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An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part Four)

Interviewer: Scott Douglas Jacobsen

Numbering: Issue 14.A, Idea: Outliers & Outsiders (Part Nine)

Place of Publication: Langley, British Columbia, Canada

Title: In-Sight: Independent Interview-Based Journal

Web Domain: http://www.in-sightjournal.com

Individual Publication Date: May 22, 2017

Issue Publication Date: September 1, 2017

Name of Publisher: In-Sight Publishing

Frequency: Three Times Per Year

Words: 3,002

ISSN 2369-6885

Gordon Guyatt

Abstract

An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC. He discusses: academic scientific organizations, research groups, and laboratories and their importance to the health of a society; observed impacts of evidence-based medicine in Canada; skepticism and importance of increasing academic and public awareness of critical thinking; hypothetical worst case scenario; hypothetical best case scenario; uncomfortable truths in the Canadian medical research community; uncomfortable truths in the international medical research community; concerns about Canadian culture and general medical knowledge; most correct ethical philosophy; most appealing political philosophy; most appealing social philosophy; clarification on social philosophy; most appealing economic philosophy; principles interrelating the philosophies; and principles that interrelate the philosophies.

Keywords:  biostatistics, epidemiology, evidence-based medicine, Gordon Guyatt, McMaster University, research.

An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part Four)[1],[2],[3],[4]

*Footnotes in & after the interview, & citation style listing after the interview.*

*This interview has been edited for clarity and readability.*

1. Scott Douglas Jacobsen: What makes academic scientific organizations, research groups, and laboratories important to the health of a society with substantial technological sophistication such as Canada?

Professor Gordon Guyatt: Aside from the economic drivers, they lead to useful things for the economy. Ideally, they are treatments or management, or sometimes tests, leading to better patient outcomes, meaning people live longer or live better. Medicine has not been the number one contributor for living longer and living better

2. Jacobsen: What have been the observed impacts of evidence-based medicine in Canada?

Guyatt: That is a bit of a challenge. One that is unequivocal is that every educational program, undergraduate or post-graduate says, “We have to teach people to use the literature.” As you know, when the Royal College comes along and looks at residency programs, people who license universities to teach doctors. They say, “Are you teaching this EBM stuff?” Students are learning it. Indeed, it is standard for institutions to teach it. Guidelines have become more evidence-based.

The stories I told, you won’t see treatment where the evidence is in and the recommendations are ten years behind the times. You won’t see a new treatment where the randomized trials suggest the thing is useless, or even harmful to people. You do not see that anymore. We have a way to go in terms of dissemination now, but care is much more evidence-based than before. Values and preferences are still neglected! Ironically enough. However, people are doing things much, much more on the basis of the evidence than was previously the case.

3. Jacobsen: You mentioned a value in the home at the very outset of the conversation to do with skepticism. Something important to develop early in life, seems to me at least, comes from a natural philosophic or scientific bent, and logic and general doubt. Canadian, American, British, and Scottish cultural heroes state this in one way or another including David Suzuki, Carl Sagan, Bertrand Russell, the aforementioned David Hume, and others. What seems like the important of their – dead or alive, I know many of them are, 3 out of 4 – role for the increasing of academic and public awareness of critical thinking and evidence-based decision making?

Guyatt: Now, you’re asking me to be a social scientist, which I am not, I have a general notion: we’re always building on what is there before. EBM is skepticism-oriented. I don’t think we’re conscious a lot of the time about what has created the culture. So if you asked me who were the most prominent in intellectual history in Western culture, and in creating an atmosphere of skepticism, you listed a bunch. If you asked me before you listed them, I would have been in big trouble in terms of listing them myself.

You’re right. They created the milieu. When I went into it, and my mentors went into it, they had a natural skepticism. I am not a social scientist. I don’t know how this happened or how these things infiltrate the culture, but they do.

4. Jacobsen: Hypothetical worst case scenario: if Canadian citizens do not have accurate science information when making decisions about medicine, science, and public policy, how would this affect their everyday lives?

Guyatt: It depends on the particular decision. I will take one public policy item, which is the safe needle programs. The Harper government tried to shut down the Vancouver site. The safe needle program saves lives. This was interesting. It went to the Supreme Court. The Supreme Court said, “You can’t do this because of the evidence.” My political background and ideas lean Left. So it will not surprise that I was not fond of the Harper government, but their anti-science, suppressing the science in areas of the environment, in the areas of health, were extremely problematic.

One public policy issue where it was very problematic was the safe needle programs. The Supreme Court said, “Okay, you can’t ignore the science.” The science saved us.

5. Jacobsen: Hypothetical best case scenario: if Canadian citizens do have accurate science information when making decisions about medicine, science, and public policy, how will this affect their everyday lives?

Guyatt: That [Laughing] goes beyond medicine. To me, the swings in education are striking. Now, we should be structured. Everybody taking examinations and licensing. Ten years later, it is all wrong. We are restricting people. Nobody is being imaginative, and so on. Just do the rigorous experiments, and we would be able to find out what really is optimal.

The same thing happens in health care organization issues.  At one point you see the provincial government saying, “Oh, let’s centralize all healthcare decision-making in the province.”

Then a few years later, “Oh, it’s all going wrong.. No, no, let’s give more power to local decision-makers”  Then, a few years later. “No, no, that doesn’t work, let’s take the power back.” There are these swings. Why? Because nobody bothers to test it properly. Let’s get together, Canada is big enough. Let’s randomize jurisdictions to have decisions centralized, or take the responsibility and have the money going with it to local decision-makers. There are different ways of organizing decision-making. Let’s test it out!

As opposed to saying, or having people doing it out of conviction, “It sounds like a good idea. It kind of makes sense.” In medicine, we have recognized that’s not a good idea. People once thought bloodletting made sense as a treatment of pneumonia. Most supported bloodletting for all sorts of illnesses. It doesn’t make sense anymore, but it made sense to people before. As opposed to doing things because they made sense, the “what makes sense” is extremely fallible.

We have been conducting experiments and finding drugs thought to be beneficial, which end up killing people. Unfortunately, it happens from time-to-time. To do that within the wider realms of all kinds of public policy would be really nice.

6. Jacobsen: What seem like some uncomfortable truths in the medical research community at the moment in Canada?

Guyatt: I am having trouble, but one we may be swinging another way. We’re undertreating pain with narcotics. A lot of people suffer, unnecessarily. That was what was being told to everybody 10 years ago. Now, we have the epidemic of narcotic deaths. People were not prescribing properly. So there would be one example. Another one is everybody should be taking large doses of vitamin d for anything that ails you.

Now, fortunately, vitamin d is pretty innocuous. So we’re probably not hurting anyone, but the evidence in support of vitamin d helping anything is limited even in an optimistic analysis. It seems to have caught on as a rage. Like I say, the narcotics examples have terrible consequences. People might take too much of an unnecessary vitamin. Fortunately, it is not having – aside from the pocket book – minimal adverse effects.

7. Jacobsen: I could see a reason for that. 200,000 to 70,000 years ago, when we were roaming around from Lebanon’s Beqaa Valley to Mozambique, in the Great Rift Valley along with our other Great Primate ancestors, you’re in the sun all day. So you’re going to create a lot of vitamin d. I could see a reason for evolutionary mechanisms selected for that would buffer against or that would make it innocuous.

Guyatt: Yes, you’ve given a good example of physiological reasoning, which sometimes leads us in the right direction and occasionally in the wrong direction.

8. Jacobsen: What about in an international context, outside of Canada in other words?

There are unscrupulous people selling stem cell therapy for anything. In low and middle income countries, where things are not regulated as much, there are whole buildings and clinics built to take advantage of vulnerable people. Another thing would be cancer treatments. Another good example is multiple sclerosis. There is an Italian surgeon who came up with something about the blood vessels. It became a big rage. Everybody went off to different places all over to get his treatment.  Now, it has been recognized as completely without foundation.

There are drugs not in use in Canada, but are in use in India – where things are not regulated as well. These are useless. They are different than vitamin d. They have side effects. In low and middle income countries, where the dollar is much more crucial, there are all sort of unfortunate things happening.

9. Jacobsen: What about Canadian culture and general medical knowledge concerns you? Because that seems to me like the root of both to you of the things you’ve described.

Guyatt: One of my favorite mentees and a good friend is – he’s about my age – late in his career, and his current enthusiasm is about treating critical health thinking to grade school children. When I started in EBM, I realized this isn’t about healthcare, but this is about everything. I have given the education example, but people are talking evidence-based this, that, and the other thing now. I am delighted to hear it.

We need skepticism. The appropriate standards of what to believe and not to believe in every area. To an extent, my colleague succeeds in getting it into the grade schools and developing critical thinking is, or would be, a very good thing.

10. Jacobsen: What ethical philosophy seems the most correct to you?

Guyatt: “Correct” is an interesting word. How about substituting “appealing” for “correct”? Which tells you what I think about ethics, I told the story of the ethical standards with the 95-year-old demented person, which was radically different in North America, Peru, and Saudi Arabia. When people believed different things, the ethical decisions would differ. None of them is right. Healthcare, one of the big issues is equity. So we talked about equity versus choice. In the US, choice is a big value. I should be able to pay for better healthcare. A different ethical stance is equity is important. The fundamental thing, in politics and healthcare, my belief is equity is a much more important ethical principle than choice.

11. Jacobsen: What political philosophy seems the most appealing to you?

Guyatt: I am an old time socialist. [Laughing] I believe in governments. I believe in strong governments. We have seen plenty of evidence. When you don’t have governments regulating banks, and businesses, you have catastrophic results. I believe in income redistribution. Those responsible for the public wellbeing do things to ensure the public wellbeing.

12. Jacobsen: What social philosophy seems the most appealing to you?

Guyatt: Social philosophy, I am really ignorant. Quickly, educate me what is meant by “social philosophy.”

13. Jacobsen: By “social philosophy,” I mean the ways in which we should more efficiently, or better, arrange our social structures as a group or as individuals.

Guyatt: We are rich by interacting with each other. It is important to respect one another and to respect different ways of doing things.

14. Jacobsen: What economic philosophy seems the most appealing to you?

Guyatt: I do not like liberalism in the sense of economic liberalism and letting free markets do their thing. We have lots of examples. Obviously, there seems to me a big overlap between political and economic philosophies. I mentioned looking at the catastrophes of letting free markets operate in an unconstrained way.

15. Jacobsen: What principles interrelate these philosophies?

Guyatt: Equity would be one. Equity would be something that cuts across political and social philosophies. In contrasting between what’s more important, individual freedom or the wellbeing of the group, the individual freedoms, lower individual freedoms, and more emphasis on the wellbeing of the group. Those would be two.

16. Jacobsen: Any feelings or thoughts in conclusion?

Guyatt: The feeling and thought, and conclusion, is having the opportunity to hold forth in this way. I have really enjoyed it. Some of what I’ve achieved in education on some things. It has been a lot of fun. Thank you for thinking of me.

Jacobsen: Thank you for your time, Professor Guyatt.

References

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    Appendix I: Footnotes

    [1] Distinguished University Professor, Health Research Methods, Evidence and Impact, McMaster University.

    [2] Individual Publication Date: May 22, 2017 at http://www.in-sightjournal.com/an-interview-with-distinguished-university-professor-gordon-guyatt-oc-frsc-part-four; Full Issue Publication Date: September 1, 2017 at https://in-sightjournal.com/insight-issues/.

    [3] B.Sc., University of Toronto; M.D., General Internist, McMaster University Medical School; M.Sc., Design, Management, and Evaluation, McMaster University.

    [4] Credit: McMaster University.

Appendix II: Citation Style Listing

American Medical Association (AMA): Jacobsen S. An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part Four) [Online].May 2017; 14(A). Available from: http://www.in-sightjournal.com/an-interview-with-distinguished-university-professor-gordon-guyatt-oc-frsc-part-four.

American Psychological Association (APA, 6th Edition, 2010): Jacobsen, S.D. (2017, May 22). An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part Four)Retrieved from http://www.in-sightjournal.com/an-interview-with-distinguished-university-professor-gordon-guyatt-oc-frsc-part-four.

Brazilian National Standards (ABNT): JACOBSEN, S. An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part Four). In-Sight: Independent Interview-Based Journal. 14.A, May. 2017. <http://www.in-sightjournal.com/an-interview-with-distinguished-university-professor-gordon-guyatt-oc-frsc-part-four>.

Chicago/Turabian, Author-Date (16th Edition): Jacobsen, Scott. 2017. “An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part Four).” In-Sight: Independent Interview-Based Journal. 14.A. http://www.in-sightjournal.com/an-interview-with-distinguished-university-professor-gordon-guyatt-oc-frsc-part-four.

Chicago/Turabian, Humanities (16th Edition): Jacobsen, Scott “An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part Four).” In-Sight: Independent Interview-Based Journal. 14.A (May 2017). http://www.in-sightjournal.com/an-interview-with-distinguished-university-professor-gordon-guyatt-oc-frsc-part-four.

Harvard: Jacobsen, S. 2017, ‘An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part Four)In-Sight: Independent Interview-Based Journal, vol. 14.A. Available from: <http://www.in-sightjournal.com/an-interview-with-distinguished-university-professor-gordon-guyatt-oc-frsc-part-four>.

Harvard, Australian: Jacobsen, S. 2017, ‘An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part Four)In-Sight: Independent Interview-Based Journal, vol. 14.A., http://www.in-sightjournal.com/an-interview-with-distinguished-university-professor-gordon-guyatt-oc-frsc-part-four.

Modern Language Association (MLA, 7th Edition, 2009): Scott D. Jacobsen. “An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part Four).” In-Sight: Independent Interview-Based Journal 14.A (2017):May. 2017. Web. <http://www.in-sightjournal.com/an-interview-with-distinguished-university-professor-gordon-guyatt-oc-frsc-part-four>.

Vancouver/ICMJE: Jacobsen S. An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part Four) [Internet]. (2017, May; 14(A). Available from: http://www.in-sightjournal.com/an-interview-with-distinguished-university-professor-gordon-guyatt-oc-frsc-part-four.

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An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part Three)

Interviewer: Scott Douglas Jacobsen

Numbering: Issue 14.A, Idea: Outliers & Outsiders (Part Nine)

Place of Publication: Langley, British Columbia, Canada

Title: In-Sight: Independent Interview-Based Journal

Web Domain: http://www.in-sightjournal.com

Individual Publication Date: May 15, 2017

Issue Publication Date: September 1, 2017

Name of Publisher: In-Sight Publishing

Frequency: Three Times Per Year

Words: 2,849

ISSN 2369-6885

Gordon Guyatt

Abstract

An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC. He discusses: Sigmund Freud, Michel Foucault, Hirsch Index, and secure placement in the annals of medical and general history; evidence-based medicine (EBM) and its definition; the three principles of EM; and what one should do with evidence as value dependent.

Keywords: biostatistics, epidemiology, evidence-based medicine, Gordon Guyatt, Hirsch Index, McMaster University, research.

An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part Three)[1],[2],[3],[4]

*Footnotes in & after the interview, & citation style listing after the interview.*

*This interview has been edited for clarity and readability.*

1. Scott Douglas Jacobsen: In a list, and many others, with the most cited researchers in Canada, and in the world, with inclusion of the dead such as Sigmund Freud and Michel Foucault, that is, the ranks done by a Hirsch Index – the calculation of papers and the citations per paper to derive an individual academic’s Hirsch Index.[5] You have over 187,000 citations with a Hirsch-Index of about 217. In short, you are one of the most cited researchers, or the most cited researcher, in Canada and the 12th most cited researcher in the world, circa second week of February, 2017. Your position in the annals of medical and general history is secure. Based on the accomplishment, what does this mean to you?

