From Peaks Island to Patients: Dr. Chuck Radis on His New Book

Today I have with me a fellow physician, Dr. Chuck Radis, who I'm sure those of you who follow Radio Maine will recognize as someone that we've interviewed before. Really a colleague of mine here in Maine who is a still practicing rheumatologist, but also a fellow storyteller. And here today because you have another book coming out, which is pretty amazing, how many does this make for you, Dr. Radis? That would be six. And some of them have been so much fun to put together because I've collaborated with my brothers on botanical garden guides, so I've been able to have each book a little bit different focus. Some of them not in medicine. I think one of the ones that I read was about the plants of Casco Bay, and it was a picture really feast for the eyes, but also a lot of interesting history. And so when my husband and I went out and about in Casco Bay with our boat, it led to a greater enjoyment of where we were because we were able to get more information around the things that we probably had been seeing for many years. I'm so happy you were able to do that. We divided it up in that my oldest brother is kind of the brains of the botanical world. I wrote some of the pros and the history and the other brother was very lucky at being able to find some of the rare species we were looking for. So it was really wonderful collaborative thing. You kind of dream about doing things with your siblings and we were able to put that together. So this latest book is Mystery in the Room, R-H-E-U-M. So a play on words, a Physician's Journey, treating patients with rare diseases. And this goes back to your being a rheumatologist, but I was immediately struck with your book that there's sort of the clinical approach, but in the meantime, you're also weaving in some information around, in this case, the first patient's diagnosis about lupus, sort of the history of it. And you're talking about Plaquenil and where this came from. And I'm wondering, did your work with botanicals and your work with plants and your brothers, did that lead to an increased interest in the history of, for example, the medications? And what words led to the wolf being associated with lupus? That's interesting that you would've thought about that. I think the short answer is probably yes, not just from the collaboration I had with my brothers, but so many of my patients would be taking plant supplements in hopes of ratcheting down inflammation and help me not only to be able to identify some of those in the wild, but also to discern what really has some scientific evidence, what hasn't been studied at all and what's been studied and debunked. And so that's been kind of a little bit of a side interest that I tried to weave into the book some. And I tried to weave into the book my current and past life, which is living on Peaks Island and commuting by boat as a way of thinking about my day. So it was really a device of still living on the island and forgetting things and my hapless way of dealing with my commute, forgetting things, leaving things everywhere. So it took me a long time to try to tie together stories about rare diseases and interactions with patients with the actual moving back and forth in a way trying to keep it interesting. My hero in this genre is Oliver Sacks who wrote The Man Who Mistook His wife for a hat in neurology. And he did such a great job with bringing to life neurologic conditions and what it's like for people to live with them and what it's like to try to diagnose some of them. And so I definitely have patterned my book after his. So here's to you Oliver What you are doing with your books and in particular with this book is really important, particularly in this day and age because having been a physician during this intense time of really spectacular scientific advances, we've seen so many wonderful things that have come about with molecular medicine and with digital medicine and all the technologies. And at the base of this, we still have people. And sometimes when you get really focused on the small, you lose sight of the big. And in this case, I think the big is truly the people and their context and where they're from and their families and how they're impacted by what they've been dealing with. So that's one of the things that I really enjoyed reading about in your book and actually in your past books, one of which was Go By Boat, which I know others who have been watching Radio Maine and listening to it know that this was something that you put a lot of time into with regard to your family and your prior work. As the primary care doctor, how do we bring this understanding that at the end of the day we're still dealing with people? How do we bring that back into medicine these days when the pressure is how many things we can get typed into the electronic health record, how many people we can get in and out of our offices, how quickly we can treat people, how efficiently, how do we just regain that, regain that personal touch and that understanding? It's a complicated topic. There's not one answer to that. I have thought a lot about trying to use the electronic medical record as little as possible while I'm in the room with the patient. And that involves getting everybody else on the team in that same mindset, meaning entering things before you see the patient reviewing their history before you go and see the patient, and then having a conversation and examining the patient without looking at your typewriter and looking away and not making eye contact. And my belief is if that's your goal, you can't always succeed in that, but you can move in that direction. The second thing is that all of these pressures come about from the huge move of physicians becoming employees. And in my earlier years, most physicians were in private practice, they didn't want to see X number of patients per week. They, they realized they made a little less and so they were in control of their time. And we've lost that. And it's become almost automatic that people look for a job with a hospital or a