The Practice of Therapy

Dr. Carney: I am Dr. Jan Kearney and I am delighted to be here this morning talking with you Gordon on the practice of therapy.
Gordon: Perfect. Well, hello everyone and welcome again to the podcast and I'm really happy for you to get to know today Dr. Jan Kearney. Welcome Jan, glad you're here.
Thank you very much. I'm delighted to be here. Yes. And Jan, I'll let you tell folks a little bit more about yourself. But what I've learned so far is, is that Dr. Carney is in Vermont and she teaches at the medical school at the University of Vermont and particularly in the area of public health.
So as I start with everyone, Tell folks a little bit more about yourself and how you've landed where you landed.
Dr. Carney: Okay. Thanks very much. Yes. I'm here at the University of Vermont, Larner College of Medicine, and I'm a professor of medicine. I'm the associate dean for public health and health policy. And I'm the chief of our division of public health here.
And we do a lot. I've been in my career. I'm at my background is in trained in internal medicine. I'm an internal medicine specialist, and I'm also a preventive medicine specialist. I went back and got a degree in public health. I was our state's health commissioner for three different governors and have a lot of experience in public health practice here.
I do a lot of teaching and research. I absolutely love students and love being curious about new things we can do to help people. Here on our here in Vermont and and anywhere else. And I think public health and that intersection between the clinical world and public health practice. I think there are more opportunities to talk about what, how that can help people and whether it's people in communities or people in clinical practice and.
And I look forward to doing that with you.
Gordon: Yes. Yes. Yeah. Well, I think this is a great topic because I know As you're you're speaking about this I think about you know how public health and or just our health in general has really risen to the top of the Top of the pile, so to speak, particularly unfortunately, I don't know that we could ever say we're out of the covid pandemic, but we're, you know, coming out of that.
I think people became much more aware. And then particularly for this audience, the folks, most of the people listening to this is how that affects mental health and just that, that sort of thing. But. In your work and just communicate, learning how to communicate with the public more about health issues, what are you, what are you learning and what are you finding that works?
Dr. Carney: I, one of the challenges was, and we saw that, we saw that really clearly in the pandemic was all the, Health information that was just wrong. It was inaccurate misinformation. And so what that made us do was think a little bit about how can, are there ways we can do a better job or help provide resources both to general public and, and to people who are seeing patients as an example of where to direct people for really high quality, evidence based information so that they can improve their health and, and really eliminate the risk to, to harm themselves, which there, which is definitely a concern with some of the unproven therapies.
Gordon: Yes. Yes. So what I know There's just a lot, you're, you're right, there's a lot of misinformation out there. What do you think it's important for people to know about how do we, how do we communi, you know, one, one thing in particular, sorry, I'm jumping around here, but one thing in particular I think about for our professions in the mental health fields is, is that people have different ideas about what it means to come to therapy and also just I know one particular issue that comes up is that with medications, I think a lot of people shy away from it because they feel like, okay, it's going to hurt me or it's going to, going to create problems.
So, yeah. So what, yeah. What are you learning about all of that?
Dr. Carney: Well, I think that I, I look for things that in my work, what are some practical things? Everybody's too busy. And so when we do things, both in our work, or just looking for information when we're home, we do things that are convenient and fast.
Right? So I think about, are there ways, are there things that we can. Websites, for example, to give people about high quality sources. And my favorite is MedlinePlus. gov. And if you just, and, and people Google things. And so one, one of the, one of the skills I think is really important is to begin to be intentional and deliberate.
About, if you google a topic, how do you know if that's really good information or bad information? Yeah. And something is something that you really don't wanna trust. And so Medline plus.gov is a great place to start. It has medications, health topics, and it, the whole, the whole key is that it also can give you some skills of.
How to determine if the information you're, you're finding that, that is trustworthy from a scientific and medical point of view. So, you know, who's saying it. You know, when did they say it? If there's no date, maybe be a little careful there. And then, how do they know, or really, what evidence are they giving you that you should trust it?
Are there any, are they mentioning any scientific studies? You know, is the person who's telling you this have a background or have a reason that you should believe them? And so be more discriminating. Some of the big university websites generally are, are a good place to go. Many of the government websites have links and easy to read materials and in different languages and, and are, are culturally appropriate.
And we're finding more of that. There, but I would, I would start with MedlinePlus. gov and from there you can, you can go through a little module about how, how to do this better and, and if you're in the office setting and you see patients perhaps it's a good thing to give them some of these resources because everyone just very conveniently might go to social media or just Google something.
So, I mean, I would start with something like that.
Gordon: Okay, that that's that's great advice because I think a lot of us in this profession, we have websites and we like to have resources. on our website that are accurate. And so, yeah, I think that's, that's an important piece. So, well, to switch gears a little bit I'm interested and curious to know how you moved into public health as opposed to the traditional clinical work and, and, and what how you see that's important for everyone.
