The Program for Humanities in Medicine John P. McGovern Lecture: Facing the Unseen: The Struggle to Center Mental Health in Medicine

Transcript

• 00:00Hi.
• 00:02Hey, everybody.
• 00:04I've never seen so many
• 00:05people on one side of
• 00:06the room. It's very funny.
• 00:07But,
• 00:09good good afternoon.
• 00:11My name is Anna Reisman.
• 00:12I am the director of
• 00:13the program for humanities in
• 00:15medicine, and and I am
• 00:16very happy to welcome you
• 00:18to
• 00:19this year's,
• 00:20John p McGovern award lecture,
• 00:23which is one of our
• 00:24four named lectures and probably
• 00:26the most
• 00:28important one.
• 00:30Did you know did you
• 00:31even know that? Okay.
• 00:33Surprise.
• 00:35And this is supported by
• 00:36the the John Pete McGovern
• 00:38Fund for the Humanities and
• 00:39Medicine.
• 00:40Doctor McGovern was a Texas
• 00:42based medical humanist, allergist, investor,
• 00:45philanthropist
• 00:46who have established several lectures
• 00:48bearing his name in medical
• 00:49schools throughout the country. And
• 00:51the McGovern school and wherever
• 00:53that is is the same
• 00:54guy.
• 00:56This award lectureship is given
• 00:58annually to a physician who
• 00:59demonstrates
• 01:00the true healing art being
• 01:02both a scientist and a
• 01:03humanist,
• 01:04and a knowledgeable humane caring
• 01:06physician. And so
• 01:07we are thrilled to welcome
• 01:09doctor Damon Tweedy, a great
• 01:10humanist in the world of
• 01:11medicine, to speak to us
• 01:13today.
• 01:14And I'm just gonna tell
• 01:15you a little bit about
• 01:16doctor Tweedy. I'll introduce,
• 01:18Randy
• 01:19Epstein, who will be in
• 01:20conversation with him, and turn
• 01:21it over to them.
• 01:23So doctor Damon Tweedy is
• 01:24a professor of psychiatry at
• 01:26Duke
• 01:27and a staff physician at
• 01:28the Durham VA. His twenty
• 01:30fifteen book, black man in
• 01:32a white coat, was a
• 01:33New York Times bestseller,
• 01:35selected by Time magazine as
• 01:37one of the top ten
• 01:38nonfiction books of that year.
• 01:40He has published articles about
• 01:41race and medicine in the
• 01:42journal of the American Medical
• 01:44Association, JAMA, and the New
• 01:45England Journal of Medicine.
• 01:47And his columns and op
• 01:48eds have appeared
• 01:50in many, publications, including the
• 01:52New York Times, Washington Post,
• 01:53and elsewhere.
• 01:54His most recent book, Facing
• 01:56the Unseen, pictured
• 01:58in the next slide that
• 01:59you'll see,
• 02:01was published earlier this year.
• 02:04And doctor Tweedy will speak
• 02:05for about twenty five minutes,
• 02:06and then he will be
• 02:07in conversation with our writer
• 02:09in residence, Randy Hutter Epstein,
• 02:12who
• 02:13has interviewed many of our
• 02:16speakers. And Randy is,
• 02:18aside from being writer in
• 02:19residence,
• 02:20she is a Yale Medicine
• 02:22graduate,
• 02:22and she teaches writing and
• 02:24journalism
• 02:25here at Yale College and
• 02:27at Columbia. And she's also
• 02:29heading up the
• 02:31brand new medical humanities
• 02:33writing for the public track
• 02:35concentration.
• 02:36So
• 02:37welcome, Damon.
• 02:39Thank you.
• 02:42Alright.
• 02:46Thanks so much. Do you
• 02:47guys hear me okay?
• 02:48Yeah. Sounds great. I know
• 02:49there's always so many competing
• 02:51things you can be doing,
• 02:52so I'm always just wanna
• 02:53stay grateful I'm just that
• 02:54you guys are coming out
• 02:55here and listening to me
• 02:56talk.
• 02:57Thank you. You know? So
• 02:58so so,
• 02:59so Randy and and, so
• 03:01we we both have, my
• 03:02I came here in twenty
• 03:03twenty,
• 03:04and they were both sort
• 03:05of part of that visit
• 03:06as well. So it's just
• 03:07great to be back.
• 03:08And so so that time,
• 03:09I was talking more about
• 03:10race in medicine. And certainly,
• 03:12if that comes up in
• 03:12our discussion, I'm happy to
• 03:13talk about that. A little
• 03:14bit of that will come
• 03:15up in this talk. But
• 03:16this is mostly about the
• 03:17world of mental health. So
• 03:18I'm a psychiatrist,
• 03:19a very unlikely psychiatrist as
• 03:21you as you'll see as
• 03:22I get into a little
• 03:23bit more.
• 03:24And I'm gonna be talking
• 03:25to court sort of about,
• 03:26like, you know, there's this
• 03:27lot of talk now about
• 03:27mental health problems and how
• 03:29much it's a big you
• 03:29know, it's it's such a
• 03:30certainly in the pandemic era,
• 03:32but even before that, it
• 03:32was a big big discussion.
• 03:34And so how did we
• 03:35get to the space where
• 03:36things seem so bad. Right?
• 03:37You know? Because the the
• 03:38so the narrative is always
• 03:39that things are so this
• 03:40is this is a problem.
• 03:41We're not doing enough. Treatments
• 03:42are poor. And so, like,
• 03:43how do we get to
• 03:44this space,
• 03:45and then kinda where can
• 03:46we go from here as
• 03:47a result of that? So
• 03:48I'm gonna be talking about
• 03:48that through the lens of
• 03:49someone who's I'm fifty years
• 03:50old. So,
• 03:52midlife, mid career, whatever you
• 03:54wanna attach to it.
• 03:55Mid career sounds better. Right?
• 03:57So, you know, fifty years
• 03:58old. And, so, you know,
• 04:00I trained in the late
• 04:01nineteen nineties, early two thousand.
• 04:03And so some of this
• 04:04may seem like, well, gee,
• 04:05this is so long ago,
• 04:05but you think about who's
• 04:06in practice. Many of the
• 04:07people in practice are my
• 04:09age and older, and this
• 04:10is kinda how we were
• 04:11introduced to this area of
• 04:12psychiatry. So you go understand
• 04:14how we got to the
• 04:15problems that we have. Gonna
• 04:16take you through some of
• 04:16that history so that you
• 04:17can sort of see, like,
• 04:18how we've gotten here and
• 04:19then sort of where we
• 04:20can move forward.
• 04:21So let's see if we
• 04:22can
• 04:23navigate this. Yeah. So there's
• 04:24the, cover of my,
• 04:26your current book. And, again,
• 04:28just thank you so much
• 04:29for for for bringing me
• 04:30here.
• 04:31So I'm gonna start with
• 04:31this quote from James Baldwin.
• 04:34He wrote about this. This
• 04:35is an s in an
• 04:36essay from the New York
• 04:37Times from nineteen sixty two.
• 04:38It's about race in medicine.
• 04:39It's about the civil rights
• 04:40movement. He's commenting on the
• 04:42fact that, you know, we
• 04:43can't change history. We can't
• 04:44change what came before us
• 04:45in terms of, you know,
• 04:46Jim Crow era, you know
• 04:47you know, slavery. But how
• 04:49we choose to move forward
• 04:50in society requires sort of
• 04:52really sort of take that
• 04:53head on. And so that
• 04:54I think there's a lot
• 04:55of relevance to that and
• 04:56resonance to that as we
• 04:57think about mental health issues.
• 04:59There's this whole idea of,
• 04:59like, you know, mental health
• 05:00issues to be unseen, you
• 05:01know, not tangible.
• 05:02But in many ways, they
• 05:03are very tangible. Right? But
• 05:04and so I think for
• 05:05a lot for a lot
• 05:06of the time, we've sort
• 05:07of overlooked that, and it's
• 05:08been to our detriment, to
• 05:09a lot of patients' detriment.
• 05:10So I'm gonna just so
• 05:11this s this
• 05:13this kind of quote was
• 05:14really inspiration for the, for
• 05:16the title of the book.
• 05:17Just as a quick aside,
• 05:18you know, book titles, they
• 05:20always kinda come to me,
• 05:21in the shower. So my
• 05:22first book, Black Man in
• 05:23a White Coat, was taking
• 05:24a shower one day and
• 05:25got out the shower. My
• 05:26white coat was hanging on
• 05:27the on the the door
• 05:28doorknob, and it's, like, all
• 05:29just kinda came together looking
• 05:30in the mirror at myself.
• 05:31And same here. It's like
• 05:32the so the shower is
• 05:33just so I would say
• 05:35showers are good for the
• 05:36both the body, but also
• 05:37the mind. You know? Because
• 05:38this whole body mind theme
• 05:39is gonna be really important
• 05:40for us when we're talking
• 05:41about mental health issues. So
• 05:42just one quick slide on
• 05:43data.
• 05:44There won't be a lot.
• 05:45It's mostly gonna be sort
• 05:46of more pictures and stuff
• 05:47like that. But this was
• 05:48a Gallup poll survey done
• 05:49earlier this year, and they
• 05:51asked US adults, do you
• 05:53feel that mental health issues
• 05:54are identified and treated better,
• 05:56worse, or the same as
• 05:57physical health issues?
• 05:58And so it's a busy
• 05:59slide, but the gist is
• 06:00that orange and red is
• 06:01not so good. Right? And
• 06:02so about seventy five percent
• 06:04of US adults
• 06:05agree with that sentiment. There's
• 06:07probably
• 06:08different reasons why. There's probably
• 06:09some maybe it's about access
• 06:10to treatment. There's different reasons
• 06:11why, but the the the
• 06:11gestalt is that we inform
• 06:13people to feel like, you
• 06:14know, the mental health system
• 06:15is not really it's kinda
• 06:16failing us in some way,
• 06:17right, and failing people. And
• 06:18so that's and so that's
• 06:19a really,
• 06:20you know, that that that
• 06:21sort of frames the whole
• 06:22kinda context of what I'm
• 06:23gonna talk about. Because I
• 06:24wanna tell you so I
• 06:25came to med school as
• 06:26a pre med student,
• 06:28in college,
• 06:29very much in the the
• 06:30orientation of, like, you know,
• 06:32bio, bio, bio. I wanted
• 06:34to be an orthopedic surgeon
• 06:35initially and then later an
• 06:36interventional cardiologist.
• 06:38And so when I thought
• 06:39about medical school, medical school
• 06:41to me was like hospital
• 06:42based, you know, trauma surgery,
• 06:44you know, learning how to
• 06:46read X rays and EKGs
• 06:48and and lab data and
• 06:49how to help someone that
• 06:50sorta kinda, you know, sorta
• 06:51TV medicine kinda way, if
• 06:52you will. Not that not
• 06:53that sorta marginalize, but that's
• 06:54my image of what medicine
• 06:56was. If you weren't in
• 06:57a hospital or emergency room,
• 06:58then you're in a clinic.
• 06:59Right?
• 07:00This is the only this
• 07:00is actually my wife's clinic.
• 07:01This is my wife's middle.
• 07:02Met med school. She's in
• 07:03Jamaica, and we had a
• 07:04little med school love story,
• 07:05but I wanna put that
• 07:05there. But, you know, nice
• 07:07nice clinics like that. So
• 07:08that's what that's what, you
• 07:09know, medicine's all about.
• 07:11In contrast, psychiatry was in
• 07:12a very different space. So
• 07:13I my first rotation in
• 07:14medical school was in surgery.
• 07:17Hospital based. Right? Very sort
• 07:18of what I expected, you
• 07:19know, to be. My next
• 07:20rotation was in a family
• 07:21medicine rotation right out adjacent
• 07:23to the hospital. Still very,
• 07:25you know, medically oriented, but
• 07:26then came psychiatry.
• 07:27And so psychiatry was in
• 07:29a this is the old
• 07:30state hospital where my where
• 07:31I did my rotation. And
• 07:33so not only was it
• 07:34not in the hospital complex
• 07:35where I was training it
• 07:36for everything else, it was
• 07:37thirty minutes away. It was
• 07:38in another county. And as
• 07:40you as you get off
• 07:40the exit to go to
• 07:41the to the psych ward
• 07:42where it was, you saw
• 07:43signs for the federal prison,
• 07:46the juvenile detention center. It
• 07:49was everything was like correctional
• 07:51issues. Right? It's all in
• 07:52this one little area. And
• 07:53so psychiatry was like so
• 07:54right there was an introduction
• 07:55that just psychiatry was different.
• 07:56Right? And maybe something could
• 07:57be kinda a little scary
• 07:58and fear fearful of because
• 07:59it's like, why is it
• 08:00isolated with all these other
• 08:01sort of part of society?
• 08:03Accordant off, if you will.
• 08:04And so that was my
• 08:05image of psychiatry, and that
• 08:06was my initial experience. Now
• 08:08the other perception of psychiatry
• 08:09is just something you see
• 08:09at the bottom. It's really
• 08:10sort of fancy psychiatry. People
• 08:12can spend four hundred dollars
• 08:13an hour for or fifth
• 08:15for fifty minutes for a
• 08:15session to talk about
• 08:17what whatever. Right? And so
• 08:19none neither one of those
• 08:20sort of fit what I
• 08:21thought was, like, the average
• 08:21person. Like, I come from
• 08:22a very sort of blue
• 08:23collar family. We're not in
• 08:25this system. Right? We're also
• 08:26this is definitely not us
• 08:27either. And so what is
• 08:28psychiatry for? And so this
• 08:30is sort of my introduction
• 08:30to psychiatry
• 08:31as a medical student. Something
• 08:33very different. And it became
• 08:35pretty clear that there was
• 08:35this divide between
• 08:37physical health and mental health.
• 08:38Right? And so,
• 08:42even think about some of
• 08:43the sort of the subtleties
• 08:44of what that looks like.
• 08:45So in the hospitals where
• 08:47I've trained, even where I'm
• 08:48at today, the, on the
• 08:49first floor, there's the primary
• 08:51care outpatient clinic. Then there's
• 08:52also, like, various medical subspecialties.