large group employer, and there's nothing wrong with that, but you do lose some of your individuality. The third thing is, even when you're in that situation, I believe physicians have leverage still. They can say no, they can form committees to figure out ways to retain their autonomy. And ultimately that isn't happening enough. Physicians, as a group, we complain a lot and we get burnt out and we accept more and more without pushing back. And in reality, I think physicians and physician extenders, nps, PAs, they have a lot more power than they think. So I think in the service of our patients, we should be doing more to push back. You're offering some very wise reflections and suggestions and some very practical ones. And one of the things that I think you've correctly identified is that unfortunately when we as humans feel overwhelmed, it is the inclination to complain and to say, oh my gosh, things are so difficult, but I don't have any power. I don't have any power to make any sort of change. And on the other side of it, when we feel powerless and our patients come to see us, then they have the sense that we feel powerless. And more often I will have patients who have come to see me and say, well, that last doctor, they really seemed like they were burnt out. And for me that's so unfortunate because So sad, It doesn't lead to their healing, it doesn't lead to their trust in the profession. So there's something about what you're saying that really is about we need to get right within ourselves and get right amongst ourselves as a group so that when we show up with our patients, we actually can do our job well. I think that's a perfect description of where we are. And as I said, it's complicated and it's going to be hard to move away from that. There is a very strange use of AI that actually I'm not a big fan of AI personally, and I worry about a lot of things with ai, but in some practices now you can tell the patient, I'm going to be using AI to record this visit, and instead of constantly being on the computer AI's listening and then puts the visit together, the physician then looks over the visit, makes corrections and they're done, and that can be out of the room. So in some ways, what I was talking about not being married to your computer screen, that is something that's happening now that perhaps is a very positive thing with ai. So I'd be interested in how that goes forward. Yes, and I've similarly had that feedback from people who are using AI in that way. When I was at a physician leadership conference not too long ago, that was actually the feedback is this particular use of AI has enabled us to actually join with our patients more effectively because Now we're not looking at the screen, we're looking back at the patient. One of the things that you talked about was I think it was listening to the person's heart and hearing a pericardial rub, so hearing a heart sound. And that's another thing that if we can use AI to take out some of this mechanical information and help us with that, we can actually go back to maybe physical diagnosis skills, Which wouldn't that be amazing. I mean, I think there's a lot, again, technology is really fantastic, but also you don't always have access to technology. You can't wait for the ultrasound to come in. So what if you could actually hear that additional heart sound and say, oh, here's a clue. Let's start here. The first thing you have to do is really want to do that. And so I would even go back further to potentially the types of people that are going to medical school and the people who are being selected. If it's an arms race to have as many degrees and basic science and lab work, and we're bringing in a lot of physician scientists into medicine, which absolutely plays a role. We wouldn't have all these technological advancements. But on the other hand, if the kind of people you bring in don't appreciate stories that they don't have the well-roundedness to connect with a wide range of people that it's hard to unlearn that it's hard to put that on board in a patient physician interaction. So some of this even goes back to who, who's going to medical school now. And as things are tighter and tighter, ultimately the admission standards maybe are excluding people who might be a better match with the kind of going forward with the kind of world we want to have with physician patient interactions. Well, if we have now AI that is able to extract information from conversations and the people who are kind of rewarded aren't the ones who are able to type the most quickly because that's not the ultimate goal, then we actually are going to be able to reward people who can get information through conversations. And the people who can get information through conversations are people who know how to talk to patients. There are people who know how to appreciate their stories. There are people who know how to ask questions around their families and their communities. So I mean, if we're talking about the goal, the goal is to get the information from the patient so that you come to a diagnosis that you can help treat or at least manage. Yeah, So we'll need people who know how to do this work now that AI is doing this other work. And ultimately this may almost be blasphemous, but I think part of the reason why so many of our patients love their nurse practitioners, PAs is that they come from a little different place. Many of them are bright enough to have gone to medical school. I've taught NPS down in UNE, and ultimately they bring with them sometimes a better ability to listen. Patients like their nps, and I don't hear that as much about their physicians who seem married and burnt out. Yes, Again, that's kind of blasphemous, but to me, I think there's a little bit of truth to it. Well, having worked with many physician associates, nurse practitioners, but also nurses and medical assistants and front office staff who all contribute to taking care of the patient, I think every patient who feels valued by a member of their medical team is then going to value that member of the medical team more so