Professor Gordon Guyatt: You described an evolution during my career. This electronic counting of citations was not something around until about a decade ago. It became a standard by which people are judged because you can count it. In the past, you can say, “This paper is good. It seems to have influenced people. People seem to like it. I get the impression people are using it.” However, that is different than the figures there. You can say, “Okay, here people are reading this, and they are using it, and researchers are citing it in their own work, and so on and so forth.”

It has downsides, where journals are judged this way, too. The journals are rated by their impact factor, which is how much they are cited. It goes into gaming. The impact factor is the citations per article. One way to improve your impact factor is to publish less studies. Only publish the ones going to be cited. Then you make a deal, “Okay, this type of article. It is just really a type of opinion piece. It is going to count in the denominator of my ranking.”

It potentially has negative effects as opposed to using other criteria for important research, at least important to some people. Is it well done? It is good research? Those things may still be important. Is it going to be cited? How much is it going to be cited? Sometimes, complete baloney may get lots of citations. Leading journals always publish because of the newspaper value of their articles, but perhaps even more the case because the way the journal is evaluated is on the basis of this impact factor. It has to do with citations.

Even so, it is nice to have this objective standard of the fact that work has made an impact, but I am not sure this is healthy. However, it is nice. Usually, what happens with an article is that it comes out, has 2 or 3 years of high citations, citations fall off, and then 5 years 10 years later, it is not cited. Probably, it is the same for most publications. It is gratifying for me. I have papers cited a 100 times during a year. That is a lot of citations. Some are 20-years-old and getting about a 100 citations per year.

Even if 20 years later they get 25 citations per year, that says, “It is a major test of time. People find it useful.” That is, you do a piece of work, then somebody builds on it. Then what you did before, and what people cite the paper tells you that they have built on it, particularly if it gets cited 20 years later.  The original work is still compelling enough to people that they say, “Okay, I’m citing the work that started us down this road.” The way these things work with the electronic counting is nice.

It has downsides. It is distracting. One colleague made fun of me. I was saying, “Hey! I was checking my h-factor, and it is still going up.” My colleague responded, “Mirror, mirror on the wall…”, referring to one of the queens in the fairy tale saying, “Mirror, mirror on the wall, who’s the most beautiful of them all?” It was warranted. There are downsides, but it is nice to have objective criteria. It says, “People pay attention to your work and value it.”

2. Jacobsen: The phrase, sometimes mistaken for a term, “evidence-based medicine,” (EBM) originated in a paper by you. What defines EBM?

Guyatt: In 1990, I coined the term. 1991 was the first published paper that used the term. People often don’t notice that one. 1992 was the paper that caught the world’s attention.

3. Jacobsen: You summarized its principles. Principle one, summarize evidence to help make and guide the best decisions. Principle two, hierarchy of evidence for randomized trials. Principle three, context of value and preferences for expert decision making. What else defines evidence-based decision making? As per the presentation style, what are some examples?

Guyatt: To start, what you listed was not there at the beginning, it evolved. The values and preferences stuff was not there at the beginning. We didn’t get it. People thought values and preferences were in the sub-conscious, but we didn’t get it. It had to be added. The 1990s were the EBM aspect. 5 years later, we tweaked the values and preferences. The way we characterize it now is one principle is that you need to summarize and have systematic of all of the highest quality evidence to make good decisions.

An illustration would be that in many areas one paper says, “This treatment is great.” Another paper says, “It is not at all great.” A focus on either one will result in a misleading presentation. You need systematic summaries of the best available evidence. I tell stories. The stories illustrate treatments for myocardial infarction, where there’s one treatment where – this has been superseded but – we put in a drug, clot-busting drugs, that broke up the clots that were causing the heart attack.

Turns out that these clot-busting drugs reduces mortality by about 1/4. It was 10 years after the answer came back from randomized trials before the community got it. It was before the era of the systematic summaries. Another story is about another drug. People have heart attacks. They have arrhythmias, which means abnormalities of the heart beat. It can kill them.  The drug was given to obliterate or decrease nasty-looking arrhythmias. We thought, “Okay, if you get rid of the nasty-looking arrhythmias, you’re going to get rid of the ones that kill people.”

It didn’t. In fact, there have been a number of such promising looking drugs that have ended up killing people more. When I was in training, I was giving one such drug out all of the time. The evidence said this wasn’t a good idea, but nobody systematically summarized; people were picking studies here and there. We systematically summarize the best evidence to avoid that problem. Next, we need to know what makes the best evidence.

You mentioned a hierarchy of evidence. EBM has been criticized for being excessively randomized-trial focused; in the past, that might be true, but it has evolved. Now, we have much more sophisticated system, that acknowledges randomized trials may be poorly done. They may give inconsistent results. They may not be applicable to your patient. I work as a general internist. I have a lot of people over 90. A lot of randomized trials out there. It raises questions about the extent to which I can apply the trials to those over 90.

Trials may be small and less trustworthy. Anyway, we recognize randomized trials as a good thing. However, you might lose confidence in your randomized trials for a variety of reasons. Similarly, we don’t need randomized trials to show insulin works in diabetic ketoacidosis – where people are dead pretty quickly if you don’t use it. We don’t need randomized trials to show epinephrine works in people with anaphylactic shock who are about to die. We don’t need randomized trials to show that dialysis is a good thing for people with renal failure, et cetera.

There’s an explicit formulation, “Yes, in general, randomized trials generally give higher quality evidence, but sometimes not without limitations, and in general observational studies have lower quality evidence, but not always with large and clear effects.” So we developed a much more sophisticated hierarchy. Some evidence is more trustworthy than others, but we have developed a more sophisticated hierarchy.

The third principle is values and principles. I introduce values and preferences by saying, “What do you think about antibiotics for pneumonia?” Even the lay people will say, “Good idea! Yea, antibiotics worked for pneumonia, we all agree on the evidence. Antibiotics for pneumonia.” I say, “Let me tell you about a patient. He’s 95 years old. He’s severely demented, incontinent of bowel and bladder, lives in a long-care institution. He’s 95, nobody’s been to visit him for 5 years, and he moans in apparent discomfort from morning to night. This individual develops pneumonia. Do you think it’s a good idea that he gets antibiotics?”

In North America, 95% of people say, “No.” They think this guy would be better off dead. So treating the pneumonia is not doing him any favours, if you ask most people, put yourself in the situation of such an individual, would you want to be treated? Most people would say, “No, thank you.” In North America, 5% of people say, “Yes, it is a good idea to treat the person.” So we all agree on the evidence. Our disagreement as to whether this individual should be treated has nothing to do with the evidence.

It has to do with something else. We label that “values and preferences.” So I go on with the story. I used this example repeatedly to illustrate the values and preferences. I went to Peru probably 10 or 15 years ago. I already used the story in North America many times. I went to Peru and said, “Who thinks this is a good idea to treat this patient?” About 2/3rds of people raised their hand and said, “Yes.” I thought, “Wow, something’s wrong here. This is a Spanish speaking audience. I’m speaking English, I have not communicated properly.” I go over it slowly, again. two thirds of the people still say, “Yes.”

I asked the host afterwards, “How come it is so different?” They said, “Catholic culture.” That was their attribution. I go to Saudi Arabia. 95% of the people say, “Yes, the patient should be treated.” All of us agreed on the evidence. That’s not why there are differences. It is something else. That’s what we call values and preferences. Then I tell stories of people at risk of stroke. The treatment reduce stroke but will increase their risk of bleeding. Some people say, “Yes, use the treatment.” Because there’s big values in preventing stroke. Some people say, “No.” Because they are terrified of a bleeding, and so on.

In other words, evidence never tells you what to do, whenever there’s trade-offs with their values, preferences, and judgements, those are always important in making the right decision.

4. Jacobsen: This goes to some of the earliest, or more modern, empiricists like David Hume with his is/ought distinction. You can get the highest quality evidence you can get, even with modern technology, but what you should do with that evidence is going to be culture and value dependent.

Guyatt: That is exactly right. That is exactly right.

References

  1. Bennett, K. (2014, October 31). New hospital funding model ‘a shot in the dark,’ McMaster study says. Retrieved from http://www.cbc.ca/news/canada/hamilton/news/new-hospital-funding-model-a-shot-in-the-dark-mcmaster-study-says-1.2817321.
  2. Blackwell, T. (2015, February 1). World Health Organization’s advice based on weak evidence, Canadian-led study says. Retrieved from http://news.nationalpost.com/health/world-health-organizations-advice-extremely-untrustworthy-and-not-evidence-based-study.
  3. Branswell, H. (2014, January 30). You should be avoiding these products on drug-store shelves. Retrieved from http://www.theglobeandmail.com/life/health-and-fitness/health/you-should-be-avoiding-these-products-on-drug-store-shelves/article16606013/?page=all.
  4. Canadian News Wire. (2015, October 8). The Canadian Medical Hall of Fame announces 2016 inductees. Retrieved from http://www.newswire.ca/news-releases/the-canadian-medical-hall-of-fame-announces-2016-inductees-531287111.html.
  5. Cassar, V. & Bezzina, F. (2015, March 25). The evidence is clear. Retrieved from http://www.timesofmalta.com/articles/view/20150325/life-features/The-evidence-is-clear.561338.
  6. Clarity Research. (2016). Clinical Advances Through Research and Information Translation. Retrieved from http://www.clarityresearch.ca/gordon-guyatt/.
  7. Craggs, S. (2015, July 21). We can actually win this one, Tom Mulcair tells Hamilton crowd. Retrieved from http://www.cbc.ca/news/canada/hamilton/news/we-can-actually-win-this-one-tom-mulcair-tells-hamilton-crowd-1.3162688.
  8. Escott, S. (2013, December 2). Mac professor named top health researcher. Retrieved from http://www.thespec.com/news-story/4249292-mac-professor-named-top-health-researcher/.
  9. Feise, R. & Cooperstein, R. (2014, February 1). Putting the Patient First. Retrieved from http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=56855.
  10. Frketich, J. (2016, July 8). 63 McMaster University investigators say health research funding is flawed. Retrieved from http://www.thespec.com/news-story/6759872-63-mcmaster-university-investigators-say-health-research-funding-is-flawed/.
  11. Helsingin yliopisto. (2017, March 23). Clot or bleeding? Anticoagulants walk the line between two risks. Retrieved from https://www.sciencedaily.com/releases/2017/03/170323083909.htm.
  12. Hopper, T. (2012, August 24). You’re pregnant, now sign this petition: Group slams Ontario doctors’ ‘coercive’ tactics to fight cutbacks. Retrieved from http://news.nationalpost.com/news/canada/youre-pregnant-now-sign-this-petition-group-criticizes-doctors-who-encourage-patients-to-sign-anti-cutbacks-letter.
  13. Kerr, T. (2011, May 30). Thomas Kerr: Insite has science on its side. Retrieved from http://news.nationalpost.com/full-comment/thomas-kerr-vancouvers-insite-clinic-has-been-a-resounding-success.
  14. Kirkey, S. (2015, October 29). WHO gets it wrong again: As with SARS and H1N1, its processed-meat edict went too far. Retrieved from http://news.nationalpost.com/health/is-whos-smackdown-of-processed-meat-a-considerable-overcall-or-just-informing-the-public-of-health-risks.
  15. Kolata, G. (2016, August 3). Why ‘Useless’ Surgery Is Still Popular. Retrieved from https://www.nytimes.com/2016/08/04/upshot/the-right-to-know-that-an-operation-is-next-to-useless.html?_r=0.
  16. Maxmen, A. (2011, July 6). Nutrition advice: The vitamin D-lemma. Retrieved from http://www.nature.com/news/2011/110706/full/475023a.html.
  17. McKee, M. (2014, October 2). The Power of Single-Person Medical Experiments. Retrieved from http://discovermagazine.com/2014/nov/17-singled-out.
  18. McMaster University. (2016). Gordon Guyatt. Retrieved from http://fhs.mcmaster.ca/ceb/faculty_member_guyatt.htm.
  19. Neale, T. (2009, December 12). Doctor’s Orders: Practicing Evidence-Based Medicine Is a Challenge. Retrieved from http://www.medpagetoday.com/practicemanagement/practicemanagement/17486.
  20. Nolan, D. (2011, December 31). Mac’s Dr. Guyatt to enter Order of Canada. Retrieved from http://www.thespec.com/news-story/2227923-mac-s-dr-guyatt-to-enter-order-of-canada/.
  21. O’Dowd, A. (2016, July 21). Exercise could be as effective as surgery for knee damage. Retrieved from https://www.onmedica.com/newsArticle.aspx?id=e13a0a94-5e96-43b9-86b7-7de237630beb.
  22. Palmer, K. & Guyatt, G. (2014, December 16). New funding model a leap of faith for Canadian hospitals. Retrieved from http://www.theglobeandmail.com/opinion/why-new-funding-model-a-leap-of-faith-for-canadian-hospitals/article22100796/.
  23. Park, A. (2012, February 7). No Clots in Coach? Debunking ‘Economy Class Syndrome’. Retrieved from http://healthland.time.com/2012/02/07/no-clots-in-coach-debunking-economy-class-syndrome/.
  24. Picard, A. (2015, May 25). David Sackett: The father of evidence-based medicine. Retrieved from http://www.theglobeandmail.com/life/health-and-fitness/health/david-sackett-the-father-of-evidence-based-medicine/article24607930/.
  25. Priest, L. (2012, June 17). What you should know about doctors and self-referral fees. Retrieved from http://www.theglobeandmail.com/life/health-and-fitness/ask-a-health-expert/what-you-should-know-about-doctors-and-self-referral-fees/article4267688/.
  26. Rege, A. (2015, August 5). Why medically unnecessary surgeries still happen. Retrieved from http://www.beckershospitalreview.com/population-health/why-medically-unnecessary-surgeries-still-happen.html.
  27. Science Daily. (2016, October 26). Ultrasound after tibial fracture surgery does not speed up healing or improve function. Retrieved from https://www.sciencedaily.com/releases/2016/10/161026141643.htm.
  28. Spears, T. (2016, July 7). Agriculture Canada challenged WHO’s cancer warnings on meat: newly-released documents. Retrieved from http://news.nationalpost.com/news/canada/agriculture-canada-challenged-whos-cancer-warnings-on-meat-according-to-newly-released-documents.
  29. Tomsic, M. (2015, February 10). Dying. It’s Tough To Discuss, But Doesn’t Have To Be. Retrieved from http://wfae.org/post/dying-its-tough-discuss-doesnt-have-be.
  30. Webometrics. (2010). 1040 Highly Cited Researchers (h>100) according to their Google Scholar Citations public profiles. Retrieved from http://www.webometrics.info/en/node/58.

Appendix I: Footnotes

[1] Distinguished University Professor, Health Research Methods, Evidence and Impact, McMaster University.

[2] Individual Publication Date: May 15, 2017 at www.in-sightjournal.com; Full Issue Publication Date: September 1, 2017 at https://in-sightjournal.com/insight-issues/.

[3] B.Sc., University of Toronto; M.D., General Internist, McMaster University Medical School; M.Sc., Design, Management, and Evaluation, McMaster University.

[4] Credit: McMaster University.

[5] Webometrics. (2010). 1040 Highly Cited Researchers (h>100) according to their Google Scholar Citations public profiles. Retrieved from http://www.webometrics.info/en/node/58.

