Future of Medicine #56

Gordon Smith:

The Maine Medical association is what the members and those who choose to serve in the leadership and are on the committees, what they choose to make it, and if you want it to be something different than you think it is, then you get involved and then you get to make those decisions.

Catherine Cloudman:

The pharmacy industry has largely allowed itself to become a commoditized industry, and so we ran an ad when we first opened our business that said, at what point did pharmacies go from being convenient to being to convenience stores that had pharmacies?

Dr. Lisa Belisle:

This is Dr. Lisa Belisle and you are listening to the Dr. Lisa Radio Hour and podcast show number 56, the Future of Medicine, airing for the first time on October 7, 2012 on on WLOB and WPEI radio Portland, Maine. The future of medicine is something that we on the Dr. Lisa Radio Hour and Podcast are working toward every week. Something that I feel very strongly is important. I graduated from medical school in 96 and family medicine residency in 1999 and went on to get a Master's in Public Health and a Preventive Medicine fellowship. These were all my traditional medical training. I was doing the same sorts of training that most doctors go through in the United States. By 2006, I knew that I needed something more. I needed to go outside the bounds of traditional Western medicine and see what else I could offer my patients. This is when I went back and I learned traditional Chinese medicine and acupuncture. And I believe very strongly in the idea that this is how we need to heal our medical system. We need to be reaching back into the past, looking at healing systems that have been helping patients for thousands and thousands of years and marrying this with moving forward. Medical informatics, evidence based medicine, computers, knowledge research, these are all things that we need to be taking into consideration as we look forward. I think this is an exciting time to be a physician. It's an exciting time for me to be practicing medicine in my own practice. I am able to create a very personalized approach for patients. I integrate acupuncture, nutrition counseling, dietary recommendations, behavior and pattern change with all the latest medical knowledge. I'm able to connect with providers in the community who are doing more high tech procedures, people who are engaging in modalities that require quite a lot of futuristic thinking. And I think I'm offering the type of care that most doctors want to be offering their patients as they move forward in medicine today. On today's show we have two individuals who have been working in the area of medicine for many years and although they're not doctors, they do know a lot about medicine and about health and healing. Gordon Smith is the Executive Vice President of the Maine Medical association and has been affiliated with that organization for decades now. He's seen the many changes that physicians within the state and patients in the state have undergone and he knows that there are ways that we can help things move forward in a very positive way. Katherine Cloudman is the founder of Apothecary By Design here in Portland. Apothecary by Design really believes in the importance of offering patients high quality medication and education and at the same time reaching back into the past and offering them a very caring attitude towards health and healing. We believe that Gordon and Kathryn are both two very good examples of how we can move forward into the future of medicine. Thank you for joining us. The Dr. Lisa Radio Hour and Podcast is pleased to be sponsored by the University of New England. As part of our collaboration we offer a segment we call Wellness Innovations. This week's Wellness Innovation is the University of New England's Interprofessional Education Collaborative or ipec. IPEC is an intercollegiate initiative designed to support and enhance the education of practitioners, scholars and researchers across health professions. Their mission is to educate these individuals to work together and with patients and clients for relationship centered healthcare that is comprehensive, collaborative, caring, safe and continuous throughout the life cycle. This is UNE's contribution to the future of integrated medicine. By exposing learning professionals to a team based training earlier on in their career to future communication and client based care will become more instinctive. For more information on this Wellness Innovation, visit drlisabelisle.com for more information on UNE, visit une.edu.

Dr. Lisa Belisle:

The Dr. Lisa Radio Hour is committed to the notion that we're in a significant time of really healthy transition in the medical world. And we like to talk to people who have been in the medical world for a while who can tell us what the history has been like and what things are looking like moving forward. So we thought it was appropriate to have Gordon Smith, who is the executive vice president of the Maine Medical association, come in and talk to us today. Thanks for coming in, Gordon.

Gordon Smith:

Thank you for having me, Lisa.

Dr. Lisa Belisle:

Now, Gordon, you and I have known each other for a while because when I was getting my master's degree in public health after my residency program, I came up and I observed what you were doing with the legislature, and I know that that's part of what you do, but there's just so many things that the Maine Medical association does. Why don't you tell us about them?

