L University of North Carolina: School of Medicine and UNC Hospitals: N.C. Memorial Hospital Oral History Project.

Transcription

1 This interview is part of the Southern Oral History Program collection at the University of North Carolina at Chapel Hill. Other interviews from this collection are available online through and in the Southern Historical Collection at Wilson Library. L University of North Carolina: School of Medicine and UNC Hospitals: N.C. Memorial Hospital Oral History Project Interview L-0367 Robert Bashford 18 October 2013 Abstract p. 2 Transcript p. 2 1

2 2 Name of interviewee: Dr. Robert Bashford Name if interviewer: Claire Craft Date and place of interview: October 18, 2013, 1001 Bondurant Hall Dr. Robert Bashford, MD (UNC School of Medicine Class of 1971): Dr. Bashford discusses his upbringing, medical training, mentorship experiences, and career transitions within the fields of obstetrics and psychiatry. Particular emphasis is on his educational experiences, the changes he has witnessed in medical education and his role as dean of admissions for UNC School of Medicine. Okay, we ll go ahead and get started. This is Claire Craft and I'm interviewing Dr. Robert Bashford. Dr. Robert Bashford: Alright, and she has blue fingernails. Okay, so can you just start by talking about where you were born and what year you were born. Dr. Robert Bashford: I was born in 1945 in Raleigh, North Carolina, and I grew up in Raleigh, North Carolina. I had a very traditional growing up in a family of four, high school, knew the same people all the way through school, very traditional. Were you a good student? Dr. Robert Bashford: No. I was an excellent student until it required studying, and then I became involved in being cool and popular and just the whole nonstudy scene. And somehow or another I really did somehow or another let my senior year just go to hell in a hat basket. It was just not working at all. So by the skin of my teeth I got in to North Carolina State, and I paid attention on the first quiz, which I hadn't studied in a year and a half or two, and I studied hard and I made a 96. It turned my life around. I thought, boy, this is cool. I can do it. So you became a better student in college? Dr. Robert Bashford: I became a better student not a great student but a good student. When you were growing up, what things did you like to do other than school?

3 3 Dr. Robert Bashford: I was infatuated with baseball and NC State basketball, and I knew everything there was to know about both Major League Baseball and, literally, NC state basketball, I knew more than anybody. I was a ball boy. I knew all the statistics. I lived it. Was there something you thought you might want to be when you grew up, when you were a kid? Dr. Robert Bashford: Methodist minister, because my dad, that was his spiritual life. It was the most important part of his life. He had sixth-grade, seventh-grade education and was a self-made person, and I spent a lot of time in church with him. He called me an ice cream Christian because he'd buy me a milkshake after church. When you went to NC State, when did you decide that you wanted to go to medical school? Dr. Robert Bashford: I'd been playing with the idea, probably my freshman year, and my dad had been ill all of his life and still functioning with the help of some cardiologists that would be at my house. And I would see them, and I would see what they did. I remember going to school one day thinking I would come home and my dad's gonna be dead. He was in congestive failure. And he wasn t. And so I began to get this idea that it was a pretty cool way to do things to be a physician. I could be helpful, and then I liked the science, and I was good at it. And I also thought for truth, you know, this has a standing in the world. I'm gonna be doing something that's admired and that is helpful to a community. So maybe my freshman year, I really put my blinders on. I said this is what I'm gonna do, I'm a pre-med student. Were you involved in a lot of other activities in college? Dr. Robert Bashford: I was involved in the Kappa Alpha fraternity house in a huge way. I was able to, I had a friend who taught me the concept of we can play hard and we can work hard. So I actually, because of my wonderful friend who's a physician, he said, look, let's go to the damn library on Saturday morning. What else are you gonna do? We can get three hours in and then we ll have it done. So I actually went to the library and went with him. But my life, until I got sick of it, was the fraternity. And finally I got satiated, and then in my junior year I couldn't stand it anymore.

