Doctors with Heart #127

Dr. David Loxterkamp:

It's been a huge learning experience and 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. Rick Marden:

That's what we all do day by day, is we make choices of what our priorities are and making conscious decisions to make those choices. 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 are choices people make day by day and not just let things happen, but make conscious choices of where are my priorities and what am I doing to reach those the

Dr. Lisa Belisle:

This is Dr. Lisa Belisle and you are listening to the Dr. Lisa Radio Hour and podcast show number 127, Doctors with Heart, airing for the first time on Sunday, February 16, 2014. We are at an interesting crossroads in medicine. Doctors and other healthcare providers are being asked to adjust their way of practice in significant ways in order to address increasing 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 such physicians, Dr. David Loxterkamp, Belfast family physician and author of A Measure of My Days and what Matters in Medicine, and Dr. Rick Martin, family physician with Brunswick Family Medicine, a member of numerous international medical mission trips. We hope you enjoy our conversations with these very heartfelt doctors. Thank you for joining us. It's always a pleasure to sit across the microphone from a fellow physician, and especially a fellow physician who has had

Dr. Lisa Belisle:

a hand in my own professional education.

Dr. Lisa Belisle:

Today I am speaking with Dr. David Loxterkamp, who is a family physician residing in Belfast with his wife and two

Dr. Lisa Belisle:

children, Dr. Loxter Camp's expertise is in

Dr. Lisa Belisle:

addiction medicine and group visits, narrative medicine and practice transformation. He is a founding member of the Searsport 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 ensure wellness in a person's health and in our healthcare system.

Dr. Lisa Belisle:

Thanks for coming in and talking with us today, Dr. Loxter Camp, great to be here.

Dr. David Loxterkamp:

Thank you. Lisa.

Dr. Lisa Belisle:

I remember first reading something you had

Dr. Lisa Belisle:

written, although I know you've been writing a long time.

Dr. Lisa Belisle:

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. David Loxterkamp:

The writing began in 1992 and it was published in 97.

Dr. Lisa Belisle:

And at this time I was in

Dr. Lisa Belisle:

my own medical training and I thought, wow, a doctor who writes, somebody like me, I can relate to this guy that. But you also are a doctor with a strong Catholic faith and you're also a runner. So there are a lot of things that you and I kind of related a lot of levels that I related to you on.

Dr. Lisa Belisle:

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 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.

Dr. Lisa Belisle:

This was something 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. David Loxterkamp:

Yes, it's being a different kind of person, I think, to every patient who 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 value of your work that is medicine. And so to within a few minutes try to figure out why the person has come to you today with this question or this problem is Always the most interesting issue. And the ability to adjust your expectations to those of the patients in the course of a very brief time is, I think, what defines the maturing physician, the person who is able to discard one's agenda in favor of something more important on the patient's mind, which is

Dr. Lisa Belisle:

a difficult thing to do because as

Dr. Lisa Belisle:

we're trained early on in medical school, we're supposed to be eliciting the right

Dr. Lisa Belisle:

answers to the right questions.

Dr. Lisa Belisle:

So we can create the right plan, we can come up with the right diagnosis. And many of us going in, we want to do it right. We're perfectionists, and we're 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. David Loxterkamp:

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 exposed as some sort of, 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 this notion of helpfulness, not patient centeredness, which I've kind of stepped away from, but helpfulness. How can I be helpful to this patient today? And the truth is that most of the answers that are important lie within the patient. And 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. So 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 in their life.

