The Family Doctor: Bill Ventres, MD, MA

Transcript

[0:00] The issue is how can we be inclusive across boundaries and if we can imagine those boundaries then we can find ways to reach across.

[0:18] Paging dr. cook paging dr. cook doctor cook you’re wanted in the o.r. dr. Koh you’re wanted in the.

[0:26] Music.

[0:45] Hello everyone and welcome to the prescription for Success podcast I’m your host dr. Randy cook.
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My guest today holds the title of Ben C Saltzman distinguished chair in family and Rural medicine at the University of Arkansas school for medical science in Little Rock.

[1:35] The journey that took him there is inspirational to say the least so let’s hear dr. Bill Ventress,
tell his story it is my pleasure today to be speaking with dr. William Ventress who likes to be called Bill they’ll thank you very much for being here.
And welcome to prescription for Success well thank you Randy it’s a real pleasure to be here.
I’m really looking forward to this conversation I want to mention that bill has recently been invested as the bin Saltzman distinguished chair and Rural Family Medicine which is indeed a great honor
and I am just delighted to know that the people,
at Medical University in Arkansas were smart enough to set up such a program and from what I can what from what I’ve been able to learn about you Bill they picked the right guy for the job.
As is always the case on this show we like to begin with the beginning and.
I always do a little research on the guests and I’m very curious I noticed that.
Your undergraduate major it Duke was history.

[2:51] And I am very curious to know if when you embarked on that
degree-seeking program in history did you have a career in medicine in mind at that time yes I did
I grew up in a family of origin that I had five choices
of what I could do in life grew up in a professional family my dad was an attorney my mom was a businesswoman later on in life she was a housewife when I was growing up it was that generation
but I had five choices a doctor,
a minister a lawyer engineer or a teacher and when I say teacher I think it’s mostly a kind of a college professor kind of teacher hmm.

[3:40] And how did you put that that particular list together I don’t think I put it together I think my parents did I think early on.

[3:49] My interest was in being somebody I wanted to be somebody and when I say somebody from that professional point of view I wanted to be,
I wanted to make some kind of difference in this world.
I also think that that difference often centered around me much more than other folks I’d got into history because I found I had some.

[4:22] Advanced placement courses it was two things that gave me I got into history because I had some.

[4:30] Advanced placement courses in history in high school and that allowed me to really pursue a liberal arts education I took the prerequisites for medical school but I.
I found that I really had a passion for small classes where I got to speak and communicate and interact with other people that wasn’t happening in the big.
Biochemistry classes
that was in history and that’s what the a peek at classes that’s what the AP classes gave me that opportunity you know it’s it’s interesting to me I think that you and I probably.
Started Medical School nearly the same time I’ve got a few years on you but in any case we were advised in those years that you really should pursue.
A liberal arts education but.
By the way you’d be smart if you would major either in chemistry or biology now that seems to be shifting a little bit.

[5:38] People are seemingly being more encouraged to pursue a true liberal arts degree.
But I’m interested do you think that that undergraduate experience made you a better doctor in anyway.
Absolutely it did not make me Randy it did not make me a better medical student I struggled.
In the first two years of medical school now I would also say that nobody goes to medical school to be a second-year medical school for the rest of his or her career.
They go to be a doctor and I think history was it opened my mind to a different perspective on life.
That’s what it did and it.

[6:28] Suggested to me that there are many different ways many different lenses by which we can see people not just the biomedical lens that
we learned so it was tough for me and I was in a sense wounded by the fact that I wasn’t doing very well in medical school
I now recognize looking back on it that there’s more to Medicine than just the biomedical aspects of care that we give,
yeah those feelings of being lost our.
Something that I think I understand because I had the same experience in spite of the fact that I was a science major undergraduate medical school was entirely.

[7:15] Particularly those very those first two years it took a while before I really began to.
I feel like I was physician material and it sounds like you had specified expiry hop it took me several years after medical school about five.
Before I really felt comfortable doing what I was doing maybe I’m a slow learner.
Maybe there were other things other factors maybe I was healing some wounds from medical school or residency
maybe I just needed to get out in the community and away from that somewhat isolated academic community.

[7:59] Into real life and real practice tell me about some of those wounds those medical education wounds.
So Randy I think that there are two or three maybe four wounds that I struggled with.
One was just that.

[8:21] I was somewhat unused to the amount of information that I was trying to cram into my head
and subsequently fell out of the other side there is a lot of that there is a lot of that that old fire hose,
metaphor that,
people used to use I don’t know if they use it anymore that you’re standing in fight in front of a fire hydrant and just absorbing information
the second thing was that.
I had all use this word I had prided myself on being a thoughtful person and.
I didn’t get the sense that being thoughtful,
was part of my medical education especially in those first two years
and even in the third year it was about a role relationship with patients with other colleagues that.
Was very hierarchical.
I am not sure that served me and I’m not sure that served the patients with whom I was working.