• 08:55Think like rheumatology,
• 08:56dermatology, those sorts of things.
• 08:58Right? Medical things. Where is
• 08:59the mental health clinic? It's
• 09:00in the basement and it's
• 09:02in the far corner, in
• 09:03the back corner of the
• 09:03hospital. Now maybe it wasn't
• 09:05intended to be that. Maybe
• 09:05there's other reasons why, but
• 09:06it seems like it conveys
• 09:07a message that there's something
• 09:09different and separate about these
• 09:10two things.
• 09:12At Duke
• 09:14so prior to nineteen eighty,
• 09:15Duke was in what's called
• 09:16the old hospital. It's called
• 09:17Duke South. And then for
• 09:18those who aren't familiar, in
• 09:20nineteen eighty, they built something
• 09:21called Duke North in front
• 09:22of that hospital. All the
• 09:23specialties
• 09:24moved to that new hospital
• 09:26except psychiatry. So psychiatry was
• 09:28actually in a separate hospital
• 09:29from every other part of
• 09:31the, you know, the medical
• 09:32sort of system. And so
• 09:34it it was so separate
• 09:35that one time we had
• 09:36a patient on the psychiatric
• 09:38ward who developed some medical
• 09:39complications.
• 09:40And so instead of being
• 09:41able to sort of kind
• 09:41of transfer that person to
• 09:42the medical ward, we actually
• 09:44had to discharge them from
• 09:45the hospital and had to
• 09:46go down to the ER
• 09:48and start all over. So
• 09:49you think about it, it's
• 09:49just very much a very
• 09:50sort of separate sort of
• 09:51world, two different kinds of
• 09:53worlds. And so I didn't
• 09:54like that very much. And
• 09:55I thought, you know, I
• 09:55came med school to be
• 09:56a, quote, real doctor, and
• 09:58I didn't like psychiatry very
• 09:59much. And,
• 10:01in my in my rotation
• 10:03at the end of the
• 10:05end of that rotation, we
• 10:06had to interview a patient
• 10:06we'd never met on this
• 10:07on this sort of state
• 10:08hospital setting. You It was
• 10:09a faculty member who I'd
• 10:10never met before, and they
• 10:11were they're evaluating you for
• 10:12a thirty minute interview. And,
• 10:14this patient, who I never
• 10:15met, was talking very slowly.
• 10:18And you could see already
• 10:19that I talked very fast.
• 10:20And there was this really
• 10:21sort of and I was
• 10:22like, I got thirty minutes
• 10:22to figure this out. And
• 10:24I started, like, cutting this
• 10:25guy off and I was
• 10:25doing I was rushing through
• 10:26things. And at the end
• 10:28of the session, the fact
• 10:29the faculty member said, you
• 10:30know, Damon, what do you
• 10:31wanna do with your life?
• 10:33So that's probably a warning
• 10:34sign. But I didn't know
• 10:35it then. I said, well,
• 10:36you know, I wanna do,
• 10:37like, cardiology or surgery. He
• 10:40said, well, those are good
• 10:41fields.
• 10:42But you gotta be able
• 10:42to talk to people if
• 10:44you if you do those
• 10:45fields. And based on what
• 10:46I've seen, I'm concerned maybe
• 10:48you might not be able
• 10:49to do that and maybe
• 10:50you should consider
• 10:52of of working in the
• 10:53lab and just not seeing
• 10:54patients. That's the worst thing
• 10:55someone can say to you.
• 10:56If you're a medical student,
• 10:57right, you wanna be a
• 10:57doctor. And so I got
• 10:58my lowest grade of all
• 10:59the rotations in medical school
• 11:01in on psychiatry. And so
• 11:02I was very happy to
• 11:03go back to this because
• 11:05I wanted to be a
• 11:05cardiologist. I was so happy
• 11:06to do this. And I
• 11:07actually started my residency in
• 11:09internal medicine. I matched in
• 11:11internal medicine with the intention
• 11:12of specializing in cardiology. So
• 11:14I was on that path.
• 11:15So the obvious question is,
• 11:16how did I get from
• 11:17that
• 11:19to pay? Right? A million
• 11:20dollar question. So
• 11:22many things happen, but the
• 11:22thing that sort of stands
• 11:23out the most is that
• 11:24one day
• 11:25in the ER, someone in
• 11:26the medical intern, and we
• 11:28get the call that there's
• 11:29a guy who's twenty five
• 11:30year old guy or something
• 11:31in the ER who's been
• 11:33acting crazy as as they
• 11:34as they put it.
• 11:36And our goal in the
• 11:37medical side was to make
• 11:37sure there wasn't some sort
• 11:39of, like, physical health reason
• 11:40why. Like, did he have
• 11:41an infection? Did he have
• 11:43a you know, something something
• 11:44that was sort of account
• 11:45for in a in a
• 11:46sort of medical way, quote,
• 11:47unquote.
• 11:48And so when I get
• 11:49down there, you know, so
• 11:49I've done that before many
• 11:50times. And I get down
• 11:52there, and this person I
• 11:53see
• 11:54is someone that I recognize.
• 11:57And it just stopped me
• 11:57in my tracks.
• 11:59It was someone I had
• 12:00known from years earlier when
• 12:01he was a college too.
• 12:01We used to play basketball
• 12:02together. He was a smart
• 12:03guy. I was going to
• 12:04law school, going to politics.
• 12:05Really, really bright guy, really
• 12:06ambitious. And, like, what is
• 12:08he doing here? Because what
• 12:09I had done and I
• 12:10had not really realized it
• 12:11up to that point was
• 12:12I had already sort of
• 12:13done this sort of thing
• 12:14that I think a lot
• 12:14of us in society do,
• 12:15where we sort of do
• 12:16this us versus them. So
• 12:17there's an us, like, all
• 12:19of us people who I
• 12:19think of as, like, normal
• 12:20people kind of thing, and
• 12:21there's a them or people
• 12:22who are, like, in state
• 12:23hospitals or who are homeless
• 12:25and who are sort of
• 12:26talking to me. So we
• 12:26can do this sort of
• 12:27game where we sort of
• 12:28separate ourselves and think that
• 12:29those those two worlds can
• 12:30never sort of collide. And
• 12:31so what happened in this
• 12:32moment was that it sort
• 12:33of felt like these two
• 12:34worlds collided because there was
• 12:35someone that I knew as
• 12:36an us was now this
• 12:38them, and I had to
• 12:39try and figure out what
• 12:39all that meant in the
• 12:40reconcile and all that. And
• 12:41I really opened my mind
• 12:42to
• 12:43you know, in so many
• 12:45ways that this was something
• 12:46that could really impact anyone,
• 12:47everyone. Because the the problem
• 12:49with the mental health system,
• 12:49the way way you way
• 12:50I learned about it in
• 12:51medical school was that by
• 12:52the time I saw someone
• 12:53in the state hospital, they
• 12:55had been probably often been
• 12:56very sick for that at
• 12:57that whole period of time.
• 12:57And I didn't know this
• 12:58other side of them, And
• 12:59they didn't get we didn't
• 13:00have visitors so that you
• 13:01didn't have families who would
• 13:02come and sort of give
• 13:03you context. You just saw
• 13:04this person who's kind of
• 13:05this other that couldn't often
• 13:06talk to you and communicate
• 13:07with you. And I think
• 13:07that's a terrible way to
• 13:08learn about psychiatry, honestly, and
• 13:10I'm gonna talk more about
• 13:11that later. I think that
• 13:12actually does potentially more harm
• 13:13than actually good as far
• 13:14as helping people humanize,
• 13:16the the broader,
• 13:17area. So, anyway, begin I
• 13:19began to sort of start
• 13:20seeing things all around me.
• 13:21When I got back to
• 13:21the medical board, I had
• 13:23patients who were, like,
• 13:26hospitalized with an overdose on
• 13:28Tylenol.
• 13:29So that's a physical health
• 13:30thing. You gotta monitor liver,
• 13:32you know, problems, but it's
• 13:33actually a mental health cause.
• 13:34Right? And I saw also
• 13:35another grad student who had
• 13:36taken the large amounts of
• 13:37dextromethorphan
• 13:38or Robitussin. And so he
• 13:39had always still had physical
• 13:40health problems, but, actually, it
• 13:42was a mental health issue
• 13:43as to why he was
• 13:44doing that in the first
• 13:44place. It was actually a
• 13:46fascinating story is that he
• 13:46was actually in class. He's
• 13:47a grad student. He was
• 13:48teaching undergrads, and then and
• 13:50and then undergrads noticing he
• 13:51was second strangers, and they
• 13:52called nine one one.
• 13:53They took him straight to
• 13:54the hospital where I saw
• 13:55him. He was, like, straight
• 13:56from the Duke campus. And
• 13:57so these are people who
• 13:58I was seeing who are
• 13:59sort of, in this kinda
• 14:00us category, but then they
• 14:01were also having these mental
• 14:02health distress that I was
• 14:03seeing. And so once you
• 14:04become more aware of it,
• 14:05it's sort of everywhere. Right?
• 14:06You see this is a
• 14:07a slide that just sort
• 14:08of shows the kinda demographics
• 14:09of mental health, issues across
• 14:11the populations,
• 14:12including physicians. And I was
• 14:14so unaware of that as
• 14:15a medical student. So now
• 14:16it's a lot different. People
• 14:17talk about a lot more.
• 14:18When I was in training,
• 14:18that was something you would
• 14:19never discuss or or share,
• 14:21that you had some sort
• 14:21of mental health problem. It
• 14:22would be a sign of
• 14:23weakness.
• 14:24Like, you know, you got
• 14:25to serve medicine's a hard
• 14:26business. You gotta be tough.
• 14:27That was a lot of
• 14:28the the ethos or mentality.
• 14:30And, we had it's a
• 14:31story I tell in the
• 14:32third chapter where there was
• 14:33a young so I'm an
• 14:34intern again on the medical
• 14:35side, and there was a
• 14:36woman who was an intern
• 14:38in a different department who's
• 14:39one night who just kept
• 14:40paging me,
• 14:42about a lab test result.
• 14:43And I just found myself
• 14:44feeling irritated. Like, why why
• 14:46we talked about this? Why
• 14:47are you calling me again?
• 14:48We gotta do this. We
• 14:49gotta do that. And she's
• 14:50kept doing it. And I
• 14:51remember a few days later,
• 14:52I went and talked with
• 14:52some of my colleagues about
• 14:53it, and it got and
• 14:54and it was sort of
• 14:55like it came like a
• 14:56punchline.
• 14:57Oh, yeah. She's just that's
• 14:58how she is. She's kinda,
• 14:58like, she's kinda wacky that
• 14:59way. And none of us
• 15:01ever thought anything more of
• 15:02it. Until several months later,
• 15:04we learned that,
• 15:06she, her distress got so
• 15:08bad, she had to, like,
• 15:09end up leaving the something
• 15:10happened with her and a
• 15:11patient in a way that
• 15:12when she made some sort
• 15:13of mistake, and she ended
• 15:14up having to leave the
• 15:15program. And it was like,
• 15:16wow. And that moment, it
• 15:17hit me like, woah. That
• 15:19first moment where I was
• 15:20supposed that not where I
• 15:21thought she was kept hating
• 15:22me, maybe that was a
• 15:23sign that something was wrong.
• 15:24It never once crossed my
• 15:26mind that there could be
• 15:27something wrong because I we
• 15:29just weren't in that we
• 15:29didn't have that kind of
• 15:30language to be thinking about
• 15:31in that way. Now had
• 15:32she been limping, had she
• 15:33had some sort of physical
• 15:34health problem, I would've been
• 15:36concerned. I was, oh, maybe
• 15:37someone can help you. But
• 15:38this mental health thing was
• 15:39something totally different. And that
• 15:40was a lot of context
• 15:41in which we trained. Because
• 15:43you can imagine and so
• 15:44sometimes I think back, I'm
• 15:45like, man, what could I
• 15:46have done? Could someone have
• 15:48noticed that? Because what I
• 15:49saw obviously was a warning
• 15:50sign, but I just totally
• 15:51didn't get it. And so
• 15:52and so that's a a
• 15:53a very,
• 15:54big thing. You know, Randy,
• 15:55maybe we can talk about
• 15:56my own experience
• 15:57later on in your your
• 15:59question because I don't wanna
• 15:59I wanna get through the
• 16:00rest of the slides. Because
• 16:01because then also that same
• 16:02year, I end up having
• 16:03to I had a really
• 16:04stressful incident. I end up
• 16:05having to see someone myself,
• 16:06and I never had that
• 16:06experience before. I wanna make
• 16:08sure we we cover that,
• 16:09later because that really, really,
• 16:10really brought it home for
• 16:11me in that particular place.
• 16:12So anyway so as much
• 16:14as mental health issues seem
• 16:15elusive and hard to put
• 16:15your finger on, like, what
• 16:16is this stuff and what
• 16:17is depression, what is ADHD,
• 16:19etcetera,
• 16:20There's some very real there's
• 16:21some very real things about
• 16:22mental health that are really
• 16:23very serious and easily to
• 16:24count.
• 16:25Suicide is the most obvious
• 16:26one. Right? It's very prevalent.
• 16:28You can sort of see
• 16:29I like this slide because
• 16:30it sort of shows when
• 16:31I finished med school and
• 16:32kinda were kinda close to
• 16:33where we are today, you
• 16:33can sort of see that
• 16:34certain trajectory has increased.
• 16:36The suicide deaths themselves are
• 16:38actually just kinda like the
• 16:39tip of the iceberg. I
• 16:40mean, certainly, it's the worst
• 16:41outcome. But for every person
• 16:42who who attempt who dies
• 16:43from suicide, there's many more
• 16:44who find themselves in hospitals,
• 16:46emergency rooms with suicide attempts.
• 16:47And there are also many
• 16:48more people who attempt suicide
• 16:50that we don't even actually
• 16:51ever even know about. About
• 16:52a month ago or so,
• 16:53I saw a patient, the
• 16:54primary care clinic doctor referred
• 16:56him to me for depression.
