“…it was a very gratifying experience to be told by my peers you’ve done a great job.”
Arch G. Mainous III, PhD, is Professor and Vice Chair for Research in the Department of Community Health and Family Medicine and Professor in the Department of Health Services Research, Management and Policy at the University of Florida
Chip is an internationally-recognized leader in primary care research, with more than 450 peer reviewed publications. His work has been cited more than 30,000 times with an H index of 85. He has received the Distinguished Research Mentor award and the Maurice Wood Award for Lifetime Contribution to Primary Care Research from the North American Primary Care Research Group. He has also been given the Innovative Program Award from the Society of Teachers of Family Medicine. He has served as a Special Advisor for Health and Healthcare to the Prime Minister of Haiti. He currently serves as the Deputy Editor of the journal Family Medicine and the Specialty Chief Editor of Frontiers in Medicine: Family Medicine and Primary Care.
A flower in stained glass by Chip Mainous
“…it’s very important that we have that doctor-patient relationship but it’s also very important that we have very competent doctors as well. There are two halves to that dyad and they both have to do the right thing.”
On a family day out
Chip Mainous is one of the leading Primary Care academics in the US but before I talk to him about his career, I’d like to ask him about his name.
Arch (Chip) Mainous III. My name is a good Southern name, I am Arch Mainous III. There already is an Arch Mainous Jr, and Arch Mainous senior who has passed away, and so to distinguish us, rather than just continuing to name everybody the same thing, you start getting nicknames like Chip and so that’s how I became a Chip.
DMacA: Tell us about your current post and your career to to date.
CM: My current post is that I am the Vice Chair for Research in the Department of Community Health and Family Medicine here at University of Florida, but I split half my time with the College of Public Health and Health Professions. I actually came here as the Chair of the Department of Health Services Research Management Policy in the School of Public Health and so I have switched how much time I had when I was chair over there. I’ve kind of evened them out so I’m half and half. I am one of the people who sort of bridges between the departments.
Before I came here I was at the Medical University of South Carolina in Charleston, South Carolina, and I was the Associate Dean for Assessment and Evaluation there in the College of Medicine. I’ve moved around a bit and I like it. For my research and my areas of interest I don’t really like to have too many boundaries so it helps me to have collaborators in all kinds of different places and to think about if there is a better way, there something new, is there something else we can do and pull stuff from different places. So that’s how I do it.
“… building that patient-physician relationship is very important to patients, not just in terms of their satisfaction, but we know they’re more likely to adhere to treatment regimens, we know they’re more likely to go along with recommendations for testing, so it also helps to coordinate care so that one physician plays that role of being ‘the interpreter of all these other things for the patient’.”
Three paintings by Chip depicting St. Guinefort,a greyhound who was made a French saint in 1250. This series of paintings depict St. Guinefort killing the viper.
With research colleagues in Haiti
DMacA: What really interests me is what you described about collaboration, and international collaboration, because you’ve done something that’s perhaps a little unusual in US Primary Care, you’ve done a lot of collaboration with the UK including Richard Baker, Denis Pereira Gray and others. Tell us an about that.
CM: Yes, I have worked with people in New Zealand, I’ve worked with people in the UK, I’ve worked with people in Haiti, we’ve collaborated with people in the Netherlands. So, how did the original thing start? I was at WONCA when it was in Dublin many years ago and Richard Baker of the University of Leicester was presenting on continuity of care, as was I, and he was the person who spoke right after me. I said “wow, that’s kind of interesting stuff, I think I’ve seen your name…” so we started talking and, from there we got a grant, and I came over as a visiting Professor to Leicester, and ended up going down to Exeter. Then I got another grant, where we did what I thought was a pretty novel thing, we compared diabetes care in the UK and the US with the idea being- what does a universal access system mean for vulnerable patients, particularly minority patients? Do they do better in a universal access system than in a market driven system? And you might have guessed- they do better in the universal access system. We also worked with Azeem Majeed, and then Sonia Saxena got involved and, in fact, I’ve been working with Sonia Saxena off and on for many years since. Then at another conference I connected with Ngaire Kerse and the people at University of Auckland, went there, worked on stuff with them.