it doesn't, I mean, physicians could easily be that person for the patient if they choose to do that. But again, there is some amount of sort of emotional self-regulation as a physician and some willingness to get into difficult conversations about things that aren't going well. I mean, I've worked for large healthcare systems, I've been on the executive leadership team of large healthcare systems, and I've been in medicine for three decades, and you absolutely can say, oh, I have no power and I can't do it. I'm just here to pick up a paycheck. But you absolutely can say, yeah, it's really hard to get into a conversation with somebody about something that maybe they don't agree with me on, but it's entirely possible. Yeah, you have to really want to be open to that. Moving back to you and your life, I was interested to hear about the loss of your father at age 11 because I think you and I have talked before and I've read your other books and I don't know that that surfaced as much as a theme for you and how it really contributed to your desire to actually pursue medicine in the first place. So talk to me about That. In our family of three boys, each of us experienced his sudden death very differently. And as the youngest, I didn't have the resentments or I wasn't bucking up against my father as I would've been if I was 15 or 17. My brothers were mostly, I just had a deep loss that I didn't really recognize. And during those following years, I'm fortunate that some of the close calls I had from reckless behavior didn't really permanently affect my life going forward, and I vowed not to be like my father. He was a very, very, very hardworking guy as a chemical engineer. And ultimately I think I did multitask my father. I ended up being really, really a busy devoted person to my profession, but I listened. I continued to listen to my family to pull the brakes on it sometimes. So ultimately there's this stance you have, you are your father's son, and if you share some of the same characteristics, maybe his loss early on was like a stop sign. You can't keep doing more and more. You have to be able to learn how to say no to an extra committee or extra social engagement and get back to what's important to you and your family. So that keeps reoccurring with me over many decades. It's hard to keep on track with that, but I try. Do you think that that contributed also to your interest in living on Peaks Island and having a life that was more in tune with what was going on in the natural world? Yeah, I think probably it did. I was fortunate in that I grew up in New Jersey, but in an area where there was a trout stream and a lot of places to hike as people raised in an eyebrow about New Jersey. But when I came to school here in Maine, I was so attracted to I guess growing up somehow in the back of my mind, I knew I would live in a more rural setting. And even though it's been difficult at times living year round on Peaks Island, it's allowed me to say no to a lot of things. And ultimately that's been kind of the touch point for everything, being able to still live out there year round. So I never regretted the decision to try to make that work. In addition to Oliver Sachs, one of the authors that you have named as being someone that was important to you as John McPhee, John McPhee wrote about, Maine actually has written about many, many places, but he's very much at home in that natural world, and he marries that with storytelling. So this particular book that you've written is more clinically focused, but you still pull in information from kind of the exterior world, you bring it into the clinical space with you. Do you feel like physicians have the opportunity to do that these days? If you mean being able to carve out that time to bring in the natural world into their lives? I think if they're not, they should. And ultimately that whole dual focus of working. But when you're not working, you're not switching on the TV all the time or staying indoors, but getting outside and trying to recharge is absolutely critical no matter what people do, finding something to recharge is so important. And not just medicine, but in so many areas. The book had a really odd evolution. I actually finished this book about, I thought I finished this book about seven years ago, and I tried to sell it to an agent and she just didn't think that it worked for her to be able to represent it. But then she said, well, do you have something else? So I gave her a half finished book, which was go by boat, and she says, oh, I can represent that. That works well for me. So this book sat for a long time, and over the years I kept publishing short essays in medical journals about rare diseases and the interaction of the doctor with patients trying to sort out symptoms and come to a firm diagnosis. But what I was missing was how to make each chapter work and how to flow it. And eventually I came on, yeah, I still live on peak sound. I'm coming in and I'm thinking about that patient on the boat and when I'm coming up at night, I'm thinking through. So it's in a way having the natural history and my trip every day by boat has enabled me to as a device, to kind of move between the stories. And until I did that, I would have book clubs try to read what I thought was the complete book, and it was just like people would lose interest, too much medical jargon too much, but hopefully the final form of it, which has lots of bridges between the stories will work and keep things interesting for a general reader instead of focusing on having it go just toward physicians or people in the medical field. Well, I also wonder if this idea that you continually show up in your own stories, like to some extent Oliver Sachs does like to extent John McFee does. I wonder if that also will be appealing to readers because one of the things that has happened as we've gotten more technologically advanced is that I think it becomes here's the patient, there's a set of facts around this patient and this is how we're going to help this patient, and nothing wrong with that. However, there's another party