• 16:58You know, I saw him
• 16:59that same day. We'll talk
• 16:59about that a little bit
• 17:00later. And, I started talking
• 17:02to him, and he says,
• 17:03well, you know, about a
• 17:03month ago, I took a
• 17:04whole bottle of clomazepine, which
• 17:05is, you know, oconopin, one
• 17:06of these benzodiazepines.
• 17:08It slept for, like, a
• 17:09a day and a half.
• 17:10It's actually a su it's
• 17:11a suicide attempt, but it
• 17:13wouldn't be captured. No one
• 17:14would ever really know about
• 17:15that because he never sought
• 17:15medical attention. There's so many
• 17:17people like that where that
• 17:17just sort of happens. And
• 17:18it's just a matter of
• 17:19chance whether they end up,
• 17:20you know, something bad happens
• 17:21or not. Right? And so
• 17:22it's really the tip of
• 17:23the iceberg in that way.
• 17:26Another thing that's really changed
• 17:27over my time in medicine
• 17:28is this sort of issues
• 17:29with mortality
• 17:30related to substance use. So
• 17:31it's a chapter in the
• 17:32book where I talk about
• 17:33sort of our own sort
• 17:34of blindness to this area.
• 17:36You know, substance use was
• 17:37like the worst thing that
• 17:38you could it's like this
• 17:39patient would be so often
• 17:40talked about in ways that
• 17:41are very sort of derogatory,
• 17:42negatively.
• 17:45Oh, this person is just
• 17:46a, you know, drug seeker,
• 17:47this, that, the other. A
• 17:48lot of those sort of
• 17:49that that language is really
• 17:50prevalent. And, a woman one
• 17:52day came to the e
• 17:53ED,
• 17:54and she has stories really
• 17:55familiar now, but I'd never
• 17:56seen it. So we she
• 17:57knows the person who had
• 17:58had a car accident, got
• 17:59a prescription for an opioid,
• 18:01the opioids start then becomes,
• 18:03like, start taking more opioids.
• 18:04Eventually, she just starts taking
• 18:05some that aren't prescribed to
• 18:06her or multiple doctors, that
• 18:07kind of thing. And before
• 18:08you know it, one day
• 18:09she consumes heroin,
• 18:11and that was her bridge
• 18:12too far for her. So
• 18:13she comes to the ED,
• 18:14and we see her, and
• 18:16it's like we don't know
• 18:17we haven't basically, have nothing
• 18:18to offer her. Now nowadays,
• 18:20things are different. She might
• 18:21get,
• 18:22you know, she might get
• 18:23naloxone,
• 18:24prevent overdose. She might get,
• 18:26start of Suboxone there. She
• 18:27might get immediately referral to
• 18:29outpatient care. We didn't do
• 18:30any of those things. We
• 18:31just sent her out and
• 18:31say, well, you know, in
• 18:32in a few days, someone
• 18:33will give you a call
• 18:34because that was the standard
• 18:35of care,
• 18:36because, you know, opioid withdrawal
• 18:38wasn't, like, medically life threatening.
• 18:39So I was like, well,
• 18:40we what do we do?
• 18:41And so if you think
• 18:42about, like,
• 18:43the missed opportunity there, if
• 18:44if, you know, those kind
• 18:45of cases. Right? And so
• 18:46a a few weeks later,
• 18:47I ended up seeing a,
• 18:49someone over at Duke who
• 18:51had overdosed and was is
• 18:52also but hers was was
• 18:53more severe because she also
• 18:55had consumes, like, Xanax. And
• 18:56so she was in the
• 18:57ICU, and she was on
• 18:58a ventilator, and I'd never
• 18:59seen this before. And a
• 19:00couple weeks later, I come
• 19:01back to the VA, and
• 19:02there's a one of my
• 19:03resident colleagues tells me that
• 19:05a former patient had died
• 19:06from an overdose. So this
• 19:07is, like, ground zero for
• 19:07me with this whole opioid
• 19:08epidemic. It was, like, right
• 19:09there in that one little
• 19:10one last stand, all happening.
• 19:12Before that, it was, like,
• 19:12sort of a nonexistent thing
• 19:14for in my way. Now
• 19:15had she come to our
• 19:16hospital with, say, chest pain?
• 19:18I would've known all the
• 19:19things to do. Boom, boom,
• 19:20boom, boom, boom. But this
• 19:22sort of substance use thing,
• 19:23well, you know, what are
• 19:23we gonna do about that?
• 19:24That's not really medical. And
• 19:25that was sort of like
• 19:26the the sort of way
• 19:27in which things were sort
• 19:27of,
• 19:29you know, brought. Sounds sounds
• 19:30sounds
• 19:31it probably sounds hard for
• 19:31me to believe, but that's
• 19:32very much how the system,
• 19:34unfolded in those days. And
• 19:35so let's talk about,
• 19:37wait. We'll we'll be good.
• 19:39You told me if I
• 19:39have to be quiet.
• 19:41So some of the some
• 19:41of the problems here here
• 19:42are the issues. So it
• 19:43was like, you know, there's
• 19:43these issues we might call
• 19:45stigma. There's system issues. Gonna
• 19:46try and breeze through these
• 19:47pretty quickly.
• 19:48My family is very much
• 19:49an example of this sort
• 19:50of stigma. This is my
• 19:51grandmother. There was a young
• 19:52woman, there was an older
• 19:53woman. She was very,
• 19:56I talk about it in
• 19:56both books, but very sort
• 19:58of anxious,
• 19:59smoked a lot,
• 20:00very hyperactive,
• 20:02and that sort of anxious
• 20:03sort of kinda way, you
• 20:04know, always sort of couldn't,
• 20:05you know, that kinda way.
• 20:07But she framed it as
• 20:08well. This is I'm a
• 20:08I'm a I've had a
• 20:09hard life. I'm a black
• 20:10woman. I grew up in
• 20:11Jim Crow era. Life's tough,
• 20:12man. And so this is
• 20:14just the way it is,
• 20:14and I and I and
• 20:15I gotta suck it up.
• 20:16And because someone one day
• 20:17suggested that maybe she should
• 20:18talk to someone, one of
• 20:19her church,
• 20:20colleagues.
• 20:21So how would I do
• 20:22that? Doesn't make any sense.
• 20:23I'm not gonna talk to
• 20:24someone I don't know about
• 20:25some problem they can't help
• 20:25me with. And that was
• 20:26her attitude. So she had
• 20:28a daughter, who's my aunt,
• 20:30who also was had had
• 20:31was was anxious, but she
• 20:32actually was was worse because
• 20:34she would have these episodes
• 20:35of anxiety attacks. She just
• 20:37would kinda shut down. And
• 20:38she'd also have periods of
• 20:39reclusiveness where she would just
• 20:40kinda be locked herself up
• 20:41in a room. So our
• 20:42medical terminology would be maybe
• 20:44panic disorder and
• 20:46major depressive disorder. That's what
• 20:47we might say in our
• 20:48in our pseudo lingo. But
• 20:49in our family's lingo, she
• 20:50just had a kinda strange
• 20:51way about it. And that's
• 20:53the way it was that
• 20:53that's how the stigma sort
• 20:54of manifests itself. And people
• 20:56would maybe not seek care
• 20:57because of these sort of
• 20:58things within their own kinda
• 20:59families and communities. So that's
• 21:01an obviously an important issue.
• 21:03As a quick as a
• 21:04quick aside, though, my aunt
• 21:05lived long enough to see
• 21:06me become a psychiatrist, and
• 21:07she was so happy and
• 21:08grateful that I became a
• 21:09psychiatrist. She thought about how
• 21:10because there's also a lot
• 21:11of thinking about going into
• 21:12psychiatry, which I mean, talk
• 21:13about. But she was so
• 21:14happy to sort of see
• 21:15that because she knew from
• 21:16her own side how hard
• 21:17it was for her, how
• 21:18hard it was for her
• 21:18to get help.
• 21:20So, anyway,
• 21:21this is obvious. Think how
• 21:22hard it's getting in all
• 21:23care. So my wife's a
• 21:24primary care doctor, and if
• 21:26she wants to see get
• 21:27someone to see a
• 21:28a surgeon or cardiologist,
• 21:31boom. It can just happen.
• 21:32She wants someone to see
• 21:33a psychiatrist. It's like moving
• 21:35heaven and earth for that
• 21:35to happen. It's like, can't
• 21:36do it. And so she
• 21:37ends up sort of filling
• 21:39that gap for so many
• 21:40patients. The primary care doctor
• 21:41ends up being the one
• 21:42who sort of has to
• 21:43manage that primary that mental
• 21:44health issue because and that's
• 21:45a big system issue. We're
• 21:46gonna breeze through this part,
• 21:47but this this this issue
• 21:49of public and private
• 21:50is a problem in all
• 21:51areas of medicine.
• 21:53I contend that psychiatry is
• 21:54worse.
• 21:55Quick quick, really terrible story.
• 21:57I wanna just preface it
• 21:58by telling you this is
• 21:58a terrible story. And that
• 21:59it was a terrible story
• 22:00then, but there's a sort
• 22:01of coda, and it would
• 22:02actually be a better story
• 22:02today, but I wanna just
• 22:03tell it to you so
• 22:03you can understand context and
• 22:05why it's important. So when
• 22:06I was a resident, there
• 22:07was a night when I
• 22:08was in the ER, and
• 22:08then two women that came
• 22:09with really similar problems. Both
• 22:11exorted them on this kind
• 22:12of overdose on some over
• 22:13the counter pills. Both need
• 22:14to go in inpatient psych.
• 22:16Common scenario in in emergency
• 22:18psych.
• 22:19First woman had health insurance.
• 22:22That means she could go
• 22:23to our our the so
• 22:24the private unit. And the
• 22:25way that process starts is
• 22:26that a nurse from the
• 22:27unit comes to the ED,
• 22:28orients her to what's gonna
• 22:29happen when she goes upstairs,
• 22:30takes her upstairs, or she
• 22:32gets care. That's how it
• 22:33should be. Right? Second patient,
• 22:35no insurance. No insurance means
• 22:37you can't hardly go anywhere,
• 22:39particularly mental health. It's just
• 22:40it's such a it's now
• 22:41that's certainly then. It's a
• 22:42little better now. Certainly then.
• 22:44And so what that meant
• 22:45was her only recourse was
• 22:47the state hospital. And you
• 22:48might ask yourself, how do
• 22:49you get from the Duke
• 22:50ER to the state hospital?
• 22:52So
• 22:53this is something I didn't
• 22:54know with them, but that
• 22:54varies a lot by state.
• 22:56So here in Connecticut, it's
• 22:56probably an ambulance, particularly someone
• 22:58who was who was, like,
• 22:59she was not, like, acutely,
• 23:00you know, she was
• 23:02you know, she was she
• 23:03was remorseful. She sought care
• 23:04on her own. But in
• 23:06North Carolina and many other
• 23:07states,
• 23:08police.
• 23:09Just think about that. So
• 23:10police taking someone from a
• 23:12hospital to hospital. So that's
• 23:13a nonmedical thing. Right? That's
• 23:14not medical. Like, why why
• 23:15are police involved? And if
• 23:16police involved, police do police
• 23:18things. So police things are
• 23:19handcuffs and
• 23:21sitting in the back of
• 23:21the plea of the spot
• 23:22car. So this is someone
• 23:23seeking medical care voluntarily,
• 23:26and this is what happens.
• 23:27And so you and so
• 23:27it makes you think, is
• 23:29mental health
• 23:30a medical issue, or is
• 23:31it a criminal issue? Right?
• 23:32And so it gets again,
• 23:33this idea of how do
• 23:33we how is our society
• 23:34even defining what these things
• 23:35are? And that then determines
• 23:36the outcomes that we sort
• 23:37of see. Now that was
• 23:39terrible. And but because of
• 23:40the sort of things like
• 23:41that, many of us who
• 23:42worked in that setting began
• 23:43to sort of sort of
• 23:44try and take action. This
• 23:45is sort of the the
• 23:46positive side of the story.
• 23:47And so we started doing
• 23:48some research looking into not
• 23:50to me, but a lot
• 23:50of my colleagues. Looking into,
• 23:51like, how are black patients
• 23:53treated? So I didn't tell
• 23:54you the idea that this
• 23:55is based on race, so
• 23:56that probably could've guessed that.
• 23:57The black woman this woman
• 23:58got transferred by police with
• 23:59a black woman.
• 24:01Didn't have to be the
• 24:01way, but that's how it
• 24:02often could be because it's
• 24:02based on, you know, economic
• 24:04staffing and that sort of
• 24:05thing. And so we start
• 24:06we started looking at, like,
• 24:07how are patients insured or
• 24:08black? How they're being treated
• 24:09in the ED? What are
• 24:10some of the disparities we're
• 24:11seeing?
• 24:11Couldn't get a lot of
• 24:12information about that. But it
• 24:14was also we had a
• 24:14summons that advocated the state
• 24:16level. So now North Carolina
• 24:17as of nine twenty nineteen
• 24:18has sort of loosened that
• 24:20law. It it and the
• 24:20police don't have to be
• 24:21defaulted. So we would have
• 24:22discretion about how we get
• 24:23transferred. So this person now,
• 24:25this wouldn't happen.
• 24:26It was only because of
• 24:27the effort of people sort
• 24:28of trying to make that
• 24:28happen. So I I would
• 24:29tell you guys, if you
• 24:30live in a place where
• 24:31you think things are terrible,
• 24:32you can only make things
• 24:33better by advocacy. Like, if
• 24:34you just wanna sit back
• 24:35and sort of complain, things
• 24:36aren't gonna things are just
• 24:37gonna continue to stay bad.
• 24:38And so I just wanted
• 24:39to give that lesson to
• 24:40you guys of how you
• 24:40can sort of take something
• 24:41that's terrible and try and
• 24:42turn it into something that's
• 24:43much better. And that's what
• 24:44we feel like we did
• 24:45in this particular case. So
• 24:46kind of moving forward, going
• 24:47back to to our our
• 24:48quote from James Baldwin. What
• 24:49are some things that I
• 24:50try to do in this
• 24:51space?