Dr. Carney: So I trained originally as a internal medicine physician. I finished my residency and I went to a conference and there was something about, we didn't really have public health and medical school and, and we had a little bit of epidemiology part of the training for that. But there was a conference I went to that, that began to show some of the, some of the science and the data of how you.
Prevent disease and improve health and entire population. So I, I was very curious, ended up going to public health school and get my master's in public health. And then in that process, that was kind of my aha moment from education, because I realized that. As a, as a clinician, I learned about all the different approaches that we could use to diagnose and treat people one at a time.
And that was great. And, and critically important the importance of our advice is paramount. And, and in addition to that, there's evidence based approaches to how we prevent disease and illness in entire populations. And that was that whole science of populations and prevention of disease and illness in those populations I became fascinated with.
So after I got my degree, I decided I wanted to try that full time. And my first position here was as the deputy commissioner of health for the Vermont Department of Health, our statewide department of health. And then within a year, I became the health commissioner and I served Almost 14 years. Wow.
And where, you know, you had to, we did an awful lot of work. People are most familiar with public health after the pandemic about the work of epidemiologists, and they've heard about vaccines, but there's a whole broad range of activities of public health to ensure the conditions that people can be healthy, that health departments do.
We work very closely. We worked very closely with It's doctors, nurses, school nurses, all kinds of, of people in our communities. And then since that, you know, since, and since I've been here and I've been here almost about 20 years now, and that educational piece and how do we bring, how do we bring that education out to more students, to more health professionals, to more people trying to do research, because we know that we need a lot more people working in public health.
We also know that the skills that Of public health can be extraordinarily helpful to clinicians and practice to, to who are interested in making their patients better.
Gordon: Yeah, yeah. So here's a, here's a big question for you. What do you see as our biggest public health concerns? Like right
Dr. Carney: now?
Gordon: Yeah,
Dr. Carney: I think we have a lot of ones.
I wouldn't say I would say number one, two, three. I'd say I'd say I have a list and a part of it depends on your perspective, you know, if it's in your local community, and you can look at the data in your own community. There's public websites to do that. And, and I share those all the time. And for a state or a country, I think that we continue to struggle with basic access to health care.
for everyone in our country. And, and I see it here in Vermont and we have rural disparities and it's much harder for people in rural settings and in, in some ways that's logical. You know, the mm-hmm in the bad weather Here the roads are bad and you might have to travel further and there may not be as many people in clinical practice for you to see.
Or, and there's lots of different barriers and those might be some of them are, are, are general and some of them are unique to your specific location. And I think that place really matters. about people's health. And I think we're learning that more and more. The role of our neighborhoods are, are access to health and social services.
So social determinants of health is very high on my list. And, you know, basic having enough food to eat housing.
Gordon: Yeah,
Dr. Carney: basic access to primary and preventative care. All these things remain very challenging in many communities and especially in our, in our rural communities. I would say mental health right now is a huge issue and for different reasons and different ages.
I think that the, the isolation that people felt we still haven't recovered from that and the young people who were in school remotely and are now learning a different way to make social connections. I think we, there's a long, there's a big literature on the importance of our social connections as you get older.
and particularly for older adults. But one thing the pandemic taught me was that those social connections are just so important for everybody of all ages. So mental health is up there. So I, I would say those would be some of the top on my list.
Gordon: Right, right. Yeah. And I know as we were chatting about here before we started recording, I know here in my area of the country here in the Appalachian region particularly Eastern Kentucky and Southwest Virginia and here in East Tennessee, the The access to health care is a challenge.
I mean, I, you know, I have even, even in my own practice, we have folks that come to us will, will drive 50 miles or more to just come to here to our, our practice. And then, yeah, and just, you know, having worked, one of the things that I did previously was I was part of an organization called Episcopal Appalachian Ministries.
One of the hats I wear is I'm an Episcopal clergy person. And so we really dealt with the poverty issue in, in the Appalachian region and just access to things. And also people knowing how to access things is a huge, is a huge problem, I think, for a lot of people. And then, You we didn't even touch on this just the whole opioid epidemic, particularly in our area, but it's all over the country.
I'm sure. And just, you know, being able to address those issues. And how do we do that? You know, that's a huge wish we had the easy button.
Dr. Carney: Yeah, it's no, no, and, and all those things. Yes. And, and in our area, we're experiencing some more things. And one of the things that we've been talking about a couple things in our, in our work, which is, you know, that communicating health information to people in a way that they want to receive it and we found some differences.
And the rural and less rural areas and and and people like their people like word of mouth. You know, you think about the faith communities and local areas, think about town papers. So being very conscious of and asking people, you know, if you. If you need health information or just, you know, where would you like to see it or, or, or how should we talk to you or, or how should we present that material and just little things like that done.
