[S1E11] The Living Years

[S1E11] The Living Years

[S1E11] The Living Years >>> https://blltly.com/2tk7XQ

Melissanthi Mahut also shines as Calliope, with a certain defiance that shines through even as her character is tormented over the course of several years. Mahut is at her best near the end, as she's freed from her decades of bondage and reminisces about her tragic history with Morpheus (which we'll hopefully see firsthand in a future season). Thankfully, this segment Madoc's repeated rape of Calliope as delicately as possible, implying rather than lingering on the act itself. All of this speaks to the show's appeal as an adaptation. It's not that different from the comic, but it generally knows when it needs to alter the formula and make adjustments for a more contemporary audience.

He served on the Board of Directors at eTrade Bank and as well as New York National Bank. He was Chairman of the Better Business Bureau Foundation of New York for over a dozen years. For 25 years, he has taught ethics and leadership in the executive programs at the University of Pennsylvania.

Claire hired me in 1990 as an assistant director of admissions. She promoted me a year later to an associate director role, and she named me as her successor in 1995. And all these years later, that five-year run still makes my head spin. I am where I am because Claire Matthews saw my potential and she helped me reach it. And so this is a conversation about mentorship, friendship and the serendipity of meeting the right person at the right moment in your life.

So Harvard made news by pushing their optional policy out for four more years. I can make some news in a less dramatic way by saying Dartmouth is extending the test optional policy for a third year. So we will extend this into the admission cycle for the class of 2027. And I think these extensions all center around the same question is, what's happening And the need to do some analysis.

But yeah, the story of test optional continues to be a pronounced one. I saw Harvard's news described as groundbreaking, and I think what surprised me about the announcement was the number of years it extended into the future. So they're taking a much longitudinal look at, okay, let's have a full undergraduate cohort move into and through the college and see what's happening. So stay tuned on this one.

Charlotte Albright:Well, Inside Higher Ed also proposes an answer to your question, \"Who isn't going\" This isn't terribly surprising, but high school juniors who believe they can't afford higher education are about 20 percentage points less likely to attend college within the first few years after high school. No big surprise there, but it's interesting to put a number on it, 20 percentage points less likely. Another worrying thought because-

Lee Coffin:That's insane. It's exciting to bring the three of us back together again. This episode is called \"Family Reunion.\" And the idea, Claire, it was sparked by your holiday message with the bluebirds, where I started thinking about the way the people I've worked with over the years have become a professional family and network that just stretches on and on and on, even when I don't see people regularly, especially now. But when I step back and think about all the people who have moved through our respective offices, I've come to think of them as my family.

And some of them are like you, are the person who hired me and Jim and got us started. And then over the years, Jim and I have produced our own little networks. And I think that would surprise a lot of people to know that there is this constellation of admission officers who if this was ancestry.com, all these paths lead back to Claire Matthews in New London, Connecticut in 1990.

Lee Coffin:Wow. 20 years you've been in Swarthmore. That's crazy. But what's interesting about Jim and Lee in this story is the two of us were applicants for an entry-level admission job at Connecticut college in the spring of 1990. Jim was a senior at Swarthmore, and I think you'd been a tour guide and a senior interviewer, so the usual path towards entry-level job. I had been working at Trinity in alumni relations and development, and was coming out of my graduate program at Harvard Ed School without any direct admission experience but I would call it admissions adjacent.

Lee Coffin:You did not hire many duds, but I remember having this conversation with you and you had my resume and you were quizzing me about my work in alumni relations and development, trying to imagine how would this segue into admissions work, and I think I made the case. And you said to me, \"What job do you imagine for yourself in five years\" And I said, \"Yours.\"

I saw in you a, a mentor who I really thought I could learn from. But I also saw a campus that was going to teach me how to tell a story, how to recruit. How to be clear about this is who we are, this is where we're going. It had a view of the future, and that ambition felt really exciting. And all these years later as I've moved on to other campuses, that hunger has been something that stayed with me as part of my toolkit as an admission officer and as a Dean like don't be lazy. You can work for a highly ranked, well-resourced place, creativity still counts.