Appendix II: Citation Style Listing

American Medical Association (AMA): Jacobsen S. An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part Three) [Online].May 2017; 14(A). Available from: http://www.in-sightjournal.com/an-interview-with-distinguished-university-professor-gordon-guyatt-oc-frsc-part-three.

American Psychological Association (APA, 6th Edition, 2010): Jacobsen, S.D. (2017, May 15). An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part Three)Retrieved from http://www.in-sightjournal.com/an-interview-with-distinguished-university-professor-gordon-guyatt-oc-frsc-part-three.

Brazilian National Standards (ABNT): JACOBSEN, S. An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part Three). In-Sight: Independent Interview-Based Journal. 14.A, May. 2017. <http://www.in-sightjournal.com/an-interview-with-distinguished-university-professor-gordon-guyatt-oc-frsc-part-three>.

Chicago/Turabian, Author-Date (16th Edition): Jacobsen, Scott. 2017. “An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part Three).” In-Sight: Independent Interview-Based Journal. 14.A. http://www.in-sightjournal.com/an-interview-with-distinguished-university-professor-gordon-guyatt-oc-frsc-part-three.

Chicago/Turabian, Humanities (16th Edition): Jacobsen, Scott “An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part Three).” In-Sight: Independent Interview-Based Journal. 14.A (May 2017). http://www.in-sightjournal.com/an-interview-with-distinguished-university-professor-gordon-guyatt-oc-frsc-part-three.

Harvard: Jacobsen, S. 2017, ‘An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part Three)In-Sight: Independent Interview-Based Journal, vol. 14.A. Available from: <http://www.in-sightjournal.com/an-interview-with-distinguished-university-professor-gordon-guyatt-oc-frsc-part-three>.

Harvard, Australian: Jacobsen, S. 2017, ‘An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part Three)In-Sight: Independent Interview-Based Journal, vol. 14.A., http://www.in-sightjournal.com/an-interview-with-distinguished-university-professor-gordon-guyatt-oc-frsc-part-three.

Modern Language Association (MLA, 7th Edition, 2009): Scott D. Jacobsen. “An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part Three).” In-Sight: Independent Interview-Based Journal 14.A (2017):May. 2017. Web. <http://www.in-sightjournal.com/an-interview-with-distinguished-university-professor-gordon-guyatt-oc-frsc-part-three>.

Vancouver/ICMJE: Jacobsen S. An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part Three) [Internet]. (2017, May; 14(A). Available from: http://www.in-sightjournal.com/an-interview-with-distinguished-university-professor-gordon-guyatt-oc-frsc-part-three.

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© Scott Douglas Jacobsen, and In-Sight Publishing and In-Sight: Independent Interview-Based Journal 2012-2017. Unauthorized use and/or duplication of this material without express and written permission from this site’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Scott Douglas Jacobsen, and In-Sight Publishing and In-Sight: Independent Interview-Based Journal with appropriate and specific direction to the original content.  All interviewees co-copyright their interview material and may disseminate for their independent purposes.

An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part Two)

Interviewer: Scott Douglas Jacobsen

Numbering: Issue 14.A, Idea: Outliers & Outsiders (Part Nine)

Place of Publication: Langley, British Columbia, Canada

Title: In-Sight: Independent Interview-Based Journal

Web Domain: http://www.in-sightjournal.com

Individual Publication Date: May 8, 2017

Issue Publication Date: September 1, 2017

Name of Publisher: In-Sight Publishing

Frequency: Three Times Per Year

Words: 2,553

ISSN 2369-6885

Gordon Guyatt

Abstract

An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC. He discusses: personal research style; good and bad educators, and good and bad students; earning professional recognitions; responsibilities associated with exposure in the media; and what makes a good speaker and presentation on medicine and public policy.

Keywords: biostatistics, epidemiology, Gordon Guyatt, McMaster University, research.

An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part Two)[1],[2],[3],[4]

*Footnotes in & after the interview, & citation style listing after the interview.*

*This interview has been edited for clarity and readability.*

1. Scott Douglas Jacobsen: What defines personal research style to you?

Professor Gordon Guyatt: A couple of things. One style may be a little obsessive-compulsive, which is required to some extent. I contrast myself with an extremely successful researcher who has everything planned for the future. He knows. For this guy, with his 5-year plan, he can go right up to 4 years and 11 months. He knows. He has a direction. I am at the other extreme. Where you ask me what I am going to be doing 3 months from now, I couldn’t tell you.

It suits me, especially with the different graduate students. Each doing something different. I can’t even track them. I follow along. So the contrasting strategies are a careful plan versus whatever idea occurs to you today and follow it along. Those are extreme differences.

Another style issue is collaboration. I’m in this extremely collaborative environment, but there are gradients. There are people who like to collaborate, but they prefer more to do their own thing. They like to lead projects. The contrast is between enjoying the collaborative working environment whatever one’s roles as opposed to being the boss.

Some investigators like to be a boss and equality in collaboration with younger or junior folks is less their style. I see myself at the other extreme of someone who loves collaboration and loves creating teams of people. Others may not be ready to treat juniors as equals, not ready to tell them explicitly, “It’s your project. You make decisions. I’ll make suggestions. I’ll make a case. I’ll tell you if I think you’re going wrong. I’ll tell you how I think it could be made better, but it’s your project and your decision.” Those are different approaches.

Each approach has its merits. There are many successful people who are disciplined, have a plan, like to be the boss, and still manage mentorship. It is not one is better than the other, or right or wrong, but I see myself more in the collaboration and team creation side of the spectrum.

2. Jacobsen: I will dig a little deeper, but connect this to mentors and students. What differentiates a good teacher or educator from the bad one, and the good student from the bad one?

Guyatt: There are different styles. A good teacher has to be enthusiastic, love what they’re doing, deeply care about what they’re doing, place a high value on sparking the excitement, response, interest, and engagement of the learner. Ideally, or to some extent a necessity, being a good at explaining, clarifying, simplifying, finding ways to communicate concepts so the light goes on in the learner. The bad teacher will be the opposite. Not terribly excited, not a high level of enthusiasm.

Also, not caring about whether the message gets through or not, and simply wants to teach the course and move on, not very good at communicating concepts, and so on, it would be the absence of the positive characteristics. Good students, it is nice if they are smart. It is nice if they are well organized. I have students who are limited in those ways. Fortunately, even those folks are committed, hardworking, most are good listeners, they take direction well.

If lucky, the best learners are imaginative, pick up ideas fast, start using the concepts themselves, start coming up with great ideas I would never have thought, which is the imagination, energetic, and enthusiastic. Occasionally, somebody comes along. A few people come along who have everything. I have had the opportunity to mentor them. It is wonderful. Most of the people in this huge slew of these PhD students only have one or more of the characteristics. Most care, are committed and hardworking, but there is tremendous variability.

3. Jacobsen: You earned the McMaster University “President’s Award for Excellence in Teaching” (Course or Resource Design), short-list for the “British Medical Journal Lifetime Achievement Award,” as well as the positions of Fellow of the Canadian Academy of Health Sciences, Distinguished University Professor at McMaster University, Officer of the Order of Canada, Fellow of the Ryan Society of Canada, and a member of the Canadian Medical Hall of Fame.[5] These mean weight to professional work, lifetime achievement, and expressed opinions by you. What do these recognitions mean to you?

Guyatt: Two mean the most to me. One is the Order of Canada or Officer of the Order of Canada because of the recognition outside of science and medicine. It is a recognition of contribution to the wider society. The other called the – the Canadian Institutes of Health is the leading academic granting body in the country, the premier, the most prestigious grants, and they have an award called – Canada’s Health Researcher of the Year (CHR), which doesn’t mean great job for the year. It is a career award. It is saying, “Who is the top researcher in the country to whom we haven’t already given an award?” There is a competition for research dollars among basic scientists, test-tube physiology-oriented scientists, and folks like me who are clinical researchers.

The basic researchers dominate the CHR. That is, the clinical epidemiology researchers see those guys get more of the money than us. There is a competition between groups. Most people would agree that the senior leadership in CHR is basic science. Anyway, several years ago, they gave me Canada’s Health Researcher of the Year award. It was nice. They were saying, “You’re the best researcher in the country, leaving aside all of those that have already won the award.” I earned the award as a clinical research, not as a basic researcher.

That was the recognition. On the one hand, with the Order of Canada, I was recognized for making a social contribution important to the society as a whole beyond my field; on the other hand, they chose me as the top researcher in the country. That was nice in terms of recognition.

4. Jacobsen: Associated with this. You have numerous representations in the media. What responsibilities to the public, and the medical, public policy, and scientific community?

Guyatt: To behave with integrity, the main responsibility when you disseminate is accuracy. Another specific concern is conflict of interest. Many people within the medical community who take public stances are conflicted. They get lots of money from industry. It is hard for that not to influence you. We have intellectual conflicts of interest. Every researcher prefers their research. If their findings contradict somebody else’s, then they are right. The other person’s findings must be wrong. This is a universal phenomenon.

There is a responsibility to be aware of one’s conflict of interest. When there are conflicts of interest, it is crucial to make the conflicts clear. Also, there is responsibility to attempt to minimize the conflicts of interest, and the presentation and interpretation of things. There is a responsibility to listen and be open to other perspectives. Other people’s points of views.

5. Jacobsen: You spoke in many, many venues and gave many, many other lectures. What makes a good speaker, and a great presentation on medicine and public policy?

Guyatt: There are the same pieces if you’re talking about medicine and public policy, or whether you’re talking about basic clin-epi. We will talk about large group presentations. [Laughing] I run a course on how to teach evidence-based healthcare. One of the things is the students often see what we hope is the best lectures. These group are small groups, but lectures are done well. They see a few lectures. Then we say, “What’s made this lecture good?” As much as we’d like to think we put on good lectures, there are issues.

First, the person must be enthusiastic. They must give the impression that they believe that what they’re talking about is interesting, energetic, and that manifests itself in various ways. I never speak from behind a podium. I give a roving mic. I come out in front of the audience getting or becoming immediate with the audience. As one of my colleagues has said, “Just talk to them.” Which means, be calm, relaxed, and conversational, and look around, and talk to the people in front of you, you should make eye contact.

With a 1,000 people, you can make eye contact all over the place. Well-organized, very knowledgeable about what you’re talking about, we have a rule: “Tell’em what you’re going to say, say it, and then tell’em what you’ve said.” An organization includes, “Okay, folks, here are the major points I’m going to make.” You do it. At the end, you say, “Okay, folks, what might you want to take away from this, what major points have we made.” That structure is a crucial thing.

Humor if you can manage it. Oh! Examples, tell stories, the way to communicate things if you’re speaking in public, my talks are mostly story after story after story of illustrating things. You need to engage people by telling stories. One thing, I have done this stuff for so long. It comes naturally. I have to be careful. If I am not careful, I will be talking at the same time in – not quite a monotone, but a very even tone.

“Point one. Now, point two. Now, point three,” as opposed to, “Point one. Now, point three, which is much more important! Point three. Point four!” The modulation of tone and affect rather than an even tone and affect. That’s one thing. That’s a bunch of stuff. I could probably think of some more.

References

  1. Bennett, K. (2014, October 31). New hospital funding model ‘a shot in the dark,’ McMaster study says. Retrieved from http://www.cbc.ca/news/canada/hamilton/news/new-hospital-funding-model-a-shot-in-the-dark-mcmaster-study-says-1.2817321.
  2. Blackwell, T. (2015, February 1). World Health Organization’s advice based on weak evidence, Canadian-led study says. Retrieved from http://news.nationalpost.com/health/world-health-organizations-advice-extremely-untrustworthy-and-not-evidence-based-study.
  3. Branswell, H. (2014, January 30). You should be avoiding these products on drug-store shelves. Retrieved from http://www.theglobeandmail.com/life/health-and-fitness/health/you-should-be-avoiding-these-products-on-drug-store-shelves/article16606013/?page=all.
  4. Canadian News Wire. (2015, October 8). The Canadian Medical Hall of Fame announces 2016 inductees. Retrieved from http://www.newswire.ca/news-releases/the-canadian-medical-hall-of-fame-announces-2016-inductees-531287111.html.
  5. Cassar, V. & Bezzina, F. (2015, March 25). The evidence is clear. Retrieved from http://www.timesofmalta.com/articles/view/20150325/life-features/The-evidence-is-clear.561338.
  6. Clarity Research. (2016). Clinical Advances Through Research and Information Translation. Retrieved from http://www.clarityresearch.ca/gordon-guyatt/.
  7. Craggs, S. (2015, July 21). We can actually win this one, Tom Mulcair tells Hamilton crowd. Retrieved from http://www.cbc.ca/news/canada/hamilton/news/we-can-actually-win-this-one-tom-mulcair-tells-hamilton-crowd-1.3162688.
  8. Escott, S. (2013, December 2). Mac professor named top health researcher. Retrieved from http://www.thespec.com/news-story/4249292-mac-professor-named-top-health-researcher/.
  9. Feise, R. & Cooperstein, R. (2014, February 1). Putting the Patient First. Retrieved from http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=56855.
  10. Frketich, J. (2016, July 8). 63 McMaster University investigators say health research funding is flawed. Retrieved from http://www.thespec.com/news-story/6759872-63-mcmaster-university-investigators-say-health-research-funding-is-flawed/.
  11. Helsingin yliopisto. (2017, March 23). Clot or bleeding? Anticoagulants walk the line between two risks. Retrieved from https://www.sciencedaily.com/releases/2017/03/170323083909.htm.
  12. Hopper, T. (2012, August 24). You’re pregnant, now sign this petition: Group slams Ontario doctors’ ‘coercive’ tactics to fight cutbacks. Retrieved from http://news.nationalpost.com/news/canada/youre-pregnant-now-sign-this-petition-group-criticizes-doctors-who-encourage-patients-to-sign-anti-cutbacks-letter.
  13. Kerr, T. (2011, May 30). Thomas Kerr: Insite has science on its side. Retrieved from http://news.nationalpost.com/full-comment/thomas-kerr-vancouvers-insite-clinic-has-been-a-resounding-success.
  14. Kirkey, S. (2015, October 29). WHO gets it wrong again: As with SARS and H1N1, its processed-meat edict went too far. Retrieved from http://news.nationalpost.com/health/is-whos-smackdown-of-processed-meat-a-considerable-overcall-or-just-informing-the-public-of-health-risks.
  15. Kolata, G. (2016, August 3). Why ‘Useless’ Surgery Is Still Popular. Retrieved from https://www.nytimes.com/2016/08/04/upshot/the-right-to-know-that-an-operation-is-next-to-useless.html?_r=0.
  16. Maxmen, A. (2011, July 6). Nutrition advice: The vitamin D-lemma. Retrieved from http://www.nature.com/news/2011/110706/full/475023a.html.
  17. McKee, M. (2014, October 2). The Power of Single-Person Medical Experiments. Retrieved from http://discovermagazine.com/2014/nov/17-singled-out.
  18. McMaster University. (2016). Gordon Guyatt. Retrieved from http://fhs.mcmaster.ca/ceb/faculty_member_guyatt.htm.
  19. Neale, T. (2009, December 12). Doctor’s Orders: Practicing Evidence-Based Medicine Is a Challenge. Retrieved from http://www.medpagetoday.com/practicemanagement/practicemanagement/17486.
  20. Nolan, D. (2011, December 31). Mac’s Dr. Guyatt to enter Order of Canada. Retrieved from http://www.thespec.com/news-story/2227923-mac-s-dr-guyatt-to-enter-order-of-canada/.
  21. O’Dowd, A. (2016, July 21). Exercise could be as effective as surgery for knee damage. Retrieved from https://www.onmedica.com/newsArticle.aspx?id=e13a0a94-5e96-43b9-86b7-7de237630beb.
  22. Palmer, K. & Guyatt, G. (2014, December 16). New funding model a leap of faith for Canadian hospitals. Retrieved from http://www.theglobeandmail.com/opinion/why-new-funding-model-a-leap-of-faith-for-canadian-hospitals/article22100796/.
  23. Park, A. (2012, February 7). No Clots in Coach? Debunking ‘Economy Class Syndrome’. Retrieved from http://healthland.time.com/2012/02/07/no-clots-in-coach-debunking-economy-class-syndrome/.
  24. Picard, A. (2015, May 25). David Sackett: The father of evidence-based medicine. Retrieved from http://www.theglobeandmail.com/life/health-and-fitness/health/david-sackett-the-father-of-evidence-based-medicine/article24607930/.
  25. Priest, L. (2012, June 17). What you should know about doctors and self-referral fees. Retrieved from http://www.theglobeandmail.com/life/health-and-fitness/ask-a-health-expert/what-you-should-know-about-doctors-and-self-referral-fees/article4267688/.
  26. Rege, A. (2015, August 5). Why medically unnecessary surgeries still happen. Retrieved from http://www.beckershospitalreview.com/population-health/why-medically-unnecessary-surgeries-still-happen.html.
  27. Science Daily. (2016, October 26). Ultrasound after tibial fracture surgery does not speed up healing or improve function. Retrieved from https://www.sciencedaily.com/releases/2016/10/161026141643.htm.
  28. Spears, T. (2016, July 7). Agriculture Canada challenged WHO’s cancer warnings on meat: newly-released documents. Retrieved from http://news.nationalpost.com/news/canada/agriculture-canada-challenged-whos-cancer-warnings-on-meat-according-to-newly-released-documents.
  29. Tomsic, M. (2015, February 10). Dying. It’s Tough To Discuss, But Doesn’t Have To Be. Retrieved from http://wfae.org/post/dying-its-tough-discuss-doesnt-have-be.
  30. Webometrics. (2010). 1040 Highly Cited Researchers (h>100) according to their Google Scholar Citations public profiles. Retrieved from http://www.webometrics.info/en/node/58.