Dr. Lisa Belisle:

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. David Loxterkamp:

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. And it was probably 10 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. So probably, I don't know, eight or nine years ago, I was called to see a patient in the emergency department, and she was a daughter of long standing patients of mine. I came to see her and she was retching and quite sick and had been so for Two or three days, soon realized that she was withdrawing from heroin, 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. This was a very, very bright young woman going to college, the first in her family to go to college. And 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 if he should get in with the wrong crowd and make some bad choices? So I needed to learn about this. And really, over the last five or six years, we've developed a program in our practice to help people with addiction to narcotics, narcotic abuse. And it's been a fascinating journey. First kind of 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 be methadone or heroin or prescription painkillers. What I learned over time was how people change and why and of what help I can be in that process. And so we've gone from one on one, doctor, patient care, and prescribing Suboxone, really indefinitely, to now hosting groups and letting these individuals teach each other and me about what is most helpful to for them in their recovery. And 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 and really the enormous challenges they've had to overcome to get to this point. And 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. So 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 in the shame they deal with in early life, experiences that are so different from mine. So it's been a huge learning experience. And 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 Belisle:

This sort of work is requiring

Dr. Lisa Belisle:

something different than what being in a traditional medical practice requires of us these days.

Dr. Lisa Belisle:

A lot of what we do these days has something called metric associated with it. It's about getting patients in, seeing them in a timely way, having quality, meeting quality goals like everybody gets. Every woman over 40 gets a mammogram and things like that. And sometimes these two things can be in contrast and in conflict.

Dr. Lisa Belisle:

You wrote about this in the bmj,

Dr. Lisa Belisle:

which used to be the British Medical Journal, this idea of humanism in the age of metrics.

Dr. David Loxterkamp:

That's right. And I really have no quarrel with metrics. It's just the choice of what we choose to measure. And I think we've set the agenda. That is, the medical profession has set an agenda that can be quite different from what practicing physicians see 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. And sometimes when you come into 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 yours. 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. So 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 in ourselves, observe in our patients over time, Rather than rely upon maybe the agenda of an urban medical center and their research topics or their research grant goals. What do we think is important and how can we measure that? I mean, one of the things that I think is very important is FaceTime. 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. In moving people to a more healthy place in their lives. And I really think that's 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 through 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? So maybe in the next 10 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 Belisle:

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[Unidentified voice]:

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Dr. Lisa Belisle:

I'm fascinated by your practice, at least in part because one colleague that you work with is one that I helped educate at Maine Medical Center, Dr. Megan Britten. Another colleague is one that I went through medical school and residency with, Dr. Carol Kuhn.

Dr. Lisa Belisle:

Your practice seems to have the ability

Dr. Lisa Belisle:

to work together well enough to make fairly big and interesting decisions. You're talking about changing the way that

Dr. Lisa Belisle:

you see patients so that you maybe

Dr. Lisa Belisle:

see patients for six hours a day, but then you do administrative work for the remaining hours of the day so that you get today's work done today.

Dr. Lisa Belisle:

That's something that you actually need to have a lot of buy in for.

Dr. Lisa Belisle:

How do you keep everybody in your practice sort of roughly on the same

Dr. Lisa Belisle:

page so you can move forward?

Dr. David Loxterkamp:

Well, 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 a big head start in trying to get a practice to function as a team. So first of all, I've made an effort to find the right people and be choosy about that. I think that's been a big help to our practice. Another is the commitment we've all made to what we call what has been called for the last 22 years now, the Thursday morning meeting. 22 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 counseling in our practice and because we wanted her to help us work better as a team. And the one 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. And so we gave voice every Thursday morning and have for 22 years, as I've said to those kinds of questions and conversations from 8 o' clock to 9 o' clock every Thursday morning. So building that kind of trust and that kind of concern for one another, I think also goes a long ways to creating a team environment. And I think lastly, people who have come to work for us have some more reluctantly than others, but have all bought into this notion of change is important, that we can't sit and 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 and our practice, but primary care more generally. So I think they've all bought in fairly freely to the notion of joining the 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 main 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 a 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 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 FQHC can bring. Even more importantly for me now is this notion of co location, which is the idea of bringing the essential ingredients of a primary care practice together. Certainly integrated behavioral health is a big part of that, but also pharmacy and lab and imaging and physical therapy and dietary education. All of these things are absolutely important. Not just to have in the same place, which is maybe kind of the moral mentality of medicine, but actually working as a team, talking about the same patients at the same time, about what they might really benefit from or how we can help them move forward in their lives. So 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 off their comfort zone, try new things with the hope, with the possibility that this could actually make their lives better. And even more importantly, further the mission that we all agree upon, which is taking care of patients where they are.