Claire Matthews:I stayed home and to raise my children for 10 years. And then I decided to go to work, but I didn't know what I would do. And a neighbor of mine and friend, Jerry Cunningham, was director of financial aid at Wesleyan. And we're sitting around his pool one afternoon and he said, \"Well, Claire, why don't you come work for me at Wesleyan I need someone in the financial aid office.\" So I decided to go to work for Jerry in financial aid.

I'm also a gardener and if you talk to admission officers who've been with me over the last 30 years, they will say, \"Lee goes to his garden and he thinks, and he makes decisions.\" So I also took that from you where I-

And for everyone else, applicants, parents, media, those of us in these jobs are people with connections, with friendships that are enduring. And also, but the mentorship, Claire is what I always really appreciated from you. I was four years into my time with you and you came into my office one day and you said, \"I've just nominated you to be the dean at Colgate.\" And I said, \"What the hell are you doing\" And I said, \"Why\" And she said, \"It's time for me to open the bird cage and see if the bird flies away.\"

But my lesson from you that I continue to try and live by with people who are on my teams is, it's important to let someone grow and to give people permission to stretch beyond where they are. And that vote of confidence you had me by nominating me to be the dean at Colgate. And then a year later saying, \"The president has asked me to work on the campaign. You're ready to be the Dean here.\" I was 31 years old, that was crazy, but you set me on my way and here I still am.

And so now, as I look around my younger peers and think, \"You want this. Avoid the temptation to go make big money doing consulting and keep the good fight and being a college admission officer. And ultimately a Dean who has the ability to help shape the trajectory of a campus and the student body and enrolls.\" Jim what's kept you in it for all these years

Lee Coffin:So for me, the full circle from that South African or two at Conn, and then the Bulgarians a few years later to being able to say the world, \"You're all welcome in this policy of global equity.\" When you about international access and the work you did initially with the South Africans, but you teed that up for Connecticut College to become a much more internationalized place than it had been.

Claire Matthews:Well, I think in that period, selective colleges were pushing to build diversity in their classes for the educational value that that would redound. So that just seemed like a natural addition to diversity. And I was not thinking of race, I was thinking of ideas. And so you bring people from different places and you make up the advantage of having some racial diversity, but more importantly, you get people who have been living in different systems who think differently, who've been educated to that point differently.

Lee Coffin:But that's another example of the way admission policy is going to evolve over time, but your commitment to diversity that you did. I saw you point back to Wesleyan a lot and say like, \"That's how it's done.\" And now, Jim and I sit in seats where we champion diversity, but the legal framework around it is under attack. What's your take on that, Claire What would be your rallying cry for those of us who care about the things you championed 25, 30 years ago, but we have to do so in a different landscape

Lee Coffin:No, of course it does. The transcript still counts. There are courses and grades from however many terms, semesters, years were remote. So as we move into this evaluation space, we now have a couple of classes and a couple of academic years, we're all are part of the learning environment. Could have been done virtually and a recommendation from a teacher who navigated this space with a class is valuable. Especially for the current crop of applicants who were juniors during the big surge last year.