[9:36] The third wound was simply.
That and I say this only in retrospect but that the patients with whom I worked in my real practice after I finished residency their lives were much.
More multi-dimensional than I was taught in medicine and I.
Recognize that unless I could connect with them in some way.
The medical aspects of cure somehow got Buried buried in the way that I don’t have control over what my patients do
when they’re not in the hospital and much of my work has been.

[10:26] The word now would be coaching.
Coaching in the sense of I’m encouraging nudging trying to get them my patients to see how they might be more healthy in their own lives in there
in the context of you know their homes their communities in their families.

[10:50] And that wasn’t taught to me a lot of wisdom in that and and you’re exactly right that.
That is certainly not the sort of knowledge that was being handed over to most of us
in that era and I’m not sure it’s being handed over to people now I’m sorry to hear that but it sounds like to me that you’re certainly trying to make a difference in that regard
and I’m also wondering if if that sort of.

[11:17] Sort of discomfort with your understanding of The Human Condition overall,
did that in some way inform your decision to pursue a degree in anthropology absolutely.
But I’ll say this and this is the truth is that even after my residency something was missing and I was
still not fully prepared to be that family physician that I had imagined myself.

[11:51] And I say imagine myself I came to Family Medicine late in my medical school career.
I really thought I wanted to be a pediatric nephrologist because one gentleman Tom Nevins I did some summer research programs with him for two summers and he treated me not like a student.

[12:12] Scott worker but like a real person and.
He was the one physician that I had really any contact with prior outside of my pediatrician the one person I had any contact with in the medical field before I went into medicine I.

[12:30] It was a profession but I didn’t really know much about it but Tom was a gracious and decent person.

[12:38] And pediatric nephrologist so,
that’s why I wanted to be a pediatric nephrologist in medical school I realized oh I don’t want to be a pediatric nephrologist I just want to be like Tom Evans mmm it’s good to have Heroes isn’t it is good to have Heroes and,
you know Tom is not famous.

[13:01] At least not in a conventional way of hero dumb
but he was my personal hero and I’m sure he was a personal hero to many other young students or Betty was sounds like,
he probably made a huge difference in the lives of a lot of medical students and subsequently a lot of patients I’m thinking.

[13:25] And and similar question you went on to get a masters degree as as well in.
Psychology and systems counseling did you not I did that was much later I have used going to school as ways of making transitions went away to college
I grew up in Minnesota went away to college that was a huge transition and an important one.
Did go to back to Minnesota to medical school
after residency there was this two-year period of time that I was actually practicing in the community and a safety net Clinic,
but
really that medical anthropology degree brought a whole new level of understanding of community and psychology not in the sense of this one individual psychology but in the sense of oh
patient psychology what it’s like to be a patient from their
that was because again a family of origin issue I had.
Seeing my dad after the age of 50.

[14:40] His life became diminished and I think that’s because he didn’t have the courage to do something new,
on the other hand my mom and my parents were divorced right around that time my mom went back to school she got an MBA she became a businesswoman
she went into the Peace Corps at age 62 she wrote up she wrote a book it was a geriatric love story I will say it never got published
but who cares she wrote a book after she got out of the Peace Corps and until her health search started to feel,
her life blossomed and so I said roughly around 50 well.

[15:26] There’s somebody I want to emulate in my family of my parents and it’s not my dad in this sense of I want my last year’s of life however many I might have
to I wanted to Blossom
and so that’s why I went back it was more about having that opportunity to you know nurture those seeds after,
twenty years of pretty much strict practice I wanted to nurture the seeds again of thoughtfulness and of.
An expansive view of the world so I actually went back to a program that was what would now be called an executive program but it was a transformational educational,
how to process a lot of self-discovery a lot of self-awareness a lot of.

[16:17] Personal revelation shared in a trusted group it was a small cohort of folks but that’s what you can do when you live on the West Coast,
yeah well it sounds like it was very productive and it’s interesting to me I’m thinking about,
as I say I think I’m a little older than you but.
No that was back in the years of everybody wondering what’s happening there is a song with the similar word but it was the tune in turn on and drop out generation.
People were busy trying to find themselves and it sounds to me as if you simply were trying to find yourself and you just did it in a little bit more.
Productive fashion.
I think my adult life has been finding myself to some extent that through my patients how I respond in the face of there,
difficulties in the face of their illnesses in some small sense and I would say this with a.

[17:27] A small as suffering and I how I respond is.
It’s something I’ve been working on for a long time and I hope to continue to work on it well I think there are certainly a lot of wisdom there.
There is always more to learn obviously you made this decision to do family medicine and I’m wondering.

