August 18, 2025 • 42 mins
We discuss practical strategies for staying up-to-date with addiction medicine research in this collaborative episode between Addiction Medicine Made Easy and the Addiction Medicine Journal Club podcast.
• Featuring a four-person roundtable with Dr. Casey Grover, Dr. John Keenan, Dr. Sonia Del Tredici, and Thomas Bannard
• Understanding why evidence-based medicine matters in addiction care
• Incorporating lived experience into addiction education and combating stigma
• Developing personalized approaches to staying current with medical literature
• Various learning strategies from reading journals to podcasts to collaborative discussions
• Finding your motivation for continuing education in addiction medicine
• Strategies for making learning "stick" through teaching and knowledge application
• Making knowledge "count twice" by developing resources from what you learn
• The value of consistent, sustainable learning processes over ambitious but unrealistic goals
To contact the Addiction Medicine Journal Club Podcast: addictionmedicinejournalclub@gmail.com
To contact Dr. Grover: ammadeeasy@fastmail.com
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Welcome to the Addiction Medicine Made Easy
Podcast.
Hey there, I'm Dr Casey Grover,an addiction medicine doctor
based on California's CentralCoast.
(00:22):
For 14 years I worked in theemergency department, seeing
countless patients strugglingwith addiction.
Now I'm on the other side ofthe fight, helping people
rebuild their lives when drugsand alcohol take control.
Thanks for tuning in.
(00:55):
Let's get started.
Today's episode is acollaboration between my podcast
and the Addiction.
Thank you.
Research and scientificliterature on addiction.
I am proud to admit that I aman avid listener of their
podcast and our two podcasts doepisodes together periodically,
and today's episode is one ofthose collaborative episodes.
We discussed how addictionmedicine professionals can stay
(01:18):
up to date on the latestresearch and science in the
field of addiction treatment tobe able to provide the best care
possible to their patients.
The episode was actually afour-person roundtable.
It was a discussion with myself, dr John Keenan, dr Sonia
Deltredici and Thomas Bannard.
Thomas works at VirginiaCommonwealth University and
coordinates their collegiaterecovery program.
(01:40):
We had an awesome discussionand I am so grateful to share it
with you.
Here we go, all right.
Well, we have a meeting of theminds.
It's afternoon my time and it'sevening for all of you, but we
are going to collectively geekout on how to keep up with the
medical literature in addictionmedicine.
(02:01):
Tom, why don't you start byintroducing yourself and tell us
what you do, sure?
Speaker 2 (02:04):
So my name is Tom Bannard.
I am the assistant director forsubstance use and in addiction
medicine.
Tom, why don't you start byintroducing yourself and tell us
what you do, sure?
So my name is Tom Bannard.
I am the Assistant Director forSubstance Use and Recovery
Support at Virginia CommonwealthUniversity.
So I work with our collegiaterecovery program.
We work with students who arein recovery from addiction and
also help students get intorecovery.
So we do that through a numberof different things, including
trips, that sort of thing, butalso kind of some more
(02:26):
formalized, structured seminars.
And then part of our mission isto make sure that everybody
that studies a health-relatedscience at VCU so whether that's
professional school orotherwise gets some exposure to
people who are in recovery fromaddiction and kind of interacts
with folks that have that livedexperience of recovery so that
when they go out and work inmedical spaces they can hold
(02:49):
that hope for their patients,which I think is a really
important part of our work.
And I'm a big fan of bothy'all's podcasts.
So I'm excited to be here.
Speaker 1 (02:56):
Yes, so I'm Casey Grover from the Addiction
Medicine Made Easy podcast.
Speaker 3 (03:01):
Sonia and John you want to go next?
Sure, I'll go, and I just haveto say that Tom threw an awesome
conference that we went torecently.
So anyone else who wants to goto Rams and Recovery at VCU
Health next year highlyrecommend.
I'm Sonia Daltredici, one ofthe hosts of the Addiction
Medicine Journal Club podcast,and I love talking about
evidence-based medicine.
I teach evidence-based medicineto our residents and I, of
(03:23):
course, do it for our podcast,and I'm interested in how sort
of the practicing doc stays upto date and stays current, so
that's why I wanted to do thisepisode.
Speaker 4 (03:33):
Yeah, my name is Dr John Keenan, so I'm Sonia's
co-host for Addiction MedicineJournal Club and I'm a family
doc.
I do some medical education aswell, though I'm not faculty
like Sonia is, so she's thefull-time acupuncturist here
amongst us, but I do get toteach our residents.
I also work inpatient,outpatient, have an admin role,
do some other subgroups, so Ialso take care of HIV patients
(03:56):
and so certainly high-volumeoutpatient practitioner, but
enjoy these conversations verymuch so.
Speaker 1 (04:02):
So I'm going to tell you something funny, sonia.
So when I was a pre-med, Iremember they would assign us
papers to read, and I thought tomyself when I am a doctor, I am
never going to read any papers,so why don't you start by
telling me what I didn't know asa pre-med and why
evidence-based medicine matters?
Speaker 3 (04:19):
Right.
Well, and I think just toacknowledge that evidence-based
medicine is more than readingthose like super dense papers.
That is one of the foundations.
But you can be a fullyup-to-date doc without ever
having to read those originalfoundational papers.
Treatment Like our patientswould be horrified if they
(04:42):
realized that maybe we'reoffering them a medicine and
there's a better treatment thatwe just don't know about because
we didn't bother to learn.
It's an expectation that youare up to date.
You know.
I remember for myself I was kindof blown away.
I had like a second yearrotation with a family doc.
You know you're like learningto do physical exam.
You have a little internshipthing with a practicing doc and
he told me he got up at fiveo'clock every morning to read
(05:03):
every day from five to six heread and this is pre it wasn't
pre-internet, but pre-likeonline resources.
So he had journals and booksand he read them every single
day and I was like, oh, is thatwhat it takes to be a doctor, be
a family doctor?
That was very meaningful to meand I've always thought of that.
And in addiction medicine it'seven more important because our
field is really changing a lot.
(05:24):
The drug supply changes, thepolitical climate changes.
It's just constantly evolving,more so than some other fields,
I think, and also we're a smallfield so the resources aren't as
mature and well-developed, so Ithink it's hard to stay up to
date in addiction medicine.
But yeah, I think it's justsuper important for us.
Speaker 1 (05:42):
So, tom, you put together an educational
conference on addiction.
What did you highlight?
How did you make it interesting, how did you make it good?
Speaker 2 (05:53):
So this is a conference.
It's called Research toRecovery and we've been doing it
for about eight years.
I got into the field reallyfrom my lived experience.
I got into recovery when I was22, so about 18 years ago, and I
didn't have any plans beforethat.
While I was in active use, Ididn't have any plans to work in
this area and then got realpassionate about it after kind
of being helped by some folksthat knew what they were doing a
(06:15):
little bit.
So when I started my career andthis is kind of I come to this
from a pretty differentperspective as y'all, I was just
thrown in.
I was working in a homelessshelter that had recovery,
support and figure it out as yougo along and that had a lot of
consequences for the folks thatwe served in terms of we
probably didn't serve them verywell or as well as we could have
(06:37):
and that weighed on me as Ilearned more.
And so when I moved over touniversity about a decade ago,
one of the things that wasapparent to me was I had access
to all this knowledge just rightnext door.
You know, I could go to a lunchlecture with these brilliant
folks and learn more than I hadaccess to when I was working in
homeless services, the educationthat was so easily available to
(07:06):
me now that I was in auniversity, setting back to
folks that were providers, thatwere especially peer recovery
specialists, that sort of thing.
So that's been cool.
It's been cool and part of thatis we produce real high quality
recordings.
It was a little bit pre orbeginning of the podcast era, so
it was that kind of idea oflet's record these brilliant
people like Sonia and John andmake sure that folks have access
to them.
Speaker 1 (07:27):
Yeah, I love that, and I love the fact that you're
doing work with peer support.
Peer support is a huge part ofmy practice, so, john, I'm going
to pick on you next.
You mentioned that you're avery high volume practitioner,
so one of the wise attendings Iworked with as a medical student
talked about having to realizethat just because you've seen it
many times in clinic doesn'tmean it's right, and his saying
(07:49):
was the plural of anecdote isnot data.
So how do you reconcile all thethings that you learn from your
patients versus the medicalliterature and synthesize that
into making the right decisionsfor your patients?
Speaker 4 (08:00):
Yeah, I think I'm sure, like many people here, we
read a lot.
But I'll tell you, likepracticing medicine with a
living, breathing person, it'shumbling, right.
You read the literature as kindof a starting point and then
there's always an X factor thatmaybe that person doesn't quite
represent the sample of thatstudy or what you kind of read
about.
So I think it's hard in thatregard, because you know
(08:20):
evidence-based medicine it'sreally kind of like
evidence-informed right, becausewe always have to kind of
tailor to the unique needs ofeach individual person.
As a family doctor we're kind oflike the pluripotent stem cell
of the medical system, right.
We kind of move into whateverdomain is needed and we saw that
with COVID.
(08:40):
We were redeployed to COVID forinpatient even though many of
us didn't do that and actuallylike no-transcript to come up
(09:14):
with an individual plan of likehow you kind of like have a
staying power.
I like to say like you're stillup to date, you still know what
you're talking about, you're onthe edge of what is coming out.
And it's hard.
The broader your scope ofpractice, the harder.
That is right.
Er is probably very difficultas well, because you touch every
domain and how much thetreatments change from year to
year.
It's appalling how quickly itmoves right.
Speaker 3 (09:37):
Well, and I really just want to emphasize something
you said, john, which is thatyou learn about the things that
are in front of you and thethings that are put right in
your lap.
But if you only do that, youactually fall behind.
Like, I think there are a lotof us who really just learn
about what we see, and ourresidents are always trying to
do that.
They're saying I'm just goingto read about my patients, read
about my patients, but like, ifyou do that, you end up with
(09:58):
unrecognized knowledge gaps.
So you have to read about yourpatients, but you also have to
know that there's more knowledgeout there, because otherwise
you're not able to cope when anunfamiliar situation presents
itself.