[00:00:00] Dr. Mia: Welcome to ask Dr. Mia podcast. This is Dr. Mia, and today I have a special guest for you. I am talking all things about mental health, specifically geriatric psychiatry with Dr. Matt Kern, and I'm gonna let Matt introduce him. [00:00:20] Dr. Matt Kern: Hey Mia. Appreciate the opportunity to be here and talk a little bit about geriatric psychiatry.[00:00:26] I know that we've worked together a little bit, but this is actually my first podcast that I've ever done. So, Really excited about that and appreciate you inviting me onto your show. [00:00:34] Dr. Mia: Absolutely. I like to say that geriatric psychiatrists are like the unicorn amongst unicorns because there are so few geriatricians in a country, there are even fewer geriatric psychiatrists.[00:00:51] So one of the first questions that for you is I wanted to hear about how you got interested in this field and just a little bit about your story. [00:01:01] Dr. Matt Kern: Yeah, absolutely. There aren't a lot of geriatricians or geriatric psychiatrists and I think that's unfortunately because. A lot of people aren't exposed to older folks in their formative years.[00:01:13] For me, that was something that I fortunately had a lot of experience with. I had my grandma re, my Granny Zions and Grandma Kern Grandma Kern, my dad's mom actually. Lived with us the last few years of her life. And so I grew up around a lot of older folks in addition to aunts and uncles, great aunts, great uncles, those sorts of folks.[00:01:33] And. I saw people living into older age even with their various vices and ailments and really understanding that a good attitude and social connection were really important. And these folks had a lot of things to teach me growing up, and I realized later on that was a connection that I really value.[00:01:52] Equally importantly I saw the value that I could give to older folks as well. They seem to enjoy speaking with me, which wasn't always the case when you're a kid. But as you get older, as you get a little bit more experience and expertise people are interested in talking with you and if you can make them feel like a person, you know, have that human connection, it's really rewarding from both sides.[00:02:15] Dr. Mia: Absolutely. I think I share a very similar childhood too of growing up around all four my grandparents and I actually talked about this in my very first episode about, you know, what is aging well Because there are so many different ways to age, and in my opinion, there's really no wrong way to age in the sense that there is so much that's outside of our control and even people who did quote unquote unhealthy things like smoking their whole lives. My paternal grandfather did that until the very end. I also came to the understanding that, having good attitude and important social connections were very important, especially as people retired and their lives kind of took on a different chapter. [00:03:09] Dr. Matt Kern: Yeah, that's so interesting, isn't it You know, we think about being healthcare providers, our job is to help people be healthy, to live well. And I feel like in my role as a geriatric psychiatrist I've really embraced some of the philosophy of, living well. And I feel like a lot of our colleagues in medicine, focus on the living part, but not necessarily the living well. Of course, you want people to be healthy. You want them to avoid things that are gonna be harmful to their health. But yeah, being around these old codgers as I affectionately call them, these uncles in their seventies and eighties, drinking and smoking on the weekends, growing up that was normal for me. Now, as a geriatric psychiatrist, I look back and think, Man, if other healthcare providers saw that environment, they would say, \"Oh my gosh, these guys are so unhealthy.\"[00:03:55] But there's, there is something to living your truth. And I think when we talk about motivational interviewing and what's important to people that's part of the conversation. And yet the older folks that I grew up with, they have a much different concept of what living well means apart from the medical structure that we use.[00:04:17] Dr. Mia: And your family's from rural Arkansas, is that's right[00:04:21] Dr. Matt Kern: Yeah. I I grew up in Fort Smith, so if anybody knows where that's at, it's on the Arkansas, Oklahoma line, about a hundred thousand folks, but about an hour outside of town. There was a farm, which is really just bunch of land that my dad bought when he was young and was, has been fixing up the work of a lifetime.[00:04:38] We've had a number of folks live out in that area. Aunts, uncle. Grandparents. And so I, I've had the privilege of going out there with him on weekends growing up and being around some of those folks, but probably the most formative person was my grandma who lived with us for a number of years.[00:04:53] I remember I would sometimes play hooky from school in grade school and say, I don't feel good. I need to stay at home today. And then once my parents went off to work, me and my grandma would play skip bow or dominoes and watch the prizes. Right. And those were some of my favorite memories.