Gail:  Who are the people who significantly influenced you in your life?

 

Risley:  The first person that comes to mind is my godfather.  He was an inventor and was really interested in science and technology.  When I was barely old enough to read, he bought me a subscription to Scientific American magazine.  I would look at the pictures and I would kind of read what it said without really understanding much.  It set the stage for some of my interests.  He had a garage just full of junk which I always called Joyland. Then growing up I lived across the street from a guy by the name of Bob Herman who designed  the first commercial minicomputer.  He would give me computer parts and I would fiddle with them.  Eventually I became an engineer.  I did a lot of computer design stuff.

Gail:  That’s incredible, and now you are a medical doctor, how did you transition?

 

Risley:  I really loved the computer stuff, but I got more into the esoteric stuff like cryptography.  It is not a field where you can spend a lot of time talking with other people.  So it is kind of a closed world.  I ran a consulting firm and spent a lot of time with machines.  I started feeling like I wanted to work more with people.  I really wanted to directly affect people’s lives.  I thought that I could be a farmer or a doctor and the farming sounded like a lot of hard, dangerous work.

The really interesting part is that I was sitting in a pizza parlor with a girlfriend and she said, “You know you really seem like you want to make a change.”  I said ,  “Well, what I would like to do is go to medical school, but I can’t do that!” and, as I said it, even before she said, “Why not?”, I said, “Why not?”  So I did my whole undergraduate program over again.  I went to San Diego City College.    Then I transferred to UCSD and got a degree in literature and writing.  I read all the stuff that said once you get into medical school all you will be doing is science.  I found that in doctoring my communication training is more valuable than organic chemistry.  Knowing how to communicate with patients and other doctors has served me well. I had this vision of medicine as sitting down with someone and talking about what was bothering them, and then coming up with a plan for dealing with it.  Instead, I found medical school was a world where you are constantly pressured to see people and to focus on what medicine you are going to give them.  The only people who were actually sitting down talking to their patients were psychiatrists.  I really had my focus on primary care medicine. It was what I wanted to do, but I saw that psychiatry was much closer to my vision.

Gail:  How did the Sacramento Medical Oasis come into being?

Risley: 

This place came into being about this time last year when we all thought we would be out of work. We were wondering where patients were going to go. We thought it would be nice if people on disability income could afford care.  We looked into whether we could accept Medi-Cal, could we get insurance money, could we get grants, was there a way to fund this new concept?   What we found was that the minute you buy into that insurance system, the costs pretty much triple.  There is billing, collections, and a whole bunch of regulatory agencies you have to keep happy.  You don’t have to deal with all of that if you don’t take insurance money.  What we came up with, after a lot of number crunching, was that we could see people for $79.00  a month and treat their psychiatric illness and their general medical illness. We don’t make a distinction.  You don’t make a “psych” appointment , or a “ medical” appointment.  Instead, we treat the whole person.

Gail:  If you had to say what your philosophy of medicine is, how would you sum it up?

 

Risley:  To borrow from a colleague friend of mine , “We meet over the patient’s suffering,” that is really what it is all about.  People don’t need doctors unless they are suffering, and our job is to address that suffering.  Whether the job is to treat their physical pain, or their psychic pain, or to help them integrate into society better, or to help them heal their bones.  It is about caring for their suffering.

 

Gail:  I learned from one of your patients, who highly recommends you, that you manage your own bipolar disorder.  How would you say the bipolar challenge affects your ability to be a psychiatrist?

 

Risley:  I don’t think my illness has ever really impacted my ability to provide patient care.  I think it is important that the world recognize that psychiatric illness can be managed well. I got my diagnosis in medical school.  A lot of people I know with bipolardisorder are self-employed so they can have flexibility in their schedule.  A lot of it is about perspective.  When you go from a state, say, of being profoundly depressed, to being really up and being hypo-manic, you begin to realize that the same situation can be perceived on one day as being bone crushingly depressing and on a different day as being an exhilarating challenge.  To recognize that has been a real gift.  To be able to have some perspective and not to just go through life feeling that I am the pawn of forces greater than I am is a true gift.

 

Gail:  What do you think about the influence of the pharmaceutical industry on the way medicine is practiced?

 

Risley:  The pharmaceutical industry currently is the whipping boy because they are the ones making the most money.  When a lot of money is involved, you have to be really careful with the amount of influence it has.   Many doctors I have talked to say, “Oh well, I know they are big, but that doesn’t influence my prescribing at all.”  I think that’s dangerous.   They do provide some education, but they also have a lot of money and influence and I try to be aware of that.

Gail: In your writing you mention the importance of an Interdisciplinary approach to medicine. What does that look like?

 

Risley:  An interdisciplinary approach to medicine is one of those things that is a great concept, but really hard to execute.  Medications don’t make the world a better place.  I can give you all the Prozac that’s made and it is not going to improve your world.  What is going to improve your world is how you approach it and how you think about it.  The medication has a real role if you are overcome with symptoms and you can’t do those things you need to make your world a better place.  Medication, if properly used, controls the symptoms well enough so you can do the work you need to get better.  The work might be something internal you do, it might be just having the energy for paying your bills, or it might be getting to a cognitive behavioral therapy group.  It takes all forms, but the medication is a small portion of the care.  What we have is a health care delivery system that says, “Well you are a doctor, you make way too much money, and the only thing we are going to pay you for is writing those prescriptions.”  Healing takes a lot of effort.