Appendix I: Footnotes

[1] Distinguished University Professor, Health Research Methods, Evidence and Impact, McMaster University.

[2] Individual Publication Date: May 8, 2017 at http://www.in-sightjournal.com/an-interview-with-distinguished-university-professor-gordon-guyatt-oc-frsc-part-two; Full Issue Publication Date: September 1, 2017 at https://in-sightjournal.com/insight-issues/.

[3] B.Sc., University of Toronto; M.D., General Internist, McMaster University Medical School; M.Sc., Design, Management, and Evaluation, McMaster University.

[4] Credit: McMaster University.

[5] Clarity Research. (2016). Clinical Advances Through Research and Information Translation. Retrieved from http://www.clarityresearch.ca/gordon-guyatt/.

Appendix II: Citation Style Listing

American Medical Association (AMA): Jacobsen S. An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part Two) [Online].May 2017; 14(A). Available from: http://www.in-sightjournal.com/an-interview-with-distinguished-university-professor-gordon-guyatt-oc-frsc-part-two.

American Psychological Association (APA, 6th Edition, 2010): Jacobsen, S.D. (2017, May 8). An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part Two)Retrieved from http://www.in-sightjournal.com/an-interview-with-distinguished-university-professor-gordon-guyatt-oc-frsc-part-two.

Brazilian National Standards (ABNT): JACOBSEN, S. An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part Two). In-Sight: Independent Interview-Based Journal. 14.A, May. 2017. <http://www.in-sightjournal.com/an-interview-with-distinguished-university-professor-gordon-guyatt-oc-frsc-part-two>.

Chicago/Turabian, Author-Date (16th Edition): Jacobsen, Scott. 2017. “An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part Two).” In-Sight: Independent Interview-Based Journal. 14.A. http://www.in-sightjournal.com/an-interview-with-distinguished-university-professor-gordon-guyatt-oc-frsc-part-two.

Chicago/Turabian, Humanities (16th Edition): Jacobsen, Scott “An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part Two).” In-Sight: Independent Interview-Based Journal. 14.A (May 2017). http://www.in-sightjournal.com/an-interview-with-distinguished-university-professor-gordon-guyatt-oc-frsc-part-two.

Harvard: Jacobsen, S. 2017, ‘An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part Two)In-Sight: Independent Interview-Based Journal, vol. 14.A. Available from: <http://www.in-sightjournal.com/an-interview-with-distinguished-university-professor-gordon-guyatt-oc-frsc-part-two>.

Harvard, Australian: Jacobsen, S. 2017, ‘An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part Two)In-Sight: Independent Interview-Based Journal, vol. 14.A., http://www.in-sightjournal.com/an-interview-with-distinguished-university-professor-gordon-guyatt-oc-frsc-part-two.

Modern Language Association (MLA, 7th Edition, 2009): Scott D. Jacobsen. “An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part Two).” In-Sight: Independent Interview-Based Journal 14.A (2017):May. 2017. Web. <http://www.in-sightjournal.com/an-interview-with-distinguished-university-professor-gordon-guyatt-oc-frsc-part-two>.

Vancouver/ICMJE: Jacobsen S. An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part Two) [Internet]. (2017, May; 14(A). Available from: http://www.in-sightjournal.com/an-interview-with-distinguished-university-professor-gordon-guyatt-oc-frsc-part-two.

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© Scott Douglas Jacobsen, and In-Sight Publishing and In-Sight: Independent Interview-Based Journal 2012-2017. Unauthorized use and/or duplication of this material without express and written permission from this site’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Scott Douglas Jacobsen, and In-Sight Publishing and In-Sight: Independent Interview-Based Journal with appropriate and specific direction to the original content.  All interviewees co-copyright their interview material and may disseminate for their independent purposes.

An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part One)

oInterviewer: Scott Douglas Jacobsen

Numbering: Issue 14.A, Idea: Outliers & Outsiders (Part Nine)

Place of Publication: Langley, British Columbia, Canada

Title: In-Sight: Independent Interview-Based Journal

Web Domain: http://www.in-sightjournal.com

Individual Publication Date: May 1, 2017

Issue Publication Date: September 1, 2017

Name of Publisher: In-Sight Publishing

Frequency: Three Times Per Year

Words: 2,922

ISSN 2369-6885

Gordon Guyatt

Abstract

An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC. He discusses: his geographic, cultural, and linguistic personal and familial background; influence on development; influences and pivotal moments in major cross-sections of early life; interests in epidemiology and biostatistics; the importance of mentors for research; tasks and responsibilities as the Distinguished University Professor in the Department of Health Research Methods, Evidence and Impact at McMaster University; and what informs pedagogy.

Keywords: biostatistics, epidemiology, Gordon Guyatt, McMaster University, Mentor.

An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part One)[1],[2],[3],[4]

*Footnotes in & after the interview, & citation style listing after the interview.*

*This interview has been edited for clarity and readability.*

1. Scott Douglas Jacobsen: In terms of geography, culture, and language, where does your personal and familial background reside?

Professor Gordan Guyatt: [Laughing] My dad is a Canadian of 5 or 6 generations. Our family moved to an area around Hamilton called Binbrook in the 1820s. They had a farm. The road that runs by the farm is called Guyatt road because they had the farm there. Those Guyatts were farmers, and the Guyatts in the region are descended in this region from them. My mother was a Czech Jew, who grew up in a little village in what is now the Czech Republic. Eventually, she moved to Prague.

She was at Prague when Hitler gained control of the Czech Republic. She ended up in a concentration camp with an extensive family. Everyone died in the Death Camps. Except her mother and her, they escaped to North America. She married a British soldier, who drove a tank into Belson. She was there at the end of the war. Upon arrival to Canada, they broke up. She met my dad in Canada. He came from an extremely different background. They managed to meet and stay together. They lived in Hamilton. I was born there. I grew up there. Now, I am still here.

2. Jacobsen: How did this influence development?

Guyatt: Through my mother’s background, I have a strong social conscience. I want to contribute as much as possible to society. I strongly identify with the less fortunate. It led to firm left-wing politics. I ran for the NDP 4 times, federally. I mercifully lost on each occasion. I have been active in politics. I started a group called the Medical Reform Group, which has been superseded by Canadian Doctors for Medicare.

I have a deep commitment for equitable, high-quality medical care for all Canadians without restrictions on the ability to pay. My academic career links with the political career. Even if you take the academic career alone, there are strong elements of belief in social cohesiveness and patients getting what they want rather than what doctors think patients want.

 3. Jacobsen: What about influences and pivotal moments in major cross-sections of early life including kindergarten, elementary school, junior high school, high school, undergraduate, and graduate studies?

Guyatt: [Laughing] Sadly, my memory of early life is sketchy. My mom said some things that influenced me. Her attitude: it would happen to the Jews again. However, she said, “Not to my kids.” My dad was from a strong Baptist family. His dad was a doctor, but qualified as a Baptist minister. He left ministerial work and became a doctor. He was a deacon on the Baptist church. It might have contributed to my values. My mother went to the Baptist church.

However, at some level, her heart was not there. She grew up as a Jew in Czechoslovakia. She went along with my dad’s world. Yet she was skeptical about his perspectives on the world. Baptists did not like drinking, dancing, or singing. They were puritanical. Also, my father was Right-wing. He had passionate Right-wing feelings. My negative characterization of some Right-wing folks is an upbringing of privilege, but even so, they manage to feel hard-done by.

Jacobsen: [Laughing].

Guyatt: [Laughing] I remember dad walking into the house every July for a few years, and saying, “For the rest of the year, I will be working for the government.” Because he was in the 50%+ percent tax bracket. He felt resentful. My mom said, “Well, that’s not the only way to look at the world.” I think skepticism, but some positive things from dad too. My dad is an extremely self-disciplined individual. On a 1-100, he is 99.5 on the self-discipline scale. He was model of true self-discipline. I turned out very self-disciplined.

Also, he loved the English language and precision in speech. As an academic, it helped me. Those are specific events, but streams of influence from childhood too. Then a clear  influence, when I was a resident in internal medicine, I loved the academic environment. I loved to teach. However, I had no interest in research. The chair of the department of medicine, who was a leader  in thrombosis research, Jack Hirsh, had a mission. He took bright young people and turned them into researchers.

He called me to his office. I described personal plans. He said, “Gordon, that’s fine, for now, but, in ten years, you’ll be bored. So, you should really think about research.” I knew one thing. I had zero interest in basic research. I was obedient and understood, “If the boss tells me, then I will do it.” I spent the second year of sub-specialty training in clinical epidemiology. Someone picked up: I am a bright guy. They thought, “We have this bright guy. Let’s lead them in the directions preferred by us.”

Hirsh sent me to the chair of the Department in Clinical Epidemiology, Peter Tugwell. Peter did a preliminary interview. This was not the interview for the program. He guided me, in the right direction. He said, “How much of your time in the long run do you want to be spending on research?” At the time, the real answer was zero. However, that answer would have been rude. I said, “25%.” He looked concerned and said, “Oh, well, if you say that in the interview, they won’t let you into the program.”

I went into the interview for the program. This time, I said, “50%.” I was allowed into the program. Lo and behold, I found, “This is great stuff! This is really interesting!” As I progressed through the program, I did not know, but, as it turned out, I am great at research. It is interesting. The more I went on, the more exciting it became. Then the same theme, I was directed. I continued to think, “I am a real doctor.” I wanted to be a real doctor. So I am with the Department of Medicine, not this Department of Clinical Epidemiology.

For some reason, the chair of Medicine, and the chair of Clinical Epidemiology, wanted my primary appointment in clinical epidemiology. I said, “Okay, I’m a real doctor. But if you want that as my primary appointment with these eggheads, then I’ll do it.” Quickly, in my training, I picked this up. Then I found myself in the best department in the world for this area, where I stumbled into it.  I was surrounded by brilliant people.

Those who taught me had a profound belief in collegiality and caring about one another, and mentoring junior people. Here I found myself not only doing interesting stuff, but with the world’s greatest mentors. Jack Hirsh continued to mentor me, and Dave Sackett, who was probably one of the leading lights. Those guys were mentors for me, but I had other senior folks in the department. They helped me too.

Now, I am in this spectacular environment. Now, I start writing grants and – lo and behold – the grants earn funding. I realized, “I’m surrounded by all of these smart people, and I find that I’m in the same league, and I actually talk to these people as equals and sometimes come up with ideas now.” Then over the next few years, I found, “Wow! This is exciting and great stuff, and I’m good at it.” There is the story of personal evolution.

4. Jacobsen: Two questions come from that. One has to do with epidemiology, biostatistics, and medicine. The medicine one as the natural inclination for you. The epidemiology and biostatistics, at least within research, as an unwilling participant. Any other interest in those disciplines – biostatistics, epidemiology?

Guyatt: No, as an undergraduate, I took the usual pathetic statistics course, which, as far as I can tell, could not be better designed to make people think that statistics is boring and uninteresting. It had the natural effect on me. As it turns out, another thing was peculiar about in contrast to other doctors about me. I never did science training. I never did biology or chemistry. Any of it. As it turns out, there was one medical school in the country for people without a science background: McMaster University. So I got into McMaster without a science background.

Once in the program, I was interested in physiologic reasoning. I went into internal medicine because it is the most interesting and challenging branch of medicine. Nothing specific to epidemiology or biostatistics, but an interest in an academic approach. This was the reason for the interest in an academic environment and in being an academic teacher. A major interest in an academic approach to the practice of medicine, which is clinical epidemiology. Clinical epidemiology, and making the medicine practical, became evidence-based medicine (EBM).

5. Jacobsen: In the previous responses, you talked about mentors. What is the importance of mentors for research – especially if they didn’t even know they had an interest or a talent in it?

Guyatt: Oh! Crucial, these folks directed me. I would never would have done these things myself. My colleague David Sackett wrote a book about mentorship. He talked about the importance of it, and the aspects of a good mentor. Dave died 2 years ago. The Journal of Clinical Epidemiology produced a series with one section of a recent issue was a review of Sackett’s life. He mentored me. He mentored tons of people. They were nice enough to ask me to do it.

A big aspect is Dave’s brilliance as a mentor. He influenced so many people. I am enormously lucky for the mentorship. It was crucial. If you are left alone, it is much more difficult. If you have the right mentorship environment, even somebody on the mediocre side, you can do well with the right support.

6. Jacobsen: You work as the Distinguished University Professor in the Department of Health Research Methods, Evidence and Impact.[5] What tasks and responsibilities come with these positions?

Guyatt: Basically, they let me do what I want. Fortunately, my preferred work keeps with the university’s mission. I do enough clinical work to stay competent. I teach at the undergraduate, residency, and post-graduate levels. I do a lot of research. For me, a wonderful marriage of research and teaching responsibilities. In the last decade, under research and teaching responsibilities, I supervise 5 or 6 PhDs at any point in time. I get credit for, as my major education credit, supervising the PhDs, but the PhDs are the ones doing research for us.

Again, I have been extremely fortunate in a series of ways from the beginning to the end in my academic career. Now, I work with young people. I enjoy it. I enjoy getting people connected. So I have educational responsibilities, which are teaching undergraduate, and some teaching at the graduate level. My main educational activity is supervising these senior trainees. You need research associated with it. By university standards, I am extremely productive, where it counts. Since I am productive, I feel that’s why they let me work on what I want.