4 4 Did you consider going to a lot of, were there a lot of medical schools you were interested in or did you always want to go to UNC? Dr. Robert Bashford: I probably always wanted to go here. I knew I was gonna be a marginal acceptance. I knew I wasn't gonna be in in November, and I wasn t. I was in in March. I knew I was probably gonna come off the wait list. I knew there were a lot of people, but I knew the people that were going to med school. I knew there were a lot of people that were more gifted than me and the world changed, Claire. We didn't do things like you guys do before you come to medical school. We didn't get out there and walk the walk. We didn't get out there and see sick people. It was a whole different approach and I think not as genuine. We just decided we wanted to be a doctor and worked hard. And, we all looked alike. We were a pretty homogenous crowd. So I forgot my question. What was the application process like to get into med school? Dr. Robert Bashford: Did I apply to all North Carolina schools? I probably did. I was granted an interview here and I interviewed with Dr. Hedgepath who was me, five ago, and he gave me some encouragement and I thought he was not a BS-er and I thought it went well. I think he thought my motivation through my father who'd been ill and by that point, my sister had died of a lymphoma and I d again been thrown into a place I didn t wanna be but I'd seen medicine, I'd seen caretakers, and I had seen the power of what people could do as physicians. So, I think he thought I was on a genuine path. I think I was. I think I really had a commitment that was a little more real than a lot of people. I had seen a lot of bad stuff in my own life, illness. I have a feeling he put me on the back of his pad of paper and said I'll get him in March. I just left feeling pretty confident. I can't bring him in in front of people that have 3.8 s, but I'll pick him up in March. That's great. What do you think about the experience with your sister, did that kind of shape what kind of doctor you wanted to be or didn't want to be? Dr. Robert Bashford: His name was Dr. Silver and he was a hematologist and I thought he was kind, bright, and I thought he was very straightforward. He

5 5 told us from the get-go sick in May, died in August he told us from the get-go we are gonna make her sicker than well because we don't have the ability to pinpoint medications. So she's gonna get really, really sick and if we get lucky she'll get well, but the odds are she's not gonna get well. Are you willing to take this risk and get very sick in trying to get well? He was there for us all the way through. Us being my mother, myself and her husband. He just held our hands all the way through it. It wasn't just him. The thoracic surgeon, Glen Young, I remember being kind, sitting down. We were at Duke and we were well taken care of and she was. So you talked a little bit about your classmates when you started here at UNC being very homogenous. Dr. Robert Bashford: Yeah, the lab was I m pointing 40 yards away we looked alike, we were mostly, nearly all white, two African-American guys, four women, maybe five, and three of them have just been superstars. But we looked alike, we looked like a crowd of young men in khakis that went to college in North Carolina, and that's pretty much what we were. There was no, what I try to do now is build a class that has diversity that goes way beyond race and ethnicity to resilience. We didn't have that much diversity. Let me think how I'm gonna say this. I think it got in the way of us taking care of people who didn't look like us, I do, and I think that was learned in residency by me, how to take care of people who didn't look like me. I don't think I got that in med school. I know I didn't get that. What year did you start med school? Dr. Robert Bashford: Do you have any idea about what the experience was like for the people in your class who were women? Dr. Robert Bashford: Yeah, two were stunningly beautiful. That didn't hurt. It didn t hurt. I think it was a good experience. I think we very much involved them. They were all great women and able to step up and one is now a huge shot in the AAMC and I said we were homogenous we were pretty nice people. I think, I'm looking at that class of 65 and I'm thinking we're pretty nice people. We liked each other. We had this funny thing happen the first year of

6 6 med school, the first time in the history of University of North Carolina at Chapel Hill Medical School, they said no quizzes. We're gonna try it and see how it goes. It's not for me. That doesn't work. I need a test. I needed something to keep me, I never took a practice test, never, and I thought the people who were doing it, what the hell were you doing? You're crazy. But spring came, I realized I was in trouble and I was and I had two, we had two weeks to study and I dug in in Columbia Arms 106 and I didn t come out for two and a half weeks. I didn t come out. I took books into a room and didn't come out. I ate some and I took a shower maybe three or four times, and I didn't come out. That's not the way to do it. What other activities were you involved in in medical school? Dr. Robert Bashford: Trying to establish a life and trying to recreate a family. Did you get married while you were in medical school? Dr. Robert Bashford: I did. I got married between my freshman and sophomore year, which was not unusual. That s what my buddies did. Everybody got a year of med school behind them and got married. All of a sudden, we lived in Chapel Hill and we were couples, but I was a couple with two children because I married a woman with two children. Was it hard to balance family and school? Dr. Robert Bashford: Um-hum, but I did it and I think I did yeah, I didn't do a very good job. I was 22, and I was really not a grown up 22 in some ways. You're like a psychiatrist, Claire, aren't you? I was not a very grown up 22. I still had a fraternity mindset, sort of. But I did it, and did I think about leaving med school? Absolutely. Absolutely. And until I had, you didn t ask me this, but until I had an experience in the summer of seeing patients, of being in a room with a great doctor, I was ready to leave. And then I went to Durham and I spent the summer as a Duke fellow between my freshman and sophomore years with Dr. Isler, who was a great doctor and a great man, and it just drew me back, because I was ready to leave. Because the Krebs cycle is not very much fun. When did you start seeing patients for the first time?