[17:54] How that experience is a family practice resident what was the effect that it had on you.
That point in your life and how it informed later choices what was going on in your head between 1985 and 88,
a lot of surviving that was back before ours limits on ours it was a tough time I was physically tired
it was only toward the end of that residency that I started getting a sense of what being a family physician was and as I said it.

[18:32] Really took me five years afterwards to figure that out Randy one of the things I did early on because.

[18:42] The discipline of Family Medicine wasn’t matching what I had hoped in terms of
community in terms of service in terms of a broader view of Medicine
I think I was trained to be kind of a supermini Polly sub specialist
but I had a different view of family medicine one that was more family-oriented in the sense of family being all those things that are non-medical.
Non biomedical that have an effect on the.
Health care of patients and what I did was out of.
My respect for four,
my elders really I interviewed the founders of family medicine now they were 60 and 70 at that time I was.

[19:38] Early 30s and I did exactly what you’re doing.

[19:46] Except that I said.
Rather than tell me about your personal development I said tell me about your relationship with family medicine and why did you want to become involved in the development of Family Medicine.
And they had wonderful stories of community of being embedded in a community of the spiritual nature of that,
Community existence of the relational aspect of Family Medicine almost being part of the family
of how the medical care that we do
may not be the kind of instantaneous success that a surgeon or a neurosurgeon or a general surgeon might have.

[20:37] But it had a worth and a value that was built on issues such as
today we’d call it continuity but one of the people he talked about Fidelity to patients and I think there’s something to that,
based on curiosity and affinity for the patient.
Hi I’m Rhonda Crow founder and CEO Forum D coaches here on our X for Success we interview a lot of great medical professionals on how they grew their careers how they overcame challenges.
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[22:03] We’ll get back to our interview in just a moment but right now I want to tell you a little bit about physician Outlook
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And now let’s get back to today’s interview remember how I said I wanted to be somebody.

[23:15] And that’s why I entered medicine will something happened over the,
many years I really want to belong to the Society of teachers of family medicine that organization has allowed me to.

[23:33] Have that sense of belonging in a in a professional way just as my work with patients has allowed me a much more,
broad sense of belonging and I will also say that there’s I’m not going to say.
Spiritual people have talked about the biopsychosocial spiritual dimensions of care spiritual touches on religion I think a little bit I,
don’t want to say that what I’m going to say is anyway religious but it is faithful,
faithful with a little F that what I do I believe
that what I do and my work in the Society of teachers of family medicine and with my patients and now at UAMS the University of Arkansas for medical sciences that.

[24:28] I can and do have some small.
With other people so it’s a faith in my belonging and with my opening the,
door for other people to census similar sense of belonging with me that
that I exist that I do make a contribution in some small way and I like to think that those add up I think that’s what keeps me going I was reading today
a wonderful article by a young family physician in Jama
how about some of the same concerns of moral injury that he felt in his training,
well I think I healed that through that sense of belonging and that young gentleman I forgotten his name I truly hope he can find that sense,
throughout his career that awaits him well perhaps that bright light award may have had something to do with your financial.
Contribution but.

[25:37] There is another item that I think had nothing to do with anything except your reputation and that is your recent investiture as the bin Saltzman distinguished chair in rural Family Medicine
at the Medical University and Little Rock that sounds like a really big deal to me and I should think that
you have every reason to be proud to be in that position and I think your Medical University should be proud that they are doing something.
As meaningful for the discipline of Family Medicine.
And in any case I’d like to hear your thoughts well first of all thank you been Saltzman by the way was the
quote father unquote of family medicine and Arkansas Post WWII he came to Arkansas and set up practice in a small town in Northeast Arkansas and later on in life became.
The head of the Department of Family Medicine and later on in fact the head of the Arkansas Department of Health so he was very strong force in Arkansas.
And quite a character I understand but it’s nice to have.

[26:55] This distinguished chair named after somebody I have never met him but after somebody who.
Put a lot of his life and a lot of his energy into something I value I also mentioned earlier on that I’ve never practiced rural medicine but when I was asked to become,
to take on this role the real issue as well I had practiced Urban
underserved medicine in many ways I’m not so sure that there’s much difference between rural Family Medicine Urban underserved medicine there are many groups in.