7. Jacobsen: What informs pedagogy for you?

Guyatt: In terms of communicating concepts: clarity, keeping things as simple as possible, using examples of everything, using paradigmatic or extreme examples to illustrate concepts, ensuring that people really understand the idea, and then gradually introducing increased levels of sophistication. Tons of feedback for people, always trying to keep it as positive as possible, while making it clear where improvements are needed, creating a facilitative environment of learning where the people feel supported and valued. They get enough positive reinforcement to them keep them going while conveying a top priority on rigour and doing work at the highest possible level.

References

  1. Bennett, K. (2014, October 31). New hospital funding model ‘a shot in the dark,’ McMaster study says. Retrieved from http://www.cbc.ca/news/canada/hamilton/news/new-hospital-funding-model-a-shot-in-the-dark-mcmaster-study-says-1.2817321.
  2. Blackwell, T. (2015, February 1). World Health Organization’s advice based on weak evidence, Canadian-led study says. Retrieved from http://news.nationalpost.com/health/world-health-organizations-advice-extremely-untrustworthy-and-not-evidence-based-study.
  3. Branswell, H. (2014, January 30). You should be avoiding these products on drug-store shelves. Retrieved from http://www.theglobeandmail.com/life/health-and-fitness/health/you-should-be-avoiding-these-products-on-drug-store-shelves/article16606013/?page=all.
  4. Canadian News Wire. (2015, October 8). The Canadian Medical Hall of Fame announces 2016 inductees. Retrieved from http://www.newswire.ca/news-releases/the-canadian-medical-hall-of-fame-announces-2016-inductees-531287111.html.
  5. Cassar, V. & Bezzina, F. (2015, March 25). The evidence is clear. Retrieved from http://www.timesofmalta.com/articles/view/20150325/life-features/The-evidence-is-clear.561338.
  6. Clarity Research. (2016). Clinical Advances Through Research and Information Translation. Retrieved from http://www.clarityresearch.ca/gordon-guyatt/.
  7. Craggs, S. (2015, July 21). We can actually win this one, Tom Mulcair tells Hamilton crowd. Retrieved from http://www.cbc.ca/news/canada/hamilton/news/we-can-actually-win-this-one-tom-mulcair-tells-hamilton-crowd-1.3162688.
  8. Escott, S. (2013, December 2). Mac professor named top health researcher. Retrieved from http://www.thespec.com/news-story/4249292-mac-professor-named-top-health-researcher/.
  9. Feise, R. & Cooperstein, R. (2014, February 1). Putting the Patient First. Retrieved from http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=56855.
  10. Frketich, J. (2016, July 8). 63 McMaster University investigators say health research funding is flawed. Retrieved from http://www.thespec.com/news-story/6759872-63-mcmaster-university-investigators-say-health-research-funding-is-flawed/.
  11. Helsingin yliopisto. (2017, March 23). Clot or bleeding? Anticoagulants walk the line between two risks. Retrieved from https://www.sciencedaily.com/releases/2017/03/170323083909.htm.
  12. Hopper, T. (2012, August 24). You’re pregnant, now sign this petition: Group slams Ontario doctors’ ‘coercive’ tactics to fight cutbacks. Retrieved from http://news.nationalpost.com/news/canada/youre-pregnant-now-sign-this-petition-group-criticizes-doctors-who-encourage-patients-to-sign-anti-cutbacks-letter.
  13. Kerr, T. (2011, May 30). Thomas Kerr: Insite has science on its side. Retrieved from http://news.nationalpost.com/full-comment/thomas-kerr-vancouvers-insite-clinic-has-been-a-resounding-success.
  14. Kirkey, S. (2015, October 29). WHO gets it wrong again: As with SARS and H1N1, its processed-meat edict went too far. Retrieved from http://news.nationalpost.com/health/is-whos-smackdown-of-processed-meat-a-considerable-overcall-or-just-informing-the-public-of-health-risks.
  15. Kolata, G. (2016, August 3). Why ‘Useless’ Surgery Is Still Popular. Retrieved from https://www.nytimes.com/2016/08/04/upshot/the-right-to-know-that-an-operation-is-next-to-useless.html?_r=0.
  16. Maxmen, A. (2011, July 6). Nutrition advice: The vitamin D-lemma. Retrieved from http://www.nature.com/news/2011/110706/full/475023a.html.
  17. McKee, M. (2014, October 2). The Power of Single-Person Medical Experiments. Retrieved from http://discovermagazine.com/2014/nov/17-singled-out.
  18. McMaster University. (2016). Gordon Guyatt. Retrieved from http://fhs.mcmaster.ca/ceb/faculty_member_guyatt.htm.
  19. Neale, T. (2009, December 12). Doctor’s Orders: Practicing Evidence-Based Medicine Is a Challenge. Retrieved from http://www.medpagetoday.com/practicemanagement/practicemanagement/17486.
  20. Nolan, D. (2011, December 31). Mac’s Dr. Guyatt to enter Order of Canada. Retrieved from http://www.thespec.com/news-story/2227923-mac-s-dr-guyatt-to-enter-order-of-canada/.
  21. O’Dowd, A. (2016, July 21). Exercise could be as effective as surgery for knee damage. Retrieved from https://www.onmedica.com/newsArticle.aspx?id=e13a0a94-5e96-43b9-86b7-7de237630beb.
  22. Palmer, K. & Guyatt, G. (2014, December 16). New funding model a leap of faith for Canadian hospitals. Retrieved from http://www.theglobeandmail.com/opinion/why-new-funding-model-a-leap-of-faith-for-canadian-hospitals/article22100796/.
  23. Park, A. (2012, February 7). No Clots in Coach? Debunking ‘Economy Class Syndrome’. Retrieved from http://healthland.time.com/2012/02/07/no-clots-in-coach-debunking-economy-class-syndrome/.
  24. Picard, A. (2015, May 25). David Sackett: The father of evidence-based medicine. Retrieved from http://www.theglobeandmail.com/life/health-and-fitness/health/david-sackett-the-father-of-evidence-based-medicine/article24607930/.
  25. Priest, L. (2012, June 17). What you should know about doctors and self-referral fees. Retrieved from http://www.theglobeandmail.com/life/health-and-fitness/ask-a-health-expert/what-you-should-know-about-doctors-and-self-referral-fees/article4267688/.
  26. Rege, A. (2015, August 5). Why medically unnecessary surgeries still happen. Retrieved from http://www.beckershospitalreview.com/population-health/why-medically-unnecessary-surgeries-still-happen.html.
  27. Science Daily. (2016, October 26). Ultrasound after tibial fracture surgery does not speed up healing or improve function. Retrieved from https://www.sciencedaily.com/releases/2016/10/161026141643.htm.
  28. Spears, T. (2016, July 7). Agriculture Canada challenged WHO’s cancer warnings on meat: newly-released documents. Retrieved from http://news.nationalpost.com/news/canada/agriculture-canada-challenged-whos-cancer-warnings-on-meat-according-to-newly-released-documents.
  29. Tomsic, M. (2015, February 10). Dying. It’s Tough To Discuss, But Doesn’t Have To Be. Retrieved from http://wfae.org/post/dying-its-tough-discuss-doesnt-have-be.
  30. Webometrics. (2010). 1040 Highly Cited Researchers (h>100) according to their Google Scholar Citations public profiles. Retrieved from http://www.webometrics.info/en/node/58.

Appendix I: Footnotes

[1] Distinguished University Professor, Health Research Methods, Evidence and Impact, McMaster University.

[2] Individual Publication Date: May 1, 2017 at www.in-sightjournal.com; Full Issue Publication Date: September 1, 2017 at https://in-sightjournal.com/insight-issues/.

[3] B.Sc., University of Toronto; M.D., General Internist, McMaster University Medical School; M.Sc., Design, Management, and Evaluation, McMaster University.

[4] Courtesy of Gordan Guyatt.

[5] McMaster University. (2016). Gordon Guyatt. Retrieved from http://fhs.mcmaster.ca/ceb/faculty_member_guyatt.htm.

Appendix II: Citation Style Listing

American Medical Association (AMA): Jacobsen S. An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part One) [Online].May 2017; 14(A). Available from: http://www.in-sightjournal.com/an-interview-with-distinguished-university-professor-gordon-guyatt-oc-frsc-part-one.

American Psychological Association (APA, 6th Edition, 2010): Jacobsen, S.D. (2017, May 1). An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part One)Retrieved from http://www.in-sightjournal.com/an-interview-with-distinguished-university-professor-gordon-guyatt-oc-frsc-part-one.

Brazilian National Standards (ABNT): JACOBSEN, S. An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part One). In-Sight: Independent Interview-Based Journal. 14.A, May. 2017. <http://www.in-sightjournal.com/an-interview-with-distinguished-university-professor-gordon-guyatt-oc-frsc-part-one>.

Chicago/Turabian, Author-Date (16th Edition): Jacobsen, Scott. 2017. “An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part One).” In-Sight: Independent Interview-Based Journal. 14.A. http://www.in-sightjournal.com/an-interview-with-distinguished-university-professor-gordon-guyatt-oc-frsc-part-one.

Chicago/Turabian, Humanities (16th Edition): Jacobsen, Scott “An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part One).” In-Sight: Independent Interview-Based Journal. 14.A (May 2017). http://www.in-sightjournal.com/an-interview-with-distinguished-university-professor-gordon-guyatt-oc-frsc-part-one.

Harvard: Jacobsen, S. 2017, ‘An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part One)In-Sight: Independent Interview-Based Journal, vol. 14.A. Available from: <http://www.in-sightjournal.com/an-interview-with-distinguished-university-professor-gordon-guyatt-oc-frsc-part-one>.

Harvard, Australian: Jacobsen, S. 2017, ‘An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part One)In-Sight: Independent Interview-Based Journal, vol. 14.A., http://www.in-sightjournal.com/an-interview-with-distinguished-university-professor-gordon-guyatt-oc-frsc-part-one.

Modern Language Association (MLA, 7th Edition, 2009): Scott D. Jacobsen. “An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part One).” In-Sight: Independent Interview-Based Journal 14.A (2017):May. 2017. Web. <http://www.in-sightjournal.com/an-interview-with-distinguished-university-professor-gordon-guyatt-oc-frsc-part-one>.

Vancouver/ICMJE: Jacobsen S. An Interview with Distinguished University Professor Gordon Guyatt, OC, FRSC (Part One) [Internet]. (2017, May; 14(A). Available from: http://www.in-sightjournal.com/an-interview-with-distinguished-university-professor-gordon-guyatt-oc-frsc-part-one.

License and Copyright

License

In-Sight Publishing and In-Sight: Independent Interview-Based Journal by Scott Douglas Jacobsen is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Based on a work at www.in-sightjournal.com.

Copyright

© Scott Douglas Jacobsen, and In-Sight Publishing and In-Sight: Independent Interview-Based Journal 2012-2017. Unauthorized use and/or duplication of this material without express and written permission from this site’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Scott Douglas Jacobsen, and In-Sight Publishing and In-Sight: Independent Interview-Based Journal with appropriate and specific direction to the original content.  All interviewees co-copyright their interview material and may disseminate for their independent purposes.

An Interview with Patrick Zierten, EMBA, MA (Part Four)

Interviewer: Scott Douglas Jacobsen

Numbering: Issue 13.A, Idea: Outliers & Outsiders (Part Nine)

Place of Publication: Langley, British Columbia, Canada

Title: In-Sight: Independent Interview-Based Journal

Web Domain: http://www.in-sightjournal.com

Individual Publication Date: April 22, 2017

Issue Publication Date: May 1, 2017

Name of Publisher: In-Sight Publishing

Frequency: Three Times Per Year

Words: 3,990

ISSN 2369-6885

Abstract

An interview with Patrick Zierten, EMBA, MA. He discusses: status of EHN; tasks and responsibilities as the national director; building on successes; greatest emotional struggle in life; the dual-life with recovery and business; advice for those struggling; the total suite of care for EHN; the feeling of being a practitioner one-on-one or in groups; general philosophy; political philosophy; social philosophy; economic philosophy; their interrelationships; upcoming collaborative projects; upcoming solo projects; recommended authors; and concluding feelings and thoughts.

Keywords: Edgewood Health Clinics Network, Patrick Zierten, philosophy, recovery.

An Interview with Patrick Zierten, EMBA, MA: Program Coordinator, Edgewood Health Clinics; Ex-National Executive Director, Edgewood Health Clinics Network (Part Four)[1],[2],[3],[4]

*Footnotes in & after the interview, & citation style listing after the interview.*

*This interview has been edited for clarity and readability.*

44. You had an idea. You followed through with it, and accomplished it – admirable. This culminated in the creation of Edgewood Vancouver. EDGEWOOD Alumni INSITE in Vancouver (2012), in part, states:

Patrick Zierten, EDGEWOOD Vancouver’s Program Director, is a happy man. “When we opened up the new office in Vancouver, one of my priorities was to bring Insite to Vancouver. Not the Insite as developed for family members living with an addicted loved one, but one specifically designed for individuals in recovery from substance dependence.”…”I met with Dale MacIntyre, EDGEWOOD’s Family Program Supervisor, and we went to work revising some of the components of the program so that it was more applicable for folks in recovery.[5]

What is the current status for the development of EHN now?

The development of this program for EHN. It’s no longer called the INSITE program. We’ve developed a number of adjunct programs to respond to the needs of people later in recovery. That part I talked about being a better human being and being in better relationships, and that’s what that program was develop for. We run workshops and relationships. We run workshops on boundary development. We run workshops on couples in recovery. It’s not one specific program. It’s a bunch of specific programs that we broke off into. Because I think as a person in recovery, we’re learning skills that we should have learned a long, long time ago. So, that’s where Edgewood health network has embraced the continuum of care, that doesn’t necessarily mean a treatment, but it could be a number of processes along this continuum.

45. It noted happiness as the main emotion at the outset of the article in description of the Vancouver facility’s foundation. What is the emotion now – especially with additional tasks and responsibilities as the national director?

I’d say happy. That’s all I can say. I am happy about what I’ve been doing, and I kind of went astray, and I know I’m called to do what I’m supposed to do here. I love the people I work with. They are passionate about what they do. I got grandkids man! I have a new wife. I’ve been with her for 17 years.

Congratulations.

Thank you.

46. Obviously, success tends to build on sets of achievements. The more one gets, the easier things tend to get – if built on the previous foundation, like building the foundation, then the indoor parking and the first floor, and then the subsequent floors in a high-rise building, for instance. In terms of staff, resources, public, and families with substance abuser support, and others, what seem like the sources of the success for Edgewood as a whole? For something to exist this long, in a society that does have drug problems, it performs a core service for the public and the individuals in the families.

Using the analogy of the foundation, the foundation of the EHN is passion to help the suffering addict, to recognize that these people are sick, not that they shouldn’t be accountable for their disease, but that they need help, and developing a staff that has that same passion. If you’ve got the right people with the same passion, and put them in a building, you’re going to get recovery. Then, as we started to look at the skills of the people we’ve brought on board, we say, “How can we better utilize their skill sets to develop programs that can help them with their passion?” Maybe, it is the INSITE program. Maybe, it is the intensive outpatient program. Maybe, it is one-on-one counselling. Maybe, it is going to this workshop for EMDR. So, you start to develop your people and programming around the assets of your people, and it’s just a matter of opening the door and they will come. It’s rather simplistic, but that’s the concept.

Field of Dreams always has use.