Gordon Smith:

Well, I think that people probably have a misconception about what the Maine Medical association is today. I mean, it was established in 1853 by 15 or so physicians who met in Brunswick at the tontine Hotel on April 28, and we just held our 159th annual meeting. So it has a rich tradition of representing physicians, but also protecting public health and speaking on behalf of patients. But there has obviously, I don't know of any association today that, 160 years after its founding, is operating under the same mission and governance principles today that it did when it started. There have been a lot of tremendous change in the health care community. It really did start with the issue, and it was one of the 50 state organizations that make up the American Medical association, which is still vilified for opposing Medicare and Medicaid in 1965, but they forget that now the AMA supported the Affordable Care act or Obamacare to some. And so there's been organized medicine, as it's sometimes referenced, is a much more diversified group than it used to be. And it has to be, because half of our members are going to be female. The vast majority of our members are going to be employed. They're not in independent practice anymore. And that's changed a lot of things, although there'll still be some who choose that route. So it's been a wonderful organization over time. We have about a dozen employees and we have three lobbyists and attorneys. I'm one of them. And we do go to the statehouse every day. The legislature's there. And we're involved in the last two years in 300 pieces of legislation, many of which involve public health. And I think that your listeners would be impressed with everything from, from eradicating BPA from children's toys to protecting our healthy main partnerships, protecting physical education in schools, prohibiting cyberbullying, a lot of those things. The association is very proud of its track record on in November. I understand you're having a program with Ed Miller of the American Lung association of Maine. Ed and I have been involved in virtually every, every tobacco control issue in Maine since about 1979. And we started, along with a wonderful physician by the name of Bill Necessian, the Maine Coalition on Smoking or Health that's now been merged into the Maine Public Health Association. But we were galvanized when at that time, Governor Brennan vetoed a bill to prohibit smoking in a jury room. If you can imagine, today we've been so successful, probably 25 pieces of legislation that have protected clean air in Maine, particularly indoor air. And now we're active in trying to protect public parks and beaches. But at that time, imagine that a governor would veto a bill that suggested that if you were asked by the government to serve in a little jury room for hours at a time, that people could fill that room with smoke. So there's a lot of wonderful history of public health activities in Maine. Many of those things are now challenged under the new political dynamic that we have. And so we've been busy as ever, unfortunately, defending some of the gains that we'd already made. And it's been difficult in this environment to be proactive because we've had to react to so many things that we thought had been settled years ago, like the value of vaccination.

Dr. Lisa Belisle:

Well, it is interesting to me because as we're talking, I'm remembering what, as a young, recently finished family medicine resident and family doctor, I was listening to, I was listening to legislation that was about smoking in, I believe in bars and restaurants. And now people who are young, not that I'm not young, but let's say 20 year olds, to them, it's unfathomable that you would go into a bar or restaurant and there would be cigarette smoke in Maine and in fact, in a big chunk of the country. But that was not that long ago.

Gordon Smith:

No, it wasn't, but it's been one of our great successes. And fewer, and partly because of that, fewer teenagers are smoking more than should, but nonetheless. And it's all about if you can't smoke in a restaurant, you can't smoke in a workplace, you can't smoke at a public place. You begin to get the idea maybe this is really bad. And if the only place we can smoke is outside. It was a very big moment when through the Bangor City Council passed the ordinance that you couldn't smoke in an automobile with a young child. That was huge. And that led to similar legislation on the state level. And it's that kind of thing that. Because it's about protecting us from secondhand smoke. I mean, people have a right to do what they're going to do, but not if it affects other people.

Dr. Lisa Belisle:

Your background isn't in medicine, though. Your background, as I think you said, was as a lawyer. There are other lawyers on staff with you. Why is it necessary for lawyers to get involved in health?

Gordon Smith:

Well, that's a good question. You wonder how the rank and file members of the Maine Medical association feel about the Maine Medical association now having three lawyers. It's just a sign of the times. I mean, there are some doctors that run medical societies across the country. But running an association today requires a skill set that's different than most physicians have. I did get into this field absolutely because of my interest in advocacy. That got me and politics. That got me involved in law, and then law got me involved in associations. And it just so happened when I was practicing privately with a law firm that we had a lot of association clients and we lobbied a lot because we were in Augusta and we were the biggest law firm in Augusta at that time. There were six of us. And I just loved the association work. So I left after a few years to just do the Realtors association. It's a wonderful association and the medical association. And one day a week I'd work at the realtor office and four days a week at the medical association so you could see what direction this was moving in. And then eventually things became difficult to do both. But healthcare today is enormously complicated. I feel every day that our other two lawyers were very, very capable and myself. We have all we can do to keep up on the federal and state activities. And we have 3,500, 3,700 medical students, residents and doctors to help us do that.