• 24:52I told you earlier about
• 24:53how my primary care doctors
• 24:54do all this stuff. They're
• 24:55the ones handling the bulk
• 24:56of all this mental health
• 24:57stuff. Right? And they're not
• 24:58trained very well-to-do that by
• 25:00and large unless they sort
• 25:01of seek,
• 25:02additional education on their own.
• 25:04They're really not trained for
• 25:05that. My wife did a
• 25:06a rotation in med school
• 25:07at a inpatient site, and
• 25:08all she saw during that
• 25:09those six weeks were people
• 25:10who were very ill, who
• 25:12were in seclusion rooms, who
• 25:13were getting complicated antipsychotic medications.
• 25:16None of that's really helpful
• 25:17for what she has to
• 25:17see in everyday practice in
• 25:19a clinical setting at all,
• 25:20honestly. And so I think
• 25:21it was she was actually
• 25:22ill served by that by
• 25:23that, experience. And so what
• 25:24I've done with the VA
• 25:26side for years is I've
• 25:27been part of this integrated
• 25:28primary care mental health team,
• 25:30where I actually am the
• 25:31sort of the director of
• 25:32this team where we work
• 25:33in medical clinics
• 25:35as mental health people on-site.
• 25:36And so if a person
• 25:37has a mental health issue
• 25:38identified in a medical setting,
• 25:40they could then immediately sort
• 25:41of see one of our
• 25:41team members, do initial sort
• 25:43of assessment to figure out
• 25:43what's next steps are. Because
• 25:45the old model is someone
• 25:46comes to a cell like
• 25:47this, they someone puts in
• 25:48a referral, and about two
• 25:49thirds of the time, the
• 25:50person never never happens. Now
• 25:52whether it's because that person
• 25:53doesn't wanna go to the
• 25:53basement and be labeled a
• 25:54crazy person, because that's sort
• 25:56of what the messages might
• 25:57be might be telling them,
• 25:58or maybe there's, like, there's
• 25:59all sort of barriers to
• 26:00that happening. And so being
• 26:01there on-site, it kinda disabuses
• 26:03all of us to the
• 26:04idea that these things are
• 26:05separate. Like, it's not this
• 26:06idea that there's a mental
• 26:07care, there's physical care. It's
• 26:08kinda all medical care. Right?
• 26:09And so I think that's
• 26:10the thing that I I
• 26:10really would like to to
• 26:11sort of impress upon you
• 26:12guys. I also do this
• 26:14course for for medical students
• 26:15where I teach them about
• 26:16things that are not the
• 26:17usual things you learn in
• 26:18a psychiatry rotation. So perinatal
• 26:20psychiatry,
• 26:21had a really interested in
• 26:22that because you we've
• 26:24all heard about there these
• 26:25maternal health disparities
• 26:27often with black women sort
• 26:28of getting divorced to that.
• 26:29For the longest time, I
• 26:30thought, well, that's mostly mediated
• 26:31by things like
• 26:33eclampsia or diabetes or turns
• 26:35out mental health issues are
• 26:36actually the biggest mediator. That's
• 26:37an amazing thing that I
• 26:38didn't even know. So a
• 26:39future OB GYN should know
• 26:40that. And so my goal
• 26:41is to really talk to
• 26:42OB GYNs about how do
• 26:43we identify mental health issues
• 26:44and to address them in
• 26:45in people in that in
• 26:46that side.
• 26:47Community care, we talk about
• 26:48people going to pee, you
• 26:48know, about psych. But I
• 26:50also take students to these
• 26:51sort of settings. I take
• 26:52students to the county jail,
• 26:53which is, gosh. You know?
• 26:54See mental health there is
• 26:55is quite a sight. Take
• 26:56them there. But they need
• 26:57to see that. They need
• 26:58to see what's like that.
• 26:58This is the biggest mental
• 26:59health provider we have in
• 27:00our area. They should see
• 27:01that. They should be able
• 27:02to understand and see what
• 27:02it actually looks like. I
• 27:03take them to these places.
• 27:04This is what I didn't
• 27:05know how to do when
• 27:06I was at, when I
• 27:07saw the woman in the
• 27:08ED. So I take them
• 27:08there to these sites where
• 27:09they can actually learn and
• 27:10see what it actually is
• 27:11like to do to work
• 27:12and say what people have
• 27:13about opium problems. I take
• 27:14him to a clubhouse. I'll
• 27:15tell you about that in
• 27:16a second. And I also
• 27:17think it's a really fancy,
• 27:18eating disorder place. I I
• 27:19do other things too, but
• 27:20this this is like state
• 27:21of the art place. Eating
• 27:22disorders are really complicated, really
• 27:24important,
• 27:24but it's it's also a
• 27:26a certain demographic that tends
• 27:27to be more afflicted by
• 27:28eating disorders.
• 27:29I actually asked the question
• 27:30to themselves. I don't I
• 27:31don't beat it over the
• 27:31head, but they can sort
• 27:32of see themselves at why
• 27:34some settings have really appropriate
• 27:35fancies care, why do others
• 27:37be careless like crap? And
• 27:39and and, like, what's that?
• 27:39And then why I want
• 27:41people to ask questions
• 27:42about that. And it's not
• 27:43for me to preach to
• 27:43them, not not me to
• 27:44be with them. I want
• 27:45them to see it. And
• 27:45and several students have told
• 27:46me that they've learned more
• 27:47about social determinants of health
• 27:49or whatever you wanna call
• 27:49it from seeing this than
• 27:51anyone giving them a lecture.
• 27:52You can just sort of
• 27:53see it and you can
• 27:53understand it and really feel
• 27:54it.
• 27:55And so the thing that
• 27:56I wanna kinda wrap up
• 27:57with is that this is
• 27:58a traditional model of how
• 27:59people learn about psychiatry.
• 28:02Hospital,
• 28:03ER,
• 28:04isolation,
• 28:04people in their worst moments,
• 28:06like the most maybe the
• 28:07worst state of their lives.
• 28:08This is what you see
• 28:08in psychiatry when you learn
• 28:10about it. That's you need
• 28:11that's important. You need to
• 28:11know how to do that,
• 28:12but you also need to
• 28:13see there's another side. So
• 28:14and so this is an
• 28:15example of this is a
• 28:16clubhouse. This is like a
• 28:17clubhouse designed for people who
• 28:19have severe mental illness, schizophrenia,
• 28:21alcohol disorder, etcetera. But it's
• 28:23like a nonmedical way of
• 28:24thinking about how how can
• 28:25they engage with the world?
• 28:26How can they learn job
• 28:27skills training? How can they
• 28:28get education? How can they
• 28:29learn how to eat better?
• 28:30Really practical, helpful sort of
• 28:32things. How can they feel
• 28:33more human? Right? And so
• 28:36about several years back now,
• 28:38I had a student
• 28:39who saw a woman in
• 28:40this kind of setting.
• 28:42And so, you know, very
• 28:43big traditional model. She, like,
• 28:44had got forced medicines, the
• 28:46usual sort of stuff that's,
• 28:47you know, tough to see.
• 28:48Just by chance, he was
• 28:50on his rotation with me,
• 28:51and he saw that same
• 28:52woman in this setting.
• 28:54And his reaction was,
• 28:56I can't believe it. How
• 28:57can they be the same
• 28:58woman? Because he had been
• 28:59conditioned to think
• 29:01schizophrenia
• 29:02is this or that. It
• 29:04couldn't be someone who actually
• 29:05is actually functioning, and that's
• 29:07how the medical model can
• 29:08actually cause more problems and
• 29:10cause more harm than good
• 29:11in some ways. Because you
• 29:12need a balance. You need
• 29:12to see both. You need
• 29:13to see there's a spectrum,
• 29:14that people are on a
• 29:15spectrum. And so you may
• 29:16see this person here. They
• 29:17may be their worst moment,
• 29:18but that may be just
• 29:18one day, and it may
• 29:19be much better six months
• 29:21from now. So you guys
• 29:22get my point? That's a
• 29:23really, really important part about
• 29:24how medical model needs to
• 29:25change, which is how we
• 29:25educate people psychiatry. And so
• 29:27these are the groups of
• 29:28students I've worked with over
• 29:29the years. I was kinda
• 29:30stayed out of the old
• 29:31guy, my boys on faces.
• 29:32And, so we we go
• 29:33to these site visits, and
• 29:34we sort of we even
• 29:35talk about our experience. We
• 29:36talk about what it's like.
• 29:37You know? What it was
• 29:38like to experience that, and
• 29:39to learn from it. And
• 29:40so I wanna leave you
• 29:41with this, final quote,
• 29:43and I'll be done. Kinda
• 29:44made it in time.
• 29:46Maybe? Maybe I did? Okay.
• 29:48So this is a quote
• 29:49from doctor King.
• 29:51Can I can I do
• 29:52great things? I can do
• 29:53small things in a great
• 29:53way.
• 29:54I think this is so
• 29:55important. I think it's so
• 29:56easy to to get overwhelmed
• 29:58by life and get overwhelmed
• 29:59by things that are external
• 30:00to us, things that we
• 30:01can't control.
• 30:02I think it's so easy
• 30:03for that. But I think
• 30:04my challenge for you guys
• 30:05is always, how can you
• 30:06think about yourself,
• 30:08and how can you because
• 30:08first of all, all you
• 30:09guys here are in a
• 30:10world of privilege.
• 30:11You really are. I think
• 30:13you have to really and
• 30:13I know life can suck
• 30:14at times. Certainly, I've experienced
• 30:16that. I know it can
• 30:17be that way. It's easy
• 30:18to sort of think, well,
• 30:19man, I'm a med student.
• 30:20It's terrible. You know, I'm
• 30:21on a search rotation. It's
• 30:22hard. But but the grand
• 30:23scheme, you guys are a
• 30:24really place of privilege. The
• 30:25grand scheme of life. There's
• 30:26a world of people out
• 30:27here who are not. And
• 30:28it's your and you have
• 30:30in your space, you can
• 30:32you can choose to use
• 30:32that for for your own
• 30:33self gratification, self interest, even
• 30:35if you're on sort of
• 30:36self aggrandizement, or you can
• 30:37use that privilege to try
• 30:39and help people along the
• 30:41way have a a little
• 30:42bit better light. And I
• 30:43would say the challenge for
• 30:44all of us is that
• 30:44how can we see someone
• 30:46at one point in time
• 30:47and help them imagine themselves
• 30:48in this other place? I
• 30:49think and so we can
• 30:51do that in medicine for
• 30:52sure. We see people in
• 30:54in struggling, and how can
• 30:55we help them get on
• 30:56a better path of life?
• 30:57I see someone who has
• 30:59an alcohol problem today. Doesn't
• 31:00mean that they're always gonna
• 31:01be that way. They're not
• 31:02gonna always be drunk and
• 31:02intoxicating what's wrong. They can
• 31:04have this other space. I
• 31:05need to help them get
• 31:05to that place. That's also
• 31:07true for our community and
• 31:07people around us. There's always
• 31:09a space of how can
• 31:10we help people,
• 31:11in a better space.
• 31:13Because I I got just
• 31:13two quick examples. That woman
• 31:15but, you know, there's a
• 31:16lot of talk about, you
• 31:17know, what happened in the
• 31:17world election last week. Right?
• 31:19So so but here's the
• 31:20thing. Think about this.
• 31:22The woman who, I described
• 31:23in the ER who had
• 31:24that bad experience where she
• 31:25was handcuffed and shackled,
• 31:27So that would've happened whether
• 31:29Donald Trump was president at
• 31:30first, Barack Obama's president. It
• 31:32was happening during then. It
• 31:34was happening when George Bush
• 31:35was president. It was happening
• 31:36when Bill Clinton was president.
• 31:37It was happening. So so
• 31:38so we can we can
• 31:39lose sight of the fact
• 31:40that this was actually in
• 31:42order to actually make change
• 31:42on the ground, we have
• 31:43to stop our local space,
• 31:45and that's where the change
• 31:46really could happen. Because this
• 31:47this terrible thing happened no
• 31:48matter who was president for
• 31:49all these years and years
• 31:50and years. So we have
• 31:51to remember that. Like, we
• 31:52can get obsessed with what's
• 31:53happening in a in a
• 31:54in a large world, but
• 31:55there's still this local world
• 31:56where we can do so
• 31:57much to really, really make
• 31:58change. And I think we
• 31:59have to always remember that.
• 32:00And I was gonna tell
• 32:01you one little final personal
• 32:02story, and I'll and I'll
• 32:03stop.
• 32:04So so when I was
• 32:05a,
• 32:06it just it may seem
• 32:07unrelated, but I think I
• 32:08hope you can sort of
• 32:08connect to it. It may
• 32:09seem a little unrelated. Because
• 32:10it's not really about medicine,
• 32:10but just more about my
• 32:11sort of personal journey.
• 32:13So when I was a
• 32:13fourteen year old student, I
• 32:14was in I was in
• 32:15a I was in a,
• 32:17so initially, I grew up
• 32:17in a community that was
• 32:18all black, hundred percent black.
• 32:20And when I was in
• 32:21the, when I was
• 32:23in middle school, I was
• 32:24in what might be called
• 32:24a low performing school, where
• 32:26where sometimes people had low
• 32:27expectations for for students. I
• 32:29mean, it's just being candid.
• 32:29I mean, you you would
• 32:30see that, and you hear
• 32:31hear things.
• 32:32But I had a teacher
• 32:33who would who was really
• 32:35invested in,
• 32:36she she recognized that I
• 32:37was good at math, and
• 32:38she suggested that I take
• 32:40a test to get into
• 32:41a magnet program.
• 32:42Now my first reaction was
• 32:43to say absolutely not.
• 32:45Because even though no one
• 32:46had ever told me as
• 32:47a black person that I
• 32:48was less intelligent than white
• 32:49students, Asian students, No one
• 32:51ever actually said that to
• 32:52me. But in some ways,
• 32:54everyone has said it to
• 32:54me because you just ingest
• 32:56it. It's just there. It
• 32:56just you just feel it
• 32:58all every everywhere you go.
• 32:59You're just constantly reminded of
• 33:00that and and told that.