Like there might be someonehaving some horrible to treat
withdrawal syndrome and youdon't know that tyaneptine is
now a drug of abuse and I didn'tknow that and you wouldn't even
(10:21):
know to know it.
Like you don't even know whatit is.
And so if you don't dosomething that kind of takes you
beyond that point of carelearning, I just think that's a
requirement, as well as justknowing about the problems that
are dropped in your lap.
Speaker 4 (10:35):
Yeah, it's easy to hit the first 90% right.
It's like a diminishing returns.
It's many, many more hours ofstudying and knowledge
acquisition to get the last oneor 2% of the interesting case
right.
I think most of us could treatlike an asthma exacerbation or a
COPD.
But then when the person comesin your office with dress
syndrome, you know, if you neversaw that before, we're studying
for it.
You don't know what you don'tknow, so you have to have some
(10:57):
plan.
Your right to develop afamiliarity with things you're
not familiar with or you haven'tseen.
Speaker 1 (11:09):
Right the first day of medical school at UCLA, the
dean walked into the room anddrew a circle about the size of
a tennis ball and he said thisis what you know, you know.
And then he circled around itabout the size of a grapefruit
and he said this is what youknow, you don't know.
And then he circled the entirerest of the whiteboard and said
this is what you don't know, youdon't know.
I will never forget that.
So, son, you brought this up.
How do you work on maximizingyour ability to learn what you
(11:31):
didn't know?
You didn't know?
Speaker 3 (11:33):
Well, right, and that's the whole point of this
discussion.
And so I guess the first thingI want to say when we're talking
about this is I'm a bigbeliever in process and
consistency.
So we'll talk a little bitabout the process as a group.
But personally for me right nowI actually I'm glad we're
having this discussion because Ineed a little bit of
improvement too.
I listen to podcasts because Ihave a lot of commuting time, so
(11:54):
I fill that with learning and Istruggle to just sit down and
study.
So I need like a deadline or aproject.
So I often, with areas that Ineed improvement on, I force
myself into a project that thenI have to learn about.
So, for example, I signed up tocare for a bunch of transgender
(12:15):
patients and that is forcing meto, you know, expand my
knowledge of transgenderhealthcare.
Or I'm about to pick whatmodules I want to do with our
outpatient residents.
We sort of divide up all themodules, so I'm going to pick
modules that are areas I'm weakin and that will force me to
learn about them.
So I know I'm a project personwho needs like an external
(12:35):
deadline.
And then I personally loveemail alerts.
I sign up for like high qualityemail alerts, and then I get
the emails and I try to keep upwith them.
There are a lot of them, but atleast I feel like I see the
highlights.
If nothing else, I've seen theheadline.
You know tyaneptine will be onthe headline of, like the ASAM
(12:57):
weekly newsletter.
So that's kind of what I'mdoing now.
I just think I need more generalinternal medicine knowledge.
I need to be more up-to-date onmy general primary care
practice.
I'm always afraid I'm going tomiss something.
The residents help keep me upto date, but again it's like
point of care.
They tell me stuff that's rightin front of us, but you know,
like I don't know.
Just a recent example thishappened to me last year, two
(13:18):
years ago.
I think I didn't know that thestandards of care had changed
for diverticulitis, like you'reactually not supposed to give
empiric antibiotics anymore inthe outpatient for
diverticulitis.
I didn't know that that hadtotally changed and the resident
had to tell me it while I wastelling her she should be
prescribing like metronidazoleand ciprofloxacin.
So that's embarrassing.
So I need more general internalmedicine knowledge.
That's what I think I need.
(13:38):
So hopefully we can talk aboutwhat I will do as we go through
this process.
Speaker 1 (13:43):
Yeah, tom, for us as doctors most of us who have not
lived with addiction it's kindof hard to actually understand
what addiction is like and whyit happens.
Can you talk aboutincorporating lived experience
when you do education, becausethat is so helpful?
We actually did somepresentations in my hospital
where we had people in recoverycome to speak to healthcare
(14:04):
providers because of the valueof lived experience.
So I'd love your thoughts.
Speaker 2 (14:08):
Yeah, absolutely.
Like I said, I've been inrecovery for 18 years, which you
know is an N of one.
You know I have to likeunderstand that, like my
experience is not everybodyelse's experience, but also that
hope matters right For you.
As an emergency medicine doctor.
You are almost entirely seeingthe patients that you see with
(14:29):
addiction.
You're seeing them at theirabsolute worst, right, and
they're not coming backgenerally to thank you, right,
for treating them because it was, you know, one of the worst
days of their life when they sawyou.
And we can be difficult, right,addiction is a really does
things to us that we pass on toother people.
I think one of the pieces for mewith working with medical
(14:49):
professionals is for them tokind of understand that you know
there's hope for that personright, that a lot of us are here
because you were there in thatmoment.
And if you don't get to see thehope on the other side, if you
don't get to see people that arein recovery which is made worse
because there's so much stigmawithin healthcare that many
people in my life don't discloseto their physicians that
(15:12):
they're in recovery, so youdon't see us on the other side,
even when we do really well alot of times because we're
afraid of that.
So I think that just kind ofconnecting to shared humanity is
a really important piece of thekind of larger picture, without
claiming that one of ourexperiences is all of our
experiences, because it looksreally really different, you
(15:32):
know, based on lifecircumstances, socioeconomic,
substance abuse etc.
So that's really when we are inclassrooms we're trying to kind
of expand people's view of whataddiction is and also what
recovery can look like for folks.
Speaker 1 (15:48):
John, what's your approach to staying up to date
with medical literature andaddiction?
Speaker 4 (15:53):
The biggest things.
I think you know I have mythree primary journals I read
every month.
So I set aside like two hoursonce a month.
So it's like the addictionmedicine journal from ASAM,
family practice and then alsoHIV digest as well.
That one has a lot of overlapbecause that group tends to be
overlyful for patients withsubstance use.
But I'm a big fan of what Soniasaid too.
(16:14):
I love my like journal stream.
So like Journal Watch from JAMAEvidence Alerts, I get these
kind of updated briefs in mymailbox on a weekly basis and it
picks like overviews of likethe biggest 20 articles in that
area and I can click on them andread in depth further.
So it's a way of scanning theliterature and then getting in
depth more so with what I want.
(16:35):
And then the biggest thing toois it's hard when you start to
practice.
If you live in an island youkind of drift away from norm.
I work with the residents everycouple of weeks.
I'm teaching them and they comeout to my office.
I have medical students andit's sort of like dad strength
at basketball no-transcriptspace now.
(17:23):
And it's interesting, some ofthe older attendings not so much
, but the younger group, theresidents, the new medical
students.
They like love this and theythink it's amazing we take the
ER residents rotating ontoxicology.
They come out for a day at theclinic and they really enjoy the
experience because most of thetime as Tom pointed out that
they're interacting with thisgroup, they're like overdosed,
(17:45):
they're kind of not in theirright state of mind.
So like seeing them recover anddo well like this person has
been with me for three years,they got their kid back or in
school it's a really positiveexperience to show the other
side of that lens, which theyprobably don't get in their
primary care area as EDresidents, you know.
Speaker 1 (18:01):
That is a hundred percent true.
We actually would often messagethe ER doc that had taken care
of a patient to let them knowthat they were doing well, just
to give them the positivefollow-up.
Yeah, so you mentioned teachingand I'll share a little bit
about what I do.
So the whole reason I startedmy podcast, addiction Medicine
Made Easy, is when I was aresident, when there was a
(18:23):
difficult topic, I wanted thattopic to be assigned to me as a
resident, like the patient witha generalized weakness in the
emergency department.
It's so broad.
I actually lectured on that mysenior year of residency because
I wanted to be able tounderstand the most difficult
topics.
I felt like if I could teachthem, I had a really good
understanding of them.
So that's where this podcastcame from.
(18:45):
I didn't want to be a cluelessphysician, so I was asking
clinical questions, and soresearching episodes is really
helpful for me.
And then I'm the medicaldirector for a local drug and
alcohol treatment program, andso researching episodes is
really helpful for me.
And then I'm the medicaldirector for a local drug and
alcohol treatment program andI'm required as the medical
director, to give oneeducational lecture a month, and
the one I picked for thiscoming month is on ketamine
addiction, and I know a littlebit about it.
(19:05):
Thank you, elon Musk, formaking it popular again as a
topic.
So, yeah, I'm going to puttogether a lecture for that and
I pulled some papers and I'mgoing to review them and I'm
going to do an evidence-basedreview of the topic.
And then I mentioned that mylovely bride, the very
intelligent, charming andbeautiful Dr Reb Close, who's
sitting behind me, she workswith the California Bridge,
which is a program that'sdesigned to help clinicians
(19:28):
innovate around addiction care,and so she's one of their
regional directors, and so shewill be asked to give a lecture
and same kind of thing.
You know she'll be like, hey,what are you hearing about
tyaneptine?
And then locally, we have a lotof collaborative efforts.
So I'm in central California,on the coast, and there's about
four counties that we worktogether and we'll actually have
quarterly meetings of like,what drugs are you seeing?
(19:48):
What are you treating, what areyour new protocols?
And each county gives updates.
So it's not really going to themedical literature, but it's
more to your point, sonia.
What is it that we don't know?
We don't know, and weregionally will collaborate and
talk about what drugs are peopleseeing?
What new protocols do we have?
What's the easiest way to getpeople on, you know, a
direct-to-inject protocol?
I will share that.
(20:10):
I'm not great about reading anyjournal regularly, but it's
more organic and because we workcollaboratively, I feel like
I'm able to not miss topics asmuch.
But yeah, I probably need tofind a good journal that I read
regularly.
Speaker 3 (20:23):
Well and the word regularly.
So here's one thing I dobelieve strongly and you guys
just everyone listening knowsthey made fun of my
organizational email prior tosetting this up, but you got to
be sort of structured.
I'm a big believer in processand consistency.
I feel like if you have aconsistent process, it's
realistic and you can do it 80%of the time, 75% of the time,
(20:47):
but you stick with it, you willget to your goal, whereas if
either your goals are too broador too unfocused or too
ambitious, and then you don'thave any kind of way to stick
with it, then you won't get veryfar.
