process now be just my own take on it, Which is interesting because obviously you wouldn't debates a small liberal arts school in Maine. I went to Bowden, another small liberal arts school in Maine. And so we come at it already from a different background than somebody who enters into it from let's say an engineering school, let's just say. Right? So then I think it predisposes people like you who want to write or want to explore different things outside of medicine. It predisposes you to kind of stay on that path. And at the same time, I also absolutely agree with you people either if you're in a private practice or you're employed, you work a lot and you care for patients and it's very time consuming. I also struggle with how do we create enough balance so people actually can find time outside of medicine to do anything other than maybe raise a family? There's not a quick and easy answer to that. I think part of it is acknowledging you can never really have a balance. You can work toward having a balance. And I think if you're working toward that, you're always looking for opportunities to do things outside of your medical practice instead of just assuming that your whole life has to be engulfed by that. And part of that is saying no. So if you're saying yes to everything in medicine, even things that maybe you don't have to say yes to or you're not exploring whether there are some things you can say no to, then you're never going to have time because it'll expand to as many hours as there are in the day. But if you are always looking for opportunities to simplify things or saying yes, more say to your family, your long-term mental health I think is better. But it takes almost constant awareness that you're making choices and sometimes those choices lead to even longer hours. Well, one of the things that I do in my current work is a lot of bringing in and retaining medical staff across specialties, but in particular primary care. And one of the things that we are noting as people who are coming into medicine are already setting boundaries and saying, I'm sorry, your definition of full-time is not something that I want to do. It's not something that works for my life. So We very rarely have people who come in as what's called a 1.0 FDE. People will come in and they'll come in halftime and maybe halftime in primary care, halftime in addiction medicine, which is the term of art, although it is substance use disorder. Now, technically, I wonder if that's also part of just rejiggering. If the expectation is full-time care looks like this, that we as physicians and advanced practice providers, if we have to kind of say, well, alright, then I can't do full-time. I can do slightly less than full-time. I can do halftime and I might have to make changes say as I'm raising my children or as my interests evolve outside of medicine. Right? Oh, I'm so glad you're bringing that up because that's the counter movement going on that sometimes I'm not always aware of and that's healthy. And some of those people eventually life changes and they change their hours. It's great as employees that people have that option, so that's great. Well, I think it's almost had to happen. I mean, when I started in medicine, even though my medical school class was half women, the people who came before me, that was not half women and the Family Medical Leave Act had just passed. And actually not even as I was, I never even benefited from the Family Medical Leave app, but as I was having my children and seeing all the other women around me who literally would have to actually drop out of medicine in order to raise families, I Mean, that was not a tonal solution. So as we've said, yes, we would like to be more inclusive of other types of practitioners, we've had to say, yeah, we're going to have to be more inclusive of other ways to live people's lives And having some of your work involved in trying to create an environment where people can do that. I think that that kind of movement is being shared by lots of institutions, I'm sure. And so that's healthy. That's great. We've Veered very far into the traditional medical kind of conversation, but I want to make sure I take some time to talk about some of the work that you do in medicine that's not here in the United States that focuses on other people from other parts of the world. So tell me about some of the work that you're doing in social justice. Sure, thanks. Both my daughters went to Portland High School and at Portland High School, as you know, there have been waves of immigrants and asylum seekers, and in their class was the latest African immigration years. Before that it was Vietnamese and then it was Eastern Europe, but for decades now it's been African. So some of their classmates were from South Sudan. I got to know the parents, they'd already formed a group. And so back in 2012, my wife and I formed a small family nonprofit and we started doing small projects in South Sudan during that period of time where there was some stability there before they really went off the rails into a civil war. And so we had the contacts here in Portland and some of the people we were working with were relatives in South Sudan, but we were able to adopt programs. We didn't have to invent things. So we would look around and we found a nice program through the Mass General in which they were already in South Sudan. They were training traditional birth attendants. My son-in-Law, who wasn't my son-in-Law now, and now he's in family practice. He went with me on that first trip and we trained 17 traditional birth attendants in a mass general program. Went back the next year, did a first aid program, and we're kind of gearing up to do more of those kinds of programs in South Sudan when most of the people we were working with fled south to a UN settlement called in Uganda. And so that's where our programs had been ever since. And until Covid, I was going there a couple times a year and we helped set up a sister nonprofit within the UN settlement through which we could do our programs. And they very much were the ones who were deciding what kinds of programs they needed that the United Nations really wasn't able to take care of on the ground there. So we've been doing that now for quite a few years and it's been manageable Because It is just a family nonprofit and we get donations from friends and family. If anyone is interested in donating toward that nonprofit, they can go to maps j.org, Maine African Partnership for Social Justice, and they could look at that webpage and perhaps decide to donate toward that. So that's been exciting that that didn't die out with the Civil War and that we were able to reboot it in Uganda, which