• 33:02And so I said, no
• 33:03way I can I can't
• 33:03do that? There's no way
• 33:04I'm gonna do that. And
• 33:05I kept avoiding her, avoiding
• 33:06her, avoiding her. And it
• 33:07took months, the deadline approach,
• 33:09because I had to basically
• 33:10take some version of a
• 33:11PSAT kind of thing. And
• 33:12I kept avoiding it. And
• 33:13then one day, she finally
• 33:14just kept she called my
• 33:15mom. I remember it was
• 33:16because it was a it
• 33:16was a Saturday morning. It
• 33:17was really rainy. And, normally,
• 33:19I'd be out playing basketball,
• 33:20but I couldn't because it
• 33:20was raining. And, and she
• 33:22called my mom and said,
• 33:22Damon, there's a Damon has
• 33:23an opportunity to take this
• 33:24test. And, I said, hell,
• 33:26no. I'm not doing that.
• 33:27But then once my mom
• 33:28found out, she's like, hell
• 33:29hell. Yes. You are. And
• 33:30so I took this test,
• 33:32and it really so I
• 33:33got into this program. And
• 33:34there were some really hard
• 33:35challenges. Like, for instance, I
• 33:36was the only black student
• 33:37in the class in chemistry.
• 33:38Every student there was white
• 33:39or Asian. I was the
• 33:40only black student. And there
• 33:41was something really bizarre that
• 33:42happened one day where they
• 33:43wanted to do a photo
• 33:44op, and they brought black
• 33:45kids from the other parts
• 33:47of the school just to
• 33:47make it seem like our
• 33:48class is integrated.
• 33:50And then as soon as
• 33:50the photo op left, those
• 33:51politicians left, they were famous
• 33:53people. Soon as they left,
• 33:55they told those kids to
• 33:55go back to the other
• 33:56part of the school. And
• 33:57I was the only person
• 33:57left. I looked around. I
• 33:58was like, what the hell
• 33:59just happened? You know? Did
• 34:00anyone realize what happened to
• 34:01me? And it didn't seem
• 34:02like anyone did. And so
• 34:03there are definitely periods where
• 34:04I felt alienated and isolated.
• 34:05But, ultimately, though, I persevered,
• 34:07and that set me on
• 34:08the path where I'm at
• 34:08today. Because without being in
• 34:09that school, I would never
• 34:11have been on a path
• 34:11I could ever conceive of
• 34:12being a doctor. I've never
• 34:13seen a black person be
• 34:14a physician. I would never
• 34:15conceive of writing books. And
• 34:16so that small act that
• 34:17that teacher had, it had
• 34:19far reaching consequences, you know,
• 34:20for my own personal life.
• 34:21And, hopefully, I'm able to
• 34:21still then pay that back
• 34:23to other people. So I
• 34:24my charge for all of
• 34:24you is to think about
• 34:25how in your own sphere
• 34:26of life can you do
• 34:28those sorts of things, those
• 34:29small things that can really
• 34:30have changed.
• 34:31And so that's that's kinda
• 34:33I said a lot,
• 34:35but I really think that's
• 34:36the that's the lesson for
• 34:36us today. And and finally,
• 34:39if anyone wants to contact
• 34:40me,
• 34:41he'll get that checked.
• 34:42Contact me with my information.
• 34:45I just wanna say thank
• 34:46you for all your time.
• 34:47Mental health issues are really
• 34:48important and dear to me.
• 34:50Things are getting better, but
• 34:51there's still a lot of
• 34:52work left to do. And
• 34:53so thank you.
• 35:00Take a breath.
• 35:03Yep.
• 35:07Are these on? Yes. Alright.
• 35:08This is alright. This is
• 35:10a lot better. Gonna chat
• 35:11for a little bit because
• 35:12I wanna open it up
• 35:13because I'm sure there's a
• 35:14lot of questions in the
• 35:15audience too.
• 35:17But one of the things
• 35:18I wanted to start with,
• 35:19I know going back to
• 35:20that,
• 35:21for those a lot of
• 35:22people here have read the
• 35:23book. For those who haven't,
• 35:24it's
• 35:25a beautiful read. It it's
• 35:27an it's an easy read
• 35:29in terms of it's written
• 35:30so beautifully. It's a tough
• 35:31read in terms of some
• 35:32of the anecdotes.
• 35:34And I think the toughest
• 35:35that sits with you, and
• 35:36you called her Stephanie, is
• 35:38the woman that was taken
• 35:39away from handcuffs. And the
• 35:40fact that she was asking
• 35:42for mental health treatment,
• 35:44and you had to say
• 35:45to her, I'm sorry, but
• 35:46the police are coming.
• 35:48It's such a gripping story.
• 35:49But I kept thinking, you
• 35:50don't talk about a lot.
• 35:51You also went to law
• 35:53school. And so I'm just
• 35:55wondering,
• 35:56from your own background,
• 36:00you know, you're seeing injustice,
• 36:01which anyone would have seen.
• 36:03But I just wanna know
• 36:04from your legal background, is
• 36:06this something that maybe sat
• 36:08with you more to see
• 36:09these legal injustices? And is
• 36:11that also how you're sort
• 36:12of combining your
• 36:14legal background with the medical
• 36:15to push for these conditions.
• 36:17Certainly help. Certainly, it makes
• 36:18more informed about policy and
• 36:19because of state laws. Right?
• 36:20State law mandated this certain
• 36:22thing. So how do you
• 36:22go about advocating for the
• 36:24change that needs to happen
• 36:25to make that place better?
• 36:26So, certainly, I mean, I
• 36:27think part of the whole
• 36:28goal of the sort of
• 36:29legal training sort of, like,
• 36:31diversion, if you wanna call
• 36:32it that, was that I
• 36:33really
• 36:34was dissatisfied with how much
• 36:36medicine was sort of not
• 36:37about medicine. Right? How much
• 36:39of these problems we were
• 36:39seeing were these outside influences,
• 36:41outside forces, these social forces,
• 36:43political economic forces.
• 36:46And so I learned a
• 36:47lot in that process. And
• 36:48I really learned how much
• 36:49the locals again, I can't
• 36:50stress how important that I
• 36:51mean, maybe here locally, everything's
• 36:52great. I don't know. But
• 36:53I can tell you where
• 36:54I'm at is not so
• 36:55much. And so I just
• 36:56how important that that part
• 36:57really has been. So that's
• 36:58where that sort of really
• 36:59has come in. To law
• 37:00school after your residency. Yeah.
• 37:02After before your residency. Right.
• 37:03Because med school, I saw
• 37:04so much stuff in med
• 37:05school that just really made
• 37:06me think this is, like,
• 37:07this is crazy. Like, what's
• 37:08going on here?
• 37:09Now I wrote about most
• 37:10of that in my first
• 37:11book by those sort of
• 37:11things I saw in med
• 37:12school.
• 37:13And then the other question
• 37:14which you brought up because
• 37:15you knew I had to
• 37:16ask you about it. You're
• 37:18very open about during your
• 37:19internal medicine residency
• 37:21about
• 37:22someone saying maybe you could
• 37:24use some mental health. And
• 37:25it's Right.
• 37:27How much did
• 37:28you set out when you
• 37:29wrote this book to say,
• 37:30okay. I'm gonna talk about
• 37:31this experience and how hard
• 37:33was it? And and with
• 37:34which the irony because the
• 37:35whole book is there's should
• 37:37not be a stigma. Yeah.
• 37:38That exactly. Right? But it
• 37:39but it's like but it
• 37:40also it really that scenario
• 37:42really helped me really understand
• 37:44the patient side in a
• 37:45way I never really grasped
• 37:46it. So it really wasn't
• 37:47like a it was like
• 37:48a everything happened this one
• 37:50moment. I had this really
• 37:51terrible day,
• 37:52and I I was I
• 37:53was I was tasked to
• 37:54do this interventional procedure that
• 37:56not only would have been
• 37:56good at, but for some
• 37:57reason, I just couldn't get
• 37:59to work that day. I
• 37:59got so frustrated.
• 38:01I started and I got
• 38:02back to the call room
• 38:03or the work room and
• 38:05was, like, swearing up a
• 38:06storm. Just everything just sort
• 38:07of hit me like just
• 38:07like a ton of bricks.
• 38:07And I and I talked
• 38:07to the chief resident, and,
• 38:07and he
• 38:09And I and I talked
• 38:10to the chief resident, and,
• 38:11and he told me based
• 38:12on sort of our conversations,
• 38:12I seemed really stressed, and
• 38:13maybe he wanted me to
• 38:13to talk to, like,
• 38:14this to, you know, employee
• 38:16health person to sort of
• 38:17just sort of see where
• 38:18I'm at because he seemed
• 38:19like I was getting really
• 38:25run down.
• 38:26And I'm a person who
• 38:27comes from a world where
• 38:29men don't cry.
• 38:31After I I bet you
• 38:32by the time I after
• 38:33I turned about six or
• 38:33seven years old, I had
• 38:35made a determination that, you
• 38:36know, I'm old enough to
• 38:37stop crying.
• 38:38And the only time I
• 38:38cried after probably six age
• 38:40or six or seven was,
• 38:42once in high school,
• 38:43state playoffs, basketball. I I
• 38:45had three point shot that
• 38:46could have put in overtime
• 38:47and I missed it. But
• 38:48see, it's socially acceptable now
• 38:49for people to for men
• 38:50to cry and that's we
• 38:51see it on TV. Right?
• 38:52It's socially acceptable to do
• 38:53that. And I also cry
• 38:54when my, my grandmother died
• 38:55who I showed there as
• 38:56a first year medical student.
• 38:58Other than that, none. Like,
• 38:59I I've I've never seen
• 39:00my brother cry and my
• 39:01dad only once when his
• 39:02brother died. And so that's
• 39:03the world that I come
• 39:04from. And so but
• 39:06when that chief resident told
• 39:07me that he seemed like
• 39:08I was too stressed,
• 39:09the the floodgates just opened,
• 39:11and I couldn't believe that
• 39:12I couldn't control myself. And
• 39:13I just kept stop I
• 39:14couldn't believe I was crying.
• 39:15I couldn't believe it because
• 39:16that's just how I was
• 39:17raised to be. And, and
• 39:19so then I go to
• 39:20this this employee health center
• 39:21about,
• 39:22you know, to get an
• 39:23evaluation,
• 39:24and it was really,
• 39:27there was such shame attached
• 39:28to it. I just remember,
• 39:30this is a funny, not
• 39:31funny kind of thing. I'll
• 39:32just give you preface about
• 39:33saying that. I remember,
• 39:36I went into this room,
• 39:37into the building
• 39:39and, I, like, covered my
• 39:41my, head up because I
• 39:42didn't want anybody to sort
• 39:44of see me go into
• 39:45the space.
• 39:48You know, that's shame. Right?
• 39:49Like, I'm embarrassed. You know,
• 39:50what? Even though there's no
• 39:51any way where they know
• 39:52it's like a nondescript building.
• 39:53It didn't say mental health.
• 39:54It was a nondescript building.
• 39:55But anyway, I in my
• 39:56mind, it was like, I'm
• 39:57going to this terrible place,
• 39:58and that means I'm a
• 39:58I'm a failure in some
• 39:59sort of way.
• 40:01And so but then I
• 40:02realized, you know, hey, man.
• 40:04I'm a really big black
• 40:04guy. If I could come
• 40:05in this room with this
• 40:06my face covered up, I'm
• 40:07gonna have bigger problems. You
• 40:08know, that's the funny not
• 40:09so funny part. And so
• 40:10eventually, I said, okay. I
• 40:11gotta I gotta face this.
• 40:12And then I go in
• 40:13there
• 40:14and,
• 40:16but then I and I
• 40:16meet with this this like
• 40:17LCSW
• 40:18social worker. And,
• 40:20as I sat in that
• 40:21room with him, I realized
• 40:22I never recognized the power
• 40:24differential
• 40:25that happens when you put
• 40:26a doctor and a patient
• 40:28are in that space. Like,
• 40:29I was an intern. I
• 40:30was thinking the world has
• 40:30beaten me down, that I
• 40:31was a victim kind of
• 40:32thing that's common.
• 40:33But it's like, I'm in
• 40:34this space with this doctor.
• 40:36I'm sorry. This this this
• 40:37guy is in LCSW,
• 40:38and he has the power
• 40:39to sort of, like, say
• 40:41that I'm, you know, maybe
• 40:42not fit to go back
• 40:43to work, and he could
• 40:44take stuff away from me.
• 40:44I've worked so hard to
• 40:46get to this place, to
• 40:47overcome everything, and he could
• 40:48take it away.
• 40:49And it was in that
• 40:50moment that I realized, like,
• 40:51what patients really feel when
• 40:52they can come to a
• 40:53doctor, like the vulnerability that
• 40:54they have, when they just
• 40:56unload themselves, like, when they
• 40:57come see me, they don't
• 40:57know what I might do
• 40:58or what I might think
• 40:59and all that. And you
• 41:00just really appreciate that in
• 41:01that moment. I never appreciated
• 41:02until I was in that
• 41:03in that space. And so
• 41:04from that point forward, I've
• 41:05always taken that with me
• 41:06now when I go into
• 41:06the room with the patient.
• 41:08Like, this might be the
• 41:08I don't know what this
• 41:09person is really going through.
• 41:10This could be the worst
• 41:11moment they've ever experienced or
• 41:13the and I have to
• 41:14honor that as a it
• 41:15may be the hundredth time
• 41:16I've seen it, but it's
• 41:18the first time that they
• 41:19may have experienced it, and
• 41:20I have to honor that.
• 41:21And so that is really
• 41:22just that experience really shifted
• 41:24my whole sort of perspective
• 41:25on how I approach people
• 41:27in the in the hospital
• 41:28and clinics. It's such a
• 41:29it's such a, you know,
• 41:30really, never forget it. So
• 41:31it was it was worth
• 41:32the the the the rawness
• 41:34of having to to to
• 41:35reveal that for that sort
• 41:36of revelation to understand that.
• 41:38And I I'll have one
• 41:39more question. Although I have
• 41:40a lot more, so don't
• 41:41if you don't have, I'm
• 41:42gonna use mine. So we'll
• 41:43open up in a second.