7 7 Dr. Robert Bashford: Not as soon as you do. I laid eyes on people in an uncomfortable way that summer. None in the first year, zero. I didn't get near a patient. But that summer, I went in the room with him for three months and we sat and he was a great doctor. He was also pretty damn funny. One of the great days of my life was Dr. Isler, his name was Leroy Isler, what a character, and he was sick one day and he called me as a first-year med student and said make rounds on my patients and give me a call and then let's talk about what's going on. I was like 25 feet tall. I never felt so empowered, and I did a damn good job. I got EKGs and labs together and I tried to be thoughtful and I called him and we made rounds over the phone. Now, I didn't know his partner was tracking along behind me. Of course he was. I was a baby, but he let me believe that I was the doc for the day. His partner was looking over my shoulder. This was a changing point of my life. So he made you see that you could do it. Dr. Robert Bashford: Yeah, I was empowered. I was pretty good at it. I had gotten he was a thinker and he thought in a very careful way, and I had picked up some of his habits about being careful and self-critical. He was very self-critical, Dr. Isler. At that time, did you know what specialty you wanted to go into? Dr. Robert Bashford: No. This is a lot of fun, Claire. Because you see, a lot of this is I like Claire quite a bit. This is a lot of fun. Internal medicine, never pediatrics, couldn't stand it, still don't. I mean, we ve got a couple at our house this weekend, the baby starts crying this morning, and I get the hell out never pediatrics. Cancer stuff for obvious reasons, but the one that ready grabbed me was psychiatry. Along with everything else my dad had rheumatic heart disease he had a significant mood disorder that came and went and haunted him and us, and his psychiatrist was profoundly important to my family. Psychiatry was incredibly distant to my dad, again seventh-grade education, plumbing and heating. So psychiatry and then at some point I realized that I wasn't very grown up and I got hooked by obstetricians. I got hooked by procedures and I got hooked by the group. I loved them. I loved the people that practiced obstetrics. They were mostly men, two women. I loved them. I loved what

8 8 they did and I loved taking care of women. I loved doing procedures. I loved delivering babies and I never once thought this was gonna get, I'm gonna get tired. It never occurred to me. I was 25 years old. So I wanna play tennis after I stayed up all night. So you applied to residency after Dr. Robert Bashford: Here's the deal, Claire, the residency at the University of North Carolina in OB is like the best in the country and it has always been, like the Iowa, there's seven of them. They're the best. So Dr. Hendricks, Dr. C.H. Hendricks, picked the cream of the crop four to be interns. He handpicked them; there was no match. He picked, he interviewed. So he had a fifth slot, and I had been an acting intern and he and I liked each other. We liked each other, so I said I'm not academically as sound as these other four but I'd love to have that fifth slot. He said, let me go to Sweden, which he was gonna do. I ve got two weeks in Sweden and let me think about it and I'll call you when I get back and tell you. He called me when he got back and said you get the fifth slot. Pretty damn cool. Can you talk about what your residency was like? Dr. Robert Bashford: Yeah, it was fun. We liked each other. We worked together. If somebody didn't work with us well, we d make him pay. We really worked together. We covered for each other. Seniors taught. Juniors taught. Sophomores taught. Freshmen, as you learned something, you began to teach somebody else something. Dr. Hendricks said I could teach a god damn idiot to do laparoscopy. I'm gonna teach you how to treat princess like a pauper and a pauper like a princess, and over and over he would say I could teach a god damn idiot how to do a Cesarean section. That's not what I'm here for. So we got this sense of how to be in the room with the patient, you asked me earlier. We finally got this sense of how to be in the room with the patient, the power differential; we just got it because he wouldn't allow us not to get it. His question was always if you had a patient you and were taking care of her and he would say would you have done that differently if she were the queen of England? Or the flip, would you have done that differently if she were a pauper on the street? He really taught us that even-mindedness of taking care of women, and he adored women and he insisted that we treat women like