is much safer. So you have that family project going, and you also wrote this book that I referred to earlier with your brother. I do relax. I'm out on the water quite a bit, but I realized that I'm kind of restless. I like having multiple things going on at the same time that I can whittle away at in my spare time. I've always had really broad interests and thankfully I've been able to usually follow them through to the end of a project. So I'm now 70 and feel like I've still got the energy to do most of these things that are important to me. So Why botany? What was it about, was this because this is your brother's interest and why botany of Casco Bay specifically? Well, my brother is in consultant and in rare and endangered species, both botanically and reptiles and amphibians. That's what he's done for his work for decades. So I've kind of gone along with that. We grew up spending parts of summers in a remote farm in West Virginia where my grandfather lived and my uncle would take us around and we would look at flower and plants and he would say, this is that and this is that. And I really, really enjoyed that. And my brother later told me, well, you remember Uncle Thurman take us around. He says, there was not a single thing that he told us that was correct. There was not one thing. And so I kind had a realization that, oh, all this knowledge that I thought I had, I had to rethink. So my brother's a great guy to get out in the woods with and just kind of review all that. So it's one of the ways we bond. I mean, that's the way we spent time. He comes up to Peak Sign and Casco Bay and he'll tromp around the woods and it's very relaxing. And I don't accumulate botanical knowledge very well, medical issues for some reason. They get kind of compartmentalized, but he's very patient with repeating and repeating and repeating. So yeah, good guy Rick Radus. And the name of that book is Flower Implants of Casco Bay. That one was Self-published this year. The other books are carried by down east, and we have it at Paul's marina and Harpswell and a couple of the island bookstores, peaks Island. So it's very limited. You'd have to really look for it to find it. It sounds very special, so it's worth looking for. Oh yeah. If you live on Casco Bay or near Casco Bay, he's a great photographer. And so he took all the photos and I helped with some of the descriptions. It's amazing what's out there, and we just really start looking at it for it. And then you were telling me, just going off on a completely other, different other direction, you were part of writing a book about John Jenkins. Talk to me about that. Right. Well, for some of your listeners, they may remember John Jenkins. He was kind of a bigger than life black politician who I went to school with at Bates. He became mayor of Lewiston, mayor of Auburn, Maine's first black state senator and was very a high level karate competitor all his life. When he died, a committee got together wanting to honor him, and I agreed to collect stories about him, which eventually morphed into writing a biography. And I've never done that kind of writing before. So it was fascinating to try to read some other biographies, not the 500 page ones, this is a very short biography, but to try to understand how that comes together. So I really enjoyed, I interviewed his family in Newark, New Jersey, which is where he came from, some of his karate connections. And that down east published that this past spring. And we had a nice celebration of John's life. And so it was important to remember him. I really feel he is an important person in Maine history, and I think this committee that got together did so many nice things to memorialize him because he passed away during Covid, and really there really wasn't a celebration of all the things he brought to Maine that were important. Well, having spent some time with you now, I have to say that you and I are likely kindred spirits. My husband would also tell you that I'm also a restless individual with a broad variety of interests. And it's actually nice to hear that it's completely fine. You could be something other than a doctor that is not your whole identity and that you can actually build a life that moves off simultaneously down different paths. So I appreciate that you've been willing to share this element of yourself with me or all the elements, because it's something that I also know to be true of myself. Thank you. And you went to Bowden and I went to Bates. I did not appreciate a liberal arts education as I was getting it, but I think that broad range of things that you're expected to experience in those kind of institutions really makes it more likely that you and I later on are doing a lot of different things, and I have to include Kolby in that all three of those institutions. It's hard being a liberal arts college. So yeah, thank you. And it's been interesting learning a little bit about your life, And I think that this, for me, you are asking, what does my day look like after this? And there's my medical stuff that I do, and then there's this that I do. And one of the things I like so much about doing this work is learning about people in a different way. And actually, I mean, it's something I value so much that somebody is willing to come in and have a prolonged conversation on themselves and their lives. I think that's not something that happens very much anymore. No, you've asked me things that I've been asked ever really. So it's been pleasure. It's been really interesting, and I appreciate you asking me. Thank you. I've read one of your books. I look forward to reading the other three, and my dad in fact handed me, I think one of your two island books, so that's on my list as well. But I hope that other people pick the time to, you said it's called Paul's Marina? Yeah, Paul's marina in Harpswell carries it. And if someone wanted to drop me an email or contact me through you, I'd be glad to send them a copy of the botanical book because self-publishing, I'd never realized just how complicated that can be, and after it comes out trying to find places that sell it. So thank you. Okay, well, very good. So there are many things that Dr. Chuck Radus can teach each one of us, not medicine, botany history, all kinds of things. So I encourage those of you who are watching or listening today to learn a little bit more about him through his books or maybe donate to his family foundation and support others around the world at the website that he described earlier, which we will also put up on our website. And it's really been a pleasure talking with you today. So thank you for taking the time. Thank You, Lisa. It's really been great. I appreciate it.