You know, on a regular basis, I think, can help a lot.
Gordon: Right, right.
Dr. Carney: Can you can you give some examples of that? Yeah, so, so we're doing a project, we're finishing a project now where, and we actually looked, it was part of a an NIH grant, and we looked at COVID testing during the pandemic, and we, we talked to people about, and we did focus groups and interviews, so we, We had conversations about really what were the things that that were helpful and got in the way so that we would learn for both both for any future public health crisis, but also to give us a better glimpse into how to reach the most rural underserved vulnerable communities.
And we did this in northern New England. And so one of the, one of the groups of older adults we were talking to wanted to have health information in one page flyers with cartoons and large font and not on the internet and making sure that we incorporated information from our own health department here.
To me, that was really important. So give us that feedback. And so what we've been trying to do is develop health information materials for different groups that sort of start with, ask people, ask people what they want and where they're at. And instead of assuming that a university or a government organization or health department or, or even a health professional should give health, health information.
In the same way for everyone, but we can be very specific about that. So we've learned, we're learning quite a lot about that. And I think we're going to try and do a lot more to try and improve health literacy, you know, one community at a time.
Gordon: Yeah, yeah, yeah, that's interesting because I think yeah, you look at the differences in generational ways of, of learning stuff, you know I just, I can think of several examples of, of people caring for older adults and maybe some resistance that they get you know, just because they hear, hear things through conversations.
In the community that's just misinformation.
Dr. Carney: Yeah, exactly. So I mean, so we're working on that. And that's part of the whole I would say public, you know, if we, if we could help people access high quality health information and bring more of that, is that going to solve the problem of not having enough people to see clinicians to see in rural areas?
No. Is it one piece of. Something that might help. Yes. And another area that we're looking at is the use of community health workers or lay health advisors or people who are not doctors or nurses as people who can help link people to services. And that's something that's been demonstrated to be very effective in areas of, for example, cancer screening And in different communities and getting that and educational materials can help people get into preventative care.
So some of these, I think we have to be creative.
Gordon: Yeah. Yeah. Yeah. This is, this is fascinating, you know, stuff. And I think for, I know for a lot of us in. In this field, the mental health fields and the allied health fields being able to be better advocates for things, I think is good. I think it's a good idea.
I know that's something that we've been working on in our practice is just having a kind of a database of resources for people. And so I think that's something that we can, I think we can help each other with. I think being able to connect with people locally and find out, okay, you know, when you run a have a, have a patient that has this particular problem, you know, who do you refer them to or how do you help them find those things?
And so I think those are, those are important. Maybe a way to think about it is just being able to be The better data and resource collectors in our in our areas. Yeah. Well, that's good. That's good. Well, Jan, I appreciate you. I've got to be respectful of your time. And I think this was a, you know, a great conversation that probably we need to continue on with.
But tell any parting thoughts that you have for the folks that might be listening.
Dr. Carney: I think that sometimes, sometimes sort of the health issues we talked about, you know, the opioid crisis, the mental health issues, the access to care all the different health issues that we're seeing and the basic health and social needs of people in our communities can seem overwhelming.
I would say one of the things I've learned from public health is that The way to make some progress is to have friends and colleagues and partners. And those partners can be people that you work with or people out in the community. And because we all want to do what we can to contribute to make people's health and lives better.
So I would just say, remember that. And in, in the challenging times. do what we can to have a sense of optimism that we share with every person that we come into contact with.
Gordon: Right, right. Yeah, I totally agree. Yeah, I think the more we can focus on our communities and being able to connect with people in positive ways is just going to make a bigger impact.
I know something we were talking about. I can't remember if it was before we started recording or not, but I think one of the things with mental health that is so important are the relationships we forge been, you know, but that, that theme has come up several times this week for me in just listening to other podcasts and just things that I've been, you know, kind of reading is, is that the happiest people.
are those that are connected socially and have good relationships with other people. You know, and those there also tend to be healthier people as well.
Dr. Carney: That's right.
Gordon: Absolutely. Yes. That's great. Well, Jan, how can folks get in touch with you if they want to connect?
Dr. Carney: They get, they can email me
Gordon: and,
Dr. Carney: They can, I'm on LinkedIn.
Gordon: Okay,
Dr. Carney: and they can, they can message me there and I'm happy to help provide any of those resources. One of the things I do is run the graduate public health programs here and we do everything we can to help provide high quality evidence based resources to the public and also to all of our colleagues professional colleagues.
Gordon: All right. Well, we'll have links in the show notes and the show summaries for people to access it easily. So thanks for being on the podcast and hopefully we'll have another conversation before long. Thanks very much.