in the room and that is us. And if you are showing up in this book on the pages yourself as yourself saying, I am the party in the room that's interacting with this patient and I am going to have an impact on this patient, good or bad, hopefully good, Right? That's so important because patients don't exist in a vacuum. They don't exist without being in some sort of medical relationship with us or other members of our team. I found in the rewrites that I was putting in more about what I was thinking as I was interacting with the patient and tried to actually be faithful to the fact that particularly in frustrating encounters, physicians are not always a hundred percent there or they're not a hundred percent empathetic. Physicians are like anyone else. You can drift a little bit. You can at the end of a long work week, you may not be the same person. You were bright and chippy on Monday morning. So I found as I was writing it that I needed to include in that interaction, particularly in visit after visit where I was sending patients out to other consultants with trying to find out really what was wrong to them, and they're coming back and I'm seeing 'em for a third or fourth time, that it was important for me to relate, well, how was I actually navigating this? And was I always saying the right things? And sometimes I would say not the right thing to a patient. I would realize that in terms of trust and developing that relationship, that people could accept a diagnosis and accept treatment because some of the treatments we have are really basically chemotherapy. And so there's that whole convincing that has to be based on trust when a final diagnosis is made. Yes, particularly in rheumatology in my field, which is family medicine, there's a broad variety of things that we might have to offer, but when it comes to your particular specialty, sometimes the disease is so bad that the cure is slightly better than the disease, but it's not Without risk. It's not without risk, and really life altering side effects Sometimes. And one of my partners when dealing with patients with life-threatening immune system disorders with basically his talk to them was, there's nothing I can give you that's worse than your disease. And that worked for some patients. Other patients need to kind of like, okay, you're taking fish oil, that sounds great. And in addition, I want to have this medicine on board. I think you quitting cigarettes is fantastic, and that lowers your risk of these side effects. And so you bring them on board with what they can do to lower the risk of these interventions and go with other supplements that people feel comfortable with that are not harmful and in some cases are helpful. But you also have to then bridge that gap between, okay, there you go, but you've been doing all that and you're still really sick, and at least for a while, we need to do A, B and C that are aggressive treatments to try to put this to sleep. And usually, as you said, with all the amazing technological advances as some of the medications in the last 20 years have just been fantastic advancements in the treatment of immune system disorders, just like light and day in my career spans that period of time when the percentage of patients who did really well was not as anywhere near as high as we wish, and now I expect my patients to do well no matter what they have. So it is a great time to be practicing medicine. What I also like about your specialty, and there are other specialties like this that are more similar to family medicine where you have a longitudinal relationship with people because if somebody goes in and they have an ankle repair, hopefully they're not going to need to go back and forth to their surgeon. Too many times it is repaired. Maybe at some point in the future you're going to still have a mechanical issue, maybe you'll go back to that same surgeon. But you and I as physicians, as clinicians, we see things when people come in to see us, we see people gradually, hopefully getting better, and then we see them when they've really kind of crested that hill and they've come to some sense of normalcy. And sometimes we see them as things return and maybe aren't able to get better again. So talk to me about that, because I know that that was also a theme in your book that patients that you talked about in the beginning, their stories were woven throughout the work that you were doing. Thanks for bringing that up because it is important to me to show patients over time, some of my early chapters with teenagers, a teenager with lupus, she appears years later, several times in the book, and not every time a patient reappears, they're doing well. So I try to be honest in that some of the greatest medical literature has been written by surgeons, and I understand why it's exciting. Things come to a head. There's the operation people who survive or not then onto the next story. But as you said, the follow-up long time, long-term isn't celebrated as much in medical literature. And so my challenge was to try to weave those people back in later chapters. I don't know if I succeeded in that, but in the end, because rheumatology and I practiced primary care for a number of years because the two are not as dissimilar as one would think, we see our lupus patients, we have to see 'em through their pregnancies, and we see people as they age. And we used to do a lot of pediatric rheumatology until we had a full-time pediatric rheumatologist, but we would see three-year-olds and six-year-olds with some of these immune system disorders. So as I was rewriting the book, I did try to have people keep coming back and see what's going on with them longitudinally or a postscript at the end of a chapter saying, well, this what's happened to this person over time, and I want to let your listeners know, these are not individual patients. These are several patients that I borrowed their stories from to turn into a single patient. So I'm not, They're maintaining privacy, Maintaining privacy, but I'm doing that by kind of drawing from a number of people who I would put