Juan P. Brito is an endocrinologist, assistant professor of medicine, and director of the Shared Decision National Resource Center at the Mayo Clinic.
In this installment of Beyond the Lab, Juan Brito, or J.P. as he prefers to be called, discusses the importance of focusing on the human elements of health care, and the “magic moments” that occur when doctors and patients understand each other on a personal level.
What made you want to become a scientist/researcher?
The distinction between being a physician and a scientist was never clear to me. Being a physician also meant being a scientist. I came to the United States in 2008 to study internal medicine and complete my endocrinology training. At that time, I also wanted to also conduct research, because of all the opportunities that were available here.
What probably triggered my desire to become a scientist and researcher was learning medicine in a way that is idealistic – meaning the way you learn to practice might be different from what you ultimately end up practicing. I believe in this “magic moment” between doctor and patient – a patient walks into an office for 20 or 30 minutes and meets a complete stranger. They entrust their thoughts, feelings and secrets to that stranger, in the hopes that they can improve their health care. That’s a special interaction. I think some of that magic has been lost in recent years, and I hope to bring some of it back through my research. My team and I are currently conducting research to try and characterize cost conversations, identify best practices, and determine the impact of these practices on medication adherence. We hope this will provide valuable information that can be used to develop new interventions or improve on existing ones.
What gets you going every day (besides coffee) and how do you stay motivated?
One of the reasons I get up every morning is because I have this second family awaiting me at my job. My research unit and I call ourselves a family. We truly care about each other and we want each other to develop and move forward in our careers. I think that’s unique to find in a workplace. We work in a space where we can all interact, and there’s no hierarchy, we’re all at the same level. We like to think of ourselves as the “tech startup” of health care (in terms of our working environment). I also think we’re doing something important for patients. Helping them improve their encounters with their physicians in a unique way is a great motivation.
What limitations or challenges do you face as a scientist/researcher?
The way funding is set up in the health care system is problematic, and it can be difficult to receive funds for projects. The way projects are funded is a little misguided and is often based on the principle of competition. For example, “project A” might look a little better than “project B” on paper, so automatically “project B” doesn’t receive any funding. The system is fragmented in this way, and doesn’t support collaboration. If this continues, it will only build more silos of experts, rather than a network of collaboration and wisdom. If collaboration is missing, science becomes repetitive, and doesn’t advance, which can be frustrating.
What do you think the public should understand about science and scientific research?
There are many assumptions about health, science and health care science: “medicine can cure you,” “there is one correct medication or test for every symptom,” “physicians can solve all problems.” This is not the case and it might never be. There is a certain amount of uncertainty in medicine. However, this is often not received well by doctors or patients, because uncertainty is difficult to deal with.
Because there are no black and white answers, there will always be some uncertainty in the results we receive from scientific evidence. Patients should be looking for someone who can help guide them on the right path that meets their needs. When you go see a doctor or physician in the clinic, don’t assume they will find you a cure; rather, the doctor is your partner in understanding options and is there to help you find a path forward for treatment. We might not be able to cure you, but we’re here to help you navigate the process.
Is there someone you look up to, consider a mentor or who inspires you? Why?
Victor Montori, M.D. who I work with at the Mayo Clinic, has been a great mentor and friend for the last seven years. He’s done more than just teach me about methods in science. I really look up to him because he’s taught me to be honest, generous and hardworking. I’m lucky to have him as a mentor and friend; his guidance is extremely valuable to me.
What more do you want people to know about you, your team or your work?
I am currently working with the Knowledge and Evaluation Research (KER) Unit at the Mayo Clinic, where we want to focus on the human aspect of care. We want to make encounters between patients and doctors more human. The threat of illness can create a lot of feelings – when you talk to a doctor, the interaction is ultimately one of two humans going through an intense process of understanding each other. At the KER unit, we want to improve that interaction and conversation.
For example, while we know that physicians have extremely high workloads, we want to get back to basics in the patient/doctor encounter, so doctors can get to know their patients better, on a more personal level. We hope to create more of those “magic moments” I mentioned earlier, when developing interventions for patients.
Also, typical quality metrics (alleviation of symptoms, medicine adherence, etc.) work in some cases, and you can achieve some of those goals with medication. However, the caring process is different – we want to ensure we effectively explain things to patients, help them navigate tools, and take the time to get to know them as individuals. We want to pay attention to biography, not biology.