Dr. Lisa Belisle:

Dr. Loxter Camp, how can people find

Dr. Lisa Belisle:

out about the books that you have

Dr. Lisa Belisle:

written, A Measure of My Days, the Journal of a Country Doctor, and What matters in Lessons from a Life in Primary Care?

Dr. David Loxterkamp:

Well, 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 kind of all the things that I've been writing about for really the last 20 years. Writing has always been a way for me to collect my thoughts, 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 recreation for me. It's really been part and parcel with my work that one really can't perform well at one without the other. So 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 in next.

Dr. Lisa Belisle:

And your wife Lindsay's bookstore is Left Bank Books.

Dr. David Loxterkamp:

Exactly.

Dr. Lisa Belisle:

So if people 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

Dr. Lisa Belisle:

lot beyond just the books and the

Dr. Lisa Belisle:

good family medicine, then they can stop in at your wife's bookstore.

Dr. David Loxterkamp:

Absolutely. And I'll just further the advertisement by saying dogs are always welcome.

Dr. Lisa Belisle:

Well, very good. And I do thank you for taking the time to 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 Searsport to come participate in my education professionally, and for being so thoughtful as a family physician in a time of great transition. So we've been speaking with Dr. David Loxterkamp, author, father, runner, writer. Thanks for coming in today.

Dr. David Loxterkamp:

Thank you very much, Lisa.

Dr. Lisa Belisle:

As a physician and small business owner,

Dr. Lisa Belisle:

I rely on Marcy Booth from Booth,

Dr. Lisa Belisle:

Maine to help me with my own business and to help me live my own life fully. Here are a few thoughts from Marcy.

[Unidentified voice]:

When I consider today's show topic, I can't help but equate it with what happens in my business. I have to remind myself and my team to consider how what we do for our clients helps their businesses stay healthy. We are often there to diagnose problems and prescribe solutions that ease business aches and pains. And we have to do it with empathy, compassion and heart. And when we see results and our clients are happy and successful, that gives us the deepest sense of satisfaction and gratitude. I'm Marcie Booth. Let's talk about the changes you need. Boothmaine.com

Dr. Lisa Belisle:

in medicine today, we're all trying to find the thing that really keeps us motivated and about which we feel passionate.

Dr. Lisa Belisle:

So I've been fortunate in the last few months to be in practice with

Dr. Lisa Belisle:

Dr. Rick Martin, who has indeed found things about which he feels passionate. And one of these is the work

Dr. Lisa Belisle:

that he does in different and foreign countries.

Dr. Lisa Belisle:

So 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 Belisle:

Rick, you're from Maine originally?

Dr. Rick Marden:

I am. I'm a native multi generational.

Dr. Lisa Belisle:

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 5, 10 miles of Bangor. My family still lives there, my sister and my parents. And then I went away for college, med school and residency and came back to raise my family here.

Dr. Lisa Belisle:

And you went to school right, in Freeport?

Dr. Rick Marden:

I went to high school in Freeport at Pine Tree Academy. Right.

Dr. Lisa Belisle:

It's been interesting to be in practice

Dr. Lisa Belisle:

with you and notice the strong connections that you have created throughout the state of Maine. Really. But even going as back far back as High school.

Dr. Rick Marden:

You know, my wife and I still have a lot of the people we went to school with who are still in the community, who are still really close friends with. And it is. It was great to come back home to Maine after being gone for 12 years and. And have really tight connections.

Dr. Lisa Belisle:

After you went away to college and

Dr. Lisa Belisle:

medical school, you came back and end residency. You came back and you practiced it in rural Maine.

Dr. Lisa Belisle:

This was a big change for you. After having gone out to California for medical school. Why did you make that decision right

Dr. Rick Marden:

after being in Southern California, where it would take 40 minutes to get to my bank 3 miles away? To move to Rumford, Maine, was quite a change. I kind of knew I wanted to do rural medicine from the time I was, I don't know, second or third year in residency and prepared for that. So I really only looked in rural spots. And of course, Maine has plenty of those to offer. Western Maine appealed to me because of the mountains, lakes, the beauty of the area, and that took me to the Rumford area.