Dr. Lisa Belisle:

Well, tell me what types of things on a day to day basis you deal with when it comes to residents, medical students and doctors, what are you actually offering for the individual physician?

Gordon Smith:

Well, we offer different things at different cohorts in a doctor's life for the Medical students, we help them learn about organized medicine and what they may be facing when they get out with the residents. We help them with their first contracts of employment. With the older physicians, we help them retire. So depending upon where you are in your career, the medical association might have a lot of different things to offer. We've had to change the menu of services a great, great deal to accommodate doctors who are employed. Because when you're employed, you're not paying your own malpractice premium. So you're probably not that all that you may not be interested in. Quote Tory form if you're practicing in a big system like Maine Health or Eastern Maine Healthcare, then you're getting a lot of services available from those folks. And you may not even relate to the Maine Medical association at all until you have a problem. That problem could come at the Board of medicine. It could come in a malpractice case, it could come as an issue with your employer. And so we've been able to maintain an infrastructure to help physicians with whatever that problem is. We also provide a lot of service at the level of the employer. We have a very, very successful peer review program where we'll send out, let's say if there's a solo practicing urologist in a small community in Maine, we'll send three board certified urologists out to that practice once a year, once every two years and do a complete analysis working with that doctor in a confidential peer review for educational purposes because that's just essential today. And so that program has grown exponentially over the last 25 years. So we do a lot of quality improvement work, patient safety work, we do a lot of consumer patient engagement. We're very big supporters of Quality Counts. I just got done two years as the board chair of the organization and is doing wonderful things as we try to transform the health care system to a more patient centered system.

Dr. Lisa Belisle:

And we had Lisa Letourneau and Dr. Lisa Letourneau and my sister, Dr. Amy Belisle from Quality Counts on just recently

Gordon Smith:

on the show and that whole staff now Quality Counts has almost 10 employees. They're almost as big as the Maine Medical association and that's that's causing its own unique issues because they're co located with us in our building and we're probably going to be able to help them find other space here in the next few months. But I'm so proud of what they're doing in transforming the practices of primary care. I think people would be impressed to know that we're not out there defending existing medical care. Every day we are out there trying to make it better, trying to increase patient safety. We know there's a lot of problems, and we know that if patients can get more engaged in their own care. This was a featured presentation at our annual meeting at Quality Counts last week with this e patient, Dave DeBrunkant. He was incredible. An MIT graduate who had metastatic stage four cancer, who engaged himself into online communities with other cancer patients, found incredibly valuable information on the Internet, working with his physician so he can give that. Talk about how important it is for patients to be engaged as partners. And it's about patients now. The old system really was designed around physicians. It really wasn't designed around patients. That situation that is now being transformed. And I think it's a hard change for people. Particularly the transition to electronic medical records has been way more difficult than anybody can imagine because it completely transforms the way that you practice. I'm 61 years old. If I was a physician, I would probably retire before I do it. I mean, because I've seen the pain of doctors feeling so good about working with patients and how many patients they could see. And then all of a sudden, now they've got this thing between them and the patient, and it is really painful. It's not nearly as painful if you've grown up like my adult daughters have with the Internet, with technology, with handheld devices. They think it's the, you know, that's all you know, then you. You easily can adjust to it. But for people like my age who grew up before all of that, it's really been painful. We know we have to go there. At least most people believe that we have to go to an electronic system. I mean, because the new generation of patients are not going to stand for the fact that anywhere in this world you can go and put your cad a plastic card into a machine and get money in that denomination in that country and get your bank balance instantaneously within seconds. And yet how many of us personally have tried to get a medical record or a page of a medical record to take to a specialist or to take care of our sick child? And it took weeks. You know, I recently had a situation in my own family where a medical. Where a lab test was sent to the wrong doctor in a different state just because the doctor had. The only commonality was this doctor had the same last name as the doctor that my family member was seeing. It just. And so in this case, I don't think she'd mind me saying it. You know, my wife gets this call from a doctor from Mass General saying, We have this lab test, Mrs. Smith, and it's not, you're not a patient here. Where is this supposed to go? So, so, I mean, three states away. I mean, how does that happen in Maine in 2012? We have to do better.