[00:05:09] One of the things that got me into healthcare: one night my parents and my siblings had all gone out somewhere and for some reason I stayed home, didn't wanna go out and do whatever they were doing. So it was just me and grandma and I was playing a computer game when I heard her dinner plate clattered to the floor.[00:05:24] I remember she was watching Wheel of Fortune and we had a great relationship. So I said, Grandma, you getting wild in there And she didn't answer. and I knew then that, that something was wrong. So I went in and checked on her and she was struggling to move. She wasn't speaking, and she had this look of fear in her eyes.[00:05:47] I immediately got fearful and I went to her and I said, Grandma, are you okay She had nitroglycerin, pills and a little capsule around her neck. And even though she had to have had a, a terrible. I could see her clutching at those nitroglycerin pills with her fingers. And so I got one out and I gave one.[00:06:06] I put one in her mouth and I said, Grandma, I'm gonna go call 9 1 1. I'll be right back. So I went and called 9 1 1. I called an aunt who lived across the street, and then I came back and I sat with her and I held her hand. I said, Grandma, everything's gonna be okay. You know, helps on the way. and I remember seeing the fear in her eyes, but also the strength and the love that she had for me in that moment.[00:06:25] Even though she didn't have any words that she could use to comfort me, I could tell just from the look in her eyes how strong she was and how fiercely that she loved me to be able to have that moment and to sit with someone who's going through a terrible, terrible health incident that eventually took her life a few days later.[00:06:43] To be able to sit with someone in that moment and share that space with is so powerful. And that's to me, one of the most important things about geriatrics dying is a part of living. And I think if we can reconcile ourselves to that fact, it's not just about how do you wanna live, but how do you want your last days to be, your last moments[00:07:04] What does dying well look like And I think reconciling ourselves to that helps us understand what living well means. [00:07:13] Dr. Mia: Absolutely. That's really beautiful and profound kind of what you just said about that very special moment you shared with your grandmother and. I think so few people actually have had that experience with their grandparents. Because I think our family units oftentimes are much more separated compared to an intergenerational household. And that, just being that presence is so important and that presence alone, is almost like, a spiritual connection in that respect. And I try to also remind myself for some of my patients where, cure is definitely not possible, and care sometimes is touch and go and trial and error, but I like to remind myself that the presence of being with them during whichever part of their journey is in itself a healing practice, a healing presence. So thank you for that, for sharing that with us.[00:08:24] Dr. Matt Kern: Absolutely. And one thing that I think that growing up with older folks around, especially the irreverent folks, the codgers, as I've affectionately called them before. It helped me understand we all go through hard things and seeing how they responded to adversity, health problems, death, other folks that they've lost.[00:08:42] It's helped me. Connect with older folks. I don't necessarily have the same health problems or struggles or issues that they do, but one thing that I don't do is spend much time at all feeling sorry for them. Feeling sorry for people doesn't help, and I think sometimes as providers we get caught up in this, \"Oh my gosh, your life sounds so hard. You're dealing with such terrible weight of burden, medications , other problems.\" But okay, yeah, that's all true. But what do you want your life to look like Knowing the context, knowing everything that you gotta carry, how can we make your life good today And honestly, that's the coolest part about geriatric psychiatry is, you know, it's their life. They're living it. They know that they've got a lot of issues and struggle. To a degree, we all do. They don't want to be patronized or pitied by their healthcare provider. They want their healthcare provider to help them live their best life, whatever that looks like. [00:09:30] Dr. Mia: Absolutely. And for the audience who may not know can you tell us a little bit about the training process to become a geriatric psychiatrist[00:09:39] Dr. Matt Kern: Yeah, I think it was something like 27th grade that I graduated. I joked to my nieces and nephews about that. So four years of medical school, I did four years of residency at Wake Forest, Atrium Health, Wake Forest Baptist now. And then I went back to Arkansas for a year to do a one year fellowship in geriatric psychiatry.[00:09:58] Dr. Mia: Gotcha. And who are the, patients that would say, I need to go see a geriatric psychiatrist like you, versus going to a regular psychiatrist with understanding that because there are so few of us, I think that ends up being an access issue more than anything.