[27:35] The United States whether they’re in Alabama or Arkansas Oregon or any other area where the people are on the margins and,
The Cure might be slightly different the geography certainly is different the economy is maybe different.
But when people are on the margins medically our job is to try the bring them into the fold and offer them the services that we can in whatever way
so that’s how I became that’s how I was invested in this chair position,
have you given any thought or is it too early for you to give us an idea of,
what your vision for the school of Family Medicine.
In your locality is going to look like and what it’s going to accomplish our department of family medicine has recently merged with the ahec program.
It’s no longer called the ahec program or Area Health Education Center’s but it’s the regional programs in Family Medicine six different different residencies around the state
so my real hope is that we can start.
Communicating learning from each other across the state of Arkansas like Alabama Arkansas isn’t.

[29:05] The wealthiest state in the Union there are lots of needs it is a predominantly.
Rural state so my real hope is that we can as a group as seven different residency programs say.

[29:28] And say to the university medical school in Little Rock we are here
the health of these people in rural areas is important
and that the only way that.
We can effectively serve and it’s not alone but it needs to be some generalist practitioner some clinician who can work in an area of need I wonder if you think,
this project that you’re about to Embark upon might in some way also inform.

[30:11] The delivery of Healthcare in urban communities,
that are impoverished because just as you say there’s not a lot of difference if your access is limited whether it be by distance or by economics
the effect is the same but would you visualize the.
This concentration on Rural medicine might have a bigger effect in the Family Practice Community Across the Nation.
I’d like to think that it would have a big effect here and
Randy I do want to emphasize that it’s not about Family Medicine versus any other field in medicine none of us in 2022 practices alone,
none of us I don’t care if you’re a neurosurgeon if your dermatologist if you’re an ophthalmologist or you’re a family doctor in
P Ridge Arkansas we all work together and we work with other people physical therapists the nursing community,
nurse practitioners physician assistants we work with Healthcare administrators you know we work with politicians to there’s no way around that and.

[31:32] Although they don’t always listen to us well but that’s probably Fair because I don’t think we always listen to politicians.
But I think the main thing is we need to be inclusive in our care you know we have four principles of medicine and that is autonomy.

[31:55] Beneficence being doing good non-maleficence not doing.
Harm and Justice and nobody talks about justice but I actually would call it inclusion so that that we include everybody that Justice part for me means,
we offer to everybody in our communities,
rural urban underserved across boundaries of geography of economics,
you know of race Little Rock if
you know anything about Little Rock you probably have heard of Little Rock Central High School’s desegregation in 1957 and
and there are still reverberations from that.
You know 65 years later though we have not yet come to deal with,
and people are working on it I don’t mean to suggest otherwise but we have a long way to go and that’s not just Little Rock by the way that’s everywhere in this country.
So the issue is how can we be inclusive across boundaries and if we can imagine those boundaries.
Then we can find ways to reach across them or Bill it sounds like.

[33:21] Your selection for this chairmanship.

[33:27] Couldn’t have gone to a more appropriate person your vision is spot-on I think and.
I have an idea you’re going to be a big success,
and so I’ll give you my preliminary congratulations on that I have really enjoyed our conversation today I could go on for hours and hours I think but out of difference to our audience.

[33:54] What I’m going to do at this point is get out of your way for a few minutes.
And I will close my Mike and dr. Bill Ventress will give us his personal prescriptions for success
so I have three prescriptions for Success I’m going to say for but I’ll start with the three the first is to see people to look Beyond the Veil of the clinical presentation,
I mentioned the biopsychosocial model it is real.
But it’s not all about the patient it’s about the lenses we use we as clinicians the perspectives that we bring
to try and understand a little bit about the patients
lives as they relate to their health and illness the second I’m going to use an acronym.

[34:45] DB a b Delta Bravo alpha bravo.
Don’t be a butthead we all have seen folks.
Who who could do a better job interpersonally let us be honest we all know that there have been times that we could have done a better job.
DB a b but I’m going to translate that into a positive,
three positive attributes be well be thoughtful and be kind be well practice self-care be thoughtful be inquisitive,
have that Affinity look for the good in the patient and be kind trust in the value of compassion.
And offer patients some sense of dignity even on their worst days.

[35:47] Number three resist resist the three peas of power prophet and prestige
at least the extremes of those because they can distract us from the joy of Medicine
and number four is don’t listen to me create your own prescriptions that have meaning in your lives.
With your families with your patients and in your practices so those are my four prescriptions and the fourth one might be just the most important,
well dr. Bill Ventress I want to thank you so much for.

[36:30] The conversation today and I I’m really impressed with your prescriptions there is a lot of wisdom there and.
I know that our audience is going to take a lot away from this conversation
before we go I want to give you an opportunity to remind people who you are and where you are and where they can find you
again Randy I’m Bill Ventress I’m a family physician at the University of Arkansas for medical Sciences in Little Rock Arkansas and the best way to find me is on email
that is w v ENT res.
At UAMS dot edu doctor bill ventris it’s been a great pleasure thank you so much for being with us on prescriptions for success.

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