As I Live and Grieve®
It’s time for grief to come out of the basement, or wherever we have stuffed it to avoid talking about it. When you suffer a loss you need support, comfort, and a safe place to heal. What you are experiencing is painful but normal, unique but similar, surreal but very, very real. As grief advocates we understand and want to provide support, knowledge and comfort as you continue to live and grieve. Host, Kathy Gleason; Producer, Kelly Keck. www.asiliveandgrieve.com
As I Live and Grieve®
Has Medicine Lost Its Mind?
Discover how one doctor's mission could reshape the primary care landscape as Dr. Robert Smith joins us to uncover the critical gaps in mental health advocacy. With primary care physicians shouldering 75% of mental health care responsibilities, Dr. Smith exposes the alarming consequences of inadequate training, resulting in misdiagnoses that echo through personal lives and society. He invites us to consider the profound impact of integrating comprehensive mental health training into primary care, underscoring the necessity of public awareness and political intervention to drive meaningful change.
From tackling the stigma of non-traditional grief to mobilizing public action for healthcare reform, this episode empowers you to champion your medical well-being through informed and compassionate engagement.
Contact:
www.asiliveandgrieve.com
info@asiliveandgrieve.com
Facebook: As I Live and Grieve
Instagram: @asiliveandgrieve
YouTube: asiliveandgrieve
TikTok: @asiliveandgrieve
To Reach Dr. Smith:
Email: smithrr@msu.edu
Website: https://www.robertcsmithmd.com/
Credits:
Music by Kevin MacLeod
Copyright 2020, by As I Live and Grieve
The views expressed by guests are their own and their appearance on the program does not imply an endorsement of them or any entity they represent.
Welcome to as I Live and Grieve, a podcast that tells the truth about how hard this is. We're glad you joined us today. We know how hard it is to lose someone you love and how well-intentioned friends and family try so hard to comfort us. We created this podcast to provide you with comfort, knowledge and support. We are grief advocates, not professionals, not licensed therapists. We are you.
Speaker 2:Hi everyone, welcome back again to another episode of as I Live in Grief. You guys are great tuning in every week and I've really, really gotten used to that and I know I tell you every so often but I may not have told you lately that you guys help me, maybe even more than I might help you, because it is through your support that I keep going and I keep meeting fascinating guests and learning lots. Today is no exception. With me today is Dr Robert Smith. Hi, dr Smith, thanks for joining me.
Speaker 3:Oh, great to see you. I'm honored to be here.
Speaker 2:Oh, it's my pleasure, absolutely. Let's get started. Before I ask any questions, would you start out by just telling our listeners a little bit about yourself? Who is Dr Robert Smith?
Speaker 3:Sure, now I've practiced for 10 years and realized how ineffective I was at managing mental health problems and ended up going back to the University of Rochester and took training there in so-called biopsychosocial medicine and some psychiatry as well, and I then went to Michigan State in 85, and I've been there ever since, got very interested in doctor-patient relationship and then later in primary care mental health, and so I've done lots of research and developing methods by which one can conduct an interview in a way to establish a doctor-patient relationship, and then in a later study, we integrated that activity with how to manage primary care mental health problems. And all of this is directed toward the fact that primary care doctors are not trained in mental health care, and so this was our effort to do that, and I've been here at Michigan State since then. I retired in 2020, but have stayed actively writing my book since then.
Speaker 2:Well, it is my pleasure to have you here Now. Full disclosure. I have my soapbox tucked away under my desk. I'll try not to bring it out, but doctor-patient relationship and patients advocating for themselves is a topic that is near and dear to me. I have found myself.
Speaker 2:When my husband was ill he had a glioblastoma. When he was ill, I became his advocate because he just didn't seem well. He knew he had this diagnosis but he just didn't seem to care one way or another. And I became an advocate. When my mother was ill, I was her advocate. And that is just me.