Dr. Lisa Belisle:

As you know, the Dr. Lisa Radio Hour and podcast is focused on the mind, body and soul. Sometimes our bodies are giving us a little indication that maybe things aren't quite right. Here to talk to us about some particular things that we can listen to when our bodies are Acting up is Dr. John Herzog of Orthopedic Specialists in Falmouth, Maine. Today's diagnosis is plantar fasciitis.

[Unidentified voice]:

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Dr. Lisa Belisle:

As part of what your function is as the executive Vice president of the Maine Medical association is to be sort of a is to have a historical memory so that people don't keep repeating the same mistakes that have been made in the past.

Gordon Smith:

Yeah, it's true. And to also listen to the members and see what they're interested in today. A lot of my colleagues around the country haven't adjusted well to the notion of employment, for instance, and how that Changes the types of issues that we might work on. Thirty years ago it was all about tort reform and scope of practice. But that's when doctors practiced individually, they paid their own premium and all malpractice companies left the state in 1970s people were bare, there was a crisis. Well, now we have the lowest, the second lowest premium is in New England after Vermont. We are in the 10th in the quarter, the lowest of the 10 states in the country. We have a great system of pre litigation screening panels. When we poll our members about what is bothering you about medicine today, what should the Maine Medical association be working on? Tory form isn't there except in if you ask obgyn, which will always be a high risk specialty in neurosurgeons. Our average member today is going to be a 40 year old female pediatrician practicing maybe three days a week who is likely to be as interested in BPA and children's toys as she is. Scope of practice and toy form Also the doctors today don't agree on anything. It used to be you had these unifying issues. Well, if you take scope of practice, many of the doctors want to expand the scope of practice practice of mid level practitioners because it will help them provide care. Still you have a more traditional group of doctors that think you want to practice medicine. You go to medical school like I did and you complete a residency, that there's no substitute for that. So it's more difficult to find those unifying principles. Our view of the Maine Medical association is it's a big tent and we want to represent physicians in their training whether they're in primary care, whether they're in specialty care. And we want to provide a menu of services and products that are appropriate and that they need. And that has obviously changed a great deal in the 30 year transformation that we've talked about from solo individual practice to people practicing, many of them employed in a large system of care.

Dr. Lisa Belisle:

Well, I appreciate your spending the time with us to talk about the future of medicine and in some part the past that you've seen yourself with medicine in the state of Maine. It strikes me that you are, you're heading up what has to be a very flexible and open organization, which is different I think than many people associate with the notion of medical associations.

Gordon Smith:

Well, let me say this. I think that we better be, you know, open minded about how we face issues and you know, a good representation of where we are today. Our new president, Dieter Krekl up in Rumford is about my age. The chair of our board is Lisa Ryan. She's an osteopathic physician. She's the first osteopathic physician, certainly who's chaired our board. She's what I would call a relatively young pediatrician. The chair of our legislative committee is going to be a young lady, Amy Madden, who's maybe three years out of her residency training. And we are going to have people from age 30 to age 80 involved in this organization. And when people say, oh, it's too liberal, it's too conservative, you're too Republican, you're too Democrat, I say, look, the Maine Medical association is what the members and those who choose to serve in the leadership and are on the committees, what they choose to make it. And if you want it to be something different than you think it is, then you get involved and then you get to make those decisions.

Dr. Lisa Belisle:

It also strikes me that when we talk about the Maine Medical association, that more and more what's happening is that you're representing patient interests as well as physician and healthcare provider interests. So I think this is an important thing for people who are listening to the show today to realize that you really are advocating on a number of different levels.