I used to be more of aperfectionist and then I would
get bogged down.
I'm like I'm going to read, youknow, 10 pages a day, and then
I would skip the 10 pages.
I'm like, okay, tomorrow I'llread 20 pages, and I wouldn't do
(21:10):
that either.
I'm like, okay, I'm going toread 30 pages so I can stay on
schedule.
That's like med school, youknow.
So it just didn't.
It didn't work.
You get behind, you get boggeddown and then everything
implodes.
So having a consistent processand designing a plan that is
realistic enough for you butactually does push you a little
bit and you can stick with, Ithink, is the way to do this.
(21:31):
So do you guys want to starthearing about my sort of
framework for figuring out howto stay with the literature?
Speaker 1 (21:39):
I'm going to try to be funny here.
Do we get a choice?
Speaker 4 (21:43):
It's as organized as the pre-discussion email we got.
Speaker 1 (21:47):
Would you like to give us a really organized
overview of how you'reapproaching evidence-based
medicine and addiction?
Speaker 3 (21:51):
That sounds like a great topic.
Everyone listening part 1Ayou're lucky you can't see the
PowerPoint.
No, there's no PowerPoint yet.
But the first thing I thinkactually is most important and I
really want to hear what youguys have to say is motivation
Is why?
Why are you doing this?
What's your unique personalgoal?
(22:14):
Because I think if you knowyour motivation, it's a lot
easier to figure out a plan thatwill work for you.
And I think, like being a gooddoctor is not specific enough,
keeping current not specificenough, Not embarrassing myself
in front of the residents it'sgetting a little closer, but you
know, some examples of sort ofgood motivation would be I want
to give good lectures, like yousaid, casey.
I want to give good lecturesthat are true to colleagues.
I need to pass the boards.
(22:34):
That might be a good motivation.
Or I want to add a new skill tomy clinical practice, like John
, when you did your HIV training, you're adding a new skill.
Or I need to work with medstudents and develop a new
curriculum.
So motivation, I think, isreally important.
So what do you guys think aboutmotivation for staying up to
literature?
Why would you bother?
Why not just do what you know,see what you see, and if you
(22:57):
don't know something, you lookit up and up to date as you go
along.
John, you want to go first?
Speaker 4 (23:00):
Yeah, I really like doing new things.
So like new things and likepushing the scope of my practice
.
I'm not kind of like nichedinto a specialty, so I so I kind
of like to take it as far as Ican go and I've really kind of
been lucky in life to date.
I really only kind of operatedwith like two goals in mind.
Since I've become an attending,it's like do things that
interest me and always try to dothe right thing and actually
(23:22):
everything else is kind offollowed behind nicely.
So the number one thing I do isI just want to learn more about
these different topics.
They interest me and it's easyto kind of put time into
something you like to do andthat you're interested in.
Speaker 2 (23:34):
Tom, yeah, so I guess my is a little different
because I'm not trying to treatall these different things, I'm
just interested in addiction andrecovery and that's like been
very clear to me for a reallylong time that that was going to
be the thing that I wasdedicating my whole life and
career to.
The bottom line for me is likethe stakes are too high and
we're not good enough.
And you know, I just lost somany people, so many people that
(23:57):
I've worked with so manyfriends in recovery spaces over
the last I don't know 16, 17years that I've been working in
the space.
That's a real motivator.
And actually the thing thatalways comes up for me with this
is early in my career I wasworking at a long-term recovery
space and I kind of switchedroles and started to just work
(24:21):
on our emergency shelter side asa large organization.
So I was running a 120-bedhomeless shelter and I didn't
really know anything abouthomeless services, especially as
compared to recovery andaddiction, and I just had a
couple of situations withclients where basically our
(24:42):
policy was if folks came inintoxicated that we would ask
them to.
Sometimes we'd just be like,okay, just chill out.
But if this happens again,you're going to either have to
go to treatment or you can'tstay in the shelter anymore.
And I mean it wasn't like therewas not enough shelter beds in
the first place, but workingwith kind of vulnerable women
who had terrible addiction thatcouldn't not drink, right, not
(25:08):
use before coming in, kickingthem out of shelter, was the
worst thing, right, but I didn'tknow that because I didn't have
any formal training in the workthat I was doing and I didn't
know the research, and so I justhad this really kind of upfront
experience with seeing one ofthe women that we asked to leave
the shelter for yearsafterwards living on the street,
and while that was happening Iwas learning what we should have
(25:29):
been doing and I was making thechanges to our programs that we
should have been doing.
But I just don't want to bethat right, and so there's real
consequences to the folks thatwe serve when we don't have the
knowledge that we need and sojust want to be better, you know
.
Speaker 3 (25:45):
How about you, Casey?
What's your motivation?
I'm going to try to be funnyagain.
Speaker 1 (25:49):
It's usually that my wife has some lecture that's due
tomorrow and she needs me toresearch it for her and I want
to just be able to like answerthe question and not have to
take 20 minutes looking it upfor her.
Okay, all kidding aside, Ithink it is that the more I
learn, the more I can help, andparticularly, I'm doing a lot of
education personally aroundmental health.
Kind of my niche is becomingthe intersection between PTSD
(26:11):
and addiction, and so I am alittle bit like John.
I'll find something that I'minterested in and just dig into
it more, and dig into it moreand get more expertise in it,
and then that translates into mywork being easier in clinic.
Mm, hmm.
Speaker 3 (26:24):
All right.
So now that we have ourmotivation, the next thing I
want you guys to think about isthe what and the when, and this
is where the kind of realisticthing comes out.
Like you might aspirationallybe like I'm going to read this
giant textbook or you know,Casey, you're going to change
and you're going to readjournals lots of journals, you
know, but no, it's realisticallyhow much time do you have?
(26:46):
When is that time and whatkinds of things do you like to
learn from and that actuallywork for you?
So probably zero time is not agood answer.
If you have zero time forlearning, you need to adjust
your work such that you havesome dedicated time if you're in
a field that changes.
But some people say their wholeeducation is one full week a
year to a conference.
(27:06):
That's what they do and that'sa full week's worth of time.
That's pretty good.
Or 15 minutes every day.
For me it's at least an hour aday of commuting time as an
educational podcast, because Icommute two hours a day, you
know.
So, realistically, what timewill you spend on it and when?
And then, what type of learningdo you like?
And it's easier to stick withthings you like.
(27:27):
So videos, podcasts, emails,books, journals, conferences,
other people Do you need to chatin person?
Can you just read all byyourself?
And just to sort of choose agateway, because, dealing with
medical knowledge, there's anentire industry that helps
people deal with medicalknowledge Abstracting services,
board prep resources,conferences, YouTube channels,
(27:51):
you know and a lot of them arepretty expensive, Like there's a
whole industry out there.
So just sort of to choose agateway, but don't don't try to
do it all.
Again, like med school, whichis, of course, our firehose of
learning, I remember thinkingmaybe if I buy like a different
textbook or another textbookI'll like no more, and
eventually I was like you knowwhat, just choose one textbook
and stick with it.
It probably tells you what youneed to know in that textbook.
Don't get a second one, Justread that one.
(28:13):
So the what time and what'syour resources that you like is
the next question.
Speaker 1 (28:18):
I'll take this one first.
So I have not found it yet.
In addiction medicine, inemergency medicine, there is an
Australian ER doc named MelHerbert who figured out that if
you made education funny itstuck better.
And so when I was practicingemergency medicine I had a
subscription to this servicecalled EMRAP Emergency Medicine
(28:38):
Reviews and Perspectives, and itwas humor soundtrack, funny
songs the host would banter.
It was beautifully done and Iwas about two and a half hours
per month of topics they rotated.
There was a very wide breadth,because emergency medicine you
have to know a little bit ofeverything.
And then they additionally hada second program called
Emergency Medical Abstracts.
(28:59):
Two physicians who actually didresidency with my wife would
banter over journal articles andthey covered between 20 and 30
articles a month.
And so I loved to exercise andso whenever I was exercising I
was learning.
I have not found that yet inaddiction medicine.
So my primary favoriteaddiction medicine resource is
the Addiction Medicine JournalClub podcast.
Speaker 3 (29:20):
Oh, you flatter us, shave, it was your blog.
Speaker 1 (29:23):
saying that oh and that's actually part of the
reason why I created my ownpodcast is I wanted to create
interesting education in theaddiction space.
So I'm still looking, but forme it's usually something audio,
because I can exercise and Ican drive.
Speaker 3 (29:35):
Yeah, and can I just point out, you did something I
don't know if you ever put thisname to it.
We call it pleasure bundling,whereas you like to exercise,
and so you bundled your learningwith your exercise, and
sometimes, if there's somethingyou have trouble doing, you
bundle it with something thatyou like to do and that helps
you get it done.
So like, do it with a friend ifyou want to hang out with
friends, or you said, do itwhile you exercise.
So I just want to point out youdid that strategy.
Speaker 1 (29:58):
I just feel like I'm fitter and smarter at the end of
a workout and it's just, it'scool.
Speaker 4 (30:03):
Every time we talk with you you're off to a like a
fit class of some sort, like ahit interval training class.
I feel like you're the most fitposition in this audience, at
least today.
We did two hours of Taekwondothis afternoon.
(30:38):
I am beat more policy related,which are very interesting reads
, but it's hard to translatethat to the exam room or the
hospital room.
So I tend to find that the bestone are articles that are
covered incidentally and otherones that are more like overview
type articles.
So those are kind of great forlike the HIV journals and also
family medicine journal.
I like ASAM weekly just like 10minute read, read the highlights
(31:00):
stories there.
A lot of that is policy andalso the same overlap.
But I would say that I'm kindof guesstimating here.
Maybe 10 to 20% of thosearticles could be applicable to
like the exam room, but stillnot the majority of it.
A lot of it's more policy typesinformation.
If I'm being honest, I bet youspecific to addiction medicine
on a weekly basis.
(31:20):
I'm probably doing anywherefrom 30 minutes to an hour a
week just on that topic and Ithink it's probably broken up
into small blocks of like 10minutes at a time.