(Laugh)

(Laugh)

47. In the same article, EDGEWOOD Alumni INSITE in Vancouver (2012), you touched on personal struggles, and in this interview. What seems like the greatest emotional struggle in personal life?

The first thing that comes to mind when you ask that question is struggling with figuring out who I was and not being judgmental. Not labelling it as good or bad. I grew up in a life where it was either good or bad. I had to get out of that thought process. And even to this day, I do not think of things in terms of good or bad. Some things get me what I wish want. Some things don’t get me what I want. Some things are just the way they are. That’s been helpful in dealing with human beings. They’re human beings with different struggles and different situations. That’s my Catholic tradition. The Catholic tradition puts you in two categories: good or bad. I had to shake that. That was a huge piece for me.

I had always thought of myself as good or bad, because of my addiction. When you have a belief system, you will search for evidence that supports that belief system. If I was bad, I’d search for evidence that I was bad. I did behaviors that supported that belief system. So, you get into that stupid trap. I had to flip everything upside down. I simply need to forgive and not judge at all.  I had to take judgment out of the whole scheme of things. That’s what first comes out for me on that question.

48. You mentioned a dual-life with recovery and business. At the same time, my general sense from you. They’re not really separate.

If I look at my recent career choice, I can see how I let my ego get the best of me. The money sounded good. The title sounded good. The prestige was kind of cool. It really resonated with my ego when I realized I was not up to the task and was miserable. I didn’t say, “You stupid idiot. I can’t believe you listened to your old ego, and ended up down this stupid path, and now you’re miserable.” I just said, “Wow, what the heck happened here?”

There wasn’t a judgment there. And that helped me. That, I think, allowed me or gave me permission to have the conversation with my boss. Whereas before, I would have said, “I can’t believe you made this choice. Now, you’re stuck with it.” I can’t let anyone know that I might have made a bad decision. Or I allowed myself to do something that isn’t true to me. My old self would never have allowed that. The new self that is not judgmental said, “Man, you did it again!”

(Laugh)

You laugh at yourself. That gave me the courage to have the conversation.

49. Any advice for those that continue to struggle with their own, similar, issues and concerns?

Don’t take yourself so seriously. It’s simple advice. How do you take yourself less seriously? Recognize, and learn to smell the roses. Stop and breathe the air. Hang around with a bunch of folks that are trying to do the same thing. That, to me, is crucial. That you hang around with people that’re trying to do the same thing as me because trying to do it on my own I’m going to go astray.  My experience is that you’d go into your default patterns. So, I have tried to be a teacher in terms of trying to smell the roses.

Find those with a common cause.

Yes! That’s what community is about. That was going to be one of my university papers was the importance of community, and how we’ve drifted away from community, and there’s a great book called The Disappearance of Bowling. It’s a guy who writes about how we used to be so community-minded a 100 years ago. Bowling was the largest sport, participant sport in North America for years back in the 60s and 70s. What he was getting at is the essence of community, we don’t have clubs anymore. Church attendance is declining dramatically. Those types of community. They’re all disappearing.

And what does that do for us as human beings, we’re built to be, and designed to be, in community. Technology is robbing us of that. The social network is robbing us of that. It is creating pseudo-communities, but we’re really fooling ourselves because we’re not really being in community when we’re talking to somebody on Facetime or Skype.

This is what I’m afraid of is today’s kids. They will just assume that this is community. I’ve seen it. I’m broad-brushing, so I’m generalizing. You go into a restaurant and they’re texting while they’re eating dinner. It may be not applicable to this segment, but what about the next generation, which grows up thinking that facebook and Tweeting, which is common place even today, but could be even more common place in the future. Then it’s not going to a microcosm. It’s going to be a macrocosm.

There’s a book by Isaac Asimov or Bradbury I can’t remember. He talks about this futuristic state where these people live on a planet, and there are only 800 people on the planet, and the rest are robots and social networks. I remember this is how mankind had evolved. That they lived in these homes, and the next nearest relative might be 7,000 miles away, but they communicated in a virtual reality as if they were sitting in their dining room talking to the other human being. And robots were doing everything. There were androids.

And procreation was you put your sperm in a cup, and send the egg, and they fertilize it in some manufacturing company, and voila! You have a child. Is that what we’re headed for in 3,000 years? It’d be interesting.

One of things I’ve become very comfortable with in life is, I don’t know. Everything, matter of fact I know very little. It’s not worth debating because it’s too far in the future to know. And if I don’t know something, I credit God for it. God provides me stability and comfort in that I don’t know everything, which is tough thing for a lot of people.

50. I want to explore some of the processes – again, without breach of confidentiality or dissemination of sensitive information – for “inpatient and outpatient addiction treatment programs” through Edgewood Health Network Inc.[6] Let’s begin, some of the reasons for those with an interest in this program of care, or others in fact, might lie in getting “your family back with a treatment program” with comprehensive focus on “physical, mental, emotional and spiritual components, as well as family, and the community system.”[7] EHN focuses on individuated recovery paths via personalized treatment.

According to the EHN website, in What You Should Need Know (2016), patient time taken for treatment varies, especially with factors such as “needs, issues, resources and strengths.”[8] You have the sole “only national network of adult inpatient and outpatient treatment services across the country, 24/7 help, and an open-source assessment tool, we provide top-tier, customized paths for every one of our patients,” too.[9]

EHN considers addiction a family disease.[10] EHN gives support services for families too. This exists alongside the other support services such as Aftercare, or Continuum of Care. How do these programs knit together into one blanket for EHNs total suite of care?

We’re providing a number of entry points into treatment. Once you get into that entry point, then there’s a program that will be developed to what your needs are, and what you’re willing to do. Those might include the family. They might not include the family. They might include the spouse. They might not include the spouse. It might include abstinence. It might not include abstinence, but the continuum will always try to bring you towards abstinence. I can walk alongside the client for three or four years before they enter an inpatient situation, and they actually start to get some sobriety. I might walk alongside them for 3 or 4 more years in one-on-one counselling. That process can be years long.

But there’s entry and access point. So I might see him for a while, and then they leave, and then they re-enter treatment again. Then we have another plan that they’d work with, that might not be successful, or not, and then they re-enter again. There are a number of entry point, but once you get into the entry point. There’s a program designed specifically for you.

51. These remain important details, and overviews, of the EHN provisions. Nonetheless, this can leave questions. How does this feel as a practitioner going through these processes with patients – one-on-one or in group?

It’s evolved. It’s changed. I got extremely involved in the emotional situation of the individual. There was a lot of transference. After a while, I realized I was working too hard for the client because I wanted to relieve my own personal anxiety. So if I make you feel better, I won’t feel so bad. It’s really self-motivated, or selfish. It’s not based on your wish for this person to get better. What I realized is that I was starting to get symptoms of burnout: irritability, restlessness, sleeplessness, bad dreams, etc.

Over time, I have been able to develop a ‘callous’, where I can hear the story and don’t get emotionally reactive to it, as much. There’s still some stories I hear and go, “Holy smokes.” – especially when there’s children involved, that activates me. Or if there’s abuse of women, I get extremely activated. That really gets me charged, but the rest of it. I have a good callous.

We don’t like to talk about what we do often in the office. We develop this black humor that you hear in emergency rooms, fireman and EMT workers. These people that manage the trauma they experience by developing this black humor. It’s not from a place of insensitivity or maliciousness. It’s from a place of “I need to do this in order to protect myself. And so, that kind of works here.” Eventually, you work past the need for black humor. You just get into a state where you’re sort of content with the information that you don’t need to be reactive. You’re not disconnected from the client from an empathetic perspective, but you’re entirely embroiled in the individual’s turmoil.

52. You noted this at the outset. What general philosophy seems the most correct to you? 

For me, in life: be kind.

53. What political philosophy seems the most correct to you?

I’m a socialist by nature.

(Laugh)

Not that it makes sense necessarily, but I don’t know. Anarchy is a good one too. I don’t know if there’s a particular political system. I’m a Bernie Sanders guy.

54. What social philosophy seems the most correct to you?

That goes back to general philosophy in the old adage: be kind and kindness will come back. Karma.

55. What economic philosophy seems the most correct to you?

It’s the old adage: eat what you kill. Make a living, but don’t be extravagant. Provide for your needs, but not for your wants.

56. What aesthetic philosophy seems the most correct to you?

Nature.

57. What interrelates these philosophies?

Love.

58. Any upcoming collaborative projects?

No, not at this point, I’ve got nothing on hand. I’m just happy settling back into my old routine.

59. Any upcoming solo projects?

No, I think – solo projects for me is thinking about retirement and what I want to do, and getting close to that, but do I want to be entirely retired. I want to take things a little easier. I’m at the end of life. That’s definitely huge on my mind. It’s funny how that happens. Of course, meaning and purpose become very important, and relationships become very important at this point in my life. How do I enhance those things until I die?

60. Any recommended authors?

Richard Rohr, that’s who I’m into right now. He’s a Franciscan monk. He writes a book called Breathing Under Water and Falling Upward. He’s got some lovely stuff on YouTube. John O’Donahue. Another guy I love, unfortunately, he’s dead. He was an Irish priest. He is kind of a Catholic pagan, and a poet. He’s a lovely, lovely, lovely man. Those are the first ones that popped into my head at the top of my head.

61. Any feelings or thoughts in conclusion?

No! Other than great gratitude for you even to consider me worth having a conversation with. I am really honored that you’re—even the fact that—

And your work!

(Laugh)

And you’re a lovely guy yourself by the way. I’m really intrigued by your intelligence, with your honesty through some of this (Parts 1 through 4 abridged – Ed.). I felt quite honored and grateful for this experience. Thank you for considering me.

Thank you for your time, Mr. Zierten.

Appendix I: Footnotes

[1] Program Coordinator, Edgewood Health Clinics; Ex-National Executive Director, Edgewood Health Clinics Network.

[2] Individual Publication Date: April 22, 2017 at https://in-sightjournal.com/2017/04/22/an-interview-with-patrick-zierten-emba-ma-part-four/; Full Issue Publication Date: May 1, 2017 at https://in-sightjournal.com/insight-issues/.

[3] MA (1997-2002), Theology, The University of British Columbia; EMBA (1990-1991), Queen’s University.

[4] Photograph courtesy of Patrick Zierten, EMBA, MA.

[5] EDGEWOOD Alumni INSITE in Vancouver (2012), in full, states:

Patrick Zierten, EDGEWOOD Vancouver’s Program Director, is a happy man. “When we opened up the new office in Vancouver, one of my priorities was to bring Insite to Vancouver. Not the Insite as developed for family members living with an addicted loved one, but one specifically designed for individuals in recovery from substance dependence.”

He goes on to describe the plans he implemented in Vancouver, “I met with Dale MacIntyre, EDGEWOOD’s Family Program Supervisor, and we went to work revising some of the components of the program so that it was more applicable for folks in recovery. Dale was kind enough to come over to Vancouver and he ran our first INSITE Program in October 2010. We now hold an INSITE Program once every three months.” Patrick talks of his own experience with INSITE.

“Fifteen years ago, I was having all kinds of problems in my recovery. I was complacent, unhappy, lacked meaning and purpose and my relationship life was in shambles. I thought I was about ready to relapse. I didn’t know what to do until a good friend of mine suggested I go to this “… INSITE program over at Edgewood, in Nanaimo”. 

“I really didn’t want to go but I was at one of those places where if things didn’t change I thought I was going to go crazy. I had no idea what to expect. Boy, was I more than pleasantly surprise!  It literally transformed my recovery process. I realized that being in recovery was not just about staying sober one day at a time, it meant that I had to change how I responded to people, how to draw boundaries and how to take care of myself.”

The Alumni INSITE program as offered in Vancouver, is designed specifically for the person with a year of substance dependence recovery, who is facing ever-increasing challenges in their relationships with others. Much of the curriculum is taken from the original Insite program but is modified to deal more specifically with early recovery relationship issues.

“The wonderful thing about this program is that many of our Alumni INSITE graduates have gone on to our INSITE Aftercare group. We have two of our original graduates that still attend Insite Aftercare.”

Zierten, P. (2012). EDGEWOOD Alumni INSITE in Vancouver. Retrieved from http://docplayer.net/5470680-For-those-seeking-help-for-addiction-access-to-more-professional.html.

[6] Edgewood Health Network Inc.. (2016). Edgewood Health Network Inc.. Retrieved from http://edgewoodhealthnetwork.com/.

[7] Edgewood Health Network Inc.. (2016). Fine Your Path To Recovery. Retrieved from http://edgewoodhealthnetwork.com/.

[8] Edgewood Health Network Inc.. (2016). What You Need To Know. Retrieved from http://edgewoodhealthnetwork.com/#!treatment-plan.

[9] Edgewood Health Network Inc.. (2016). What You Need To Know. Retrieved from http://edgewoodhealthnetwork.com/#!treatment-plan.

[10] Family Programs and Support (2016) states:

Addiction is a family disease because many family members are profoundly impacted by the behaviour of an addicted loved one. The best way for family members to support their loved one’s treatment and to take care of themselves is to undertake their own recovery process.

The Edgewood Health Network encourages family members to undertake their own path of recovery through our family programs. We provide a facilitated group process that offers education about addiction and its impact on relationships. It’s a chance for family members to learn ways that will change destructive relationship patterns. If you have been hurt by someone else’s addiction or wish to improve your relationships, our family programs are for you.

Edgewood Health Network Inc.. (2016). Family Programs and Support. Retrieved from http://edgewoodhealthnetwork.com/#!family-support-programs.

Bibliography

Edgewood Health Network Inc. (2016). Edgewood Health Network Inc. Retrieved from http://edgewoodhealthnetwork.com/#.

Jack Hirose & Associates, Inc. (2016). Patrick Zierten, EMBA, M.A.. Retrieved from http://www.jackhirose.com/speaker/patrick-zierten-emba-m-a/.

LinkedIn. (2016). patrick zierten. Retrieved from https://ca.linkedin.com/in/patrick-zierten-8022637.

Media Awareness Project. (2016). Drug Forum A Success. Retrieved from http://www.mapinc.org/drugnews/v05/n1697/a05.html?1818.

Mirus Rehabilitation Care Centre. (2016). Meet the North York Team. Retrieved from http://www.mirusrehabcare.com/about-our-addiction-treatment-center.html.

The Bible: New International Version. (2017). Matthew 7:12. Retrieved from https://www.biblegateway.com/passage/?search=Matthew+7%3A12.

The Globe and Mail. (2013, September 24). John Cleese explains why he loves Canada. Retrieved from https://search.yahoo.com/yhs/search?p=john+cleese+on+canada&ei=UTF-8&hspart=mozilla&hsimp=yhs-003.

The Rave. (2005, November 11). CN BC: Community Discussion Focuses On Drug-Use Prevention. Retrieved from http://www.rave.ca/en/news_info/28877/all/.

Zierten, P. (2012). EDGEWOOD Alumni INSITE in Vancouver. Retrieved from http://docplayer.net/5470680-For-those-seeking-help-for-addiction-access-to-more-professional.html.

Zierten, P. (2011, September 1). Motivated to Change but Not Ready for Residential Inpatient. Retrieved from http://www.edgewood.ca/assets/uploads/enews_summerfall2011_155.pdf.

Appendix II: Citation Style Listing

American Medical Association (AMA): Jacobsen S. An Interview with Patrick Zierten, EMBA, MA (Part Four) [Online].April 2017; 13(A). Available from: http://www.in-sightjournal.com/an-interview-with-patrick-zierten-emba-ma-part-four.