Gordon Smith:

Our mission is to advocate for physicians and their patients and to protect public health. Those are three different prongs that we put resources into each one. And again, I'm so proud when we ask our physicians now through SurveyMonkey, we can ask our members things every week. And so we continually try to listen to what is it that you're interested in? And the last really substantial polling that we did, their interest was in getting their patients coverage. That was the thing that most that they responded was most bothersome in their practice was seeing people with poor insurance coverage, public or private or no coverage. And that's not self serving. That's impressive.

Dr. Lisa Belisle:

Gordon, how can people find out about the Maine Medical Association?

Gordon Smith:

We have a Wonderful website@mainmed.com, m a I n e m dash it's about to be about to have a new website, but it will have the same Internet address and we've got sections there for patients, for providers, for. We've completely revised it to make it more modern and to make it cleaner. Our consultants of course, told us you've got way too much content, you know, thousands of pages of things. And so we've tried to clean it up and tried to improve the indexing. Even I would go in there and couldn't find what I was looking for. So we're excited about that. That will probably be unveiled in the next 30 days. So the best way to learn about us is to go to the website or just call me up in our little office in Manchester, Maine. We're listed right under the Maine Medical Association.

Dr. Lisa Belisle:

Well, we've been speaking with Gordon Smith, who is the executive vice president for the Maine Medical association and longtime friend of my family, my family of doctors. So thank you for all that you are doing for the physicians and other health care providers within the state of Maine and also for what you've done for for the healthcare providers within my family.

Gordon Smith:

Well, and thank you for your emphasis on wellness and complementary medicine. I think today it's not a matter we got to explore during the interview, but doctors are far more willing now to acknowledge they don't know everything, they can't help every patient, and they're much more willing to work in partnership with not only the patient, but with people working outside of what we would consider traditional medicine. And that's going to be important in the future.

Dr. Lisa Belisle:

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[Unidentified voice]:

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Dr. Lisa Belisle:

On the Dr. Lisa Radio Hour, we like to bring in guests who are thinking about things in new and different ways. And one of our recent sponsors just came on was founded by somebody who we know is thinking about things in very new and different ways. Her name is Katherine Cloudman. She's the co founder of Apothecary by Design, which we're so appreciative of the sponsorship of our program. But I'm also really appreciative of having the time to spend with you over several meetings because you're doing very interesting things here in the state of Maine. So thank you for for coming in.

Catherine Cloudman:

Thank you for having me.

Dr. Lisa Belisle:

Let me start with what is Apothecary by Design and where is it located? Sort of the standard information. Sure.

Catherine Cloudman:

Well, we're located at 84 Marginal Way in the intermed building. We're part of that Bayside neighborhood, which is sort of an up and coming neighborhood in Portland. We are an integrated pharmacy and when I say an integrated pharmacy, what I mean is that we have some solutions that are integrated across pharmacy where we've got compounding, where we make prescriptions from the raw ingredients. We have a specialty pharmacy where we work with patients who have chronic complex diseases. We have a regular retail pharmacy where we can help patients with their everyday medications. And we have a nutritional, health and well being department where we talk to folks about alternative remedies to certain conditions and where supplementation might be appropriate to help manage side effects or nutrient depletions caused by any traditional medications that they are on. And we can clinically support that with our pharmacists and nurses and patient coordinators who have some background in that area.

Dr. Lisa Belisle:

You yourself came from a very different background, not necessarily healthcare related. Tell me about that.

Catherine Cloudman:

That's true. I have a business background and most of my work at Apothecary by Design is centered around helping to manage the business side. But I started a consulting firm a number of years ago called Cloudhawk Management Consultants and worked with closely held and family owned businesses throughout New England on business valuation, strategic planning, succession planning and helped those businesses pass from one generation to the next, which was a fun thing to be A part of. And in my travels as a consultant, I came across a couple of folks who were the founders of Portland Professional Pharmacy, which was a client of mine for a number of years. And back in early 2000s, I helped them sell their business to a publicly traded company. But I got to know their business really well as we worked on some of their strategic planning initiatives and really loved their business model and what they were trying to do, and decided that that would be something I'd love to be a part of at some point. And I'd spent a lot of time kind of helping businesses create value and grow their own businesses. And I just thought at some point along the way, that was something I wanted to do as well.

Dr. Lisa Belisle:

Why is it important to you to be involved in something that's maybe challenging at times? I mean, the Apothecary by Design is seated firmly in the medical world, and there's a lot of transitions happening right now.