9 9 they should be treated. He really gave us something that we wouldn't have gotten otherwise. Do you think that was a similar mindset that a lot of doctors at that time here had or is that unusual Dr. Robert Bashford: I can't answer that. I mean obviously, I don't think many people had that opportunity to have that kind of daddy, which he was. We met Friday afternoons late and Monday mornings early. There was no secret why we did that. So you wouldn t go the hell out of town. It was easy, late Friday afternoon, Monday morning early. He was our daddy and he walked the walk, so I can't say about other people but boy that's where we learned. That's where we got it. The truth, he made us tell the truth and you can lie in so many different ways in medicine. You can couch it. I mean sort of. I made him think that I had examined a patient my first year as a resident. You know this story, as an intern? I led him to believe I had examined a patient, and I'm glib. I hadn't but I didn't say I hadn't I just didn't say I had. But I had not examined the patient, so the day passed and late that afternoon he called me to his office and he never looked at me, he looked at the window. He never looked at me. He said if you ever lie to me again, you won't get a residency in this country and all I could think. Guadalajara where would I be, Mexico? So we had this silly thing for two years, where he d ask me something, and I d say, I don't know. I don t know. And my junior year he said time to know, big boy. Was your residency a pretty grueling schedule? Dr. Robert Bashford: Yes, and this makes me 180 years old, but yes. I mean you would be, you were up for 36 hours. And then if you had a sick patient, you stayed with them until some resolution, if you could. At some point you went home of course, but yeah, it was hard. Do I think back and think did I make more mistakes? Oh, yeah. Did I make more mistakes in those last 12 hours? Of course I did. So it's good, I see both ways. It's good because of the continuity, and if you ain't there, you don't see it. That's what Dr. Hendricks said. If you re not there you don't see it. And you need to see one of everything. And in obstetrics in those years, illegal abortions were causing 16-year-old girls to die in the emergency room with DIC. And we were kind of hematologists, we were clotters, and

10 10 you could see we d walk in the emergency rooms and you d see a 16-year-old girl, you knew what the hell was going on. She's bleeding from everywhere. So, you stayed with it and tried to get some resolution, saw the consults. It was hard. I know that this new schedule and new hours has got so many advantages to it, but sometimes I think you don't stay until there's resolution, and you don't see as much stuff. Of the other students that you were residents with, was there anybody that you looked up to in particular or anybody you're close with? Dr. Robert Bashford: That I was residents with? Um-hum. Dr. Robert Bashford: Yeah, absolutely. Wesley C. Fowler was my chief. He was a young attending when I was an intern and I just watched everything he did and modeled everything he did. I talked like him; I bought some boots that looked like his. Just took on all of his qualities of, as best I could, completeness. And then I ended up running his GYN-Oncology service for six months, as the chief resident, and it s the best doctor I'd ever been. So you were chief resident? Dr. Robert Bashford: Yeah, as the best doctor I d ever been, those six months. It was another time; we all took a tour being chief resident. So then Claire, I got lots of mentors. One of my mentors was Bill Blythe, who was a nephrologist, and he said you're not gonna be an obstetrician forever. I said what does that mean? He said you're not gonna be an obstetrician forever. I didn t know what the hell it meant. Med school and residency were hard and my class was pretty hypochondriacal. We got a lot of things. We had seven lymph nodes, all of which were negative, were removed, 65 class. In med school? Dr. Robert Bashford: Um-hum. Here's looking, wasn t it I think what we didn't have was somebody to help us with that side of training. Nobody ever said look, there's gonna be parts of this that's gonna be emotionally very difficult and you're gonna get yourself involved in studying something that's gonna scare the hell out of you, some of you. That wasn t there. That wasn t there for us. It was just buck up