American Psychological Association (APA, 6th Edition, 2010): Jacobsen, S.D. (2017, April 22). An Interview with Patrick Zierten, EMBA, MA (Part Four)Retrieved from http://www.in-sightjournal.com/an-interview-with-patrick-zierten-emba-ma-part-four.

Brazilian National Standards (ABNT): JACOBSEN, S. An Interview with Patrick Zierten, EMBA, MA (Part Four). In-Sight: Independent Interview-Based Journal. 13.A, April. 2017. <http://www.in-sightjournal.com/an-interview-with-patrick-zierten-emba-ma-part-four>.

Chicago/Turabian, Author-Date (16th Edition): Jacobsen, Scott. 2017. “An Interview with Patrick Zierten, EMBA, MA (Part Four).” In-Sight: Independent Interview-Based Journal. 13.A. http://www.in-sightjournal.com/an-interview-with-patrick-zierten-emba-ma-part-four.

Chicago/Turabian, Humanities (16th Edition): Jacobsen, Scott “An Interview with Patrick Zierten, EMBA, MA (Part Four).” In-Sight: Independent Interview-Based Journal. 13.A (April 2017). http://www.in-sightjournal.com/an-interview-with-patrick-zierten-emba-ma-part-four.

Harvard: Jacobsen, S. 2017, ‘An Interview with Patrick Zierten, EMBA, MA (Part Four)In-Sight: Independent Interview-Based Journal, vol. 13.A. Available from: <http://www.in-sightjournal.com/an-interview-with-patrick-zierten-emba-ma-part-four>.

Harvard, Australian: Jacobsen, S. 2017, ‘An Interview with Patrick Zierten, EMBA, MA (Part Four)In-Sight: Independent Interview-Based Journal, vol. 13.A., http://www.in-sightjournal.com/an-interview-with-patrick-zierten-emba-ma-part-four.

Modern Language Association (MLA, 7th Edition, 2009): Scott D. Jacobsen. “An Interview with Patrick Zierten, EMBA, MA (Part Four).” In-Sight: Independent Interview-Based Journal 13.A (2017):April. 2017. Web. <http://www.in-sightjournal.com/an-interview-with-patrick-zierten-emba-ma-part-four>.

Vancouver/ICMJE: Jacobsen S. An Interview with Patrick Zierten, EMBA, MA (Part Four) [Internet]. (2017, April; 13(A). Available from: http://www.in-sightjournal.com/an-interview-with-patrick-zierten-emba-ma-part-four.

License and Copyright

License

In-Sight Publishing and In-Sight: Independent Interview-Based Journal by Scott Douglas Jacobsen is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Based on a work at www.in-sightjournal.com.

Copyright

© Scott Douglas Jacobsen, and In-Sight Publishing and In-Sight: Independent Interview-Based Journal 2012-2017. Unauthorized use and/or duplication of this material without express and written permission from this site’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Scott Douglas Jacobsen, and In-Sight Publishing and In-Sight: Independent Interview-Based Journal with appropriate and specific direction to the original content.  All interviewees co-copyright their interview material and may disseminate for their independent purposes.

An Interview with Patrick Zierten, EMBA, MA (Part Three)

Interviewer: Scott Douglas Jacobsen

Numbering: Issue 13.A, Idea: Outliers & Outsiders (Part Nine)

Place of Publication: Langley, British Columbia, Canada

Title: In-Sight: Independent Interview-Based Journal

Web Domain: http://www.in-sightjournal.com

Individual Publication Date: April 15, 2017

Issue Publication Date: May 1, 2017

Name of Publisher: In-Sight Publishing

Frequency: Three Times Per Year

Words: 4,237

ISSN 2369-6885

Abstract

An interview with Patrick Zierten, EMBA, MA. He discusses: tasks and responsibility in the service sector; some things never leaving; varied positions helping with work professional/career capacities; the most meaningful experiences; tasks and responsibilities with work at Edgewood Health Network and Edgewood Vancouver Addiction Services; mirrored experiences with actors; Stanislovsky and transference; Vilayanur Subramanian Ramachandran and the mirror neuron system; Motivated to Change but Not Ready for Residential Inpatient; report on the discussion for parenting and substance use; the problem of laws becoming principles; kids mirroring guardians; sister as teetotaller; status of father and mother; Richard Pryor on beatings; and verboten subject matter and social suicide.

Keywords: addiction, Burger King, Edgewood Health Network, Patrick Zierten, Richard Pryor, The Orchard Recovery Centre.

An Interview with Patrick Zierten, EMBA, MA: Program Coordinator, Edgewood Health Clinics; Ex-National Executive Director, Edgewood Health Clinics Network (Part Three)[1],[2],[3],[4]

*Footnotes in & after the interview, & citation style listing after the interview.*

*This interview has been edited for clarity and readability.*

27. You have been the area manager at Burger King Corporation from 1970 – 1986, market manager at Kentucky Fried Chicken from 1987 to 1995, addictions counsellor at Open Door to Learning and Living from 1997 to 2001, program manager/counsellor at TWC from 2001-2003, and the executive director at The Orchard Recovery and Treatment Center from March, 2003 to January, 2007.[5] In brief, what tasks and responsibilities came with these stations from the service sector with respect to food to the counselling sector?

They were all business skills. Once you get the basic premise of how to make money, it’s pretty applicable in anything that you do. I was building a career and a family. It was extremely important to me to accomplish those things. So, staying in a career allowed me to make more money, I get into recovery and money & success is not a big deal anymore. I go to university and did not have a nickel to my name, and I borrowed a bunch of student loans. I started as a counsellor, and the skills were basically being a human being. I’m just one human being with another human with similar experience, and I can help them navigate the hell they’re going through.

I was a counsellor at the Orchard. I then went to another place because I wanted to work with guys on the street. I went back to the Orchard and was their executive director. Now, I am getting back into the business side. It is starting to slowly creep back in. Finally, I started work for Edgewood 8 years ago.

28. It does. Two things come to mind for me. One thing of particular note. You are in the present. You have a high level of emotional intelligence in terms of one-to-one interaction. Second thing is, as you noted at the outset of the interview, with respect to becoming more and more Canadian as time has gone on, and with being “old,” there’s a sense in which, as with that rugged American individualism, some things never leave. But I think these can be attenuated or used in a positive way.

Yea, yea! I’m not denying that’s still not a part of me. It’s in there. It’s been mellowed a little bit. Why is it mellow? Is it because of Canada? Is it because of my recovery? Is it because of my getting old? It is probably all of those things. Is it because I have a better relationship with my family? I don’t know.

29. How did these varied positions over decades serve subsequent professional/career capacities? How is this beneficial one into the next? One position was food service sector. The next was food service sector. The rest were counselling and managing.

How did these varied positions over decades serve subsequent professional/career capacities? You’re challenging me.

Well, as life goes on with anything you do, you become more knowledgeable of the particular industry that you’re in and you get better at it or understanding the nuances of it better, and you become a lot more proactive than reactive. That probably served me well in my business and career. You almost have to look at my life as two different lives. There’s the business life, and this recovery life.

What I learned with counselling is more about myself through my experience with others, I couldn’t know the things I know about myself unless I was in relationship with another human being. I need something to bounce back me. When I’m in the relationships with people, I get a sense of who I am. I begin to understand what I like, what I don’t like, how I function in certain situations, how I don’t function in certain situations, what makes me anxious, what makes me happy, where before I was not that reflective.

That was not my intention in entering the counselling field. It just happened. By understanding me, by knowing how I tick, I am able to help others in discovering who they are also. That really at the end of the day is what therapy is about – getting another person to understand who they are and what they stand for so that can start taking positions in their life.

31. It does answer it. In fact, I remember something from another interview with the Grand Secretary of the Alberta Lodge of Ancient, Free and Accepted Freemasons, Jerry W. Kopp. To preface with freemasonry’s organizational structure in Canada, you have the basic lodge, the districts of lodges, and the grand lodge for the lodges and districts. In British Columbia, it’s the British Columbia & Yukon Grand Lodge.

I managed an interview with the Grand Secretary. He said something to the effect that in their tradition: “Man know thyself.” Something relevant to your interest in the Greeks. I clued into the ancient Greeks, which goes into the Milesian school of the pre-Socratics. Thales thought the world was made of water. Of course, he lived by the Aegean Sea.

Yes, yes!

But the main one was “man know thyself” and that, more often than not, gets attributed to Socrates.

The unexamined life is not worth living.

That’s right. But I think this goes back to Thales, at least in the Western tradition. 40,000 years ago, we had the aboriginal dreamtime narratives. The philosophical histories differ, sometimes overlap, and continue into the present.

What were the most meaningful experiences for you?

It is so interesting in my addiction life, events that should have been extremely meaningful aren’t. I don’t think I experienced them in their totality. My children were extremely meaningful experiences for me. But I think, if I weren’t drinking, would it have been much better? It’s not about the drinking. It’s about the ignorance that I lived in. I think it’s part of the reason for my drinking. I couldn’t see things. I couldn’t feel things the way other people feel them.

I think the drinking was an offshoot to manage that. Why at 16 did I choose to stand up to my dad? That’s a meaningful experience. Leaving to Florida, that was a meaningful experience for me. I’ve had 43 addresses in my life. Each of those were meaningful events, but I don’t think they had the impact. If they had the significant impact that they should have had, I think I probably would have done things differently. Of course, the most meaningful impact was when I got sober. I experienced things at a level that I had never experienced events in the past. The little things that became much more meaningful for me, not the births of my children, but the fact that I was celebrating my 43rd birthday. I got excited. It had a lot more impact than any of my birthdays before, going back to university. It was nothing like when I went to Queen’s. There was not joy in Queen’s.

But going to Regent (UBC), it was so much fun! I was a little kid. I was experiencing life. I was learning things that I should have been learning in kindergarten. That’s really meaningful events. Only really meaningful events have occurred for me in my recovery. I ignore other stuff.

32. Now, you are the program director at Edgewood Vancouver Addition Services from March, 2007 to the present, and the national director for Edgewood Health Network from September, 2014 to a recent time, which ended.[6] Without breach of confidentiality or dissemination of sensitive information – I have to be sensitive this, especially with 5 certifications in ethics such as TCPS 2 – what tasks and responsibilities come with the station(s)?

Of course, as I mentioned to you before, I am no longer the national director of EHN Clinics. I am just the program director, but what I am responsible for is the business and the day-to-day administration in this operation, unlocking the doors in the morning, and locking the doors at night, and keeping it financially viable. I am not into making a ton of money here. I am just trying to keep the doors open. Probably, the most important thing is working with the counsellors here and working with the other people, and how do I mentor them, and keep them motivated, and keep them excited about what they do, along with managing their self-care.

Because we hear a lot of horrible stories. One thing that happens, I recognized with therapists, the traumas re-occur with living in the individual’s narrative by hearing the horrible stories. So, managing self-care is big. The other big piece is my own clinical experience with the individuals like how do I interact, what programming do we need to develop with these people along their journey, what program should we be running, and that’s probably my main thing right now.

I guess to keep the essence or the spirit alive in the office. That’s really my primary duty. How do I keep the essence or the spirit alive in the office?

You mentioned something interesting about reliving experience. Is this the view of the counsellors themselves, the patients, or both?

Many of us come into this field because many of us are trying to heal ourselves. It is the wounded healer syndrome. When I hear some stories, if I’m not well-integrated in myself, you can re-activate some of your own trauma by hearing someone else’s trauma. That happens with younger counsellors.

Another thing is transference happens. Well, maybe it shouldn’t. But, it does. It does happen. It is not that transference is bad. It is only bad when transference activates the counsellor to where they’re doing more work than the client is.

33. I wonder if that mirrors some for the experiences of actors.

Help me understand what you mean there, I think I get you.

34. The use of Stanislovsky, or some well-known, well-used, and full of principles and practices acting technique that an actor or actress pursues, practices, and puts into play in some major role. But then, say it’s some horrible role, that apparently is very popular now. They act it out. They then begin to have nightmares as if they are that horrible person. There might be a transference there.

Yea, yea, yea.

35. It might have to do with the mirror neuron system – seeing someone else. Some studies show this. There’s two people. One drinker and one observer. You, the other person, take a cup and sip from the cup. The other person observes this action. Your motor neurons coordinate this action. The observer’s mirror neurons, about 1/3 of them, will fire in response to this observation as if they are you. They are in you, and you are in them, about 1/3rd. It is mirroring oneself in another. Professor Vilayanur Subramanian Ramachandran argues for, or proposes as a hypothesis, this as the foundation for civilization. The in-one-lifetime transfer of knowledge and expertise for adaptive survival and reproductive success compared to the evolution of characteristics through standard natural selection, environmental pressure, and sufficiently large reproduction over many, many generations.

Jeremy Siegel, he’s a psychologist who talks about attachment theory. He talks about the same thing you’re talking about de Waal who research is on bonobos. He’s probably a primatologist. He’s talking about why there’s altruism in humans, right? It is Darwinian. Anyway, we’re going on tangents.

36. In the September 1, 2011 publication of Edgewood News – that is, Volume 6, Issue 3, Summer/Fall 2011, you wrote an article entitled Motivated to Change but Not Ready for Residential Inpatient, which divided into commitment, motivation, and relapse prevention.[7] Where does this statement about process stand now – around 5 years into its future?

The article where I talked about intensive outpatient programming, which talked about who would be a viable intensive outpatient rather than an intensive inpatient. And the three things that you would look at. The first thing you look at is someone’s commitment for staying sober. His level of motivation, which is very similar to commitment. And something similar to commitment is excitement to it, especially as potential relapse prevention criteria.

I wanted to ask because processes for various techniques can be updated often, and the DSM can be updated…

 …once every ten years or so…

…it seems like every week!

(Laugh)

(Laugh)

Not quite that much, but there is controversy around the applicability of the DSM-5 or the DSM-4 diagnosis.

37. You took part in a panel on substance abuse, in 2005, with “Sally Hamel…Constable Mark Fulton… Corporal Rich DeJong…[and] Ben Tamblyn.”[8]  In a report in line with the same discussion, Media Awareness Project reported you, as the program director at the Orchard Retreat Centre at the time, stating that 8/10 clients seen by the Orchard Retreat Centre “came from homes that advocated the use of drugs, including alcohol.”[9]  According to the same report, and even further, they wrote:

If we talk about zero drug tolerance, said Zierten, but we do it while we are pouring ourselves a cocktail, what kind of statement are we making?… While communication, coupled with education, are steps towards prevention, agreed Zierten, he also advocated stronger parenting measures, stricter discipline and the use of “tough love” techniques by caregivers. What results came from this discussion?[10] 

Where does the discussion reside now?

When you quoted this, I thought, “Man, you do thorough research, holy smokes!”

Thank you, that makes me happy.

Well, it starts in the context of the parental home. Well, if the parental home is allowing you to smoke cannabis on the back porch when it is still an illicit drug, or allow you to drink alcohol under age, you’re telling them that taking something illegal is okay. I’m not denying the fact that they’re going to go off and do it. That’s just being a teenager. That’s just what we do. But to actually facilitate and condone the behaviour sends out a terrible message to the individual because what it does is it says that it’s okay to be dishonest in some situations.

At least when they sneak around the parents and drink behind closed doors, they know they’re sneaking. They know they’re doing something dishonest, but now we change that whole culture. That whole context and say it’s not really cheating. I condone this. Even though the laws say you shouldn’t, we as the family unit say you can do it.