• 41:48Actually, I just lost that
• 41:49one thing I was gonna
• 41:50ask about that.
• 41:51But, yeah, you taught I
• 41:53mean, the main point of
• 41:54your book is talking about
• 41:55this separation
• 41:56that we have of psychiatry
• 41:58here, medicine there.
• 42:01And the program that you
• 42:02run seems wonderful,
• 42:04but it's probably not available
• 42:05in most places.
• 42:07Do you think it should
• 42:08be mandatory
• 42:09then for primary care doctors
• 42:11and internists to have some
• 42:13kind of training?
• 42:15Or
• 42:16even if they don't have
• 42:17the training to somehow be
• 42:19able to recognize
• 42:20things that you recognize in
• 42:22this book
• 42:23that stem from a mental
• 42:25health issue. Sure. So, I
• 42:26mean, you know, every medical
• 42:27school has some kind of
• 42:28psychiatry rotation requirement. Right? So
• 42:31how do we choose to
• 42:32so one of the challenges
• 42:33is how much time we
• 42:34have. Some school I think
• 42:35here it's more actually than
• 42:36it is at Duke. I
• 42:36think here it's six weeks,
• 42:37I think, and Duke is
• 42:38four weeks. That's a separate
• 42:39conversation,
• 42:41or maybe it's not. But
• 42:42but what I would say
• 42:43though is that, how you
• 42:44choose to use that time,
• 42:47can be really important. Like,
• 42:48how come what do we
• 42:48expose students to? They need
• 42:50to know some signal of
• 42:51what acute psychiatry looks like
• 42:52and what it's like, but
• 42:53they really gotta have experience
• 42:54of, like, what is that
• 42:55more sort of practical side
• 42:56of of of of mental
• 42:57health? What is that side
• 42:58like? What is it like
• 42:59to sort of navigate an
• 43:00outpatient setting where someone has
• 43:01a physical health illness? But,
• 43:03you know, they have depression
• 43:04and anxiety. People have, you
• 43:05know, physical health problems are
• 43:06really stressful. Right?
• 43:08Think about all things that
• 43:09can go wrong with the
• 43:09body and how that thing
• 43:11can impact someone emotionally. And,
• 43:12you know, it's it's really
• 43:13important to be able to
• 43:14really appreciate that and understand
• 43:15that and think about how
• 43:16can we identify problems, and
• 43:18then how can we then
• 43:19sort of connect people to
• 43:20the kind of care that
• 43:21they might need. And because
• 43:22I think a lot of
• 43:23times the default in a
• 43:25in a in a primary
• 43:25care setting is,
• 43:27because of the system, the
• 43:28structure, you know, the visits
• 43:29are ten minute visits. Well,
• 43:31all we can do really
• 43:32is certain prescribe certain medicines,
• 43:34and maybe we haven't even
• 43:35been taught how to use
• 43:36these medicines. I mean, you
• 43:37can can imagine how many
• 43:38times I I feel like
• 43:38I'm having to, like, clean
• 43:39up some of the things
• 43:40that I don't blame the
• 43:41primary care doctors. I mean,
• 43:42they weren't they weren't given
• 43:43the great education, and they're
• 43:44just trying to do the
• 43:45best they can. And you
• 43:46see people on these really
• 43:46complicated regimens like, wow. This
• 43:48is really not what they
• 43:49need.
• 43:50And so how do you
• 43:51educate people to sort of
• 43:52do that? So one issue
• 43:53is education of primary care
• 43:54doctors. Other issue, of course,
• 43:55is how do we make
• 43:56our health care system
• 43:57more patient centered, to address
• 43:59these kinds of needs. So
• 44:00it's, like, two things kinda
• 44:01need to happen together. But,
• 44:03yeah, doctors definitely need more
• 44:04training.
• 44:05I wouldn't just distend it
• 44:06to primary care doctors. I
• 44:07mean, you talk about I
• 44:08mean, all fields. Right? I
• 44:09mean, if you treat diabetes
• 44:10patients with diabetes, I mean,
• 44:11mental health issues are really
• 44:12important. And if you need
• 44:13to have some kind of
• 44:14semblance of what that's like
• 44:15and how they can influence
• 44:16the the care and how
• 44:17to optimize care, it's really
• 44:18important. Kidney disease really could
• 44:20really stressful. You know, as
• 44:20you think about how it's
• 44:21everything you think of. Right?
• 44:22It all intersects.
• 44:24So I think it's it's
• 44:25just really important across the
• 44:26board. Well, I have some
• 44:27questions also about the writing
• 44:28process because we have some
• 44:30writers in the audience. But
• 44:31I'll save Good luck. Because
• 44:32I'd like to open. Open
• 44:33No. I'll save it for
• 44:35myself too. I'd like to
• 44:35open it up Yeah. Questions.
• 44:35And and introduce yourself when
• 44:36you ask the question. What
• 44:36year you're in or Okay.
• 44:36Oh, okay.
• 44:44But, yeah, tell us your
• 44:45name, what year, what year.
• 44:49Hi. Thanks thanks for being
• 44:51here. My name is, Will
• 44:52Roberts. I'm a first year
• 44:53fellow at the National Clinical
• 44:54Scholars Program. Oh, I can
• 44:56actually just finish my training
• 44:57in internal medicine residency, and,
• 44:59thank you for all the
• 45:00stories that you've shown. Definitely
• 45:02agree with a lot and
• 45:04definitely resonate with a lot
• 45:05of that. One one question
• 45:06that I had and a
• 45:06theme that I had noticed,
• 45:08you know, through, part of
• 45:09my training was,
• 45:11you know, just how much
• 45:12trauma that that's out there.
• 45:13We're Sure. Dealing with, still
• 45:15dealing with, like, the aftereffective
• 45:16of a pandemic. Sure. Patients,
• 45:17communities have trauma. Yeah. Us
• 45:19trainees have trauma. What
• 45:22efforts do you know of,
• 45:22or what are your thoughts
• 45:24on how we need to
• 45:25merge trauma into the medical
• 45:27space as well? That's a
• 45:28great question. You know, think
• 45:29think about even the idea
• 45:30so, like, there's there's this
• 45:31whole term you may hear
• 45:32called trauma informed care. But
• 45:34even think about some of
• 45:34the things we do in
• 45:35medicine, like, that you don't
• 45:36even think about. I know
• 45:37I've certainly done in the
• 45:38past, but I'll never do
• 45:39it again. But, like, even
• 45:40the idea, like, if you
• 45:40need to, like, examine someone's,
• 45:41like, thyroid and you just
• 45:42kinda go up to the
• 45:43person and just, like, just,
• 45:44like, you know, touch you
• 45:45know, like, think about what
• 45:46that what this person might
• 45:47have had experienced and what
• 45:49you just what you're just
• 45:49doing in that moment. You're
• 45:50just sort of, like, invading
• 45:51people. Right? And we do
• 45:52that all the time what
• 45:53I've been thinking about it.
• 45:54So that's just one sort
• 45:55of level with thinking about
• 45:56how trauma informed care can
• 45:57be really important, and just
• 45:59in that sort of in
• 45:59that sort of space. But
• 46:01just, you know, the balance
• 46:02one of the challenges, though,
• 46:03is that
• 46:04we have to have
• 46:05systems in place
• 46:07to provide care because you
• 46:08don't wanna just open things
• 46:09up. Right? You say something,
• 46:10you you open up this
• 46:11trauma, and then it's like,
• 46:13we have no way to
• 46:14do do it with doing
• 46:15it with it once it's
• 46:16there. Right? Because that person's
• 46:17bare their whatever thing it
• 46:18might be. So So we
• 46:19have to have system. This
• 46:20is where, like, a integrated
• 46:21care model is great because
• 46:23if a person comes in
• 46:23our setting, they might see
• 46:25you and they may talk
• 46:25about this trauma.
• 46:26We're right there to then
• 46:28be able to sort of
• 46:28re on the receiving end
• 46:29to sort of then sort
• 46:30of help them with the
• 46:31next steps. So that's where
• 46:32it kinda we need multiple
• 46:33things to have have happening
• 46:34kinda simultaneously.
• 46:35But it's a really big
• 46:36deal. And it's a big
• 46:37deal for providers as well.
• 46:38I mean, there's a whole
• 46:39lot there to unpack. I
• 46:40mean, there's a whole lot
• 46:41of challenge that a lot
• 46:42of providers have gone through.
• 46:43I do think we've we've
• 46:44come better than where we
• 46:45once were, but there's still
• 46:47certainly,
• 46:48more that needs to needs
• 46:49to happen. But again, part
• 46:50of why change is hard
• 46:51and part of why we're
• 46:52where we are now is
• 46:52because of all the sort
• 46:53of things that have sort
• 46:54of led us to where
• 46:55we are today. Right? It's
• 46:56sort of the lack of
• 46:56attention to these issues make
• 46:58these things much more challenging
• 46:59to address.
• 47:00But yeah. Great question. But
• 47:01yeah. Have you ever done
• 47:02that where you just, like,
• 47:02you know, just like you
• 47:03just start touching people without
• 47:04even really thinking about yeah.
• 47:06All the time. Yeah. It's
• 47:06like you just start touching
• 47:07someone's stomach. You just, you
• 47:08know, you but I'm really,
• 47:09like, thinking about what is
• 47:10this person really been through
• 47:11and is this right, you
• 47:12know. And I mean, I
• 47:13don't do that anymore, but
• 47:14it's, like, for years, I
• 47:15did. It's something we all
• 47:16should be thinking about. You
• 47:17know? We just do without
• 47:18even something. And sometimes we
• 47:20see more if it's a
• 47:20guy, well, he can't have
• 47:21trauma, we're just gonna just
• 47:22you know, with one man,
• 47:23maybe we're more attuned to
• 47:24it, but men can have
• 47:25trauma, terrible trauma too. We
• 47:26need you to be thinking
• 47:26about all of everyone.
• 47:29How are you doing, doctor
• 47:30Tweedy?
• 47:32First I want to
• 47:33say
• 47:34my name is Shah Ali.
• 47:35I'm a Pgy2 orthopedic resident
• 47:37here at Yale. So I
• 47:39love when people who are
• 47:40not in psychiatry
• 47:41come. I love this this
• 47:42is why I feel like
• 47:43I'm I mean talking this
• 47:44makes you feel good so
• 47:44I don't mean to cut
• 47:45you off but it makes
• 47:46you feel good Really nice.
• 47:47Well, I'm happy that kind
• 47:49of dovetails into my question
• 47:50a bit. First, I wanna
• 47:51thank you. I think you're
• 47:53really a big part of
• 47:54why I'm in medicine. Reading
• 47:56your book Wow. You're too
• 47:57nice. No. It's true. Reading
• 47:58your,
• 48:00book Black Men in White
• 48:01Coat did something for me.
• 48:02It changed my whole, like,
• 48:03way of thinking.
• 48:04So my question for you
• 48:05with that book and with
• 48:06this book is, what are
• 48:07some of the obviously, you
• 48:09have a goal when you
• 48:09write a book. But what
• 48:10are some of the unforeseen,
• 48:12like,
• 48:14benefits and things that you've
• 48:15noticed that your writing has
• 48:16done for people,
• 48:18for medicine,
• 48:19that, you know, you're proud
• 48:20of and that you can
• 48:21share with us? Well, I
• 48:23mean, I guess you're maybe
• 48:24a great example. Just hearing
• 48:25what you said was so
• 48:26kind.
• 48:27But, yeah, you know, thank
• 48:28you thank you so much
• 48:29for that. But, you know,
• 48:30every so you know, you'll
• 48:31every
• 48:32always happens every week. And
• 48:33the week doesn't go by,
• 48:34I don't get some kind
• 48:34of, like, letter or email
• 48:36or something from somebody,
• 48:38that where they where they
• 48:39talk about how, you know,
• 48:40maybe I help them see
• 48:41this thing a little bit
• 48:42different or maybe I help
• 48:42them be able to understand
• 48:43what was going on with
• 48:44their family member. And and
• 48:46there's always these sort of
• 48:47small things, and it really
• 48:48makes me,
• 48:50you know, power through because,
• 48:51you know, I I mean,
• 48:52you may not I talk
• 48:53a lot here, but it
• 48:54I really don't
• 48:55Talking to people is really
• 48:56hard for me, actually. I'm
• 48:57not a I'm a really
• 48:58introverted person. My happy place
• 49:00is actually in front of
• 49:00a computer in my little
• 49:01board of books. It's really
• 49:02hard for me to do
• 49:03this. But I feel like,
• 49:04you know, it's just but
• 49:05getting those those letters and
• 49:06hearing what you just said
• 49:07makes me sort of power
• 49:08through my own sort of
• 49:08challenges. It makes me feel
• 49:10like, you know, there's something
• 49:11that I'm doing this that's
• 49:12worthwhile.
• 49:13And so, yeah, I just,
• 49:13I mean, I would say
• 49:14that just getting those letters
• 49:15and notes and hearing those
• 49:16sort of testimonials is really
• 49:17what helps keep me going.
• 49:18So, I mean, just can't
• 49:19thank you enough.
• 49:20Yeah.
• 49:26Hi. I'm Namley. I'm a
• 49:29fourth year medical student, but
• 49:30I'm at the school of
• 49:31public health right now and
• 49:31will graduate next year. And
• 49:33funny enough, I remember you
• 49:35saying I heard you speak
• 49:36nine years ago saying that
• 49:37you were introverted.
• 49:39And I was like, sure.
• 49:40But I understood.
• 49:42It's true, man. No. And
• 49:43and I I really appreciate
• 49:45you pushing through to get
• 49:46this message out there because
• 49:48as you can see, the
• 49:48impact is really
• 49:50it it
• 49:52extends far beyond just that
• 49:54time and that place. Yeah.
• 49:55So my question is not
• 49:56related to that, though. Just
• 49:57wanted to acknowledge. Okay. Wow.