11 11 buckaroo. And the thing came full circle, Claire, when I came back here to apply for residency in psychiatry is this what you want? Are you getting what you want? Yep. It's going well. Dr. Robert Bashford: Good. When I came back to apply for a residency in psychiatry, I got Butch Fowler to write a letter for me, and he wrote a letter and it had three or four sentences in it. He said this is the best resident I've ever had. It didn t say anything else. So I got my residency in psychiatry. I got a phone call because he was beloved in this place, and I got a phone call from the training director, Pret Walker, and he said you're 40 and we're taking a chance on you but we can't not take you. So you were 40 when you went back to your residency and before that right after you finished your residency Dr. Robert Bashford: I went to Wilmington. I went and practiced and I either got fired or quit, not sure which, but the senior partner and I had a hard time and we ve resolved that and his granddaughter got white-coated three weeks ago. And he and I have worked that out, and we realized that we didn't give each other enough room. We didn't give each other enough. I knew stuff he didn't and he knew stuff I didn't, but we couldn't pull it off. So I either got fired or quit, a lot of cursing and smoke, and then I found a practice that was perfect with four other people that were like-minded, like-aged, understood that helping each other paid off as well as screwing each other. In the previous practice screwing each other, leaving stuff to be done, and this new practice, we'd do it but everybody would do it. It was just a good feeling, so 10 years of just pleasure, one angry moment in 10 years with the five partners, one. That's great and what led you to decide that you wanted to be a psychiatrist? Dr. Robert Bashford: In 1985, I told my best friend David, who s a lawyer, I said, you know, I'm gonna do something different. I began to play it off three friends. I have a New York friend, I have a lot of friends but my close, close friends, I have a Charlotte friend and my friend David, and I began to bounce this off them and my wife then. So I went to Charleston and I got a residency offer. God, I didn't mean to do that. Went down there and interviewed and I got a residency offer. I knew the chairman; I d gone to high school with him. I came back and panicked and chickened out and said I'm gonna go

12 12 be an infertilitist. That'll be interesting. I'll be interested again, because I was bored. I'll be an infertilitist. So I went and I learned all about that and learned a lot of crazy stuff, crazy good stuff infertility; but then two years later I came back up here and interviewed, got the residency and never stopped to think the price, or I'd have never done it. If I had done the math and done the dollars, I'd have never done it. If I had put a piece of paper down and seen what it was gonna cost me, probably I d have never done it but I had a very supportive wife and a very supportive mom. And my mother said if you're gonna do this, I'm gonna try to make this so that it s not so painful for you. So considering your first residency and then your second one, what were the big differences? What had changed? Dr. Robert Bashford: Boundaries, yeah, boundaries. An OB residency is so much different than a psychiatry residency because a psychiatry residency is how are you gonna be in a room with the patient in a very different way, very different way. And I didn't get it for a while. Do I get it now? I think I do, yeah, I think I do. The first residency, we work, work, work, work, and second residency was think, think, think, not so much work. I don't think I got exhausted but that's different now because our psychiatry residents are turning a unit over every three days but these were days where patients would say at the hospital you wouldn t even begin to think about the discharge plan until they d been there a few days and it was kind of a golden era, but we also we kind of screwed it up. So it was more thinking. I liked it, it was with a bunch of people your age, a little older than you and I liked them. I fit in with them and them liked me and they learned that I knew something that they didn't and I learned that they knew something I didn't and I just began to have a good time and about my second year began to see myself as a psychiatrist and I'm beginning to think you know, I'd like to be academician. I had young attendings that are now huge shots out in the world. They're chairmen and deans, they're 35-year-old attendings and I latched on to them. I was 40. They were 35. They were attendings but I latched on to them, and I liked what they did and I liked how they did it. You said earlier that you did not want to be a pediatrician.