So maybe like 10 minutes a dayjust down the rabbit hole in
some article that comes acrossmy desk, often those kind of
review articles that come up inyour email that give me 20 or 30
articles to highlight.
Speaker 3 (31:41):
And is that enough, do you think, for you?
Sounds like, given everythingelse you have to know, it sounds
like a pretty big chunk of yourlearning time actually.
Yeah.
Speaker 4 (31:48):
I think where I'm at right now it's decent.
I mean, there's always newthings to learn.
This kind of also reflects theinfancy of this kind of field a
little bit right.
I think that there's a lot oflearning comes from shared
learning.
I feel like we went to ASAMconference.
The best parts of that waspeople just talk in the room
about what they're doing and alot of it's not super high level
research, right.
A lot of it's like anecdotal,like I'm doing this, really,
(32:10):
you're doing that, and likethat's interesting to try.
That.
I might try that.
I don't feel like we get theselarge RCTs that we get for other
things.
I mean, how many trials have weseen about cholesterol statins
for heart disease?
I mean we've studied that.
We know it's good.
So many, so many.
Yeah, I'm like why are we stillstudying that?
And then we can't even answerthe basic questions for
addiction medicine and I don'tknow.
(32:30):
Maybe a question for Tom whendo you think we sit?
Do you feel like we've justentered this space as like
health professionals?
Because I feel like we'vetalked a little about this
offline before that.
You know, I feel like recoverycommunity has been somewhat
independent of the medicalcommunity for a long time.
Speaker 2 (32:45):
Yeah, and certainly treatment has been separated out
from the rest of medicine for avery long time and with some
really substantial consequences.
So it's interesting, I mean.
I think it's obviously a hugeaddition from a quality of life
standpoint.
But the other thing that I wasreflecting on that having more
physicians really heavilyinvolved is you'll have a lot
(33:06):
more accountability than we havehistorically had around
addiction treatment and recovery.
So that's a reason that a lotof folks that work in this space
haven't historically done agreat job of keeping up with
what's on the edge and that sortof thing.
Obviously there's a lot of greatclinicians out there and a lot
of great addiction medicinepeople, but the accountability
(33:27):
hasn't been there and so it'snot like as clear when somebody
is doing something theyshouldn't be doing as it is.
For you know, when you all areprescribing things and it's all
documented and has historicallybeen documented.
No-transcript is just to proveour worth, just to prove that we
(34:19):
belong in the space.
In Virginia the peer professionis nine years old, right.
So you can't possibly have anyrobust data to say this is
definitely working and to try totrack that in this rapidly
growing space and be able to sayanything definitive about any
of that is basically impossibleafter such a short period of
(34:42):
time.
So especially the peer recoveryspace is very much a build the
plane as we're flying it from aresearch perspective, even
though we have a long, longhistory of robust peer-based
healing from addiction and wehave a fair amount of literature
specifically about, you know,12-step and 12-step facilitated,
but we don't about this wholekind of peer recovery field,
(35:04):
which really pushes beyond that.
So I love, in terms of researchsources, recoveryanswersorg is
done by the Recovery ResearchInstitute.
Speaker 3 (35:13):
I love them.
Excellent email newsletters.
Speaker 2 (35:17):
They are great, john Kelly and their team, brandon
Bergman and Emily they're justawesome up there in Boston and
then I listen to y'all's podcastand then for me, organizing
these events so organizing ourresearch collaborative and then
organizing our spring conferenceis just huge for me to stay up
to date because that kind ofother person, accountability is
(35:38):
important for me, and thecommunity connections as well.
Speaker 1 (35:42):
So, sonia, I think the last two points we were
going to go over is how do youmake the learning stick once you
found your resource and setaside the time to do it, and
then how do you make thelearning that you do count?
How is it useful?
How does it help you?
Do you want to start?
And performance improvement?
Speaker 3 (35:58):
And it's got to be active.
So, whatever that means for you, something to make it stick.
For me that's either takingnotes or turning it into a
project, like I said before,like I turn it into a lecture or
a unit I'm doing for theresidents and sometimes I write
(36:20):
lecture slides on topics, evenif I don't have a lecture in
mind.
I just make slides and that'smy kind of making it stick.
And then someday maybe I'll usethem, someday not.
And then engaging with otherpeople in person I think is
really important For me.
Talking about something withother people I feel like is key.
So that's the one thing interms of making it active for me
.
And then I'm just a hugebeliever on like make it count.
(36:44):
I say make it count twice ormake it count three times, so
you learn about something and,like I said, you turn it into
lecture slides.
Or you learn about somethingand you turn it into a research
project.
Or for us, you know we have thepodcast, so all of my reading of
the addiction medicineliterature goes towards I have a
goal, which is finding articlesfor the podcast, and so I
(37:05):
actually like read through allthese journal table of contents
looking for articles for thepodcast and so I actually like
read through all these journaltable of contents looking for
articles for the podcast.
So I do something with thatknowledge and I think that's the
problem.
That's why I need help with mygeneral medical knowledge is I
do have my teaching for theresidents, so that helps, but
it's like what am I doing withthat studying?
If I'm just like reading atextbook or scanning New England
Journal of Medicine articles, Ireally need to do something
(37:26):
with it.
So I will turn it into epicsmart phrases for those of you
who use epic like handouts forpatients, anything.
I have to do something with theinformation.
And then I feel like I've sortof done two things I'm smarter
and I have a product that I candeploy in any other kind of
setting.
Speaker 4 (37:42):
John how about you?
I think similar.
I think I got to make it comealive somehow, so it's either
apply it to a patient, which isprobably often one of the
reasons that I'm actually doingthe research.
I got to talk about it with mypeers.
So we have a doc meeting everyFriday with my partners and
often I bring up someinteresting stuff just for kind
of group sharing, which we havesome interesting discussions or
teaching with the residents.
(38:02):
So those three and the medicalstudents, which is kind of a
captive audience whoever willlisten.
Speaker 3 (38:08):
They're forced to nod and show a great interest.
Speaker 4 (38:14):
It's the closest thing to a yes man I'll ever get
.
I could say anything.
The medical students kind oflike nod and shake their head.
I could be saying some reallycrazy stuff and they're like oh
yeah, that's great, dr Keenan.
Speaker 2 (38:23):
Tom, how about you?
I like that idea of make itcount twice.
I hadn't conceptualized it assuch, but I always try to work
on like one talk a year.
That's really a stretch for me.
So, like last year, it wascannabis and I hung out with all
these wild cannabis researchers, which is, you know, if you
want to dig deep into a funnytopic, all the different ways
(38:44):
they measure how high a mouse isis a really entertaining
subtopic of research.
But you know, that area ofdeveloping a talk for new area
that I don't know a lot about interms of addiction, and then
also the conferences.
I'm always looking for greatspeakers.
So watch out, casey, for ourconference and that kind of
thing.
So that really keeps me fresh.
(39:06):
Just, you know, spending sometime listening to people I
admire is great.
Speaker 1 (39:11):
So I have to say and I'm going to try to be funny
again is I think we just allneed to marry the right person,
because for me, being married toanother addiction medicine
doctor is great, it really helps.
But yeah, for me it's all aboutteaching.
So, as I mentioned, you know,when I was a resident, I wanted
the hardest topics because I hadto understand them to be able
to teach them, and so for meit's like oh, this would make a
(39:33):
great podcast episode.
Or I'll have a casualconversation with a colleague
and they'll say something likewait, I need to know more about
that, can I interview you?
Same thing with my patients.
I've got a couple of patientsthat I've interviewed on the
podcast, and it has always beenone of my life goals to find
what I don't know, I don't knowand try to learn about it.
So I think it's fun.
My daughter I can hear herrolling her eyes from the other
(39:54):
room.
I love trivia, I love learningand facts and knowledge.
It's enjoyable to me to expandmy brain and that's been very
motivating for me.
But in terms of using it andmaking it count, I totally agree
Taking notes, turning it into ahandout or a smart phrase, or
for me oh gosh, that would makea good podcast episode, and I've
(40:16):
actually started now.
Anytime I lecture, I recordmyself and use it to make a
podcast episode, just because itsaves time.
Speaker 3 (40:22):
So yeah, making it count twice Well, this was
awesome.
I feel like I definitely gotsome good ideas from you guys.
I mean, to me it seems like allof us and maybe this is just us
or maybe this is everybody arekind of project people.
Like to force ourselves tolearn.
We'll pick something that makesus learn.
So sort of sitting quietly byyourself and reading the
textbook from cover to coverdoesn't seem to work for any of
(40:46):
us.
But that's fine.
That's fine because I think allof us are doing good work and I
know for myself I'm alwaysstriving to find a process that
will keep me being the doctor Iwant to be.
Speaker 1 (40:55):
Yeah, this has been a great topic and love the
collaboration.
Truly Addiction MedicineJournal Club is where I get most
of my medical literature.
Speaker 3 (41:02):
Oh, now, that's like a lot of pressure, uh-oh.
Speaker 1 (41:05):
Well, I give you guys shout outs, like the most
recent one I did onanti-methamphetamine addiction.
I referenced the podcastepisode you guys did on the
Vyvan study.
Anyways, love the collaboration.
Speaker 3 (41:14):
That was all John and I'll put in the show notes.
I'll put links to these variousresources that we mentioned on
the podcast and a few more thatI like, and that's it.
Speaker 4 (41:30):
I, everyone has an awesome night.
Well, you guys are at bedtime.
Speaker 1 (41:32):
I've got to go make dinner for my family, so, all
right, good night everybody.
It was great chatting with you.
Before we wrap up, a huge thankyou to the Montage Health
Foundation for backing mymission to create fun, engaging
education on addiction, and ashout out to the nonprofit
Central Coast OverdosePrevention for teaming up with
me on this podcast.
Our partnership helps me getthe word out about how to treat
(41:52):
addiction and prevent overdosesTo those healthcare providers
out there treating patients withaddiction.
You're doing life saving workand thank you for what you do
For everyone else tuning in.
Thank you for taking the timeto learn about addiction.
It's a fight we cannot winwithout awareness and action.
There's still so much we can doto improve how addiction is
(42:13):
treated.
Together we can make it happen.