• 49:59So you mentioned before the
• 50:01education of physicians is just
• 50:03sorely lacking in
• 50:05useful practical,
• 50:07part of psychiatry. Mhmm. So
• 50:09I wanna go into emergency
• 50:10medicine. Mhmm. And urgency tends
• 50:12to sort of breed normalizing
• 50:14really problematic heuristics or Yes.
• 50:17Lends us to lean
• 50:19into stereotypes and lean into,
• 50:22sort of the ills of
• 50:23society.
• 50:25What would you and, you
• 50:26know, not every place has,
• 50:27like, a psych ED like
• 50:28Yale does. And so emergency
• 50:29medicine,
• 50:30physicians are confronted with people
• 50:32Yes. They're on the worst
• 50:33days of their lives Yes.
• 50:34They're and often sometimes with
• 50:35the worst, like, psychiatric crises
• 50:37that they've had. So all
• 50:39of that being said,
• 50:41what is some of the
• 50:42biggest
• 50:43or a a biggest lesson
• 50:45that you would offer to
• 50:47people at that forefront in
• 50:49interacting with people going through
• 50:50psychiatric crises?
• 50:52Yeah. So some of that
• 50:53is like, well, because the
• 50:54system you know, there's bed
• 50:55space problems. Like, there's a
• 50:56lot of there's so many
• 50:57system issues. Right? So what
• 50:58do you have someone comes
• 50:59to the ER, we can't
• 51:00get them anywhere. Right? And
• 51:01they and they're stuck in
• 51:02this ED setting that's non
• 51:03therapeutic for a long time.
• 51:05So people have faced that
• 51:07problem and and come up
• 51:08with really creative
• 51:10solutions and creative
• 51:11alternatives.
• 51:12And I think that's the
• 51:13that's always the charge for
• 51:14the charge for you is
• 51:15if you find yourself in
• 51:16this space, what can you
• 51:17now do with that? This
• 51:18would make make that thing
• 51:19better because it certainly happens.
• 51:20You know, people are stuck
• 51:20in the ERs for you
• 51:21know, when I was in
• 51:22training, it didn't happen as
• 51:23much, but then as beds
• 51:24got less and less, you
• 51:25see people just in the
• 51:26ER, psych ERs for and
• 51:28then regular ERs for weeks.
• 51:30We had a story about
• 51:31a kid who was in
• 51:31the ER for, like, a
• 51:32month. It's like, what do
• 51:33you I mean, how can
• 51:34that not be trauma? Taking
• 51:35a trauma. How can that
• 51:36be traumatized for, like, a
• 51:37a nine year old to
• 51:38be in a in an
• 51:39ER, you know, for a
• 51:40month,
• 51:41and and not see the
• 51:42light of day. Right? And
• 51:43so but it takes
• 51:45I mean, I hate to
• 51:46say this, but so much
• 51:47of our society is, like,
• 51:48something bad has happened before.
• 51:49Sometimes we we enough people
• 51:51wake up to sort of
• 51:51make that change that needs
• 51:52to happen. So I just
• 51:53encourage you to sort of
• 51:54be on the forefront of
• 51:55wherever you are. I mean,
• 51:56there's so many different creative
• 51:57solutions out there. There are
• 51:57people who are doing ED
• 51:58psych and finding ways to
• 52:00sort of make that better,
• 52:01who are just, like, not
• 52:02psych people, but actually just
• 52:02primarily ED doctors. There's a
• 52:04lot out there actually. So
• 52:05I encourage you to sort
• 52:05of seek that out as
• 52:06you get to wherever you
• 52:07wherever you land because there
• 52:08are people who are sort
• 52:09of, you know, confronting this.
• 52:11The other spade you made
• 52:12another point that I wanted
• 52:13to say. What did you
• 52:13else did you say? It
• 52:14was something else you said
• 52:14I wanted to respond to.
• 52:15Oh, something about,
• 52:17I don't know what it
• 52:18was now. But yeah. But,
• 52:19you know, thank you again
• 52:20for coming back after so
• 52:20many years. You know, I
• 52:21wanted to say thank you
• 52:22for that as well.
• 52:24Yeah.
• 52:27Okay.
• 52:28Hi. My name's John. I
• 52:30actually
• 52:31I study a biophysics and
• 52:32quantum mechanics here. Wow.
• 52:34I came here kinda because
• 52:36of your story. I actually
• 52:36was gonna go to Duke
• 52:38if I came Oh. Oh.
• 52:39Oh. Oh. Oh. Oh. This
• 52:40just means,
• 52:41unintended
• 52:42unintended
• 52:43consequences. This is an unintended
• 52:44consequence. Woah. Yeah. There's always
• 52:46this that always happens in
• 52:47life. Oh my gosh. Yeah.
• 52:48And we're
• 52:49But Oh, I feel oh,
• 52:50gosh. I feel bad. Met
• 52:51their students,
• 52:53both here and back home.
• 52:54I'm from Massachusetts.
• 52:55And a lot of them
• 52:56are turning away from the
• 52:57sciences because they don't wanna
• 52:58be perfect.
• 52:59So They wanna be perfect?
• 53:01They don't wanna be perfect.
• 53:01They don't wanna be perfect.
• 53:02Feel like that to be
• 53:03perfect to do any of
• 53:03these types of jobs. So
• 53:05I actually gave a lot
• 53:06of students your book.
• 53:08Oh, okay. And there some
• 53:10of them are starting to
• 53:10sway because they see that
• 53:11you're not perfect because you
• 53:12put into your book. Yeah.
• 53:13It's very not perfect. But
• 53:14it's really interesting that these
• 53:15young men don't
• 53:16want to do this because
• 53:18we see being black in
• 53:19these spaces require you to
• 53:20be perfect.
• 53:21Yes. So, Oh, gosh. It's
• 53:23kind of a big question.
• 53:25But what what do you
• 53:26what do you have? I
• 53:26feel like you're the best
• 53:27person to ask about that
• 53:28because you have to deal
• 53:29with that every day. Who
• 53:30knows? This feeling of being
• 53:31perfect, you mean? Yeah.
• 53:33Well, I feel that all
• 53:34every step of the way.
• 53:36So, yeah. I mean, that's
• 53:37a good question because if
• 53:38there is a perception. Right?
• 53:39You know, if you're the
• 53:41feeling like I'm the only
• 53:42black one of the only
• 53:42black always the only black
• 53:44person there, only black person
• 53:45there. There's sometimes that feeling
• 53:46of like, well, if if
• 53:47I don't do don't hold
• 53:49this thing right, it's gonna
• 53:51reflect not just on me
• 53:52but on this larger
• 53:54community of people who might
• 53:55come behind me. Right? So
• 53:56there's definitely that sense. I
• 53:57don't think that dogs me
• 53:58as much as that. Maybe
• 53:59just because I've gotten older
• 53:59and more more more secure
• 54:01in what I've done. But,
• 54:01certainly, when I was in
• 54:02training, I I certainly felt
• 54:03some of that.
• 54:06That's not a great thing,
• 54:07is it? So so so
• 54:08the challenge is how do
• 54:09you take something like that,
• 54:11which seems like a burden,
• 54:13instead flip it into, like,
• 54:14how could how is it
• 54:15I'm in this space, and
• 54:15I have this opportunity to
• 54:17potentially help that next generation
• 54:18of people. And maybe you
• 54:19share your story about how
• 54:20you're not perfect but you're
• 54:21still in this space.
• 54:23One thing one story that
• 54:24never made into my book
• 54:25was actually,
• 54:26speaking of not perfect, my
• 54:27first day as a as
• 54:28a, maybe I should write
• 54:30a story about this. So
• 54:31I got my my first
• 54:32research
• 54:33experience as a college student,
• 54:34very first at my freshman
• 54:35year. I got the chance
• 54:36to work in this lab
• 54:38in in an NIH, and
• 54:39it was like a they
• 54:40were doing this, cardiac I
• 54:41wanna be cardiologist, and they
• 54:42were doing these surgical procedures
• 54:44on rats.
• 54:45And, this is the very
• 54:46first day, and I'd never
• 54:48seen anything like that before.
• 54:49Right? I'm walking in this
• 54:50room and they're doing these
• 54:50surgeries on these rats that
• 54:51have been anesthetized.
• 54:53And, suddenly, I was like,
• 54:54woah, I don't sometimes it
• 54:55feel right. Like, am I
• 54:56here? I'm not there. And
• 54:57then all I can remember
• 54:58is someone say is,
• 55:00don't let him fall. And
• 55:01so very first day, first
• 55:04hour pass out,
• 55:06I remember being wheeled to
• 55:07the ER. That was my
• 55:09very first so that's clearly
• 55:10not perfect. And so but
• 55:11what do you do with
• 55:12bad experiences? Right? So you
• 55:14can just sort of give
• 55:15up or you can say,
• 55:16okay, how can I make
• 55:17this a learning opportunity? Because
• 55:18that's really what life is
• 55:19about. Right? How do you
• 55:20sort of when you fall
• 55:21down, how do you get
• 55:22back up. Right? And so,
• 55:23I was in an ED
• 55:24and I tell you, I
• 55:25learned everything that wasn't learned
• 55:26about, fainting and syncope. And
• 55:27by the time I got
• 55:28to med school, I was
• 55:29like the expert on syncope.
• 55:31I got they were like,
• 55:31woah. How do you know
• 55:32so much about this? It's
• 55:33like, how do you turn
• 55:34something that's really a negative
• 55:35experience? And that was the
• 55:36very first day, but but
• 55:36I was determined to go
• 55:37back there and not let
• 55:38that sort of be the
• 55:39be the final word on
• 55:40me.
• 55:41Because you can't because the
• 55:42world always wants to there's
• 55:43something that's really true for
• 55:44young black people, but, anyway,
• 55:45other people too. I mean,
• 55:46women know the world always
• 55:47wants to put you in
• 55:48boxes and and and define
• 55:49who you can be and
• 55:50and and all this sort
• 55:51of thing. And so your
• 55:52charge for you is how
• 55:52do you not let people
• 55:54continue to to define you,
• 55:55and how do you find
• 55:56a way to define yourself
• 55:57and write your own story?
• 55:58And that's really sort of
• 55:59that thing that I've been
• 55:59sort of driving me at
• 56:01every step of the way
• 56:02because there's always those those
• 56:03sort of challenges you're gonna
• 56:04find. Another thing I always
• 56:05encourage you is how do
• 56:05you find people who will
• 56:07support you, who will build
• 56:08you up, whether it's peers,
• 56:09whether it's people who are,
• 56:10you know, mentors. And it
• 56:12doesn't have to always be
• 56:12somebody who looks just like
• 56:14you.
• 56:15There there there's a brutal
• 56:16people out there who really
• 56:17who who can who, you
• 56:18know, I think that's something
• 56:19I mean, certainly, that can
• 56:19be really helpful, but it's
• 56:20not like the it's not
• 56:21always the the ultimate thing
• 56:22you have to have either.
• 56:24And so the charge for
• 56:25people who are not unrepresent
• 56:27represented minorities is how do
• 56:29you make yourself
• 56:30known as an advocate for
• 56:32people? How do you to
• 56:33help people bring people along?
• 56:35And so that's something that,
• 56:36you know, that's something that
• 56:36for you and other folks
• 56:37to consider. How do you
• 56:38do that in a deliberate,
• 56:39intentional way? One quick example
• 56:41of that was in was
• 56:42in med school. My,
• 56:45my wife and I really
• 56:46struggled in med school. It's
• 56:47hard. You know, we were,
• 56:48like, first generation college students.
• 56:49We're in a space where
• 56:50people really, Duke's not that
• 56:51bad. I mean, it just
• 56:52can happen it's gonna happen
• 56:53anywhere. It's not just Duke.
• 56:54Gosh. I really hate the
• 56:55people I scare I really
• 56:56hate that. That's the first
• 56:57I've ever heard of that.
• 56:58That's scary. Oh my gosh.
• 56:59I gotta redo this book
• 57:00now. I gotta go back
• 57:00and change it. It's not
• 57:01that bad. But we we
• 57:03struggled in med school, because
• 57:04of that sort of whole
• 57:05kind of fish out of
• 57:06water first generation kind of
• 57:07thing. And,
• 57:10there was a faculty member
• 57:11who was a gynecologist,
• 57:13a GYN oncologist. He's an
• 57:14older white guy, and he
• 57:15was a really prominent researcher
• 57:16there. At some point along
• 57:18the way, he just made
• 57:19a decision that he was
• 57:19gonna,
• 57:22have start having a black
• 57:23student in his lab every
• 57:24year. He just decided something
• 57:25no one told him to
• 57:25say, I'm gonna do this.
• 57:26I'm just gonna do this.
• 57:27This is something I feel
• 57:27like there's a need for
• 57:28it. And he became a
• 57:29mentor to so many, black
• 57:31medical students. I mean, he
• 57:31still had many other me
• 57:32had one black, so he
• 57:33had many other students who
• 57:34weren't black. So it's not
• 57:34like we're going to this
• 57:35idea. Because we go to
• 57:36this idea that we're taking
• 57:37away zero sum gain. He's
• 57:39he had plenty of people
• 57:39he's helping too. But he
• 57:40had a point where he
• 57:41was helping a black student.
• 57:42And my wife really struggled
• 57:43in med school, and he
• 57:44took her to her lab,
• 57:45and he really helped her,
• 57:47to get through med school.
• 57:49And now she's doing great.
• 57:51But she would have known
• 57:51about him
• 57:53only because he had done
• 57:53that for some of those
• 57:54students before, and he had
• 57:55developed a reputation for being
• 57:56someone who's an advocate in
• 57:57that way. So I think
• 57:58those are the kind of
• 57:58things you can do that
• 57:59are small things. Right? Small
• 58:00things that are really impactful
• 58:02for people. I think she
• 58:03never lose sight of that
• 58:04piece. Like, we get so
• 58:05wrapped up in the whole
• 58:06world, but how do we
• 58:07work how do we deal
• 58:08with our own world and
• 58:09help people in this in
• 58:10our own world? Because we're
• 58:10not doing any good if
• 58:11we just sort of obsess
• 58:12about that. We're not doing
• 58:13anybody good.
• 58:16Two, three. Of course. Oh,
• 58:18yes. Yes. Yes. Yes. Oh,
• 58:19yeah. Oh, yeah.