13 13 Dr. Robert Bashford: No. Then you decided to go into adolescent and child psychiatry Dr. Robert Bashford: Oh I see; that s an interesting question. I don't like little children very much. [laughter] I don t dislike them. I just don t like little children very much, so I tend towards adolescents. I see young kids but my age group is when you can get real articulate and you can talk about and think about yourself, on up into college and medical students. I mean for truth, some medical students are adolescents and have adolescent issues, and I have tolerance for adolescents, and I myself am sort of an adolescent, and I remember my adolescence and I remember the pain, I remember the joy, I just remember. I remember the feeling. I remember trying to get stuff straight. So I like that, I have a tolerance for it, and adolescents tickle me and all their stuff and young college students and med students because god I love talking about myself, because I'm getting ready to throw something at Claire because she's laughing too hard at that, which means she knows what I'm talking about so I just threw something at her. I have a sense that you don't ever, there are no new issues, if you don't get schizophrenia. It's all stuff you didn t get straight when you were an adolescent. There's no such thing as a new issue. There is an issue that you're not doing well with because you can't take what you didn't get straight in adolescence. That's the truth. All right and so after you finished your residency did you start working here at UNC? Dr. Robert Bashford: Yeah, I got hired by David Janowsky, hired me. I went over to Duke and looked at a job and I went to Philadelphia because there was a man there that I had, I had gotten a big award from the American Psychiatric Association because I was different and I got a big damn award and I met him, so I went to Philadelphia, interviewed, went to Duke and interviewed and got a really nice job offer at Duke but I went back. I said let me come back, look and see what you do during the day. I went back and looked and it was so, so attending driven that I turned that down. The residents would kind of show up and said what have you got for me? I didn't like it so I got a job offer in '91 and then ran into a great mentor, Bob Golden. He became chairman and his daughter's a student here. And we ve just interviewed his brilliant

14 14 son, who we offered a slot. Bob said you are not a gifted academician. You are not gonna be a gifted researcher. You don't like it and you won't be good at it but boy I bet you can teach. And you like students so I'm gonna give you a big chunk of your salary just to be out there and be the lead teacher in psychiatry to the face of medical students. All of a sudden the world turned around and kids started going into psychiatry. Tony Lindsey and I won every award you could win for teaching and I did the commencement talk seven times. I was a part of this life of this place in a way that was beyond anything I could ever hope for, and the funny thing is I knew it while it was happening. I understood it. I understood this is too damn cool. So Bob continued to mentor me. If there was a job I wanted, he said no, you won't be good at; it ll be speaking to your weaknesses. Real mentoring. Then he would come and say there's a job I've got that you need to do because it speaks to your strengths. Do you have a good balance between taking care of patients and Dr. Robert Bashford: I do. Tuesday and Thursday afternoon I see people and I'll go to my fellows didactic today at noon, which I go to every Friday because they know a hell of a lot of stuff. So I can keep up and then if I see patients on Tuesday and Thursday I talk to my colleagues a lot about taking care of patients and tell me this. I'm shit, what are we doing here? So I stay credible, I think, as a clinician. One day when Dr. Roper fires me, you know, I can see patients. At what point did you take on your current role as dean of admissions? Dr. Robert Bashford: Four years ago, Dr. Roper called me and said how would you like to be admissions dean? I'd never been on the admissions committee and I said you know, I'm gonna be selling the best product at the right price in America and I'm gonna be with gifted kids and I'm gonna be the face of this medical school, yeah, I think I'll do that. What do you like most about your job now? Dr. Robert Bashford: Being the face of the medical school, being with gifted young people, having a relationship with colleagues, this is a very collegial place. I like the people I work with. I like the faculty. My committee, I love my 20 dedicated committee members who

15 15 get two glasses of wine at Christmas for all the work they do. I get to practice some medicine it took me a year to get traction in this job and Zell Hoole, who had it before, was really helpful because I couldn't quite get a picture of what I was trying to do. I think I got it now. Can I articulate it? Probably, what I'm trying to do, I'm trying to build a class that looks like the world that is full of nice people with a genuine journey to medicine, yeah. Okay. What's the hardest part about your job? Dr. Robert Bashford: Getting pressured either formally or informally to do something that, but I got air cover there. I get to do, my bosses have given me absolute air cover to do this the right way and if you do it the right way, you're gonna piss some people off and I'm allowed I try to do this in the nicest way. I try to make everybody a friend of the medical school. I've tried to alienate two people. I tried hard and I did and I meant to. I'm glad I did and I d do it again but I didn't want them to be friends [knock at door] come in. Dr. Robert Bashford: Cedric. Cedric: Hey. Dr. Robert Bashford: Claire. Cedric: Cedric: Claire: Hey, Claire. Hi. How are you? Great, how are you? Dr. Robert Bashford: Claire and I are doing an interview. She's asking me all about myself and you know how much I love that. Cedric Cedric: I'm getting out of here before [Crosstalk] Dr. Robert Bashford: You have any idea how much I like talking about myself. Cedric: I can only guess. Dr. Robert Bashford: I mean I'm just, she keeps asking me questions and I just Cedric: You re full vent.