Thanks for listening andremember treating addiction
saves lives.
Speaker 4 (42:33):
Bye.
Welcome to the Addiction Medicine Made Easy
Podcast.
Hey there, I'm Dr Casey Grover,an addiction medicine doctor
based on California's CentralCoast.
(00:22):
For 14 years I worked in theemergency department, seeing
countless patients strugglingwith addiction.
Now I'm on the other side ofthe fight, helping people
rebuild their lives when drugsand alcohol take control.
Thanks for tuning in.
(00:55):
Let's get started.
Today's episode is acollaboration between my podcast
and the Addiction.
Thank you.
Research and scientificliterature on addiction.
I am proud to admit that I aman avid listener of their
podcast and our two podcasts doepisodes together periodically,
and today's episode is one ofthose collaborative episodes.
We discussed how addictionmedicine professionals can stay
(01:18):
up to date on the latestresearch and science in the
field of addiction treatment tobe able to provide the best care
possible to their patients.
The episode was actually afour-person roundtable.
It was a discussion with myself, dr John Keenan, dr Sonia
Deltredici and Thomas Bannard.
Thomas works at VirginiaCommonwealth University and
coordinates their collegiaterecovery program.
(01:40):
We had an awesome discussionand I am so grateful to share it
with you.
Here we go, all right.
Well, we have a meeting of theminds.
It's afternoon my time and it'sevening for all of you, but we
are going to collectively geekout on how to keep up with the
medical literature in addictionmedicine.
(02:01):
Tom, why don't you start byintroducing yourself and tell us
what you do, sure?
Speaker 2 (02:04):
So my name is Tom Bannard.
I am the assistant director forsubstance use and in addiction
medicine.
Tom, why don't you start byintroducing yourself and tell us
what you do, sure?
So my name is Tom Bannard.
I am the Assistant Director forSubstance Use and Recovery
Support at Virginia CommonwealthUniversity.
So I work with our collegiaterecovery program.
We work with students who arein recovery from addiction and
also help students get intorecovery.
So we do that through a numberof different things, including
trips, that sort of thing, butalso kind of some more
(02:26):
formalized, structured seminars.
And then part of our mission isto make sure that everybody
that studies a health-relatedscience at VCU so whether that's
professional school orotherwise gets some exposure to
people who are in recovery fromaddiction and kind of interacts
with folks that have that livedexperience of recovery so that
when they go out and work inmedical spaces they can hold
(02:49):
that hope for their patients,which I think is a really
important part of our work.
And I'm a big fan of bothy'all's podcasts.
So I'm excited to be here.
Speaker 1 (02:56):
Yes, so I'm Casey Grover from the Addiction
Medicine Made Easy podcast.
Speaker 3 (03:01):
Sonia and John you want to go next?
Sure, I'll go, and I just haveto say that Tom threw an awesome
conference that we went torecently.
So anyone else who wants to goto Rams and Recovery at VCU
Health next year highlyrecommend.
I'm Sonia Daltredici, one ofthe hosts of the Addiction
Medicine Journal Club podcast,and I love talking about
evidence-based medicine.
I teach evidence-based medicineto our residents and I, of
(03:23):
course, do it for our podcast,and I'm interested in how sort
of the practicing doc stays upto date and stays current, so
that's why I wanted to do thisepisode.
Speaker 4 (03:33):
Yeah, my name is Dr John Keenan, so I'm Sonia's
co-host for Addiction MedicineJournal Club and I'm a family
doc.
I do some medical education aswell, though I'm not faculty
like Sonia is, so she's thefull-time acupuncturist here
amongst us, but I do get toteach our residents.
I also work inpatient,outpatient, have an admin role,
do some other subgroups, so Ialso take care of HIV patients
(03:56):
and so certainly high-volumeoutpatient practitioner, but
enjoy these conversations verymuch so.
Speaker 1 (04:02):
So I'm going to tell you something funny, sonia.
So when I was a pre-med, Iremember they would assign us
papers to read, and I thought tomyself when I am a doctor, I am
never going to read any papers,so why don't you start by
telling me what I didn't know asa pre-med and why
evidence-based medicine matters?
Speaker 3 (04:19):
Right.
Well, and I think just toacknowledge that evidence-based
medicine is more than readingthose like super dense papers.
That is one of the foundations.
But you can be a fullyup-to-date doc without ever
having to read those originalfoundational papers.
Treatment Like our patientswould be horrified if they
(04:42):
realized that maybe we'reoffering them a medicine and
there's a better treatment thatwe just don't know about because
we didn't bother to learn.
It's an expectation that youare up to date.
You know.
I remember for myself I was kindof blown away.
I had like a second yearrotation with a family doc.
You know you're like learningto do physical exam.
You have a little internshipthing with a practicing doc and
he told me he got up at fiveo'clock every morning to read
(05:03):
every day from five to six heread and this is pre it wasn't
pre-internet, but pre-likeonline resources.
So he had journals and booksand he read them every single
day and I was like, oh, is thatwhat it takes to be a doctor, be
a family doctor?
That was very meaningful to meand I've always thought of that.
And in addiction medicine it'seven more important because our
field is really changing a lot.
(05:24):
The drug supply changes, thepolitical climate changes.
It's just constantly evolving,more so than some other fields,
I think, and also we're a smallfield so the resources aren't as
mature and well-developed, so Ithink it's hard to stay up to
date in addiction medicine.
But yeah, I think it's justsuper important for us.
Speaker 1 (05:42):
So, tom, you put together an educational
conference on addiction.
What did you highlight?
How did you make it interesting, how did you make it good?
Speaker 2 (05:53):
So this is a conference.
It's called Research toRecovery and we've been doing it
for about eight years.
I got into the field reallyfrom my lived experience.
I got into recovery when I was22, so about 18 years ago, and I
didn't have any plans beforethat.
While I was in active use, Ididn't have any plans to work in
this area and then got realpassionate about it after kind
of being helped by some folksthat knew what they were doing a
(06:15):
little bit.
So when I started my career andthis is kind of I come to this
from a pretty differentperspective as y'all, I was just
thrown in.
I was working in a homelessshelter that had recovery,
support and figure it out as yougo along and that had a lot of
consequences for the folks thatwe served in terms of we
probably didn't serve them verywell or as well as we could have
(06:37):
and that weighed on me as Ilearned more.
And so when I moved over touniversity about a decade ago,
one of the things that wasapparent to me was I had access
to all this knowledge just rightnext door.
You know, I could go to a lunchlecture with these brilliant
folks and learn more than I hadaccess to when I was working in
homeless services, the educationthat was so easily available to
(07:06):
me now that I was in auniversity, setting back to
folks that were providers, thatwere especially peer recovery
specialists, that sort of thing.
So that's been cool.
It's been cool and part of thatis we produce real high quality
recordings.
It was a little bit pre orbeginning of the podcast era, so
it was that kind of idea oflet's record these brilliant
people like Sonia and John andmake sure that folks have access
to them.
Speaker 1 (07:27):
Yeah, I love that, and I love the fact that you're
doing work with peer support.
Peer support is a huge part ofmy practice, so, john, I'm going
to pick on you next.
You mentioned that you're avery high volume practitioner,
so one of the wise attendings Iworked with as a medical student
talked about having to realizethat just because you've seen it
many times in clinic doesn'tmean it's right, and his saying
(07:49):
was the plural of anecdote isnot data.
So how do you reconcile all thethings that you learn from your
patients versus the medicalliterature and synthesize that
into making the right decisionsfor your patients?
Speaker 4 (08:00):
Yeah, I think I'm sure, like many people here, we
read a lot.
But I'll tell you, likepracticing medicine with a
living, breathing person, it'shumbling, right.
You read the literature as kindof a starting point and then
there's always an X factor thatmaybe that person doesn't quite
represent the sample of thatstudy or what you kind of read
about.
So I think it's hard in thatregard, because you know
(08:20):
evidence-based medicine it'sreally kind of like
evidence-informed right, becausewe always have to kind of
tailor to the unique needs ofeach individual person.
As a family doctor we're kind oflike the pluripotent stem cell
of the medical system, right.
We kind of move into whateverdomain is needed and we saw that
with COVID.
(08:40):
We were redeployed to COVID forinpatient even though many of
us didn't do that and actuallylike no-transcript to come up
(09:14):
with an individual plan of likehow you kind of like have a
staying power.
I like to say like you're stillup to date, you still know what
you're talking about, you're onthe edge of what is coming out.
And it's hard.
The broader your scope ofpractice, the harder.
That is right.
Er is probably very difficultas well, because you touch every
domain and how much thetreatments change from year to
year.
It's appalling how quickly itmoves right.
Speaker 3 (09:37):
Well, and I really just want to emphasize something
you said, john, which is thatyou learn about the things that
are in front of you and thethings that are put right in
your lap.
But if you only do that, youactually fall behind.
Like, I think there are a lotof us who really just learn
about what we see, and ourresidents are always trying to
do that.
They're saying I'm just goingto read about my patients, read
about my patients, but like, ifyou do that, you end up with
(09:58):
unrecognized knowledge gaps.
So you have to read about yourpatients, but you also have to
know that there's more knowledgeout there, because otherwise
you're not able to cope when anunfamiliar situation presents
itself.
Like there might be someonehaving some horrible to treat
withdrawal syndrome and youdon't know that tyaneptine is
now a drug of abuse and I didn'tknow that and you wouldn't even
(10:21):
know to know it.
Like you don't even know whatit is.
And so if you don't dosomething that kind of takes you
beyond that point of carelearning, I just think that's a
requirement, as well as justknowing about the problems that
are dropped in your lap.
Speaker 4 (10:35):
Yeah, it's easy to hit the first 90% right.
It's like a diminishing returns.
It's many, many more hours ofstudying and knowledge
acquisition to get the last oneor 2% of the interesting case
right.
I think most of us could treatlike an asthma exacerbation or a
COPD.
But then when the person comesin your office with dress
syndrome, you know, if you neversaw that before, we're studying
for it.
You don't know what you don'tknow, so you have to have some
(10:57):
plan.
Your right to develop afamiliarity with things you're
not familiar with or you haven'tseen.