into one patient. And I do think that that for me has always been the great joy of medicine, truly is the relationship building. And sometimes it's a relationship that only lasts for half an hour because sometimes you will see a patient and you will never see them again for whatever reason. But then there are other patients that not only will you see them during that time, you'll see them as their life moves along, you'll meet their sister, their child, their grandchild in family medicine. We would deliver babies and then we could watch the babies grow up. And it was really knowing that whatever you were doing, however you were showing up as a clinician, you were actually having impact on their ability to live their life in a way that was perhaps more joyful, at the very least less painful. And that's something that takes time. It does. And ultimately those relationships sometimes follow after a visit or two where you just think, oh my gosh, I'm dreading this person. Come back. Let's be honest, this was a really hard visit. But over time, sometimes that really changes and you find out something about a person that you better understand them and you understand where they're coming from. So I tend to listen and ask questions that I'll put in the medical record about things that I can ask next time, the name of their cat, a son maybe is having some drug problems to bring it up just briefly as part of a visit. So I put that in the medical record as many people do, and ultimately I have a better understanding of difficult patients. And when I say difficult, that runs the gamut from just not wanting to do what you think they should do to people who have so many adverse health habits that it's hard for them to be well. And hopefully we're part of the problem solving to help them get to a point where they can adopt healthier lifestyles. But as being in the trenches with family practice, so many of the problems are, if not self-induced, they're worsened by our own health habits. And the same thing goes true in rheumatology. The better health people are on to begin with, the more likely they'll do really well with all these medicines we have to give sometimes and they won't have those side effects. So we started our conversation with some discussion around the frustration of where things are right now in medicine, and there certainly is a lot of frustration. So I want to bring us back to why is it that we keep showing up? I mean, you as a clinician, you're seeing patients still a week, a month up in Ellsworth. So you carve that time out of your personal life, you make space for the travel up there, and there's something about it that really speaks to you, and there's something about it that causes you to write about it and to have a conversation with me here today. So what is it for you that you are tapping into that's caused you to open that clinical door and sit with patients time after time? I haven't spent much time thinking about that. That's a good question. I think my life outside of medicine has enabled me to be more resilient and to be able to weather the ups and downs of clinical practice. Of course, I'm an older physician now, and ultimately I don't think I could manage full-time practice. I wrote an essay for one of the rheumatology journals about as physician age, they should look for opportunities in which they can continue to practice, but not necessarily as a locum, going somewhere, picking up a practice, spending your weeks or month, and then going on to something different, but doing something longitudinally. And if anybody is interested and they want to contact me about looking into places in Northern Maine to come for a week at a time, and I dovetail with a rheumatologist from the Bronx, New York. So I'm up there in Ellsworth for a week and two weeks later, a rheumatologist from the Bronx comes up. Those kind of practices are so satisfying because I see my same patients with new patients mixed in, and I don't think I could manage a different kind of practice where everything is new each time you go. So I've always enjoyed the long-term relationships, and there are opportunities for physicians as they downsize and they're getting to a point where they can't practice full time to look into opportunities to practice still and to contribute. And as I said, if anybody wants to contact me about opportunities in Northern Maine, because we really, in our state, we really need every ilk of medical practice from family practice to specialty practices. Well, certainly I would encourage anyone who is in that stage of their career where they still want to practice and they have something to offer. Rheumatology as a specialty, certainly that mean if you're watching and you'd like to reach out to Dr. Chuck Radis. I think that's a fantastic idea. And also, I still want to get back to that question. What is the thing that keeps you doing this? Is it just because you feel this dedication to patients in the state of Maine, or what do you personally get out of this? As somebody who's been in medicine, I really like my patients. I look at my schedule when I'm seeing patients, and most of them, I look at that list and it triggers a follow-up question in my mind when you kind of unravel that I really found the right profession to be in, I have why I continue to enjoy it so much into my seventies is hard to really fathom. I'll have to think about that more because I don't have a ready answer for it. Well, you're welcome to come back again. Oh, thank you. And especially if you come up with the answer to that, we'll have a whole show just on that for you. Well, thank you. Thank you. Well, it's been my pleasure to speak with Dr. Chuck Radis again today. He has a book coming out his sixth book, mystery in the Room, R-H-E-U-M, for those of you who don't have the same sort of double entendre understanding of what medical the term is. But room is from rheumatology, a physician's journey, treating patients with rare diseases. If you haven't already read one of Chuck's other books, one of them is Go By Boat and these journeys that Chuck is taking, not