Catherine Cloudman:

Well, you know, change has two sides of the coin. It can be very positive and it can be very disorienting for people. For us, I think we have the opportunity to take advantage of some things that are happening within healthcare that allow us to focus in on a more customized approach to helping people. And I think that is sort of a wave that we will see happening here in the future. More personalized medicine, more of a focus on someone's individual needs and really caring for that individual in a very specific and unique way and in a very collaborative way with the other individuals that are helping that particular patient. So we do a lot of that at Apothecary By Design now. We work very collaboratively with the different practitioners that are helping our patients. We consider ourselves part of that healthcare team. And I think that's one of the many unique things about what we do. If you think about the pharmacy profession, a lot of these individuals, a lot of these pharmacists are spending a fair amount of time in school. They're getting a very strong degree, and many of them are coming out of pharmacy school with options that maybe don't meet what they envisioned as far as their professional career. And so we really wanted to create a opportunity for people to have a very professional career path within pharmacy. And I think we've worked very closely with a number of the pharmacy schools to make that happen.

Dr. Lisa Belisle:

I've met several of your pharmacists, and I know that you are working to do a lot with education online and things through social media. You have a nurse that works with you. It seems like this is something that they're being trained to do. Why do you think that pharmacists and nurses are underutilized by other pharmacies or other places in the healthcare system?

Catherine Cloudman:

Well, I think some of it has to do. If you think about the way pharmacy works today, the pharmacy industry has largely allowed itself to be become a commoditized industry. And so we ran an ad when we first opened our business that said, at what point did pharmacies go from being convenient to convenience stores that had pharmacies? And if you think about that and you think about what it's like to walk into many of the pharmacies that you might walk into, the pharmacy's tucked away in a little corner in the back, and you walk down and an aisle of sodas and snacks and maybe alcohol or cigarettes or something that probably has nothing to do with your health. And then you make your way back to the pharmacy and at some point you may get a chance to talk to the pharmacist. But they're so busy and the criteria for which they're being measured is so focused on quantity and output that they don't really get enough time to interact with patients in a way that can impact how someone might take their medications very differently, or to talk to them in a more in depth way about the side effects and how they might manage them, and to really effectively advocate for that patient as they're kind of moving down their journey of trying to tackle whatever health situation that they're tackling. And these folks have gone to school to try and impact how someone is living their life, and they view themselves, rightly so, as having the credentials to be able to do that. And so in our world, we've really tried to create that opportunity. And even if it's happening telephonically, there's a way to do that where you're investing the energy in speaking with the patient, proactively reaching out to the patient. We do compliance monitoring on our specialty patients, depending on what disease state they're in, where we reach out to them on a monthly basis before their refills are due, speaking to them about how they are adhering to their medication protocol, what problems they might be having, what side effects they might need some help managing prior to that phone call. If it's a transplant patient, we've reached out to the transplant unit and I've spoken with them about any dosage changes. We're going into this phone call fairly knowledgeable about what needs to happen with this patient. We've built the rapport with that Patient from the beginning, probably from the time that they were discharged from the hospital, because our clinicians go up to the hospital at Maine Medical center and they're part of the discharge team, counseling the patient about the medications that they're on, helping the family determine what is going to be the right system for them to keep this patient compliant. That's a very different kind of model than what you see in a lot of other pharmacies. And so I think it's a model that builds trust, builds a relationship, and generates a higher adherence to their medication protocol.

Dr. Lisa Belisle:

It sounds more like you're actually in the empowerment business than you are in the pharmacy business. In a way, you're empowering the pharmacist to do their job better, and you're empowering patients and their families to comply at a higher level.

Catherine Cloudman:

I think that's true. And I think because we're very focused on strong communication with the patient and with their practitioner, it's a reinforcing kind of model as well. So if there's something that's not going quite right with that particular patient, we're on the phone to the practitioner, talking to them about what we're seeing and what we're hearing. And does it make sense for you to be making a phone call, or is there something that we can do to try and get this back on track?

Dr. Lisa Belisle:

Do practitioners seem surprised by this level of involvement, or do patients and their families ever seem surprised?