[00:10:19] Dr. Matt Kern: Yeah I hate that there's access issues and I wish that there were more folks that were interested in doing this work because it's so rewarding. And I think there are folks that are interested that may not realize they're interested yet. So I'll say, if somebody's, from the patient perspective, if you're struggling with something, talk to your doctor talk to Dr. Mia. Right And Dr.. Mia or your primary care doctor is struggling to manage this stuff. Know that there's always an option and that's the hope that I give all the patients that I talk to as well. Say, here's what I'm thinking. Let's start you on this, or let's do this intervention. And down the line, here's a few more things that we can do. So I think as a provider where whatever discipline you're in, If you're running out of real estate for what you think maybe is the next step, don't wait to try to reach out and get a geriatric psychiatry consultation for your patient.[00:11:08] Sometimes it's a one time, we're working on doing setting up a new e-consult, where you can just send a message and I can review the chart and let folks know what's going on or what I think best next steps are. Sometimes that's all you need. Or if that's not sufficient, happily see those folks and provide them with a roadmap that I think will help them towards success. There's always a shot at success. [00:11:29] Dr. Mia: Absolutely. And I think there's still a lot of stigma about mental health compared to physical health and the type of psychiatric illnesses that perhaps people are not able to visibly see. Like if you broke your leg and you can't walk, you know, that's a very obvious, hopefully non-judgmental illness. Then say if you have bipolar. There is still very much a stigma with mental illness compared to a physical illness and that there are some internalized thoughts that, \" this is not a problem because it's just the situation that I'm in right now.\" or perhaps \"I don't want to take a medicine to change who I am\" or, \" I'm not crazy.\" Just curious as to what your advice would be. If you have patients who think like this or have folks who are trying to convince their loved ones to, to seek some psychiatric help. [00:12:32] Dr. Matt Kern: Absolutely. And it's a big question, right There are multiple approaches. It depends in part, on your own personality. It also depends on your role. As a caregiver, that's something different than a provider as a family member. So I'll say my general strategy is let's not, call it mental illness, first of all, I think using their language especially for older folks or folks who come from different cultures. But, clinical words can often be off putting for older folks or folks from different cultures, they may not say I'm anxious or I'm depressed. I have one patient who calls it his\" shaky\". More than a few don't feel like they're depressed, they're just worn out or they're tired of caregiving. And so what the way that I talk with them is I say, \" the medicine I'm suggesting can help you feel, help you with your shaky feeling, or can help you with feeling worn out.\"[00:13:20] I think we need to maybe pivot away from talking about mental illness and let's talk about mental wellness. you feel like you're living your best life right now I feel like very few of us can say, Yeah, I'm living my best life right now. And if you are, that's fantastic. I don't think you need to come see me at all. If you don't think that you're living your best life, ask yourself, what can you do today, in the next week, in the next month to set yourself up for success Maybe not becoming the best version of yourself, but at least getting closer, incrementally closer all the time. If you can't answer how to get closer to living your best life or to living more well, then ask your friends, ask your family. Hey I don't think I'm living my best life right now. Maybe they've got suggestions. A lot of times they don't. Okay. Maybe then it's time to talk to your doctor. If your doctor's got a couple of suggestions, great, fantastic. If you make it all the way to me, you're probably aware that maybe you're not living your best life.[00:14:12] So I don't really care what we call it. That's one of the virtues of psychiatry is. Have a broad diagnostic range. It's more art than science of psychiatry. You can't test a blood level and say, Yes, that's depression. Yes, this is anxiety. But we, what we can do is talk about what's bothering you.[00:14:29] What's, if you have anxiety, if you have shaky, what is that stopping you from doing that you'd like to do Okay. I don't wanna focus on the symptoms, I wanna focus on your goals. What's important to you and how can I get you there You mentioned, I think in episode two about the five M's.