• 58:21Six months or Thank you.
• 58:22Experience with someone. Yes.
• 58:26Yes. Yeah. Third year can
• 58:27help second year, second year,
• 58:28first year. God, you can
• 58:29anyone people in college, high
• 58:30school, you can be like
• 58:31the end all be all.
• 58:32Like, they come I'm an
• 58:32old man. They don't like,
• 58:33what's this old man talking
• 58:34about? But you guys are,
• 58:35like, closer to that space.
• 58:36You can do a lot
• 58:37more in some ways to
• 58:38really reach out to people
• 58:39who are much closer in
• 58:40age,
• 58:41and that sort of way.
• 58:44Oh, gosh.
• 58:47It
• 58:48Question and then and then
• 58:49we'll no longer, and chat
• 58:49a little bit
• 58:52Yeah.
• 58:53Yeah. Yeah. Yeah. I'm happy.
• 58:55And also, again, if if
• 58:56people can't stay and they
• 58:57want there's something they wanted
• 58:58to say, to me, please
• 58:59reach out to me. That
• 59:00even I have an unusual
• 59:01last name, of course. I
• 59:02caused some grief when I
• 59:03was a young kid, for
• 59:04that name. And, and so,
• 59:05yeah, please reach out to
• 59:06me. I always get something
• 59:08people's when they send email,
• 59:09it's like it's really cool.
• 59:10Again, what what keeps you
• 59:11going? Just the idea people
• 59:12can help if I can
• 59:13help someone a little place
• 59:15beyond just me coming here
• 59:16talking today, and then you
• 59:17could then in turn use
• 59:18that to help someone else.
• 59:19I mean, that's just really,
• 59:20really what it's all about
• 59:21from from my standpoint.
• 59:23You had a question? Oh,
• 59:24you okay. Sorry. You're right.
• 59:25I thought it was this
• 59:26gentleman. Sorry. Go ahead. So
• 59:28who are you? Hello. Who
• 59:29are you? Yes. So, my
• 59:31name is Malaz. I'm a
• 59:33second year MD PhD student
• 59:34here at Yale.
• 59:36The, the question that I'm
• 59:38gonna ask basically hints at
• 59:40this element where when we
• 59:41put people in boxes that
• 59:43tend to dehumanize people. Sure.
• 59:45And I think you hinted
• 59:47at that through multiple themes
• 59:48throughout your talk. For example,
• 59:50like, referring to us and
• 59:51them, where it makes you
• 59:53see them as others, which
• 59:55can be dehumanizing.
• 59:56And there are some elements
• 59:59that I am seeing throughout
• 60:00my medical education is that
• 01:00:02when we study psychiatry
• 01:00:04or we talk about psychiatry,
• 01:00:05it feels in a way,
• 01:00:07it's more linked to
• 01:00:09a pattern of symptoms, pattern
• 01:00:10of behaviors
• 01:00:12that it feels like when
• 01:00:13we
• 01:00:14when we see patients or
• 01:00:15talk about them, it feels
• 01:00:16like we're putting them into
• 01:00:17these symptom categories that feels
• 01:00:19very dehumanizing. And
• 01:00:23I feel like
• 01:00:24part of mental health is
• 01:00:25the subjective element of it.
• 01:00:26Right? It's the fundamentally, it's
• 01:00:28being sub subjective. But when
• 01:00:30we take that subjective element
• 01:00:31and make it more objective
• 01:00:32to better understand it, it
• 01:00:34feels like we're studying something
• 01:00:35completely different. And so my
• 01:00:37question is asking about,
• 01:00:40in your own practice or
• 01:00:42in your own career,
• 01:00:44how have you seen those
• 01:00:45subjective elements of mental health
• 01:00:47and,
• 01:00:49integrated into the clinical care
• 01:00:50of patients? Because
• 01:00:52I feel like mental health
• 01:00:54can be seen as that
• 01:00:55is a different way that
• 01:00:56people perceive the world. Right?
• 01:00:58So how can
• 01:01:00you help see patients in
• 01:01:02the way they see the
• 01:01:03world with the limited resources
• 01:01:05that you have as a
• 01:01:05physician, like Right. The limited
• 01:01:07time you have with people
• 01:01:08and things like that. And
• 01:01:10going back to let's say
• 01:01:12you were to back go
• 01:01:13back to medical school, what
• 01:01:14kind of experiences
• 01:01:15you would have
• 01:01:16you you would think that
• 01:01:17would be
• 01:01:19would have been helpful Helpful.
• 01:01:21To help you,
• 01:01:22get interested in psychiatry and
• 01:01:24help you Right. See it
• 01:01:25in a way that's more
• 01:01:26interesting for the career of
• 01:01:27that mix. So I'll ask
• 01:01:28the second question first.
• 01:01:30Really good questions. The second
• 01:01:31question is, like, what would
• 01:01:32have been more helpful looking
• 01:01:33back? I kinda alluded to
• 01:01:35it. Is it seeing people
• 01:01:36on a spectrum? Like, you
• 01:01:36know, this idea, like, if
• 01:01:37you have a you you
• 01:01:39see someone with let's take
• 01:01:40someone who has an alcohol
• 01:01:41related problem. You see in
• 01:01:42a medical setting, it's like
• 01:01:43they're intoxicated with withdrawal. That's
• 01:01:44tough. Right? But what if
• 01:01:46you're seeing what if you
• 01:01:46also expose simultaneously to people
• 01:01:48who are in that other
• 01:01:49end of that spectrum, who've
• 01:01:50been free from alcohol use,
• 01:01:52they've been on this journey
• 01:01:52for ten years, and you
• 01:01:53sort of get to see
• 01:01:54both of those things. So
• 01:01:55you know that there's a
• 01:01:55continuum. So you might see
• 01:01:57someone in the ED who's
• 01:01:58really in that in that
• 01:01:59one state, but you can
• 01:02:00also
• 01:02:01have in your mind that
• 01:02:02this person could be somewhere
• 01:02:03else. And so a lot
• 01:02:04of times in medical, it's
• 01:02:05like this acute care cross
• 01:02:06sectional crisis oriented. And how
• 01:02:08can you so I would
• 01:02:08think we need some sort
• 01:02:09of way to sort of
• 01:02:11balance that out. Right? Like
• 01:02:12I told you about the
• 01:02:13the place with the schizophrenia
• 01:02:14where someone's in the hospital,
• 01:02:15but it's also a setting
• 01:02:16where they can see people
• 01:02:17with schizophrenia who are doing
• 01:02:18functioning pretty well. That's that's
• 01:02:21what helped. Your point about
• 01:02:22labels and and objective in
• 01:02:24boxes, it's a great question.
• 01:02:26I I have two two
• 01:02:27responses.
• 01:02:28For some people, those labels
• 01:02:30or boxes as as you
• 01:02:31put them,
• 01:02:33are really helpful because they
• 01:02:34have a certain set of
• 01:02:35experiences,
• 01:02:36and it helps them kinda
• 01:02:37make sense of it. It
• 01:02:39helps them not feel like
• 01:02:39they're alone or the only
• 01:02:40person who's felt this. So
• 01:02:42it can be helpful.
• 01:02:43For other people, it can
• 01:02:44be really
• 01:02:45harm
• 01:02:46and it's like, I don't
• 01:02:46want this label. I don't
• 01:02:47want this box. I also
• 01:02:49it also some people can
• 01:02:50be conditioned to think of
• 01:02:51every their whole life can
• 01:02:52be filtered through this diagnosis.
• 01:02:54It's like and they don't
• 01:02:55see themselves as an individual.
• 01:02:56They only see themselves as
• 01:02:57a diagnosis.
• 01:02:58That's not good. Right? And
• 01:02:59so I what I what
• 01:03:00I like to do is
• 01:03:01you can kinda talk talk
• 01:03:02to someone. You kinda get
• 01:03:03a feel when you're talking
• 01:03:04to someone
• 01:03:05what what what they
• 01:03:07how they see it. So
• 01:03:08there's some people who really
• 01:03:09want that label. They want
• 01:03:10that debt. They want that
• 01:03:11sort of tangible box, and
• 01:03:13it helps them. And this
• 01:03:14maybe takes school to to
• 01:03:15years to do this, but
• 01:03:16and so then I'm I
• 01:03:17I can lean into that.
• 01:03:18But other people I know,
• 01:03:18that's not what they want.
• 01:03:19And so I'm I don't
• 01:03:20go about the way you
• 01:03:21I don't say, well, my
• 01:03:22goal here today is to
• 01:03:23give you this label, and
• 01:03:24and because that's not what
• 01:03:25they want. And I wanna
• 01:03:25just understand your experience and
• 01:03:27how we can help you.
• 01:03:27And we can talk about
• 01:03:29whatever label we we can
• 01:03:30apply to doesn't matter so
• 01:03:30much. It's like, how do
• 01:03:31we how but how can
• 01:03:33I help you today? And
• 01:03:34so and so I think
• 01:03:35for me, it's like recognizing
• 01:03:36what it is that this
• 01:03:37person's kind of values, what
• 01:03:38is they feel like is
• 01:03:39gonna be most helpful to
• 01:03:40them. Does does that make
• 01:03:40sense? Because I think if
• 01:03:41you just do this one
• 01:03:42size fits all, you're gonna
• 01:03:43run to the problems because
• 01:03:45people are very different and
• 01:03:45very unique. I will also
• 01:03:47push back on you. When
• 01:03:47you say psychiatry is only
• 01:03:49subjective,
• 01:03:50I think there's so much
• 01:03:51more of general medicine is
• 01:03:53a lot more subjective than
• 01:03:54we want to think it
• 01:03:55is. Like, of of course,
• 01:03:56there's acute care medicine, broken
• 01:03:57bone, heart attack. There's things
• 01:03:59that are very objective, acute
• 01:04:00care, chronic. You have a
• 01:04:02problem, you fix it. But
• 01:04:03so much of general medicine
• 01:04:05is not so clear cut.
• 01:04:06It's so complicated.
• 01:04:08Chronic pain,
• 01:04:09headaches,
• 01:04:10these things are really complicated.
• 01:04:11There's physical health overlay. There's
• 01:04:13mental health overlay. It's complicated.
• 01:04:15And I think one of
• 01:04:16the problems is this medical
• 01:04:17model that we sort of
• 01:04:17put everything in
• 01:04:18often falls short when we
• 01:04:20try and apply it to
• 01:04:21things that are much more
• 01:04:22chronic and much more complicated.
• 01:04:24You know, even something as
• 01:04:25simple as, like, high blood
• 01:04:26pressure. Yeah. There's treatments, there's
• 01:04:27medicines, but there still could
• 01:04:28be other ways which people
• 01:04:29think about it, conceive about
• 01:04:30it. There's other nonmedical ways
• 01:04:31it could be approached. All
• 01:04:33this needs to be sort
• 01:04:33of taken into how we
• 01:04:34think about medicine. And so
• 01:04:36I I was I was
• 01:04:36I'm not trying to make
• 01:04:37a point, but I think
• 01:04:38it's really important for you
• 01:04:38to get beyond just mental
• 01:04:40health in the way. It's
• 01:04:40really much more broadly,
• 01:04:42an issue in medicine. I
• 01:04:43think we feel people when
• 01:04:44we just sort of put
• 01:04:44people in this sort of
• 01:04:45the medical model works great
• 01:04:47for some things, but for
• 01:04:48some things, it doesn't work
• 01:04:48so great. And we have
• 01:04:49to be able to sort
• 01:04:49of understand that and meet
• 01:04:51people in in a in
• 01:04:52a bigger way. Even in
• 01:04:53your field, man, I mean,
• 01:04:53orthopedic surgery, I mean, you
• 01:04:55know, it seems so concrete,
• 01:04:56but there's there's areas where,
• 01:04:57you know, they keep coming
• 01:04:58pain and stuff and it's
• 01:04:58like, am I gonna do?
• 01:04:59Right? I mean, I could
• 01:05:00I could do another surgery
• 01:05:01or I can, you know,
• 01:05:02and maybe that's not gonna
• 01:05:03really help them, but I
• 01:05:04can do it or or
• 01:05:05I can do something else.
• 01:05:05Right?
• 01:05:07Yeah. It's really tricky, man.
• 01:05:08So you gotta gotta be
• 01:05:09able to think about every
• 01:05:09area of medicine. So my
• 01:05:11last thing I'll say is
• 01:05:11and I'll be quiet.
• 01:05:13Promise,
• 01:05:14promise. Even if you guys
• 01:05:16don't go into psychiatry, the
• 01:05:17world can use more psychiatry,
• 01:05:18but we we really need,
• 01:05:20more doctors
• 01:05:21in all fields of medicine
• 01:05:22who kinda get that this
• 01:05:23stuff's important. I don't really
• 01:05:25I mean, we don't really
• 01:05:25need more psychiatrists as much.
• 01:05:26We need more doctors in
• 01:05:27other fields to kinda get
• 01:05:28this. We need one big
• 01:05:29surgeon to kinda get everything
• 01:05:30just doesn't not gonna be
• 01:05:31solved with another surgery. We
• 01:05:32we need we need that.
• 01:05:33We need, like, everything. We
• 01:05:34need if we could do
• 01:05:35that, then we're gonna be
• 01:05:36able to sort of help
• 01:05:37the people in the in
• 01:05:37the in the in the
• 01:05:38best way. So,
• 01:05:40yeah.
• 01:05:41Stay. No. We'd so appreciate
• 01:05:43Yeah. This is this is
• 01:05:43awesome. Gotta talk longer. Great
• 01:05:45talker.
• 01:05:46For people in the audience
• 01:05:48that might also be introverts,
• 01:05:50we wanna end now. Yeah.
• 01:05:52Exactly. Come up. And if
• 01:05:53you didn't feel like asking
• 01:05:54your question in front of
• 01:05:55a crowd,
• 01:05:56you can introvertedly
• 01:05:57Thank you. Come up and
• 01:05:59talk. I won't bite.
• 01:06:01Thank you so much. This
• 01:06:02is really appreciate your time
• 01:06:03coming. Thank you.