And, so the Netherlands, that was an interesting thing set up Tim Stokes. He arranged a study to survey primary care physicians, family physicians, in the US, the UK, and the Netherlands. That study, which has been cited more than 2,000 times, showed that doctors like continuity, they like seeing the same patients. A lot of the time we forget that, because we look at things like – how do we set up a clinic so it’s easy access, and we think of activities like that- and it actually tends to move away from that dyad of one doctor seeing the same patient and building that relationship.
DMacA: You said something very interesting and that is, about how the doctors like the continuity, because we’ve heard a lot about how patients like continuity. I know you’re interested in doctor-patient communication and have written about that. Tell us more about your thoughts on doctor-patient communication.
CM: I think doctor- patient communication is critical. I think that we tend not give it the primacy I think it should. We look at health systems and think the only thing that patients want is to be able to get in and out. They just want to be able to get in today and that’s that. But we know is that building that patient-physician relationship is very important to patients, not just in terms of their satisfaction, but we know they’re more likely to adhere to treatment regimens, we know they’re more likely to go along with recommendations for testing, so it also helps to coordinate care so that one physician plays that role of being ‘the interpreter of all these other things for the patient’. We could say that the electronic medical record can do that, but I don’t believe that’s true and there’s data that shows that it’s not really the same. So, I think it’s very important. It’s important, providing you have a good doctor – so I’m going to add that in.
We did a study about two years ago and what we did was- we know that patients like their doctors and follow what their doctors recommend. And we said, what happens if the doctor recommends something that shouldn’t be recommended, then what happens? So, we looked at the data. At that time the US Preventive Services Task Force had a guideline on prostate cancer screening and the study was about the guideline, which was a Level D which means don’t do it as the harms outweigh the benefits. So it wasn’t a question of, I’ll just talk to my patient and we’ll see.
We asked, what happens if the patient sees the same doctor, has this relationship with this doctor, and the doctor recommends this. Well, guess what patients get? But they’re getting a low value test. So, I think we need to come back to that and say, yes, it’s very important that we have that doctor-patient relationship but it’s also very important that we have very competent doctors as well. There are two halves to that dyad and they both have to do the right thing.
“The problem is that the patient is trying to figure out who to trust, who’s most credible, and so I think that it’s important that we talk about communication and we try to get those messages out. But, in my opinion, we need to go through the family physician. “
Being interviewed on Lithuanian Television.
DMacA: Let’s continue on this theme of communication, because you’re a communication professional in the wider sense. You’ve worked with many medical journals but you’re also interested in direct communication with the public.
CM: We’re running into a real problem right now about communication and so I’m going to link this back to where the personal doctor, or where the family doctor, comes in. At least in the United States, and I can’t say so much for other places like the UK or Australia, but what I can say is that in the US we’re seeing an erosion of trust in medical experts, particularly government experts, so whether it’s the head of the CDC or the Food and Drug Administration or similar, those where people are trying to talk directly, are getting lost. Because, what’s now happening is that, in terms of communication, we’re seeing a lot of voices that are competing. So, someone who runs a podcast, Joe Rogan for example, has a huge following and he’ll give his opinion and then the head of the CDC will give their opinion. The problem is that the patient is trying to figure out who to trust, who’s most credible, and so I think that it’s important that we talk about communication and we try to get those messages out. But, in my opinion, we need to go through the family physician. We need to get the guideline to go to the doctor, to then go to the patient, rather than directly. In that way you can tell your patients, knowing their medical history, knowing their comorbidities, knowing their age, and so on and so forth, what medicines they’re on which might be contraindicated for something. Then you can interpret it. You can say, I don’t think now is the right time for you to do this, or I don’t think this is the right test, or the right treatment.
We’ve been doing this for a long time. In other ways, direct to consumer advertising does the exact same thing. Every single time that you see, and I’m always stunned when I watch television, and they say – “for those of you with non-small cell lung cancer here’s the right treatment”- I think… you’re going to decide what treatment you get based on an advertisement on television! That doesn’t make much sense to me but, I think if we do that, we can get back to the trusted entity giving that information back. That’s my feeling. I’ve done a lot of things with interviews and put stuff out and I think it works. In fact, I know it works up to a point. But I also believe that there’s a difference between scientists, physicians, and the government, in terms of how people value and see the credibility of those three.
DMacA: The idea of communicating through that trusted relationship between doctor and patient is so important and the government message is so important. It’s interesting because you haven’t been shy about engaging with the popular media. You’ve taken on a couple of topics in the popular media.