Speaker 1 (11:09):
Right the first day of medical school at UCLA, the
dean walked into the room anddrew a circle about the size of
a tennis ball and he said thisis what you know, you know.
And then he circled around itabout the size of a grapefruit
and he said this is what youknow, you don't know.
And then he circled the entirerest of the whiteboard and said
this is what you don't know, youdon't know.
I will never forget that.
So, son, you brought this up.
How do you work on maximizingyour ability to learn what you
(11:31):
didn't know?
You didn't know?
Speaker 3 (11:33):
Well, right, and that's the whole point of this
discussion.
And so I guess the first thingI want to say when we're talking
about this is I'm a bigbeliever in process and
consistency.
So we'll talk a little bitabout the process as a group.
But personally for me right nowI actually I'm glad we're
having this discussion because Ineed a little bit of
improvement too.
I listen to podcasts because Ihave a lot of commuting time, so
(11:54):
I fill that with learning and Istruggle to just sit down and
study.
So I need like a deadline or aproject.
So I often, with areas that Ineed improvement on, I force
myself into a project that thenI have to learn about.
So, for example, I signed up tocare for a bunch of transgender
(12:15):
patients and that is forcing meto, you know, expand my
knowledge of transgenderhealthcare.
Or I'm about to pick whatmodules I want to do with our
outpatient residents.
We sort of divide up all themodules, so I'm going to pick
modules that are areas I'm weakin and that will force me to
learn about them.
So I know I'm a project personwho needs like an external
(12:35):
deadline.
And then I personally loveemail alerts.
I sign up for like high qualityemail alerts, and then I get
the emails and I try to keep upwith them.
There are a lot of them, but atleast I feel like I see the
highlights.
If nothing else, I've seen theheadline.
You know tyaneptine will be onthe headline of, like the ASAM
(12:57):
weekly newsletter.
So that's kind of what I'mdoing now.
I just think I need more generalinternal medicine knowledge.
I need to be more up-to-date onmy general primary care
practice.
I'm always afraid I'm going tomiss something.
The residents help keep me upto date, but again it's like
point of care.
They tell me stuff that's rightin front of us, but you know,
like I don't know.
Just a recent example thishappened to me last year, two
(13:18):
years ago.
I think I didn't know that thestandards of care had changed
for diverticulitis, like you'reactually not supposed to give
empiric antibiotics anymore inthe outpatient for
diverticulitis.
I didn't know that that hadtotally changed and the resident
had to tell me it while I wastelling her she should be
prescribing like metronidazoleand ciprofloxacin.
So that's embarrassing.
So I need more general internalmedicine knowledge.
That's what I think I need.
(13:38):
So hopefully we can talk aboutwhat I will do as we go through
this process.
Speaker 1 (13:43):
Yeah, tom, for us as doctors most of us who have not
lived with addiction it's kindof hard to actually understand
what addiction is like and whyit happens.
Can you talk aboutincorporating lived experience
when you do education, becausethat is so helpful?
We actually did somepresentations in my hospital
where we had people in recoverycome to speak to healthcare
(14:04):
providers because of the valueof lived experience.
So I'd love your thoughts.
Speaker 2 (14:08):
Yeah, absolutely.
Like I said, I've been inrecovery for 18 years, which you
know is an N of one.
You know I have to likeunderstand that, like my
experience is not everybodyelse's experience, but also that
hope matters right For you.
As an emergency medicine doctor.
You are almost entirely seeingthe patients that you see with
(14:29):
addiction.
You're seeing them at theirabsolute worst, right, and
they're not coming backgenerally to thank you, right,
for treating them because it was, you know, one of the worst
days of their life when they sawyou.
And we can be difficult, right,addiction is a really does
things to us that we pass on toother people.
I think one of the pieces for mewith working with medical
(14:49):
professionals is for them tokind of understand that you know
there's hope for that personright, that a lot of us are here
because you were there in thatmoment.
And if you don't get to see thehope on the other side, if you
don't get to see people that arein recovery which is made worse
because there's so much stigmawithin healthcare that many
people in my life don't discloseto their physicians that
(15:12):
they're in recovery, so youdon't see us on the other side,
even when we do really well alot of times because we're
afraid of that.
So I think that just kind ofconnecting to shared humanity is
a really important piece of thekind of larger picture, without
claiming that one of ourexperiences is all of our
experiences, because it looksreally really different, you
(15:32):
know, based on lifecircumstances, socioeconomic,
substance abuse etc.
So that's really when we are inclassrooms we're trying to kind
of expand people's view of whataddiction is and also what
recovery can look like for folks.
Speaker 1 (15:48):
John, what's your approach to staying up to date
with medical literature andaddiction?
Speaker 4 (15:53):
The biggest things.
I think you know I have mythree primary journals I read
every month.
So I set aside like two hoursonce a month.
So it's like the addictionmedicine journal from ASAM,
family practice and then alsoHIV digest as well.
That one has a lot of overlapbecause that group tends to be
overlyful for patients withsubstance use.
But I'm a big fan of what Soniasaid too.
(16:14):
I love my like journal stream.
So like Journal Watch from JAMAEvidence Alerts, I get these
kind of updated briefs in mymailbox on a weekly basis and it
picks like overviews of likethe biggest 20 articles in that
area and I can click on them andread in depth further.
So it's a way of scanning theliterature and then getting in
depth more so with what I want.
(16:35):
And then the biggest thing toois it's hard when you start to
practice.
If you live in an island youkind of drift away from norm.
I work with the residents everycouple of weeks.
I'm teaching them and they comeout to my office.
I have medical students andit's sort of like dad strength
at basketball no-transcriptspace now.
(17:23):
And it's interesting, some ofthe older attendings not so much
, but the younger group, theresidents, the new medical
students.
They like love this and theythink it's amazing we take the
ER residents rotating ontoxicology.
They come out for a day at theclinic and they really enjoy the
experience because most of thetime as Tom pointed out that
they're interacting with thisgroup, they're like overdosed,
(17:45):
they're kind of not in theirright state of mind.
So like seeing them recover anddo well like this person has
been with me for three years,they got their kid back or in
school it's a really positiveexperience to show the other
side of that lens, which theyprobably don't get in their
primary care area as EDresidents, you know.
Speaker 1 (18:01):
That is a hundred percent true.
We actually would often messagethe ER doc that had taken care
of a patient to let them knowthat they were doing well, just
to give them the positivefollow-up.
Yeah, so you mentioned teachingand I'll share a little bit
about what I do.
So the whole reason I startedmy podcast, addiction Medicine
Made Easy, is when I was aresident, when there was a
(18:23):
difficult topic, I wanted thattopic to be assigned to me as a
resident, like the patient witha generalized weakness in the
emergency department.
It's so broad.
I actually lectured on that mysenior year of residency because
I wanted to be able tounderstand the most difficult
topics.
I felt like if I could teachthem, I had a really good
understanding of them.
So that's where this podcastcame from.
(18:45):
I didn't want to be a cluelessphysician, so I was asking
clinical questions, and soresearching episodes is really
helpful for me.
And then I'm the medicaldirector for a local drug and
alcohol treatment program, andso researching episodes is
really helpful for me.
And then I'm the medicaldirector for a local drug and
alcohol treatment program andI'm required as the medical
director, to give oneeducational lecture a month, and
the one I picked for thiscoming month is on ketamine
addiction, and I know a littlebit about it.
(19:05):
Thank you, elon Musk, formaking it popular again as a
topic.
So, yeah, I'm going to puttogether a lecture for that and
I pulled some papers and I'mgoing to review them and I'm
going to do an evidence-basedreview of the topic.
And then I mentioned that mylovely bride, the very
intelligent, charming andbeautiful Dr Reb Close, who's
sitting behind me, she workswith the California Bridge,
which is a program that'sdesigned to help clinicians
(19:28):
innovate around addiction care,and so she's one of their
regional directors, and so shewill be asked to give a lecture
and same kind of thing.
You know she'll be like, hey,what are you hearing about
tyaneptine?
And then locally, we have a lotof collaborative efforts.
So I'm in central California,on the coast, and there's about
four counties that we worktogether and we'll actually have
quarterly meetings of like,what drugs are you seeing?
(19:48):
What are you treating, what areyour new protocols?
And each county gives updates.
So it's not really going to themedical literature, but it's
more to your point, sonia.
What is it that we don't know?
We don't know, and weregionally will collaborate and
talk about what drugs are peopleseeing?
What new protocols do we have?
What's the easiest way to getpeople on, you know, a
direct-to-inject protocol?
I will share that.
(20:10):
I'm not great about reading anyjournal regularly, but it's
more organic and because we workcollaboratively, I feel like
I'm able to not miss topics asmuch.
But yeah, I probably need tofind a good journal that I read
regularly.
Speaker 3 (20:23):
Well and the word regularly.
So here's one thing I dobelieve strongly and you guys
just everyone listening knowsthey made fun of my
organizational email prior tosetting this up, but you got to
be sort of structured.
I'm a big believer in processand consistency.
I feel like if you have aconsistent process, it's
realistic and you can do it 80%of the time, 75% of the time,
(20:47):
but you stick with it, you willget to your goal, whereas if
either your goals are too broador too unfocused or too
ambitious, and then you don'thave any kind of way to stick
with it, then you won't get veryfar.
I used to be more of aperfectionist and then I would
get bogged down.
I'm like I'm going to read, youknow, 10 pages a day, and then
I would skip the 10 pages.
I'm like, okay, tomorrow I'llread 20 pages, and I wouldn't do
(21:10):
that either.
I'm like, okay, I'm going toread 30 pages so I can stay on
schedule.
That's like med school, youknow.
So it just didn't.
It didn't work.
You get behind, you get boggeddown and then everything
implodes.
So having a consistent processand designing a plan that is
realistic enough for you butactually does push you a little
bit and you can stick with, Ithink, is the way to do this.
(21:31):
So do you guys want to starthearing about my sort of
framework for figuring out howto stay with the literature?
Speaker 1 (21:39):
I'm going to try to be funny here.
Do we get a choice?
Speaker 4 (21:43):
It's as organized as the pre-discussion email we got.