Dr. Lisa Belisle:

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:

My third year in Brunswick. And there are patients who still come from the Rumford Dixfield area. You know, it's a real privilege as a family practice doctor to be involved with people with the birth of their children, with the death of their parents or their spouse, to be really allowed into the trust, to be allowed into their lives. And those relationships are strong, and an hour and a half of driving often doesn't. It doesn't stop them.

Dr. Lisa Belisle:

You're also somewhat of a rarity these days in that you are 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 to 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 patient. But it's a, you know. And again, what a privilege to be there at the birth of a child, to go through the journey of pregnancy and all the struggles and ups and downs, and then to be there at the birth and then see the kid, see the baby, see the child grow over time is, you know, it's great. I really enjoy it.

Dr. Lisa Belisle:

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 kind of go in different directions. The parents do one thing, the kids 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:

You know, I think we do try to do that. I think it's important to make family a priority. And I think we're lucky to be able to do that, to have some flexibility. I'm lucky that the people I work for allow me to have some flexibility in my schedule. It's a privilege, it's a responsibility. It's part of our role to each other as humans to take care of each other. And who better to take care of than our own children? Growing up, my parents maybe didn't have the same opportunity my dad had to work 10, 12, 14 hours a day. He couldn't adjust his schedule. And I have that luxury, and so I choose to do that. And I enjoy going to my daughter's basketball game at four in the afternoon, even though I, you know, left the office early.

Dr. Lisa Belisle:

Well, you talk about it as though it's a lucky thing. I think that, I mean, I know

Dr. Lisa Belisle:

how many patients you see and you're

Dr. Lisa Belisle:

definitely meeting all of what we call productivity standards and in fact, surpassing them. So you're able to be incredibly efficient and effective and offer very compassionate care to your patients and get enough of that done during the day so that you, the hospital, recognizes that you're a very valuable physician. Not every doctor is able to do that.

Dr. Rick Marden:

Choices, right. It's all about choices and what we do. Some of my choices are I do some of the computer part of work at 10 o' clock at night so I can be with the kids from four to bedtime. So 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 life, that's what we all do day by day, is we make choices of 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 are choices people make day by day and not just let things happen, but make conscious choices of where are my priorities and what am I doing to reach those.

Dr. Lisa Belisle:

You've also made conscious choices that have enabled you to Travel widely and as I said earlier, do something that you feel passionate about and that is to offer care to people in other countries.

Dr. Rick Marden:

Yeah. You know, it started when I was at Pinetree in Freeport as a senior. 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 that's a real eye opener as a child who's never left Maine hardly to go to another country and to see poverty and to see want and to realize how blessed you are here in our country. And from there it's been something we've done every couple years. We've done a trip somewhere in the world to do either a medical mission or a building project or something of that sort.

Dr. Lisa Belisle:

And you've also brought your children along and your wife.

Dr. Rick Marden:

My wife in college, before we were together, spent a year teaching school in the Marshall Islands. So she had a similar passion already in place. And 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. So we started when our youngest was two doing trips. And they love it. They think it's the greatest time of the year.

Dr. Lisa Belisle:

So describe this most recent trip to Guatemala. I was fortunate. I came into the practice just as you were getting ready to go and 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:

Well, first, thanks for covering the practice so I could go. That helped dramatically. So this year we went with a friend of mine who organizes. He has a five year plan for the region of Guatemala that we've gone to twice now. He's gone the last three years and he has two more years planned. This year we went to do a medical mission. There was a building project to build bathrooms for a dorm for a nursing school that's going to be established in the area. And we did medical trip and saw probably 800 to 1,000 patients in six days that we were on site.

Dr. Lisa Belisle:

That's a lot of patients to see

Dr. Lisa Belisle:

for a relatively short period of time. How many people were on this trip with you?