Speaker 2:And I cannot believe the number of people out there that even realize that it's okay if they question their doctor. So the doctor-patient relationship is primary for me. And then when you add in the primary hyphen or slash mental health issue, it becomes critical because your PCP, your primary care physician or primary care provider if you see a physician's assistant or nurse practitioner, for example they should be at least aware of the most basic mental health education and information so that they can help you determine when you may need some additional help. How many times have we said in our grief how long is it okay for me to just not want to get out of bed in the morning. How long is it okay for me to just sit on the couch every day and never go anywhere? Your doctor should be helping you in this endeavor when you go see them. Okay, kicking the soapbox back under the desk. So I've entitled this episode. Has Medicine Lost Its Mind, has it, dr Smith?
Speaker 3:It certainly has. I've been in this business, I was telling you, I guess, since about 1978. And I and many, many others have worked to try to get medicine to better address mental health care. Medicine, quite frankly, has been refractory and this is why I've decided to go public with, as Medicine Lost Its Mind, my book.
Speaker 3:Your listeners may be upset by what I'm going to tell them now, and everybody knows there's a crisis in mental health care, but few and this includes those in medicine know why there's a crisis and, in turn, how it can be correct. Simply put, primary care doctors are conducting 75% or more of all mental health care, but medicine does not train them for this job and the result is predictable they overlook most diagnoses altogether. They don't even recognize a mental health problem and when they do make a diagnosis or a treatment, it's usually wrong, and the downside effect of that is catastrophic. Unrecognized mental illnesses such as depression, anxiety, drug addiction, lead to divorce, job loss, school failure, addiction, incarceration, homelessness, many of which can be prevented if the doctor recognized the mental health problem in the first place. Now don't blame your doctor, don't blame your primary care doctor. They're doing the best they can. They're not trained best they can. They're not trained for this job. In fact, if you talk to one of them I talk to them all the time because I still do work at Michigan State Talk to them, they'll tell you.
Speaker 3:Bob, one of them told me yesterday there's no psychiatrist in my town. What am I supposed to do? Another one says oh, there's a couple of psychiatrists, but it takes nine to 12 months to get a patient in to see them. And the point of this that I'm making, that they're making, is that psychiatry sees no more than 12% of all mental health patients in the US. Psychology sees another 12%. That's why primary care doctors provide 75% of all mental health care, but they're not trained. Now there's a simple solution to this. It must be obvious to everyone listening Train the doctors who provide the care. Has medicine lost its mind not to do this? And yet medicine doesn't do it? And that's again that's why I'm going public, as it were, with has medicine lost its mind? To point a way that this can be corrected. Basically, the public needs to be informed and insist through their politicians that medicine change direction.
Speaker 2:Yeah, I couldn't agree more. Now, the 75 percent. When you said 75 percent it made me think, oh, oh, yeah, you're absolutely right, although I can't claim the statistic, but I know you have. But I think to myself. For example, when my mother, who was terminally ill, she was on hospice, she happened to be a resident in the nursing home at which I worked, so I was having to juggle my day. She was on the fourth floor of the dementia ward because she would occasionally have some hallucinations and she had early dementia and hadn't progressed. But there were some days that she might have had a hallucination or something and the staff just could not calm her down. So what would they do? Kathy's in the building.
Speaker 2:They would pick up the phone and call me and I would rush from my job up to the fourth floor to try to help my mother, to try to reach my mother and get her to calm down, and everything like that which I was usually able to do. But then I would go back to my desk, put my other hat on and try to immediately become that professional director of medical records. And after a while I caved. I had a day that I went to work in the morning and I went in my office and just locked my office door because I couldn't face anybody. I was sobbing uncontrollably. I went to the doctor and he said oh, you have depression. Here's a prescription.
Speaker 3:That's not right.
Speaker 2:You know, and when I think back on that, I think, well, I mean, whatever you call it, the issue is that I'm trying to be two people at once and instead of trying to talk to the staff, for example, and say you know you can't do that, whatever, but at any rate, I was grieving at that point. I knew my mother was eventually going to die, so I was in that advanced stage of grief. So if we bring this issue with mental health into the realm of grief, for which this podcast is really about, grief was recently or a type of grief, I believe, was recently added to the DSM, the Diagnostic Statistical Manual, whatever, whatever for mental health, so there is a type of grief that is now an actual mental health diagnosis. Is that correct?
Speaker 3:Yeah, it's called prolonged grief disorder. It was added to DSM-5 in, I think, 2022. The original DSM-5 just had it under investigation, but they now went formally and included it there, okay, and how would you define prolonged grief?