[00:14:45] I use a very similar model, the four M's. So mobility, medication, mentation or thinking, and then what matters. And when I'm teaching in clinic and talking to residents and medical students, PA students I tell them, the what matters is the most important question that you can ask somebody in geriatric psychiatry. Because without understanding what matters to them, you're not gonna reach them. You're not gonna collaborate, you're not going to do what they want you to do. And ultimately what they came to your office to accomplish. [00:15:16] Dr. Mia: I feel like there's a lot of similarities between geriatricians, geriatric psychiatrists, behavioral neurologists, all of us who kind of deal with the same patient population, but coming from a slightly different discipline. And I know Matt and I have shared some patients who have both mood issues as well as memory issues. And sometimes it's very challenging to get to the bottom of which ones the chicken and which ones to egg. I think going back to what matters to most to people is really important and sometimes depression and mood changes almost makes a person not really know what matters. [00:15:59] Dr. Matt Kern: Mm-hmm. . And I think that's actually a clue that like, if you have trouble thinking about what you want, like how to live your best life, there may be a component of depression in there too. If I could a minute to speak about depression and the loss of perspective, Cause as you mentioned with your mom, sometimes it's difficult to engage somebody in a conversation about their mental health. So first and foremost, it's gotta be their choice to, to seek help. But the way that you can frame that is, \"Hey, mom, Hey dad, here's what I've noticed. Have you noticed these things Do you feel like you're living your best life\"[00:16:34] And they may say, \"No, I'm not living my best life, but here's why.\" Okay. Okay, we'll let it drop for now, but revisit the conversation in a week, two weeks, three weeks, four weeks, and ultimately say, you know, Mom, what's the hurt in maybe going to talk to somebody about it and say, \"I don't wanna do that. I'm not crazy.\"[00:16:49] I'm not saying you're crazy. I'm just saying if it has, 1%, 2% chance of helping, why don't we give it a shot and just see what you think. So a lot of times you can engage older folks that way of saying, Yeah, but what else are you doing on Tuesday You don't got a job to go to. And that's more my style of just that down to earth, prodding people towards their wellness. Ultimately if they don't got plans, why don't we go give it a try [00:17:12] One metaphor that I use in talking to people about the loss of perspective is, being depressed or dealing with mental illnesses like living in a shoebox. It feels very dark. It feels like your world is very small, and it feels like there's just not a lot of light or energy, and that's true. It's literally true because you're living in a shoebox. You're gonna feel cramped. You're gonna feel worthless, like you can't do anything. My job is to help you see that it might be possible that there's a world outside of that shoebox.[00:17:42] It may not feel true, but if we could let a little bit of light in, if we can let that crease in, maybe you get one ray of sunshine for just a little bit, maybe it goes away too. But if we can provide that brief perspective of a world outside of your depression, a world outside of your anxiety, maybe that's valuable. And maybe we can use that to work towards wellness. [00:18:04] Dr. Mia: Absolutely. And I think it's not a discussion of either or, It's not just taking medicine without doing other life enriching activities. It's sometimes people need a little bit of medical assistance to be able to then access other life rejuvenating, mood helpful things like, seeking social connection. I think depression and anxiety to many extents are so common and social isolation and loneliness are so common, especially as people age. I think that's very easy to fall into the thought that, this is just what happens when I hit 75 or 80 and all my friends have passed away. So there is very little meaning left in my life, and I think that's a thought. That may not be actually true but because of whether it's ageism or just our culture, I think it's easy for people to fall into that kind of thinking.[00:19:10] Dr. Matt Kern: Absolutely we use the biopsychosocial model in psychiatry and therapy. And that basically, the way I explain it to patients is about 33% of your mental health is gonna come from your biology, your genetic inheritance from your parents. Also, the medications that you take, not just psychiatric medications, but some of the other things like blood pressure medications can affect your energy level. And then about 33% is gonna come from your psychology or how you feel or how you think about your mental health. And then another third is gonna come from your situation that you're in, your social situation. What kinda activities do you do Who do you engage with What does your support system look like[00:19:45] And you mentioned medication is not the only answer. And I emphasize that I, as a psychiatrist, I'm not trying to sell you on medication at all. I'm trying to tell you, this is just a piece of the puzzle. Where are your deficiencies here Maybe you're taking too many medicines, which is often the case in our geriatrics folks.