Catherine Cloudman:

I think surprised in a good way. In some cases, yes. I think they're very surprised. And I think it's actually particularly as we've taken what I call sort of this medication therapy management model within the specialty pharmacy area and have migrated to doing more aspects of that within retail pharmacy and within our compounding area. It's something that I think practitioners and patients have sort of gotten used to. You know, they've sort of. They don't expect that level of service when they're going to many other places. And so practitioners kind of have to get a little used to someone advocating for their patient. And I think now that we've been in business for four years, and they kind of see how that model is working and they know that they can trust us, and they sort of welcome the phone call. They know that the phone call is going to be a very relevant phone call. And I think that's an important piece. You have to build the trust in the relationship, not just with the patient, but also with the practitioner.

Dr. Lisa Belisle:

Like me, you are a Maine girl, a Maine woman now, but you grew up in Gorham. And you, you went to Gorham High School. I think you and I graduated around the same time. And I won't out you on how long ago that was, but around the same time and you came back and you're raising your family here. So Maine is somehow important to you. Why is that?

Catherine Cloudman:

Maine just is a very special place. It's, you know, I probably like you have spent some time living in other parts of the country or traveling around. And I'm always kind of proud to say I'm from Maine and kind of chuckle a little bit when I'm someplace, you know, abroad. And they say, where is Maine? And you say north of Boston. But it is a great place to have grown up. It's a great place where you have a lot of people who I think have some common values. And I'm very thrilled to be raising my children here. And, you know, I have a sister who lives in Maryland and works at the Pentagon and is, you know, commuting to and from work each day for an hour and raising three kids in that environment around the Beltway. And, you know, I'm really proud of everything she's doing, but it's a lot harder to try and just get your life to work in that setting. And I feel like we have been very fortunate to have established ourselves here and to be a part of this community that is so reinforcing to one another, whether it's our school community or, you know, where we live in South Portland, or, you know, our community that we're, you know, building down in the Bayside area. You know, this is a community where people want other people to succeed and people want people to move to Maine because it's a great place to live and it's a great place to work. And I think we're all, in general, pretty proud of it and what it has to offer. So I feel very fortunate to be here.

Dr. Lisa Belisle:

And do you think that that has had any impact on why you're doing the type of work with Apothecary by Design that you're doing?

Catherine Cloudman:

Absolutely, both in terms of how I do my work, how our business has grown in some respects. For example, we opened our business four years ago and we worked with Bangor Savings bank to do our financing originally. And I had had some relationships with some of the key people at Bangor Savings bank prior to opening this business in my former consulting life. And this was a group of people who were willing to bet on a startup, you know, brand new independent pharmacy, in the face of, you know, all of the Rite Aids, Walgreens and CVSS of the world because they believed in our model and they believed in the people who were behind the model. You know, whether it's Bangor Savings bank or the relationship with our accounting firm or, you know, the relationship with our wholesaler, these are all people that we've known in our prior lives who believe in us and who believe our model can be successful. And that has been very rewarding to see a lot of those relationships kind of come back out of my past and be able to tap into and utilize them into my future. You know, kind of harkening back to the community concept. One of the most rewarding things for me is just being out in the community and hearing about, you know, somebody having a good experience at Apothecary by Design. And sometimes I just get to overhear it. You know, we were joking before about the exercise class and occasionally I'll be at an exercise class and I'll hear some people talking about Apothecary by Design and I think that is so neat that they are sharing their experience about this business that we've helped to build, which is really fun for me. And when you get to hear about the success stories of, you know, something really working for a particular patient, whether it's a specialty patient who was suffering from infertility and, you know, finally after going through their treatments, has gotten pregnant and has sent us a thank you note or a bouquet of flowers, those are really, you know, special moments that we cherish at our store.

Dr. Lisa Belisle:

It is interesting that you deliberately named the store I'll call it a store, although it's a lot more than just a store. But apothecary. Why the word apothecary?