Speaker 3:Basically it is defined as lasting more than 12 months and all the symptoms you would expect Loneliness, missing the person involved, looking for the person, hearing the person and various attributes that some people can become depressed as part of it, but it is terribly devastating to the person and it often happens in caregivers. Caregivers are I'm just going back to what you had said earlier a terribly overlooked population. During COVID, a statistic that comes to mind caregivers during COVID had a 30% incidence of suicide, significant suicidal thought. That was higher than anybody else during that time, and so caregivers are under unbelievable distress.
Speaker 3:When the person they're caring for then dies, they are left with all of the frustration and so on that they experienced during life and understandably, often got upset, say, with your mother, for things they do and don't do, maybe got angry at them, notwithstanding you love them very much. You wouldn't have been doing that in the first place, but it's human nature to get angry at somebody that spills the bedpan or that swears at you because you're doing something to them, and so you get angry back at them. Then, after they've died, these people start ruminating, sometimes Horrible guilt. They feel guilty about having been angry at the very person they loved and cared for, and this is the seeds of depression that often accompanies prolonged grief disorder, depression that often accompanies prolonged grief disorder, and it's terribly at least in my experience common to have that. And caregivers, again, are vastly overlooked. Doctors need to attend to the person caring for the terminally ill patient, as well as the patient themselves.
Speaker 2:So if someone is grieving now it's been almost seven years since my husband has been gone you know, probably, if I look at the criteria for prolonged grief, I have some of those symptoms. I still miss him. I am not looking for him. So I mean, there are definite criteria that are used to guide the diagnosis, but if someone says to me, oh my gosh, I cannot get out of this pit I am in, it is not up to me to say, oh, you have prolonged grief. It is not even up to your PCP to have it. However, your PCP should at least have the wherewithal and the knowledge to say tell me more about this. What do you mean? What else is going on in your life? What other behaviors are you exhibiting? And then, based on those answers, possibly give a referral.
Speaker 3:That's absolutely right, and that, again, is the problem. As I said earlier, doctors are not trained in mental health, and so I mean to make this explicit doctors, out of the thousands of hours of training and four years of medical school three, four, five, six years of residency only 2% of that time is devoted to mental health care, and that's a five-week rotation on psychiatry in the third year of medical school, which three and four years later has long washed out, and so on. That's the only supervised training they get in mental health care. What middle they get otherwise is lectures, lectures don't do it.
Speaker 3:You have to be supervised with a grieving mother, a grieving spouse, a depressed person and so on. You have to be supervised with an actual patient that has that by a trained faculty. That's what medicine does with physical disease. That's what they spend. All that seven or eight years doing is being supervised in taking care of heart attacks, strokes, copd, what have you all the medical? They're supervised intensively and caring for these people, but medicine does not provide supervised training for mental health problems, and that's the issue. You mentioned something on prolonged grief. Part of that. Diagnosis requires interference with daily activities and talking with you, you sound pretty active. You sound like you've gotten pretty much back into it. I would suspect you're not in that category, even though you'll never stop thinking of your husband and your mom.
Speaker 3:You'll never stop and that's okay. But the fact that you're back, very active, involved, that would take you probably out of that category.
Speaker 2:Right and I'm well aware of that. I guess what I wanted to point out to people was that don't immediately, well, finish the podcast first, but once the podcast is over, don't immediately go to Google and look up prolonged grief, dsm-5 and start to diagnose yourself. You can go out of curiosity and for your own education and then take what you have learned to your PCP.
Speaker 3:And sister.
Speaker 2:Because he is likely, he or she is likely to not undergo additional training at this point in their career. But you can help educate them and that's where the advocacy comes in. You can present them with an article or something and say, look, this is what the DSM-5 says. I think this might be my issue. You can say it. You can advocate for yourself or for someone you know that is really, really struggling. That's the point I'd like to make.