16 16 Dr. Robert Bashford: Yeah, that's what I am, yeah. Cedric: Cedric: Sorry to interrupt. No problem. Yes, we need to talk today. Dr. Robert Bashford: Yeah, I'll find you. Cedric: Sounds good, sorry to interrupt. Good to meet you. You, too. Dr. Robert Bashford: You know him? I don't think so. Dr. Robert Bashford: Did you know Larry Keith? Larry Keith ran MED and was responsible for 2000 underrepresented minority kids going into medicine and dentistry. He's Larry Keith now. He's great. Okay, what did you I wanna talk a little bit more about teaching. What did you like most about teaching? Dr. Robert Bashford: Nearly everything, I remember getting, every year, when I began the class, this is the big formal class in psychiatry, I would be really anxious as I drove to begin the class. I thought that was a great sign. I really wanted it to go well and what I think I enjoyed the most was humanizing psychiatry for these medical students and trying to get across we re all psychiatrists. You re gonna be practicing it whether you like it or not so please listen up because you're gonna be doing it, no matter what you do and making psychiatry look not weird, I think I did a really good job in that. It's like entertain with this hand and put some information in with this hand and watch the birdie, bam, and I think it turned around their view a lot of what psychiatrists were and then the other thing that I have loved is just putting on the table, we all have got issues and this is one, I mean we don't all have lupus but damn, most of us have got issues and see you need to work and think about them yourself as you help patients with them. So that part, going back to what I didn't get when I was in med school, nobody ever said

17 17 that. Nobody ever was supportive in a way of let's take care of you as you do this hard stuff. Yeah. What about during your residencies, was there an effort to talk to you about things like that, balancing life and Dr. Robert Bashford: Um-hum, much different, much different, although, Dr. Hendricks had done that in my OB residency. We were welcome to talk to him about life, and he would ask family, are you seeing your wife, you know, he would ask. But psychiatry, they do a pretty good job of thinking about what you're thinking about and if you're in the room with the patient and you begin to think about something, how did you get there? What's going on with you that third year you just listen to yourself? So you had to We tried to take care of each other, I think. It was a whole different kind of residency. I went and took the boards in psychiatry, oral boards. I did fine on the written boards, really well, surprised myself. I went to the oral boards like I was an obstetrician and I failed the shit out of them because I took psychiatry oral boards with an OB mindset and, how could I explain that? I did and I failed because those psychiatrists wanted me to do it a different way. OB is and I'm doing my hands going down the vortex. Psychiatry is going out and then be coming back. If that doesn t mean anything to you than it doesn t, but it s the damn truth and I went bam. And said the diagnosis is bipolar affective disorder, but that wasn t what they wanted. They wanted me to think about what other things it might be and then arrive. Dr. Robert Bashford: I had to retake oral boards and do I want this to be in there? failed again. I had killed the written boards. Oral boards were two taped interviews and one live interview and you went first, I failed in Houston then I failed in Kansas City. I'm still an obstetrician and I'm still way too obstetrician-y so I backed up, waited a couple of years and went to Milwaukee and passed the boards, passed the oral boards and then child boards were a cinch. So what did I learn from that? A lot of important things. Am I helpful for students for that? I think so. What did you do during those two years?