Speaker 1 (21:47):
Would you like to give us a really organized
overview of how you'reapproaching evidence-based
medicine and addiction?
Speaker 3 (21:51):
That sounds like a great topic.
Everyone listening part 1Ayou're lucky you can't see the
PowerPoint.
No, there's no PowerPoint yet.
But the first thing I thinkactually is most important and I
really want to hear what youguys have to say is motivation
Is why?
Why are you doing this?
What's your unique personalgoal?
(22:14):
Because I think if you knowyour motivation, it's a lot
easier to figure out a plan thatwill work for you.
And I think, like being a gooddoctor is not specific enough,
keeping current not specificenough, Not embarrassing myself
in front of the residents it'sgetting a little closer, but you
know, some examples of sort ofgood motivation would be I want
to give good lectures, like yousaid, casey.
I want to give good lecturesthat are true to colleagues.
I need to pass the boards.
(22:34):
That might be a good motivation.
Or I want to add a new skill tomy clinical practice, like John
, when you did your HIV training, you're adding a new skill.
Or I need to work with medstudents and develop a new
curriculum.
So motivation, I think, isreally important.
So what do you guys think aboutmotivation for staying up to
literature?
Why would you bother?
Why not just do what you know,see what you see, and if you
(22:57):
don't know something, you lookit up and up to date as you go
along.
John, you want to go first?
Speaker 4 (23:00):
Yeah, I really like doing new things.
So like new things and likepushing the scope of my practice
.
I'm not kind of like nichedinto a specialty, so I so I kind
of like to take it as far as Ican go and I've really kind of
been lucky in life to date.
I really only kind of operatedwith like two goals in mind.
Since I've become an attending,it's like do things that
interest me and always try to dothe right thing and actually
(23:22):
everything else is kind offollowed behind nicely.
So the number one thing I do isI just want to learn more about
these different topics.
They interest me and it's easyto kind of put time into
something you like to do andthat you're interested in.
Speaker 2 (23:34):
Tom, yeah, so I guess my is a little different
because I'm not trying to treatall these different things, I'm
just interested in addiction andrecovery and that's like been
very clear to me for a reallylong time that that was going to
be the thing that I wasdedicating my whole life and
career to.
The bottom line for me is likethe stakes are too high and
we're not good enough.
And you know, I just lost somany people, so many people that
(23:57):
I've worked with so manyfriends in recovery spaces over
the last I don't know 16, 17years that I've been working in
the space.
That's a real motivator.
And actually the thing thatalways comes up for me with this
is early in my career I wasworking at a long-term recovery
space and I kind of switchedroles and started to just work
(24:21):
on our emergency shelter side asa large organization.
So I was running a 120-bedhomeless shelter and I didn't
really know anything abouthomeless services, especially as
compared to recovery andaddiction, and I just had a
couple of situations withclients where basically our
(24:42):
policy was if folks came inintoxicated that we would ask
them to.
Sometimes we'd just be like,okay, just chill out.
But if this happens again,you're going to either have to
go to treatment or you can'tstay in the shelter anymore.
And I mean it wasn't like therewas not enough shelter beds in
the first place, but workingwith kind of vulnerable women
who had terrible addiction thatcouldn't not drink, right, not
(25:08):
use before coming in, kickingthem out of shelter, was the
worst thing, right, but I didn'tknow that because I didn't have
any formal training in the workthat I was doing and I didn't
know the research, and so I justhad this really kind of upfront
experience with seeing one ofthe women that we asked to leave
the shelter for yearsafterwards living on the street,
and while that was happening Iwas learning what we should have
(25:29):
been doing and I was making thechanges to our programs that we
should have been doing.
But I just don't want to bethat right, and so there's real
consequences to the folks thatwe serve when we don't have the
knowledge that we need and sojust want to be better, you know
.
Speaker 3 (25:45):
How about you, Casey?
What's your motivation?
I'm going to try to be funnyagain.
Speaker 1 (25:49):
It's usually that my wife has some lecture that's due
tomorrow and she needs me toresearch it for her and I want
to just be able to like answerthe question and not have to
take 20 minutes looking it upfor her.
Okay, all kidding aside, Ithink it is that the more I
learn, the more I can help, andparticularly, I'm doing a lot of
education personally aroundmental health.
Kind of my niche is becomingthe intersection between PTSD
(26:11):
and addiction, and so I am alittle bit like John.
I'll find something that I'minterested in and just dig into
it more, and dig into it moreand get more expertise in it,
and then that translates into mywork being easier in clinic.
Mm, hmm.
Speaker 3 (26:24):
All right.
So now that we have ourmotivation, the next thing I
want you guys to think about isthe what and the when, and this
is where the kind of realisticthing comes out.
Like you might aspirationallybe like I'm going to read this
giant textbook or you know,Casey, you're going to change
and you're going to readjournals lots of journals, you
know, but no, it's realisticallyhow much time do you have?
(26:46):
When is that time and whatkinds of things do you like to
learn from and that actuallywork for you?
So probably zero time is not agood answer.
If you have zero time forlearning, you need to adjust
your work such that you havesome dedicated time if you're in
a field that changes.
But some people say their wholeeducation is one full week a
year to a conference.
(27:06):
That's what they do and that'sa full week's worth of time.
That's pretty good.
Or 15 minutes every day.
For me it's at least an hour aday of commuting time as an
educational podcast, because Icommute two hours a day, you
know.
So, realistically, what timewill you spend on it and when?
And then, what type of learningdo you like?
And it's easier to stick withthings you like.
(27:27):
So videos, podcasts, emails,books, journals, conferences,
other people Do you need to chatin person?
Can you just read all byyourself?
And just to sort of choose agateway, because, dealing with
medical knowledge, there's anentire industry that helps
people deal with medicalknowledge Abstracting services,
board prep resources,conferences, YouTube channels,
(27:51):
you know and a lot of them arepretty expensive, Like there's a
whole industry out there.
So just sort of to choose agateway, but don't don't try to
do it all.
Again, like med school, whichis, of course, our firehose of
learning, I remember thinkingmaybe if I buy like a different
textbook or another textbookI'll like no more, and
eventually I was like you knowwhat, just choose one textbook
and stick with it.
It probably tells you what youneed to know in that textbook.
Don't get a second one, Justread that one.
(28:13):
So the what time and what'syour resources that you like is
the next question.
Speaker 1 (28:18):
I'll take this one first.
So I have not found it yet.
In addiction medicine, inemergency medicine, there is an
Australian ER doc named MelHerbert who figured out that if
you made education funny itstuck better.
And so when I was practicingemergency medicine I had a
subscription to this servicecalled EMRAP Emergency Medicine
(28:38):
Reviews and Perspectives, and itwas humor soundtrack, funny
songs the host would banter.
It was beautifully done and Iwas about two and a half hours
per month of topics they rotated.
There was a very wide breadth,because emergency medicine you
have to know a little bit ofeverything.
And then they additionally hada second program called
Emergency Medical Abstracts.
(28:59):
Two physicians who actually didresidency with my wife would
banter over journal articles andthey covered between 20 and 30
articles a month.
And so I loved to exercise andso whenever I was exercising I
was learning.
I have not found that yet inaddiction medicine.
So my primary favoriteaddiction medicine resource is
the Addiction Medicine JournalClub podcast.
Speaker 3 (29:20):
Oh, you flatter us, shave, it was your blog.
Speaker 1 (29:23):
saying that oh and that's actually part of the
reason why I created my ownpodcast is I wanted to create
interesting education in theaddiction space.
So I'm still looking, but forme it's usually something audio,
because I can exercise and Ican drive.
Speaker 3 (29:35):
Yeah, and can I just point out, you did something I
don't know if you ever put thisname to it.
We call it pleasure bundling,whereas you like to exercise,
and so you bundled your learningwith your exercise, and
sometimes, if there's somethingyou have trouble doing, you
bundle it with something thatyou like to do and that helps
you get it done.
So like, do it with a friend ifyou want to hang out with
friends, or you said, do itwhile you exercise.
So I just want to point out youdid that strategy.
Speaker 1 (29:58):
I just feel like I'm fitter and smarter at the end of
a workout and it's just, it'scool.
Speaker 4 (30:03):
Every time we talk with you you're off to a like a
fit class of some sort, like ahit interval training class.
I feel like you're the most fitposition in this audience, at
least today.
We did two hours of Taekwondothis afternoon.
(30:38):
I am beat more policy related,which are very interesting reads
, but it's hard to translatethat to the exam room or the
hospital room.
So I tend to find that the bestone are articles that are
covered incidentally and otherones that are more like overview
type articles.
So those are kind of great forlike the HIV journals and also
family medicine journal.
I like ASAM weekly just like 10minute read, read the highlights
(31:00):
stories there.
A lot of that is policy andalso the same overlap.
But I would say that I'm kindof guesstimating here.
Maybe 10 to 20% of thosearticles could be applicable to
like the exam room, but stillnot the majority of it.
A lot of it's more policy typesinformation.
If I'm being honest, I bet youspecific to addiction medicine
on a weekly basis.
(31:20):
I'm probably doing anywherefrom 30 minutes to an hour a
week just on that topic and Ithink it's probably broken up
into small blocks of like 10minutes at a time.
So maybe like 10 minutes a dayjust down the rabbit hole in
some article that comes acrossmy desk, often those kind of
review articles that come up inyour email that give me 20 or 30
articles to highlight.
Speaker 3 (31:41):
And is that enough, do you think, for you?
Sounds like, given everythingelse you have to know, it sounds
like a pretty big chunk of yourlearning time actually.
Yeah.
Speaker 4 (31:48):
I think where I'm at right now it's decent.
I mean, there's always newthings to learn.
This kind of also reflects theinfancy of this kind of field a
little bit right.
I think that there's a lot oflearning comes from shared
learning.
I feel like we went to ASAMconference.
The best parts of that waspeople just talk in the room
about what they're doing and alot of it's not super high level
research, right.
A lot of it's like anecdotal,like I'm doing this, really,
(32:10):
you're doing that, and likethat's interesting to try.
That.
I might try that.
I don't feel like we get theselarge RCTs that we get for other
things.