Speaker 3:Well, that's a good point, and I would take it one step farther. Is that in somebody who has prolonged grief disorder, whose daily life is being significantly interfered with, you know, unlike yours and take this to the doctor. Don't hesitate to say stop a minute, dr Jones, I need to talk about this. Be assertive. Plan what you want to say ahead of time, maybe while you're sitting in the waiting room or even before. Have three points. They are incredibly effective and treatment cognitive behavioral treatment often targeted to grief, is highly effective, particularly if antidepressants are added to it. The cognitive behavioral treatment is more effective than antidepressants, but the two together magnify each other. So if you think you've got this, do just what you said. Take this to your doc and tell him I would like to see a grief counselor.
Speaker 2:Right, so it may not be necessary to see a psychiatrist the first time, correct?
Speaker 3:That's correct.
Speaker 2:Okay, and I've had a number of grief therapists social workers, people who are they're certified in grief, but I really don't know what national certification there is in grief. There are certainly people who are they're certified in grief, but I really don't know what national certification there is in grief. There are certainly people who have degrees in thanatology, for example, but grief therapists in general, many of them will offer you the opportunity for an initial consult, either over the phone, virtually sometimes in person, absolutely free. They may offer you that, you know, for a 15, 20, 30 minute session. I actually know a few that will offer you an entire hour of their time free to discuss what you're going through. So there is no reason you can't avail yourself of those opportunities too, because it's important not only that you find someone who has the knowledge of the issue you're having, but also that you feel comfortable sharing your deepest, darkest personal information, because many people who are grieving are filled with shame and guilt because they can't get past things. It's a very difficult.
Speaker 3:There's a stigma to it. Yes, it really is. People with prolonged grief are stigmatized, especially if the grief might be, say, not to a spouse or a child, to an animal.
Speaker 2:Absolutely.
Speaker 3:They are stigmatized for quote, not pulling themselves up by the bootstraps.
Speaker 2:Absolutely, because a number of people are issuing well-intentioned comments like well gosh, it's been an entire year.
Speaker 3:It's time to get on with your life.
Speaker 2:Yeah, move on, baby.
Speaker 3:Move on yeah.
Speaker 2:Yeah, I think that's changing some, because when this podcast started there were just a handful of podcasts with the topic of grief. Now there are many, many, many, many. Just like books. There are many books out there. The one area as far as books that's not quite sufficient is in the area of young adult books. Those seem to be missing, but anyway, so things are changing.
Speaker 3:Let me comment on one other thing. The counselor does not have to be a specific grief counselor. Most psychologists, medical social workers, people with good counseling training, can all conduct this type of work, so it doesn't have to be, and I would rely on my primary care doctor. They should know reliable people within the community, whom perhaps whom they've worked with before in requesting referral, and so they shouldn't restrict themselves just to a person that labels themselves grief counseling.
Speaker 2:Right, right, okay, good point. Good point as well. I want to say you had made a comment that somebody said to you well, there's no psychiatrist in my community. If you live in a rural community where there is no one immediately available, look what the pandemic did for us. It got us acquainted with the virtual community so you could if you live in New York, you could talk to a therapist in California.
Speaker 3:And this is my psychiatrist and psychologist friends tell me. This is, and research supports this, it's effective, it works and this is a way of extending now short supplies of both psychology and psychiatry. Both of them need to be vastly increased. I'm talking about increased training of primary care doctors. There need to be more psychologists and more psychiatrists. Medicine simply has never attended to this and, as you probably know, mental health problems are the most common health condition in the US. A fourth of us will have a mental health problem during any one year.
Speaker 2:Absolutely.
Speaker 3:A hundred million people, almost. So this is the magnitude of this. I mean, consider this, I'll get off my high horse here no that's okay. Consider this that medicine is failing to provide training and sufficient numbers of specialists for the most common health condition their practitioners will face, and has medicine lost its?
Speaker 2:mind.
Speaker 3:Right.
Speaker 2:Well, my guess is that that's not going to change that part of it, even though the answer seems perfectly clear that maybe, when licenses are due for renewal, doctors have to renew their licenses. Is that correct?
Speaker 3:Oh sure, Periodically.
Speaker 2:That there should be a requirement for a certain type of training. I mean just as if, with the pandemic, there should have been a requirement for the doctors to undergo some training. I'm guessing it's probably not going to happen.