18 18 Dr. Robert Bashford: Panicked because I was told very clearly by my boss then that you can't be an academician if you're not board certified. It's not gonna work. I'll support you to take the boards but, and I knew if I didn't pass, you got to go back and start all over. What did I do? I did a lot of interviews with somebody sitting in with me, trying to hone that skill, of a half-hour interview, how you do it, make people comfortable but at the same time move the process and gather information and when I did this in Milwaukee, I knew I'd done great. I did fine. I got it and I knew why I had not done well previously. Was that good for me? No. [laughter] My marriage fell apart at the same time. No, it was not good for me. No. Did that help build me into no. Maybe, I don't know. It was hard. I saw the future that I wanted threatened in a way that I had never imagined because I can't be a psychiatrist five days a week, eight hours a day in an office downtown. I'm not made for that and the patients would suffer and I would suffer so I knew I couldn't do that. What are you gonna do, Claire? I'm not sure. Dr. Robert Bashford: What do you think you're gonna do? I don't know. I'm kind of interested in pathology. Dr. Robert Bashford: Oh, that's right, we had this conversation. Well you won t be practicing psychiatry. What? Dr. Robert Bashford: You won t be practicing psychiatry. Probably not. Dr. Robert Bashford: By being in pathology, I promise you won't Oh, yes, I won't. Okay, can we talk about after you passed the boards and kind of other things that you did with your time and you know, what kinds of things you did outside of your work? Dr. Robert Bashford: I've always had a group of friends that our travel life revolved around golf, and I don't play golf anymore. I do a little bit, no I don't, but it revolved around golf and I would travel overseas in

19 19 Ireland and England and just lots of golf around the country with people I loved so that was sort of the carrot I always kept out there. And then I'm lucky enough to have a friend that always needed somebody to travel with him around the world. I got to travel to China and Russia. He needed somebody to go with him and I was very happy to do that. And then, just trying to network in this place and find my place, which became consult liaison child psychiatry, that's where I ended up finding a real identity, a teacher and running the child consult liaison service that we saw, we do 500 consults a year with sick kids. I made that career. I have very, very successful, that's such a stupid word, marriage, new marriage but a very, very successful new marriage. I got a life in Wrightsville Beach in Wilmington because that's where I was when I delivered babies so I spent a lot of time with that life. I still do. That's great and I wanted to ask you kind of your perspective on how medical school and medical students have changed since you were a medical student and now you're helping to choose the medical students. Dr. Robert Bashford: I got that you have, first, I don't know if you're any smarter as I don t even quite know what smart is. You are equally smart. My classmates were smart as hell. Some of my classmates have changed the world in labs. They're smart, but your view of the world is bigger. Your view of medicine is bigger maybe because you have to think about healthcare reform. You have to, you must think about it. You have a life outside of medicine, this is for sure. You have a life outside of medicine that allows you to be a doctor but not only be a doctor. The classmates of mine that burned out, and two with suicide, were only doctors. That's all they had and that became their life and it wasn't sustainable and the others just burned out because it's just not sustainable, so the med student today understands that medicine is so damn important to them and so is their life. I think we're not as hard on looking at our own errors. I think there's a drift toward not having real candid feedback, not being able to come forward and say I made a mistake. I think there's a drift away from that.

20 20 What else is different? Well, it's just the damn stuff that you have to go through to see a patient. Once you get in a room with a patient, it's the same but the stuff that my residents have to go through electronically and produce electronically, and that computer can get between, that screen can get between you and the patient if you're not careful because you don't have the ability to sit down with a pad and paper now and talk with the patient as easily. What else is different? You guys are seeing patients earlier and you're coming into medicine for the right reasons. You got service in mind. I think there were some of us in my class that just wanted to be doctors to be doctors. It might have been a piece of me, but you got service and you're good citizens. The hours are less and that in the end s probably good. That's probably good and that's about it. Basically, nothing's changed. Basically that time when you're in a room with the patient hasn't changed and will not change no matter how much stuff you have to go through. Once you're in that room with that patient together, nothing's changed. Oh, what else? You have to memorize 5 million things, and in the new curriculum we're gonna try to take that away so that you can learn. You can know and not have to memorize, knowing because it's just too much information and it's overwhelming. I don't see how you do it. I don't see because my ticket was memorization. I never understood the Krebs cycle, but I memorized it. The new curriculum is designed for me, it's gonna help me understand it, not necessarily be able to spit it back. I didn't get it. Is there anything that we hadn't talked about yet that you Dr. Robert Bashford: No, I don't think so. Thank you very much for your time. Dr. Robert Bashford: It was a pleasure. [End of Audio] Duration: 55 Minutes