Why did you choose a career in medicine?
"I鈥檝e always wanted to leave the world a little better than I found it. And when I thought about opportunities to do that, medicine made sense to me. Partly because I had familiarity with it - both my grandfathers, and my father were physicians and my uncle and my father were in academics. And I figured if I could help other people, I could make a difference in the world."
What inspired you to pursue psychiatry?
"In my clinical years, I was looking for a part of medicine that was interested in the whole person. When I was in med school, doctors around me talked about their patients in terms of their disorder, but not who they were as an individual.
The idea that people鈥檚 experiences affected their bodies and their minds was invigorating. I thought鈥now this is a type of medicine where I can really make a difference in someone鈥檚 life.
One of the reasons I got into psychiatry, although it wasn鈥檛 intentional, was that my mother experienced very severe depression. My mother was 5鈥10鈥. She was a brilliant, vivacious, and brave individual.
The day I got into medical school, the only person I could find to tell was my mom. So, I waited until visiting hours to see her at the hospital. She was there receiving Electroconvulsive therapy (ECT) treatment for her depression. But that day when I visited her with my good news, her depression was so severe, that she had gotten down to 89 pounds. She couldn鈥檛 eat, she couldn鈥檛 sleep. So, I鈥檓 sure that was a factor that led to my interest in psychiatry. My mother was someone who I wanted to help."
What are your reasons to continue on this path?
"Because I love it! Being a psychiatrist makes me smile. I love being able to see and help patients. It is really rewarding. I love being an academic because it allows me to have a much broader range of opportunities. As an academic psychiatrist, I鈥檝e been able to see patients, to ask questions about the brain, or about pharmacology, or psychotherapy, and then try to answer those questions by . And hopefully the knowledge I鈥檝e passed along to trainees over the years has been helpful in their practice.
Helping new investigators has also brought me joy. So, in 1992 I started a program for new investigators to learn about careers related to academics, careers at the NIH and the FDA, and careers in research. We continue to train 20 new investigators a year, through the meetings.
I was also determined to help busy physicians working in low-income and rural settings, and those working in public hospitals. I saw a need for them to stay up to date on the best treatments, but I knew most lacked available resources. So, in 2003 we came out with the first issue of , a quarterly clinical review journal designed to inform practicing psychiatrists of advances in the field."
"What I liked about psychiatry is the interest in individuals as people first. As psychiatrists, we had to know about the whole person: their childhood, their family, their medical history, their challenges, joys, and aspirations. We got to know individuals in a much more holistic way, and that鈥檚 what excited me."
What lessons have you learned along the way?
"The best lessons I鈥檝e learned have come from my patients.
As a 4th year medical student, on a sub-internship on the oncology ward, I had a patient who I was told was very mean, and very angry. It turns out, this patient was a veteran with terminal cancer. When I first met him, and I asked how I could help him, he told me he鈥檇 lost so much weight because he couldn鈥檛 eat with his ill-fitting, painful dentures. My patient wasn鈥檛 angry, he was hungry. The lesson that taught me was simple: Ask my patients what they need. Ask them how I can help.
Another patient I saw early on was a gentleman on 14 different medications. He had been a smoker, he was diabetic, he was a bi-lateral amputee, he had COPD, heart disease, and high blood pressure. I had just 30-minutes to examine him and rewrite 14 prescriptions by hand. After introductions, I asked him how he managed to keep up with 14 medications, all on different schedules. After a while, he answered, 鈥淲ell doc, I don鈥檛. I just take these three, twice a day. The other doctor was trying so hard to help me, that I didn鈥檛 have the heart to stop him.鈥
That taught me the importance of listening to my patients and inspired new conversations with my patients:
- What things are bugging you the most?
- What are your priorities?
- What medications are you taking vs. what medications have been prescribed?
- You are the captain. I can coach you, but this is your life. My job is to help you, not to judge you.
I've also learned that there can be a real divergence between symptoms and quality of life - how someone actually functions in their daily activities. That discovery led me to develop the 鈥渟cale of functioning鈥, which has been used by many in the field.
The converse is also true. When we treat someone acutely with anxiety or mood disorders, their symptoms will resolve. But healing takes a great deal longer. And with this healing there may be changes felt in the family dynamics. Families are used to this person not being well, and as the individual gets better things will change. So, I鈥檇 often invite the family in for therapy to help them all prepare, and to foster a safe and supportive environment."
Why did you choose the 香蕉视频 of Utah, Huntsman Mental Health Institute?
"That鈥檚 easy, the opportunity was amazing. It was the confluence of the $150M gift from the Huntsman family, another commitment to raise $350M more, the commitment by the 香蕉视频 of Utah鈥檚 senior leadership to make mental health a priority, and the pro-mental health legislation in Utah. These were unique dynamics at the time. It made me realize what was possible: an academic institute that would set the bar and be the prototype for an NCI-like institute devoted to mental health."
As the CEO for Huntsman Mental Health Institute how do you define success?
"My success is a reflection of the success of my faculty, our trainees, and staff members in 85 clinical, collaborative, and training locations, and the patients we care for.
I鈥檓 grateful that together we can make a difference in our world. Regardless of the title, I鈥檝e always felt tremendous gratification anytime I can help others. To me, that鈥檚 success."