Catherine Cloudman:

Sure. We actually it's funny that you ask that because there were probably a few people who advised us against using the name apothecary because they said, geez, we're not sure people are going to know what that is. And you know, for us, what we wanted to illustrate both in our name and in how we do things, is that we're sort of a throwback to the old soda fountain pharmacy that people do remember as their local apothecary. But we are the modern day version of that with the modern day technologies and the cutting edge knowledge around both alternative therapies and pharmaceutical therapies that might be appropriate for people. So the name for us was important because it was distinctive from what you're hearing. We didn't want people to hear pharmacy. And the image that flashes into people's mind when they hear pharmacy are those sort of those aisles that I described before that had lots of product that really don't have anything to do with your health. That's what people think of. They think of a big box retail store. They don't think of a place that they go to where they're going to spend time learning about their health, maybe grab a cup of coffee or tea and wander around the store and learn more about supplements that may be appropriate for them. That's part of the reason why we chose Apothecary. We really wanted it to be different.

Dr. Lisa Belisle:

Apothecary also does offer educational programming. Talk to me about some of that.

Catherine Cloudman:

Sure. We have offered almost since we first opened a wide array of free educational programs that we typically would run on a monthly basis, taking the summer off because we do live in Maine and they really vary in terms of topic. As we talked before about collaborating and working with different practitioners, it was kind of an outgrowth of that collaboration where we wanted to provide some educational opportunities for our patients, also strengthen our partnership with different practitioners. So we've offered programs on autism, adhd, women's health related issues, infertility, Just a wide range of topics that have really resonated with people. And you know, we typically, our speakers will come in and also do a presentation and, and then provide us with their presentation materials which we make available then on our website so that they live out there for a longer period of time and people can access that information. We feel like that's an important part of being a part of the community to provide those educational events. And with our new space, I think we'll have a chance to expand those opportunities to some extent. We also do some sponsorship of some different webinars that some of our practitioners are doing on their end so that we can help reach out to a larger audience out there as well.

Dr. Lisa Belisle:

What have you learned personally in this process of founding this amazing organization and store? But during a very significant economic problematic time,

Catherine Cloudman:

I've learned to be very patient both with myself and with others. And you know, I guess the most important thing, and maybe this is in part age and maybe it is just life, but I've learned to just accept the fact where one door closes, another one tends to open and whether it's an opportunity that, you know, we were really hoping might take some strategic initiative that we were really hoping was going to take hold that for whatever reason might not have panned out. What I have found is that typically something brighter and better comes along. Part of it's fate, part of it is having your eyes open. Part of it is having enough sort of irons in the fire that that can happen for you. But whatever it may be, it's not allowing yourself to get too frustrated by the fact that those changes are going to happen. And you have to be flexible enough to kind of roll with the punches and be optimistic enough and believe in yourself and believe in your business enough that it's all going to work out.

Dr. Lisa Belisle:

I feel a little silly asking this question that was so profound. But back to nuts and bolts. Apothecary By Design how do people find out about your store?

Catherine Cloudman:

Well, our website is www.apothecary carrybydesign.com. that's one way we always welcome anybody coming in to talk with us and ask questions. And we love to make ourselves available for that. We have a Facebook page that people can follow. We have a Twitter feed. We've got a lot of resources available on our website. Educational resources, information about our past events, future speakers that might be coming up at the store. So it's a great wealth of information and also information about particular disease states that some people might be impacted on.

Dr. Lisa Belisle:

Well, we've been speaking with Kathryn Cloudman, who is the founder, co founder of Apothecary by Design here in Portland. And we thank you for not only coming in and speaking with us today about this very important Future of Medicine topic, but also being a resource for the community and for our listeners and for sponsoring our show. Because without people like you and people who are forward thinking, we wouldn't be able to have this be possible.

Catherine Cloudman:

Well thank you very much for having me. I've really enjoyed it.

Dr. Lisa Belisle:

You have been listening to the Dr. Lisa Radio Hour and podcast show number 56, the Future of Medicine. Our guests today have included Executive Vice President of the Maine Medical Association, Gordon Smith and Co Founder of Apothecary by Design, Katherine Cloudman. As you might imagine, our conversations with guests often go far beyond what we can actually put on air, and we encourage all of our listeners to go to our website, doctorisa.org and listen to the extended interviews because there's a lot more wisdom to be found there. Also, please take advantage of our podcasts available through itunes. All of our past shows are available for download for free. Be sure to like our Facebook page and send us a little note and let us know how you think that we're doing through our website. This is Dr. Lisa Belisle. Thank you for being part of our world. May you have a bountiful life.

Dr. Lisa Belisle:

Sam.

Gordon Smith:

Sa.