 

Gail:  What do you think are some of the important things we need to do as a mental health community to achieve better quality of care and life for our members?

 

Risley:  The number one thing is that we have to get rid of the stigma around mental health.  One of the things that I am amused and really heartened by is that we providers have people who walk in the door and say, “ I am having this muscle ache,”  and then we start talking, and the real reason they are here is something else.  We have been able to break down that barrier at the Oasis.  Generally speaking, Mental Health services are very separate from the rest of medicine and people in need don’t know how to access the mental health system.  The doctors doing the work don’t have access to the tools they need to make it easy to make that happen.  So people are stuck, and they are stuck really only because we refuse to acknowledge that psychiatric illness is cardiac illness, it is cancer, it is foot pain, and everything overlaps.  I used to think there were clear cut illnesses.  But if somebody has a broken bone, how did they get that broken bone?  What kind of behavior were they engaging in?  It may be an insignificant piece of it, or it may be really significant.  But until you ask, you do not know.

 

Gail:  Your patients have told me that the Oasis has made psychiatric care very accessible to them.  What else do you see unique about the Oasis?

 

Risley:  What isn’t unique about it?  It is a big experiment in a lot of ways.   It first struck me when I was at Massage Envy getting a massage.  They have a way of reducing the anxiety about getting a massage.  I found a lot of parallels with what people experience in accessing psychiatric care to the anxiety that might be provoked around getting massage.   I was president of the Psychiatric Society for about twoyears. 

 

When I went to look for a doctor, here I was on the inside, about as inside as you could get, and I felt the same anxiety.  You end up making a lot of calls. There is a shortage of psychiatrists. It is hard to find someone who is taking new patients.  Here I was on the inside and it was an intimidating, expensive, scary system.   Imagine what it must be for someone who has no connections? My co-conspirator, Sonny Cline, and I have similar backgrounds.  We are both trained in primary care as well as psychiatry.  At the Oasis, we believe strongly that we have something to offer people and people have something to offer us.  That is what it is all about.  We have a relationship with the patient, we don’t have a relationship with the insurance companies.

 

 

At the Oasis patients are invested in their own care.  We try to keep our rates as low as possible, but it is still a significant amount of money.  They are buying it, they are the customer.   They have certain rights to expect that people with private insurance or the county system don’t feel that they have.  A consumer will go to the doctor and say “well I really want this,” and the doctor says, “well, the insurance company isn’t going to pay me for that, so you are not going to get it.”   I often say it is like having an insurance executive there in the room with you when you are getting an exam.  We have people who come to the Oasis with insurance because they like the one on one, people without insurance come here because they don’t have a lot of options.  I have a couple people who have followed me from the County and say it’s worth $79 bucks a month to not have to deal with the appointment system and not to have to worry about getting a different doctor every time.   Some people think I am really critical of the county system, and actually I am not.  I have worked in that system since 1997, and I think it is remarkable what they do with the resources they have, but there is a huge bureaucratic overhead.  We are different from the county system, but we can never be a substitute.  We just provide an alternative for some.

 

 

Gail:  What do you think the future of psychiatry looks like?

 

Risley:  There will be a lot more accessibility to Mental Health Services and our knowledge of the brain will greatly increase.  We know so much more about the brain than we did 15 or 20 years ago, and it is still nothing.  It is a growing field.  We used to say that when people got sick, that they have “fever.”  Now we look at fever as a symptom of a larger problem of different illnesses.  So I think the day will come when we look at depression or anxiety or psychosis as symptoms of a broad spectrum of illnesses instead of taking one treatment modality.

Gail:  What brings you the greatest joy in practicing medicine?

 

Risley:  What brings me the greatest joy is seeing people who have resigned themselves to being sick, turn a corner and experience a sense of empowerment.  To see them make a positive change is never just about their medication.  It is never just about getting a therapist, it is never just about finding a resource like the Wellness Center.  But it is a combination of using many opportunities and resources.   Then one day they wake up and say, “I am a human being, I am a productive person, and I can bring joy to others.”  They come here and they tell me that.  Then I realize that I have been a part of that transformation.  What can you do in life that brings more joy than that?

 

Dr. Risley is the first graduate of the combined residency program in family medicine and psychiatry at UC Davis. He is a former assistant clinical professor and physician diplomat at UCD. In addition to practicing psychiatry at TCORE, he integrates family medicine and psychiatry at Sacramento Medical Oasis, Inc (www.sacmedoasis.com).

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Interview conducted by Gail Erlandson, MA.

Gail has a Master of Arts  Degree in Pastoral Ministry from the University of San Francisco and a Bachelor of Arts Degree from the University of Portland in Interdisciplinary Studies. Gail taught at Loretto High School for eleven years and has served on staff at Loaves and Fishes.  Gail is a mentor at the Wellness and Recovery Center North.