I mean, how many trials have weseen about cholesterol statins
for heart disease?
I mean we've studied that.
We know it's good.
So many, so many.
Yeah, I'm like why are we stillstudying that?
And then we can't even answerthe basic questions for
addiction medicine and I don'tknow.
(32:30):
Maybe a question for Tom whendo you think we sit?
Do you feel like we've justentered this space as like
health professionals?
Because I feel like we'vetalked a little about this
offline before that.
You know, I feel like recoverycommunity has been somewhat
independent of the medicalcommunity for a long time.
Speaker 2 (32:45):
Yeah, and certainly treatment has been separated out
from the rest of medicine for avery long time and with some
really substantial consequences.
So it's interesting, I mean.
I think it's obviously a hugeaddition from a quality of life
standpoint.
But the other thing that I wasreflecting on that having more
physicians really heavilyinvolved is you'll have a lot
(33:06):
more accountability than we havehistorically had around
addiction treatment and recovery.
So that's a reason that a lotof folks that work in this space
haven't historically done agreat job of keeping up with
what's on the edge and that sortof thing.
Obviously there's a lot of greatclinicians out there and a lot
of great addiction medicinepeople, but the accountability
(33:27):
hasn't been there and so it'snot like as clear when somebody
is doing something theyshouldn't be doing as it is.
For you know, when you all areprescribing things and it's all
documented and has historicallybeen documented.
No-transcript is just to proveour worth, just to prove that we
(34:19):
belong in the space.
In Virginia the peer professionis nine years old, right.
So you can't possibly have anyrobust data to say this is
definitely working and to try totrack that in this rapidly
growing space and be able to sayanything definitive about any
of that is basically impossibleafter such a short period of
(34:42):
time.
So especially the peer recoveryspace is very much a build the
plane as we're flying it from aresearch perspective, even
though we have a long, longhistory of robust peer-based
healing from addiction and wehave a fair amount of literature
specifically about, you know,12-step and 12-step facilitated,
but we don't about this wholekind of peer recovery field,
(35:04):
which really pushes beyond that.
So I love, in terms of researchsources, recoveryanswersorg is
done by the Recovery ResearchInstitute.
Speaker 3 (35:13):
I love them.
Excellent email newsletters.
Speaker 2 (35:17):
They are great, john Kelly and their team, brandon
Bergman and Emily they're justawesome up there in Boston and
then I listen to y'all's podcastand then for me, organizing
these events so organizing ourresearch collaborative and then
organizing our spring conferenceis just huge for me to stay up
to date because that kind ofother person, accountability is
(35:38):
important for me, and thecommunity connections as well.
Speaker 1 (35:42):
So, sonia, I think the last two points we were
going to go over is how do youmake the learning stick once you
found your resource and setaside the time to do it, and
then how do you make thelearning that you do count?
How is it useful?
How does it help you?
Do you want to start?
And performance improvement?
Speaker 3 (35:58):
And it's got to be active.
So, whatever that means for you, something to make it stick.
For me that's either takingnotes or turning it into a
project, like I said before,like I turn it into a lecture or
a unit I'm doing for theresidents and sometimes I write
(36:20):
lecture slides on topics, evenif I don't have a lecture in
mind.
I just make slides and that'smy kind of making it stick.
And then someday maybe I'll usethem, someday not.
And then engaging with otherpeople in person I think is
really important For me.
Talking about something withother people I feel like is key.
So that's the one thing interms of making it active for me
.
And then I'm just a hugebeliever on like make it count.
(36:44):
I say make it count twice ormake it count three times, so
you learn about something and,like I said, you turn it into
lecture slides.
Or you learn about somethingand you turn it into a research
project.
Or for us, you know we have thepodcast, so all of my reading of
the addiction medicineliterature goes towards I have a
goal, which is finding articlesfor the podcast, and so I
(37:05):
actually like read through allthese journal table of contents
looking for articles for thepodcast and so I actually like
read through all these journaltable of contents looking for
articles for the podcast.
So I do something with thatknowledge and I think that's the
problem.
That's why I need help with mygeneral medical knowledge is I
do have my teaching for theresidents, so that helps, but
it's like what am I doing withthat studying?
If I'm just like reading atextbook or scanning New England
Journal of Medicine articles, Ireally need to do something
(37:26):
with it.
So I will turn it into epicsmart phrases for those of you
who use epic like handouts forpatients, anything.
I have to do something with theinformation.
And then I feel like I've sortof done two things I'm smarter
and I have a product that I candeploy in any other kind of
setting.
Speaker 4 (37:42):
John how about you?
I think similar.
I think I got to make it comealive somehow, so it's either
apply it to a patient, which isprobably often one of the
reasons that I'm actually doingthe research.
I got to talk about it with mypeers.
So we have a doc meeting everyFriday with my partners and
often I bring up someinteresting stuff just for kind
of group sharing, which we havesome interesting discussions or
teaching with the residents.
(38:02):
So those three and the medicalstudents, which is kind of a
captive audience whoever willlisten.
Speaker 3 (38:08):
They're forced to nod and show a great interest.
Speaker 4 (38:14):
It's the closest thing to a yes man I'll ever get
.
I could say anything.
The medical students kind oflike nod and shake their head.
I could be saying some reallycrazy stuff and they're like oh
yeah, that's great, dr Keenan.
Speaker 2 (38:23):
Tom, how about you?
I like that idea of make itcount twice.
I hadn't conceptualized it assuch, but I always try to work
on like one talk a year.
That's really a stretch for me.
So, like last year, it wascannabis and I hung out with all
these wild cannabis researchers, which is, you know, if you
want to dig deep into a funnytopic, all the different ways
(38:44):
they measure how high a mouse isis a really entertaining
subtopic of research.
But you know, that area ofdeveloping a talk for new area
that I don't know a lot about interms of addiction, and then
also the conferences.
I'm always looking for greatspeakers.
So watch out, casey, for ourconference and that kind of
thing.
So that really keeps me fresh.
(39:06):
Just, you know, spending sometime listening to people I
admire is great.
Speaker 1 (39:11):
So I have to say and I'm going to try to be funny
again is I think we just allneed to marry the right person,
because for me, being married toanother addiction medicine
doctor is great, it really helps.
But yeah, for me it's all aboutteaching.
So, as I mentioned, you know,when I was a resident, I wanted
the hardest topics because I hadto understand them to be able
to teach them, and so for meit's like oh, this would make a
(39:33):
great podcast episode.
Or I'll have a casualconversation with a colleague
and they'll say something likewait, I need to know more about
that, can I interview you?
Same thing with my patients.
I've got a couple of patientsthat I've interviewed on the
podcast, and it has always beenone of my life goals to find
what I don't know, I don't knowand try to learn about it.
So I think it's fun.
My daughter I can hear herrolling her eyes from the other
(39:54):
room.
I love trivia, I love learningand facts and knowledge.
It's enjoyable to me to expandmy brain and that's been very
motivating for me.
But in terms of using it andmaking it count, I totally agree
Taking notes, turning it into ahandout or a smart phrase, or
for me oh gosh, that would makea good podcast episode, and I've
(40:16):
actually started now.
Anytime I lecture, I recordmyself and use it to make a
podcast episode, just because itsaves time.
Speaker 3 (40:22):
So yeah, making it count twice Well, this was
awesome.
I feel like I definitely gotsome good ideas from you guys.
I mean, to me it seems like allof us and maybe this is just us
or maybe this is everybody arekind of project people.
Like to force ourselves tolearn.
We'll pick something that makesus learn.
So sort of sitting quietly byyourself and reading the
textbook from cover to coverdoesn't seem to work for any of
(40:46):
us.
But that's fine.
That's fine because I think allof us are doing good work and I
know for myself I'm alwaysstriving to find a process that
will keep me being the doctor Iwant to be.
Speaker 1 (40:55):
Yeah, this has been a great topic and love the
collaboration.
Truly Addiction MedicineJournal Club is where I get most
of my medical literature.
Speaker 3 (41:02):
Oh, now, that's like a lot of pressure, uh-oh.
Speaker 1 (41:05):
Well, I give you guys shout outs, like the most
recent one I did onanti-methamphetamine addiction.
I referenced the podcastepisode you guys did on the
Vyvan study.
Anyways, love the collaboration.
Speaker 3 (41:14):
That was all John and I'll put in the show notes.
I'll put links to these variousresources that we mentioned on
the podcast and a few more thatI like, and that's it.
Speaker 4 (41:30):
I, everyone has an awesome night.
Well, you guys are at bedtime.
Speaker 1 (41:32):
I've got to go make dinner for my family, so, all
right, good night everybody.
It was great chatting with you.
Before we wrap up, a huge thankyou to the Montage Health
Foundation for backing mymission to create fun, engaging
education on addiction, and ashout out to the nonprofit
Central Coast OverdosePrevention for teaming up with
me on this podcast.
Our partnership helps me getthe word out about how to treat
(41:52):
addiction and prevent overdosesTo those healthcare providers
out there treating patients withaddiction.
You're doing life saving workand thank you for what you do
For everyone else tuning in.
Thank you for taking the timeto learn about addiction.
It's a fight we cannot winwithout awareness and action.
There's still so much we can doto improve how addiction is
(42:13):
treated.
Together we can make it happen.
Thanks for listening andremember treating addiction
saves lives.
Speaker 4 (42:33):
Bye.
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
Cardiac Cowboys
The heart was always off-limits to surgeons. Cutting into it spelled instant death for the patient. That is, until a ragtag group of doctors scattered across the Midwest and Texas decided to throw out the rule book. Working in makeshift laboratories and home garages, using medical devices made from scavenged machine parts and beer tubes, these men and women invented the field of open heart surgery. Odds are, someone you know is alive because of them. So why has history left them behind? Presented by Chris Pine, CARDIAC COWBOYS tells the gripping true story behind the birth of heart surgery, and the young, Greatest Generation doctors who made it happen. For years, they competed and feuded, racing to be the first, the best, and the most prolific. Some appeared on the cover of Time Magazine, operated on kings and advised presidents. Others ended up disgraced, penniless, and convicted of felonies. Together, they ignited a revolution in medicine, and changed the world.