Speaker 2:I think that's correct to affect a movement in at least the US for advocacy, so that people themselves are told and are counseled and are educated and made aware that if you are having issues it is your responsibility. It is somewhat a form of self-care to make sure that your needs, your symptoms, are being addressed. I do it with my doctors. If I have a question and I don't feel I'm getting the results and I'm still having a problem, I will call my doctor on it.
Speaker 2:When my husband Tom was ill in the hospital and there was a particular doctor actually and I don't know if he was an intern, I don't know what level he was, but I know he was a doctor and there was a particular doctor that I didn't feel had the right perspective for my husband's treatment. I actually it took. It was a challenge, but I actually eventually got to the director, the medical director of the hospital, and said I want this doctor removed from my husband's team. Good for you. Good, and it was done. And another doctor stepped in that I felt comfortable with and my husband responded well, the doctor listened to me. This other doctor it didn't even want to answer my questions.
Speaker 3:That's one of the things that we have actually done and Rochester University of Rochester is well known for this of establishing ways it's called patient-centered interviewing Absolutely effectively communicate which means a lot of times listening and establish a good relationship, and in fact that's some of the work that we did. We developed the first evidence-based patient-centered method. It's in textbook now that's widely used. Unfortunately, doctors still don't get enough training, in that it tends to be given in the first or second year of medical school and then gets washed out after four more and seven and eight more years. So you're right on, and your ideas of being assertive with your doctor are very important.
Speaker 3:Most doctors will respond to that Doc, stop just a minute. I need to tell you the things that I want to talk about, and do that right at the first of the visit. Don't wait until the doctor's on the way out of the room. When you first sit down, say I've got three things. I got to take responsibility for yourself. Doctors are busy and if you don't say anything and add stuff, they'll go in and out as fast as they can.
Speaker 2:Well, and sometimes I think the doctors that I have done this to say done it too. It's feel like I'm punishing them, but they have responded favorably. It's like, finally, you know, maybe they hadn't considered that.
Speaker 2:And if you think about it, if you go in with something as simple as a cough, there may be 90 or 100 or more diagnoses. So I mean, it's just you know, they have to kind of go through a flow chart. Cough here's what I can do. Here's what I can do. Here's what I can do. Oh, it takes time, but you're the one that's been living with this cough. So if you have a thought, pose it to the doctor.
Speaker 3:Common question. We recommend doctors to ask somebody with a cough they come in. How is this affecting your life? Oh? Somebody might say oh, not at all, I just thought I'd better check. Somebody may say I'm coughing at work. My boss is nervous about it. I'm afraid I'm going to lose my job. It's an entirely different thing with the same cough.
Speaker 2:Absolutely, or I'm coughing up blood. It's an entirely different issue. So it's the relationship between doctors and patients that needs to change. It's not all on the doctor's shoulders.
Speaker 3:No, and it comes down to trust, doesn't it? Absolutely, absolutely Trust.
Speaker 2:And that relationship is so important. It really is, oh gosh. Well, my soapbox is kind of out but, like I say, I wonder if there is a way to really focus as much on advocating for yourselves medically on advocating for yourselves medically.
Speaker 3:I think things like what you're doing right now is a primary podcast or a new thing to many people, and the more that information can get out, know what you want to talk to your doctor about, write it down and then tell them right at the first of the visit. Absolutely, absolutely. Be assertive, and it's okay to do that. The vast majority of doctors actually appreciate it because it helps guide them in what they do.
Speaker 2:Absolutely, absolutely. And whether it's grief or whether it are some other physical symptoms you're having, you're in charge of your own health. After all, it's your health. That's right. So make sure you're getting the care that you need and if your provider is not able to find it or something, perhaps ask for a referral, you can direct your care and chances are, your insurance will be fine if it's the doctor that gives you the referral, that's right. And as well, by doing it through your own PCP, if you are given a referral, that doctor that you go to for the referral will stay in touch with your PCP, so your PCP will stay advised of what they have found. So it's essential.
Speaker 2:At this point in my life, I have started what I'm calling developing my care team. I'm at an age and physical condition now where I don't think one doctor is enough to have on my team. I need some specialists because of some diagnoses I have. So I'm building a team. For every referral I go, that's a doctor that I'm adding to my team because my health is important to me. I want to be around for a long time. I love my family. I'm not ready to go anywhere.
