How/when did you become interested in science and medicine?

I got interested in medicine when I was an undergraduate at Iowa State University in Ames. I'd originally thought I would pursue a career in engineering because my early work experience had been with a group of consulting civil engineers and land surveyors. I realized that I wasn't actually suited for the field when I noticed how bored I became in a class that was devoted to studying the mechanics of the 3 point hitch using a computer assisted graphics program (which was still a relatively new and innovative educational tool). I actually graduated from IA State with a BS in an area then known as Distributed Studies (Zoology, Biology, Chemistry-not a combined or triple major, just the areas in which my courses were concentrated!). This led to a short career in Medical Laboratory Science, another area that I found less than scintillating as I spent a great deal of time in the Microbiology laboratory as a technologist, studying negative urine cultures---many negative urine cultures. I finally thought that I would be much more interested in a career that involved helping people rather than in looking at nutrient agar plates. This propelled me into medical school at UI.

What interested you to pursue a career in psychiatry?

What moved me into a career in Psychiatry was the incredible variety of clinical experience available in the area. Plumbing the mystery of psychological suffering cannot be accomplished without considering the physical suffering of patients as well, which must be understood in the context of developmental, social, cultural, and spiritual dimensions as well. It's enormously complex, certainly humbling at times, but the rewards are apparent in every day practice.

Is there a teacher or mentor who helped shape your career?

I consider myself a Psychosomatic Medicine sub-specialist (formerly Consult-Liaison Psychiatry), an area of Psychiatry that is becoming increasingly recognized as vital to medicine now that clear links are being established between medical and psychiatric illness, notably ischemic heart disease and depression. I think Dr. Russell Noyes, Jr., MD, Professor Emeritus, UIHC Psychiatry, a widely published and internationally recognized expert and teacher in anxiety disorders, was one of the key figures during my residency in which he demonstrated many times to me the value of thinking about the role of both psychiatric and medical factors in the production, maintenance, and resolution of illness. He helped me formulate one of my own basic positions in this field, which is to strive to always think "both/and" rather than "either/or" about medical and psychiatric symptoms and syndromes. Dr. Noyes is a careful and thorough scientist, writer, and humanist who often astonished me and other trainees with his ability to interview a patient with complex problems and synthetically integrate seemingly disparate elements of the presentation into a coherent formulation that at once made perfect sense both in the medical and psychiatric realms.

How did you choose to come to the UI?

I chose to come to the UI because of its great reputation in research and patient care. At the time, there was a fascinating and telling struggle to integrate the biomedical approach with the psychodynamic approach in psychiatry, which tended to mirror the national movement, placing UI into an important niche in the history of thought in this area.

What kinds of professional opportunities or advantages does being a faculty member at Iowa provide? What about challenges?

Of course the major advantage to being a faculty member at UI is that it affords me an opportunity to always be at the cutting edge of advances in the understanding and treatment of medical and psychiatric illness. There is a restless and questing sort of energy here that inspires personal and professional growth in part because it is ceaselessly occurring all around me. There are many challenges, some of which involve clarifying the relative emphases on research, teaching, and patient care. How those challenges are being addressed is visible in almost every department. It's exhilarating to observe and participate in the many creative efforts of brilliant minds collaborating in carving out the direction in which future leaders will grow the institution.

Please describe your professional interests?

My emphasis is in the area of Psychosomatic Medicine, a long established field which has recently been given a new mantle and is now a recognized subspecialty in Psychiatry as of the spring of last year, capping a more than decade long effort by internationally known leaders in consultation-liaison psychiatry. The American Board of Psychiatry and Neurology will administer the first exams for subspecialty certification in June of 2005. Our own department has mandated that fellowship training in Psychosomatic Medicine, leading to my application to the Accreditation Council for Graduate Medical Education (ACGME) for approval of such program within the UI Department of Psychiatry. I am pleased to announce that in November, the ACGME formally approved our program, of which I am the first director. I am also Director of General Hospital Psychiatry at UI. One of my goals in that capacity has been to coordinate the development of a cadre of experienced transplant psychiatrists to collaborate with the UI organ transplant team.

What are some of your outside interests?

My wife and I have just started to enjoy amateur bird watching. There are hundreds of species of birds native to Iowa or that pass through it; it's extraordinary that we can identify about 20 just from our backyard.

Do you have an insight or philosophy that guides you in your professional work?

The longer I practice the more I realize that my most important insight is how quickly my current fund of knowledge shrinks over time. I'm also becoming more aware of the importance of humility in my relationships with patients, colleagues both here in academia and in the community, and at home. Keeping up with advances in medicine and psychiatry is a daunting task, calling for a concerted and constant effort to stay abreast of new developments as well as reviewing the basics. Of course, our patients are our best teachers, and cultivating the skill of good listening is a life-long project as well.

If you could change one thing about the world (or world of medicine), what would it be?

I suppose if I am restricted to changing only one thing about the world and medicine, it would be to someday eliminate intolerance; intolerance of change, intolerance of cultural and racial differences, intolerance of the essential grey-ness of the world in which we live and work. The cultivation of flexibility and acceptance is a skill that probably should be rewarded more concretely in our society.

What is the biggest change you've experienced in your field since you were a medical student?

I think the biggest change in psychiatry is the recognition of the difficulty in separating body and mind, leading to the encouragement of developing new ways to understand illness behavior, depression in medical illness, and the role of the interface between physiology and psychology in health and disease.

What one piece of advice would you give to today's medical students?

The advice I would give to medical students is that making a commitment to lifelong learning is an investment not just in their futures, but by extension, in the futures of their patients, their communities, and medicine in general. That would include learning, in whatever way is best suited to them, how to integrate work, love, fun, and leaving a legacy into their lives.

What do you see as "the future" of psychiatry?

I think the future of psychiatry holds great promise for a more balanced view of people as more than just the sum of their parts: psychological, physical, cultural, and social. In just the past few years the addition to curricula in residency programs emphasizing cultural competence, and spirituality, the gradual but definite growing together of residencies including development of combined medicine-psychiatry, family medicine-psychiatry, neuropsychiatry, tends to show what I consider a slow maturing of thought, a healing of the Cartesian split between mind and body that bodes well not just for the future of doctors and patients, but for society as a whole.

President Skorton named 2005 as the "Year of Public Engagement." In what ways are you engaged with the greater Iowa public?

President Skorton's "Year of Public Engagement" is aptly named. I prefer to think of my role as an educator of physicians and other clinicians in the community. One of the best places for me to learn from my colleagues across Iowa and for them to learn from me is via the UI Consult call service. I've talked with physicians from all over the state who want to discuss their challenging cases and get a different perspective on clinical care, ensuring that they are continuing to meet the needs of their patients. This cannot fail to filter down to the communities in which they live, fostering a collegial relationship and connection amongst all of us that serves the common good. I think it is easy sometimes for academic centers to become entrenched into a philosophy that assumes that they are training only researchers and academicians, an idea that serves only to further distance them from the people who support them in the first place. Actually, UI has been reaching out and engaging the public in many ways for many years.