[00:20:01] Maybe we need to focus on the social interventions or, I'm hearing some all or nothing thinking. I'm hearing some dark, pessimistic, way of viewing your life. Maybe we really need to focus on the psychology because each of those contributes just about equally to how well you're gonna do and how well we can optimize your mental health.[00:20:20] Dr. Mia: Yeah. The all or nothing thinking, I think, gets a lot of people in trouble and I see myself falling into some of those thought patterns sometimes too. So just to normalize that, not everything is an illness. Last question for, Dr. Kern is, are there any other tips or things you wanna tell folks who may not know much about geriatric psychiatry [00:20:46] Dr. Matt Kern: So first of all, geriatric psychiatry isn't just about treating the patient. Oftentimes it's about helping families understand the illness that the their loved one is going through. Whether it's talking about a new normal or what we can expect from the progression of an illness like dementia caregiver fatigue and burnout are often the triggering events for when a person needs to transition to a higher level of care like an assisted living or nursing home. And I think you talked about some of that stuff in episode three. But so oftentimes I can help with that caregiver fatigue, caregiver burnout. It's not just about talking to a patient. So you may think, Oh, mom or dad is too far gone, like a psychiatrist isn't gonna help. I can still, we can still talk about planning and how to approach these situations, how to keep them calm. Maybe medication is a part of that. But maybe we're just having a conversation as caregiver and provider for what we can do to manage these things at home. Keep these folks at home as long as possible, because often that is the goal.[00:21:40] Another thing that I like to do is like I said, use a no nonsense down to earth approach. Talk about if I were you or if I were in your shoes, I find that speaking non clinically can be disarming and avoid a battle, right So I'm not recommending this as a doctor. I'm recommending this as a person who lives this life most days. And so may have a perspective that's a little bit more informed than, the fearful or depressed perspective that you're coming from. You're struggling. You came here to obtain my expertise and I'm gonna give that to you in a no nonsense sort of way.[00:22:14] So using this as, if you were my loved. It can help soften the blow of recommending a medication. I've joked before to some of my folks, if I were your loved one, I would come down and I would strap that CPAP to your face every night, because I know that will help with your mental health and your physical health. And in joking a little bit like that can help set people at ease while still emphasizing the importance of what I'm recommending. I often joke for my quote unquote non-compliant folks, I said, Okay, you ready for me to wag my finger at you And then they say, Okay. And I wag my finger at 'em and I say, Okay, now we got that out of the way.[00:22:50] Let's talk about why this has been hard for you. And that can, they there's shame and guilt for not following doctor's advice. Or sometimes, you don't wanna tell your doctor that you haven't been taking the medication. Let's talk about it. Let's get that other crap out of the way cuz this is your life.[00:23:02] One other strategy that I wanted to mention that I found useful, especially in the context of people who might be a little bit skeptical about medication, skeptical about psychiatry in general. I like to literally weigh my options. Imagine you're holding both hands up in the air, and you're weighing things in both hands. And I say, you have a choice. I'm not gonna make this decision for you, but what I can help you do is understand the pros and cons, the risks and benefits of what you're going through. You came here for a reason, here's an intervention.[00:23:31] We can try or you can continue like you've been without anything changing. That seems harder to me. So maybe we can try something new. Knowing we can always go back to how things are now. And the whole time I'm giving them the spiel, I'm weighing my hands in the air to show them, this is your choice. But gosh, it sure seems like one of these options might be a worthy trial. [00:23:56] Dr. Mia: Absolutely. And I think patients wanna know that. That it is a trial, that there are a lot of fear and nervousness about trying medications. But I think I always tell my patients the same thing, that if this medicine doesn't work for you, let's talk about it and let's come up with a different plan, and certainly I am not a pill pusher for you at all. In fact, oftentimes we work on ways to take away some of the other medicines that you might be on that perhaps you don't need to be on. But thank you so much for joining us today, Matt. I really appreciate this conversation and for those who are listening, if you are enjoying this conversation, please leave me a review on Apple Podcast or the podcast platform of your choice and share this episode with those that you think my enjoy listening as well. Thank you so much. [00:24:58] Dr. Matt Kern: Thanks Mia. 59ce067264

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