Speaker 3:Make sure you have a good primary care doctor. They're the ones that coordinate all of this. A specialist, be it pulmonary or diabetes or whatever, does not coordinate your care and you get into a situation where you've got too many doctors, absolutely. So be careful about having a good primary care doctor that you like, that you can talk to and that you can tell them what you want to talk about. But primary care is the essence of this and they should be the hub around which you work.
Speaker 2:Absolutely. He's like the team captain, exactly, and as long as mine keeps listening to me and giving me the time that I need to discuss my conditions, then we're in good shape, sure, yeah, well, sadly, our time has come to an end, but before I actually sign off, I want to turn the microphone over to you. Want to turn the microphone over to you. I especially want you to tell everybody about your book, because your book has the same title I've given to this episode, for good reason. So has medicine lost its mind? The floor and the microphone are yours.
Speaker 3:Sure Well, thank you. The book comes out March 4th and it'll be available in all bookstores and various online places, from Barnes, noble to Amazon to Bookshop to Books A Million. All of these places will have it available. I would also I've mentioned earlier about the importance of the public becoming involved, and this is what the last part of the book is about, and it tells how to do this On my website, which is robertssmithmdcom, and there's an MD at the end. That's the only way you can differentiate Robert Smith from eight million other ones, so be sure that it's on there, robertssmithmdcom. On the very first page that that brings up, there will be a spot that says something to the effect of Join Now. This will take you to a letter that you can send to various important people, from the president, to your congressperson, to your senator and to others. You simply take that letter, plug it into your own email and then, on the same site, there is a link to send it to the president, to the surgeon general, to other people, and also a way to find your own congressperson's email and your senator's email. You can add a note of your own experiences and why this is important, but the letter tells what needs to be done, which is basically that a federal committee needs to be established to investigate why medicine is not training people in the most common health problem they're going to see in practice and they have been refractory. This needs to go to the public and to get their representatives in gear. And so go to that site, use this letter, plug the right emails in and send it. This has worked before.
Speaker 3:Ralph Nader, with Unsafe at Any Speed, called the blew, the whistle, as it were, on the automobile industry, who knew seatbelts worked but didn't put them in because they were too expensive. This is why you wear seatbelts today, because that book that he wrote got the public going. Rachel Carson in Silent Spring did the same thing. The chemical industry had DDT in the water that you and I were drinking and they knew it, but did nothing about it because it was too expensive to correct. Her book prompted political authorities to establish the Environmental Protection Agency that we have today. This is why you drink clean water today. The same thing can happen with this. We need to activate the public and get them going. Medicine needs help.
Speaker 2:Powerful words, powerful words, and I have kicked my soapbox back under my desk, but it's available to me to come out at any time, I might add, and I really think that your book is going to be incredible. I can't wait to get my copy. I think our minds are connected in so many ways, and I'm going to try to think of some ways that we can work on the advocacy component as well.
Speaker 3:That'd be great.
Speaker 2:Maybe I'll even ask my doctor if he is willing to partner with me on something and we'll just see what he says about that one. That one will raise his eyebrows for sure. He's a wonderful man and I appreciate him very, very much. But for now it's time to say farewell. Dr Smith's contact information will be in the podcast notes, so don't worry, if you didn't write down the website, just check the podcast notes. It'll be there and it'll probably even be an active link that you can just probably click on if you are sitting at your desk computer or laptop. And other than that, again, take care of yourself and for me today, after the conversation, advocating for yourself and your own medical well-being is man. That's a huge self-care topic, so please consider it. I hope you've enjoyed what you've heard today. If you have any questions, reach out to Dr Smith, reach out to me and let's all be partners in this endeavor. Okay, all righty, well, tune in again next week, as we all continue to live and grieve. Thank you, dr Smith.
Speaker 3:Oh, pleasure to be here.
Speaker 1:Thank you so much for listening with us today. Do you have a topic that you'd like us to cover or do you have a question from one of our episodes? Please email us at info at asiliveandgrievecom and let us know. We hope you will find a moment to leave a review, send an email and share with others. Join us next time as we continue to live and grieve together.