Dr. Rick Marden:

So our medical team was about 25 people, composed of several nurse anesthetists, nurse practitioner. I was the only doctor. There was several high school students helping out, which was great. My own children went with me a couple times on 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 so long days with a lot of traveling to remote villages and two hours on back rutted muddy roads in minivans with 25 people in a 17 passenger van sort of experience.

Dr. Lisa Belisle:

What types of things were your daughters able to do?

Dr. Rick Marden:

So they sat beside me and if I needed a medicine I sent them to the guy who was running the pharmacy side and would tell them what to get. If I needed a 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 spina bifida and had an infected wound on his back. And my 9 year old was with me and I asked her to take a picture and she looked at me and said, dad, I don't think I'm going to do that. It was a pretty funny moment. She just looked away and didn't want to see the procedure.

Dr. Lisa Belisle:

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 was happy to have them come. This is the first time I've had him come on the mission part with me and, and my 11 year old, she's almost 12. Really enjoyed the medical part this time and seeing what I do. And previously she thought that medicine was pretty, a terrible thing to do. It was too bloody, it was too awful. And last month she informed me that she's going to be a doctor. We'll see how she changes her mind over time. But I think the experience was good for her. I think she realized this is a, you know, 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.

Dr. Lisa Belisle:

The goal of the Dr. Lisa Radio Hour is to help make connections between the health of the individual and the health of, 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.

[Unidentified voice]:

In 2009. I had just come out of moving through the Great Recession. I guess you might say most of us were sort of getting our bearings after the debacle on Wall street and the economic collapse. And I remember I started that spring, my business went down by 40% in one year. And so I was scrambling and I put this exhibit together for the Rockport show at Maine Home Design magazine and I I pretty much did it solo by myself and I found it very healing and it was all working with the sacred feminine and it was very introspective in nature. And one of the things I realized when I work 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 the wet season and contracts during the dry, cold season. So these are things to remember in life that Try to be supple, Try to move with the energy, try to move with the flow. Don't become too rigid. Rigidity is good, but it needs to be balanced with the supple flow of the wood energy. I'm Ted Carter and if you'd like to contact me I can be reached@tedcarterdesign.com

Dr. Lisa Belisle:

the Dr. Lisa Radio Hour and podcast

Dr. Lisa Belisle:

understands the importance of the health of

Dr. Lisa Belisle:

the body, mind and spirit. Here to talk about the health of the body is Jim Greatorex of Premier Sports Health, the division of Black Bear Medical.

[Unidentified voice]:

At Black Bear Medical, we lead with our hearts every day. From our daily fundraisers for the numerous charities in Maine to our everyday customer service, we do what we can do to help our customers feel better from the inside out. Injuries and ailments can be scary and have just as much of an emotional impact as a physical one. Let our experts look at the whole you and your situation and help suggest the products and services you need to get you back to being you. It's part of our culture and I promise to you. Visit blackbearmedical.com or stop by one of our retail stores in Portland or Bangor to see just how much heart we have experience.

Dr. Lisa Belisle:

were the problems that you saw in Guatemala very different than the problems that you see on a day to day

Dr. Lisa Belisle:

Basis here in Maine?

Dr. Rick Marden:

Yeah, we don't see a lot of parasites in Maine. And we saw everyone had. In the villages where we went, pretty much everyone had some sort of parasite illness. And that was. They didn't even complain about it. You just happened to ask the questions that would lead you to that diagnosis. Oh, yeah, I have that. And you figure out very soon that when the latrine is 10ft from the river that everyone's going to have, that's used as the water supply, that everyone's going to have similar issues. So they just thought that they were supposed to be fatigued and having fevers and body aches, and that's just how life is. And then they would come in for bad wounds from, you know, 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 ventilation. So there's a lot of upper respiratory symptoms.

Dr. Lisa Belisle:

And we know that in some countries we've imported Western problems. Did this occur in the backwoods of Guatemala?

Dr. Rick Marden:

So 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 then there was a lot of diabetes, a lot of blood press issues in those settings versus the Mayan villages, which was more of the parasitic infections.