CM: I’ve taken several on in the popular media, and maybe to my detriment, but I think it’s important to get out and say where I think it needs to go. I think that the government is really in a crisis of credibility and so I think it’s important that academics, scientists, can get it out. I also think that does another thing, which a lot of people don’t see, is that someone like yourself also reads the media so it isn’t just through reading an academic journal, you’re also hearing this message too.
I think it’s important that we that we separate out the podcasters and influencers from the people who have the expertise. If we do that we’re in in better shape. So I try to say, look, I’m not a social influencer but I do know something about this topic and so this is where I think it should go and then we can see what happens.
DMacA: Do you think national organizations, colleges, international organizations, need to be more active in popular communication?
CM: I think that’s a very good point. Here at the University of Florida they have media offices and they come to me and they say – have any studies that are going to be big. I have one that’s going to be coming out in January and we are already working on that. This is very important because I frame some relatively technical information in a way that everybody can understand. But yes, the universities need to do that. The universities need to go beyond just influencing their peers.
So, let me let me clarify this a little bit. When people start talking about your impact, there are several impacts, there are several audiences that we want to look at. One is your peers and you can see that with citations – how many times is this article cited. But then we also need to get it out beyond that, out to patients, out to the public, out to the lay media. That’s why, when you have an article that might appear on the BBC, that’s actually quite important, or US News, or World Reports, or the New York Times. Those things are actually quite influential. It’s very important that we make sure that we do that because that’s getting it out too.
When we look at articles, we can say how many times it was cited. But, we can also look at Altmetrics and see how many times it was mentioned in the media, how many other people talked about it. I think that’s important too. Altmetrics and Reddit and some of that stuff can get a little off message in their discussions but I think that’s an important way to disseminate information from experts, not the government.
I just want to keep saying, there’s a government, there’s scientists, and then there’s the physician. The patient-physician thing should be primary but I think scientists also have to get their information out too, not just talking to other scientists and impressing other scientists.
“When people start talking about your impact, there are several impacts, there are several audiences that we want to look at. One is your peers and you can see that with citations – how many times is this article cited. But then we also need to get it out beyond that, out to patients, out to the public, out to the lay media.”
DMacA: You talked about Altmetrics, and you talked about impact, which is a very nice segue into my final question. And that is, you were recently awarded the Maurice Wood Award for Lifetime Contribution to Primary Care Research. Tell us about that.
CM: That was quite humbling. I have done a lot of stuff, and on a variety to topics but, that was given by an international group, and voted by my peers, and it was a very gratifying experience to be told by my peers you’ve done a great job. And, because it was International too, as we talked about at the beginning, I’ve tried to build links with friends and colleagues in different places.
It may appear narcissistic when you’re out in the media and it looks like you’re just doing it because you want to be in front of everybody, but I really believe that affects things. If I can give you a little example from years ago. It’s not about the Maurice Wood Award but, almost 10 years ago, working with Richard Baker at Leicester, we did a study on pre-diabetes in the UK and, at that time, there was no screening for pre-diabetes. It was not in the National Health Service, it wasn’t in anything like that, and we showed that there were a lot of people who had it. Realising that pre- diabetes is basically just a high risk for developing diabetes because it’s just a slightly lower level of glucose and a lot of these people transition. So it got a lot of press and put me on two BBC radio stations, the super serious morning one which actually hit me like at two o’clock in the morning (US Time) but that had the head of Diabetes UK and people like that saying this is a wakeup call for the UK. Then they put me on one of the other stations – a drive time programme- where they were playing music and they stopped and they talked. So it was two different audiences. I thought it was fun but, when others say these results are a wakeup call for the UK, it felt like I think they’re getting it. Not to take full credit, or any credit for it, but within a year and a half, the UK started screening for pre-diabetes. They didn’t before they heard us talk about all this stuff, and maybe there was a lot of other information they were already talking about, but they did after that, and I have to believe that there was some influence when the head of Diabetes UK said this is super important.
CM: What’s absolutely fascinating is your impact across the range, from the popular media and the popular press, down to the individual accolades from your peers. It’s fantastic to see your name, and absolutely justified, to see your name on the list of greats for the Maurice Wood Award. Chip, as always, it’s a great pleasure to talk to you. Thank you very much indeed.