Dr. Lisa Belisle:

What about smoking?

Dr. Lisa Belisle:

Was there any role that. That played?

Dr. Rick Marden:

You know, there was a fair amount of smoking in the more city. City like setting, not so much in the Mayan villages.

Dr. Lisa Belisle:

You described yourself as getting interested in this when you went to the Pine

Dr. Lisa Belisle:

Tree Academy as a senior. The Pine Tree Academy is Seventh Day Adventist. What is it about being a Seventh Day Adventist that causes this sort of interest in helping people?

Dr. Rick Marden:

You know, I think there is a culture, or hopefully there is and will be a culture of service that's not unique to Seventh Day Adventism, but unique to people who care about others, people who want to show the world that there's. That we care, that love exists and that there's goodness. And I really hope that that's where that comes from, is just hopefully, as Christians, if you claim the love of God, then you want to show that love to others. And if it's physically helping them, if it's making a building, if it's one trip I did, we just built restrooms for a maternal child health clinic. You know, whatever you can do to help others, 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 Belisle:

And you personally have helped people through

Dr. Lisa Belisle:

these mission trips by using your own

Dr. Lisa Belisle:

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. David Loxterkamp:

Right.

Dr. Rick Marden:

The last three trips we've done have been independent, without any sort of affiliation at all. I've done a few trips as part of affiliations, but to most of those still are you pay X amount for building supplies or you pay X amount for the medical supplies. But the last three we've done have been independent. And you kind of figure out, well, I'm going to need this, this, and this. I better buy it and bring it with me.

Dr. Lisa Belisle:

So this is something that gets budgeted into your household expenses over the course of two years is something that you and your wife have to agree upon. And it's. I mean, 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. Yeah. The Africa trip from four years ago took a lot of budgeting and, you know, just airfare and five people traveling to Africa and leaving a practice for a month. And there was a 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 dodging scorpions and spiders and had an adventure.

Dr. Lisa Belisle:

Yes.

Dr. Lisa Belisle:

You described to me one trip in which you were in one large room with families separated by sheets and you were on the floor and it was difficult to sleep. And you got to hear everybody else's nighttime shifting and moving and coughing.

Dr. Rick Marden:

That was two years ago in Guatemala, and that was a challenge. There were six families in a room maybe 30ft by 20ft 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 Belisle:

So that is an interesting contrast between

Dr. Lisa Belisle:

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:

So adventure is part of it. And I think that you just have to look at it as an adventure. There are. But, yeah, it's great for the kids to see how the rest of the world lives and how privileged that we are day to day. You know, before the taping this morning, I had to choose whether to go to BART or Starbucks. That was my hardship this morning. It wasn't, where am I going to find rice to make my tortillas for, you know, right 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 Belisle:

What are some of the similarities that you've seen in going to Africa and going to Guatemala and maybe even taking care of your patients in Brunswick?

Dr. Rick Marden:

Well, people need help everywhere. I think that's a similarity. You know, there is. Working in Brunswick, Maine, is a medical mission. Working anywhere you are is a medical mission. It's, you know, taking. 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, of course, the third world country is just the lack of resources, the lack of knowledge, that drinking bad water leads to parasites, leads to me not feeling well. And just they don't understand that the village we were in just didn't get that, which is difficult. You know, you're faced 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. And that same concept exists in the office here in the States. You know, you have to take care of yourself. You have diabetes, you have to make changes. If you don't, bad things are going to happen. So I think working with people to help themselves is probably the common thread between the different settings.

Dr. Lisa Belisle:

Rick, you're a young physician, or relatively young.

Dr. Rick Marden:

You've been out in practice relatively young.

Dr. Lisa Belisle:

Well, you're a little bit younger than I am, so I think of you as young. You've been out 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 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 the responsibilities from a clerical perspective, from a paperwork perspective, are very different and take more time. And we're being pulled away from our patient encounter time to do more of that sort of thing. And there's Pluses and minuses just to that 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 typing and having that barrier between us and the patient or 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. So the technology I think is one, the requirements for whatever, whether it's getting a pre certification for a CAT scan that takes 25 minutes and two telephone calls, those sort of things pull us away from our patient encounter time, which is one of the things I struggle with, is wanting to spend more of my time with the patient and less time doing those things.

Dr. Lisa Belisle:

And do you see that there are possible opportunities in what has been happening, the changes with Obamacare and the requirements

Dr. Lisa Belisle:

that we're being asked to meet now?

Dr. Rick Marden:

Yeah, I think we have to look for the, for those opportunities. You know, there's pluses and minuses to those things. I won't get into the politics of the Affordable Care act, but you know, there's pluses and minuses. It's not all good, it's not all bad. And I think that's how most things are. And you try to find what are the strengths. For example, you know, a family whose 24 year old couldn't get coverage now comes to see me and has coverage. Meanwhile, one of my fishermen 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 kind of see how things go before getting too worked up about it. But at the same time, I think we have some obligation to be aware of the current situation and what is our role to. What is our role to change or to endorse or to help tweak whatever that is. So 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 Belisle:

How do the mission trips that you do every other year, how do these contrast to and inform your medical practice on a day to day basis and looking forward into the future?

Dr. Rick Marden:

Well, you know, it is, it's like hitting a reset button when you come back. You know, I do feel charged up and ready to go and excited to be back in my office too. So I think they're Helpful for that perspective. The patients in Brunswick, what a response I got this time when they found out I was going and so much support. People wanting to donate their medicines they didn't need anymore, people wanting to give money to help sponsor the trip. People want to be part of something. They want to help other people. And I really discovered that on this trip in particular, with the outpouring of support from my patients in Brunswick. I'm not sure what our next adventure is. We'll see when it comes.

Dr. Lisa Belisle:

You work on a regular basis with

Dr. Lisa Belisle:

the residency program at Central Maine Medical Center. As one of the teachers up there,

Dr. Lisa Belisle:

what advice do you have for our younger physicians?

Dr. Lisa Belisle:

Whether they're residents and who have already

Dr. Lisa Belisle:

graduated from medical school or whether medical students who are still in the midst

Dr. Lisa Belisle:

or maybe they haven't even gone to medical school yet.

Dr. Rick Marden:

I do. I probably give my advice unsolicited a lot to the residents. I think a really important thing is to do what you love, to have passion about it and to care. And so that's what I try to tell them is don't just take a job. Find something that you love and make it yours so that you want to go to work, so that you enjoy your work, so that you appreciate your opportunity. And if it doesn't, if that's not happening, make it happen. Family medicine in particular, where there's so many options available to us in how we practice and what we do. So find what you love and pursue it.

Dr. Lisa Belisle:

Rick, it's a privilege to have you here with me today. I know that you're patience think very highly of you. Having now helped take care of your patients for a few months. I think that 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. And I think it also kind of spills over into the work that you do in other countries. So it's great to know that there are people who are so passionate about the work that they do. So thank you for that and thank you for coming in. We've been speaking with Dr. Rick Martin, 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 Belisle:

You have been listening to the Dr. Lisa Radio Hour and podcast show number 127, Doctors with Heart. Our guests have included Dr. David Loxterkamp and Dr. Rick Martin. For more information on our guests and extended interviews, visit drlisabelisle.com the Dr. Lisa Radio Hour and Podcast is downloadable for free on itunes. For a preview of each week's show, sign up for our e. Newsletter and like our Dr. Lisa Facebook page. Follow me on Twitter and Pinterest and read my take on health and well being on the Bountiful Blog. We'd love to hear from you, so please let us know what you think of the Dr. Lisa Radio Hour. We welcome your suggestions for future shows. Also let our sponsors know that you have heard about them here. We are privileged they enable us to bring the Dr. Lisa Radio Hour to you each week. This is Dr. Lisa Belisle. I hope that you have enjoyed our Doctors with Heart show. Thank you for allowing me to be a part of your day. May you have a bountiful life.