38. It tacitly and explicitly states laws are more loose principles, rules of thumb, or relative.

Relative! Relative to situation, what applies to others might not necessarily apply to us. That is my argument. A guy is having a drink and pouring a big tall martini or something is trying to tell the kid not to drink. Your best solution is to abstain. I’m just trying to explain that what kind of messages do you want to send to your kids.

A good message is to say, “Don’t drink!” That’s a great message to say. Why is drinking so important in culture? There are many cultures that don’t drink. Sometimes, they’re forced by religious doctrine, or where alcohol is not considered that important of a social mechanism as it is in Western culture, but here we got to have a drink.

If you want to get your children to think about substances differently, then act differently, don’t have a drink every night when you come home from work. Maybe, at social events and Christmas and weekends, when you’re out with friends or something, I wonder how much when my dad was telling me not to drink and was pouring himself his vodka gimlet, every night when he came home from work. As a matter of fact, everybody in the whole neighbourhood was drinking. It was the 1950s, right? It was when drinking at work was two or three martinis was the way to go. How did that influence? Did that give me the go-ahead to try earlier. I don’t know. What is worse now, hole smokes, these parents now no longer drink alcohol but smoke dope with their kids.

Now, I don’t know – you hear stories of them doing crystal meth, and heroine, and cocaine with their kids, and those are horrifying. I am not against legalization of cannabis. It is going to happen. It should be legalized. But realize that cannabis, it is not a benign drug. There is no such thing as a benign drug. I think there needs to be some regulation around it. Don’t do things that you don’t want your kids to do. You look like a hypocrite, otherwise.

39. Kids are mirrors. Kids look to authorities. Their guardians, intuitively. They build their behaviour patterns off that. I think that’s right in line with what you’re saying.

Kids do one of a couple things. They do exactly what we do over time, or they do the exact opposite. Kids seldom do what we say, but often do what we do. When I think about my reaction in my family system, I have two brothers who are alcoholics, and my sister is totally abstinent. And all of those are in reaction to my father. Three of us joined him. My sister said, “I’m never picking up a drink because of that.”

40. Your sister became the teetotaller.

She’s the teetotaller, absolutely. Unfortunately, she struggles with an eating disorder. So, the anxiety lives within our family system, and is still prevalent in her. She is just managing it through her eating patterns rather than her drinking patterns.

41. Something that seems important for this narrative. One sub-narrative to this metanarrative. What is the status of your mother and father at this point in time?

They’re dead. Dad died when I was in my thirties. And we were estranged. He died of his disease. He managed to get some clean time here and there, but at the end of his life, he ended up with a brain tumor. He got lung cancer too. Smoking addiction killed him. The morphine got him. He started drinking again. Technically, on his death certificate, it says he died of lung cancer and brain cancer, but in reality his addiction, if it didn’t cause it, it definitely exacerbated it.

My mom died – 16-year dead. She died of a heart attack very suddenly. But the wonderful thing was that I was in sobriety at this point, and she felt very good that I was sober. I think that I was her favorite. And she knew that my life was really a mess. We had a lovely reconciliation.

I noticed I was trying to forgive my dad. I realized that, “Oh my goodness, I am getting very angry and resentful with my mother.” I realized that she abandoned me when I was 8 years old when dad was beating me. “Where were you mom?” We had a lengthy conversation about that. She started crying, and she felt terrible. She said, “I was terrified of your father.” When she said that, there was immediately forgiveness. Because I had understood the terror he had created. I understand why she’s paralyzed. It suddenly made everything okay.

Unfortunately, I didn’t have an opportunity to talk to my dad, and I don’t know to this day if I’ve really, truly forgiven him, and I don’t know if you can tell unless I see him eyeball to eyeball. But the mere fact that I refer to him as my father is indicative of where I am on that continuum. If you were to ask me 20 years ago, I would have said, “That son of a bitch.” That would have been the first thing, and there would have been anger there. That answers that question.

42. The story you told me about your mother being in terror, and the beatings that you suffered. It reminds me of a Richard Pryor clip or scene he paints, say, where he describes that his father used to beat him, and his mother used to cry out, ‘It hurts me more than it hurts you.’ And he thought of replying, ‘Then let him beat your ass?!’

(Laugh)

Yea! That’s the thing. Comedians can put things like that, terrible instances like that, and make it funny, but that’s it. Poor mom, I felt sad for her. She didn’t plan her life to be that way. That’s for darned sure. She didn’t know she was marrying a guy that was going to be an alcoholic. They were madly in love at one point. They had dreams and hopes and desires. My dad’s drinking was not bad when I was first born. She just couldn’t get out of it. She was Catholic on top of it. So, she couldn’t leave. Catholics are stupid like that. We hang in there.

43. If you leave, the community is so deep, and I think this is generally true, if you are deeply involved in a community, and if you leave the community or do something verboten, whether by behaviour or word in that community, if it’s by word in that community it’s blaspheming the Holy Spirit, or if behaviour such as divorce, it’s social suicide, family and friends.

It’s the need to belong. We need to belong to something. We will risk terrible, terrible harm to ourselves just to say we belong.

Appendix I: Footnotes

[1] Program Coordinator, Edgewood Health Clinics; Ex-National Executive Director, Edgewood Health Clinics Network.

[2] Individual Publication Date: April 15, 2017 at http://www.in-sightjournal.com/an-interview-with-patrick-zierten-emba-ma-part-three; Full Issue Publication Date: May 1, 2017 at https://in-sightjournal.com/insight-issues/.

[3] MA (1997-2002), Theology, The University of British Columbia; EMBA (1990-1991), Queen’s University.

[4] Photograph courtesy of Patrick Zierten, EMBA, MA.

[5] LinkedIn. (2016). patrick zierten. Retrieved from https://ca.linkedin.com/in/patrick-zierten-8022637.

[6] LinkedIn. (2016). patrick zierten. Retrieved from https://ca.linkedin.com/in/patrick-zierten-8022637.

[7] Zierten, P. (2011, September 1). Motivated to Change but Not Ready for Residential Inpatient. Retrieved from http://www.edgewood.ca/assets/uploads/enews_summerfall2011_155.pdf.  

[8] Media Awareness Project. (2016). Drug Forum A Success. Retrieved from http://www.mapinc.org/drugnews/v05/n1697/a05.html?1818.

[9] The Rave. (2005, November 11). CN BC: Community Discussion Focuses On Drug-Use Prevention. Retrieved from http://www.rave.ca/en/news_info/28877/all/.

[10] The Rave. (2005, November 11). CN BC: Community Discussion Focuses On Drug-Use Prevention. Retrieved from http://www.rave.ca/en/news_info/28877/all/.

Bibliography

Edgewood Health Network Inc. (2016). Edgewood Health Network Inc. Retrieved from http://edgewoodhealthnetwork.com/#.

Jack Hirose & Associates, Inc. (2016). Patrick Zierten, EMBA, M.A.. Retrieved from http://www.jackhirose.com/speaker/patrick-zierten-emba-m-a/.

LinkedIn. (2016). patrick zierten. Retrieved from https://ca.linkedin.com/in/patrick-zierten-8022637.

Media Awareness Project. (2016). Drug Forum A Success. Retrieved from http://www.mapinc.org/drugnews/v05/n1697/a05.html?1818.

Mirus Rehabilitation Care Centre. (2016). Meet the North York Team. Retrieved from http://www.mirusrehabcare.com/about-our-addiction-treatment-center.html.

The Bible: New International Version. (2017). Matthew 7:12. Retrieved from https://www.biblegateway.com/passage/?search=Matthew+7%3A12.

The Globe and Mail. (2013, September 24). John Cleese explains why he loves Canada. Retrieved from https://search.yahoo.com/yhs/search?p=john+cleese+on+canada&ei=UTF-8&hspart=mozilla&hsimp=yhs-003.

The Rave. (2005, November 11). CN BC: Community Discussion Focuses On Drug-Use Prevention. Retrieved from http://www.rave.ca/en/news_info/28877/all/.

Zierten, P. (2012). EDGEWOOD Alumni INSITE in Vancouver. Retrieved from http://docplayer.net/5470680-For-those-seeking-help-for-addiction-access-to-more-professional.html.

Zierten, P. (2011, September 1). Motivated to Change but Not Ready for Residential Inpatient. Retrieved from http://www.edgewood.ca/assets/uploads/enews_summerfall2011_155.pdf.

Appendix II: Citation Style Listing

American Medical Association (AMA): Jacobsen S. An Interview with Patrick Zierten, EMBA, MA (Part Three) [Online].April 2017; 13(A). Available from: http://www.in-sightjournal.com/an-interview-with-patrick-zierten-emba-ma-part-three.

American Psychological Association (APA, 6th Edition, 2010): Jacobsen, S.D. (2017, April 15). An Interview with Patrick Zierten, EMBA, MA (Part Three)Retrieved from http://www.in-sightjournal.com/an-interview-with-patrick-zierten-emba-ma-part-three.

Brazilian National Standards (ABNT): JACOBSEN, S. An Interview with Patrick Zierten, EMBA, MA (Part Three). In-Sight: Independent Interview-Based Journal. 13.A, April. 2017. <http://www.in-sightjournal.com/an-interview-with-patrick-zierten-emba-ma-part-three>.

Chicago/Turabian, Author-Date (16th Edition): Jacobsen, Scott. 2017. “An Interview with Patrick Zierten, EMBA, MA (Part Three).” In-Sight: Independent Interview-Based Journal. 13.A. http://www.in-sightjournal.com/an-interview-with-patrick-zierten-emba-ma-part-three.

Chicago/Turabian, Humanities (16th Edition): Jacobsen, Scott “An Interview with Patrick Zierten, EMBA, MA (Part Three).” In-Sight: Independent Interview-Based Journal. 13.A (April 2017). http://www.in-sightjournal.com/an-interview-with-patrick-zierten-emba-ma-part-three.

Harvard: Jacobsen, S. 2017, ‘An Interview with Patrick Zierten, EMBA, MA (Part Three)In-Sight: Independent Interview-Based Journal, vol. 13.A. Available from: <http://www.in-sightjournal.com/an-interview-with-patrick-zierten-emba-ma-part-three>.

Harvard, Australian: Jacobsen, S. 2017, ‘An Interview with Patrick Zierten, EMBA, MA (Part Three)In-Sight: Independent Interview-Based Journal, vol. 13.A., http://www.in-sightjournal.com/an-interview-with-patrick-zierten-emba-ma-part-three.

Modern Language Association (MLA, 7th Edition, 2009): Scott D. Jacobsen. “An Interview with Patrick Zierten, EMBA, MA (Part Three).” In-Sight: Independent Interview-Based Journal 13.A (2017):April. 2017. Web. <http://www.in-sightjournal.com/an-interview-with-patrick-zierten-emba-ma-part-three>.

Vancouver/ICMJE: Jacobsen S. An Interview with Patrick Zierten, EMBA, MA (Part Three) [Internet]. (2017, April; 13(A). Available from: http://www.in-sightjournal.com/an-interview-with-patrick-zierten-emba-ma-part-three.

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An Interview with Patrick Zierten, EMBA, MA (Part Two)

Interviewer: Scott Douglas Jacobsen

Numbering: Issue 13.A, Idea: Outliers & Outsiders (Part Nine)

Place of Publication: Langley, British Columbia, Canada

Title: In-Sight: Independent Interview-Based Journal

Web Domain: http://www.in-sightjournal.com

Individual Publication Date: April 8, 2017

Issue Publication Date: May 1, 2017

Name of Publisher: In-Sight Publishing

Frequency: Three Times Per Year

Words: 3,906

ISSN 2369-6885

Abstract

An interview with Patrick Zierten, EMBA, MA. He discusses: MA at The University of British Columbia and the EMBA at Queen’s University; degrees and benefits to professional work; personal benefits from the work; communication and recovery; reconciliation; Zierten taking a moment; being abstinent, but not necessarily in recovery; being self-driven; the Jesus Myth; and the Golden Rule.

Keywords: Edgewood Health Clinics, Jesus, Patrick Zierten.

An Interview with Patrick Zierten, EMBA, MA: Program Coordinator, Edgewood Health Clinics; Ex-National Executive Director, Edgewood Health Clinics Network (Part Two)[1],[2],[3],[4] 

*Footnotes in & after the interview, & citation style listing after the interview.*

*This interview has been edited for clarity and readability.*

16. You earned an MA (1997-2002) in theology at The University of British Columbia and an EMBA (1990-1991) at Queen’s University. What is the story?

(Laugh)

Well, work paid for that. I didn’t have an undergraduate degree. Work was beginning to smell some issues were up with me. My drinking was getting progressively worse. But I was working here in British Columbia, and then later in Toronto. They said, “What do you want to do?” I said, “There’s this lovely program at Queen’s. Why don’t you let me do that? This might straighten things out.” I don’t even think this could be considered a Masters program based on the information given to me. This is way back in 88’ or something like that. So, I went to that and they paid for it.

I drank like a fish that entire thing. I was constantly intoxicated during the thing. It didn’t teach me anything that I didn’t already know. I knew on the business side of things. They give you a lot of credits for previous work too. They gave me credits based on the previous professional work. I would say my takeaway from that thing was nothing. It bought time in my job is what it did.

Now, theology is a different issue. I think what the Masters programs did for me was team me discipline. The Masters, at least of theology, gave me the permission to think creatively. I didn’t have an undergrad. But from what I’ve heard, you get information and regurgitate it on a test. It doesn’t require new thinking.

17. What you’re telling me, with the EMBA, you were at the moment of spiritual emptiness more or less, and then this followed into the Masters in theology. You are recovering. You’re taking these classes. And at the early part, you are in detox. At the latter points, I would speculate being in some form of AA (Alcoholics Anonymous).

Yes.

18. How did this benefit professional work with the emphasis on the MA rather than the EMBA based on the previous response?

The MA allowed me to become a counsellor. That’s all that was needed to get the first job that I got at the Orchard Recovery Centre. They just wanted a Masters degree. They didn’t care about what it was in. So, that plus some other work with family systems and certificate work in drug counselling made me a counsellor, and of course my own experience. And I read extensively.

Slowly, people realized that I had this business background. I started to take on more and more administrative duties when Edgewood hired me here 8 years ago, they asked me to open the office in Vancouver. Then a company bought us out called Edgewood Health Network and said, “Gee, Patrick, we’re building all of these clinics. Why don’t you head this up? You have all of this business experience plus you’ve got the clinical background.” I said, ‘Yea, I’ll head this up.” Six months into it, I realized I don’t want to do this.

I truly believe that being a counsellor is a calling from God. God wants me to help people. But I was doing 90% of my work as business because I was running all of these clinics. It went back to this same emptiness in my gut. I had to go back to my boss and say, “I’m sorry. I’m not your guy. In the past, I probably would’ve pushed through it.” And if I was drinking, I would’ve been drinking.

I was willing to take a cut in pay. Even if they said, “If you’re not the guy, you cannot be working for the company.” I was willing to do all of that. I had to be true to myself. I had gone astray, again. My ego had not quite died in that last 20 years. It was still hanging around. They hired somebody to take the position. And I’m going through transition now. As of April 1, I am running this little office all by myself. So, that, I guess, that business side influenced my life. The business side of me influenced my ego. Theology influence my counselling.

19. In terms of personal life, with the previous responses related to the profession and the calling, any personal benefits from this work? Of course, some obvious ones, but there seems to be a tangle between when it happened, how it happened, and this as an attempt to parse the personal from the professional.

I don’t know if the schooling or the Masters did anything for my personal life. There was this work. There was this façade. There was this pseudo-self that supported my work life and family life. It was all tied together. Of course, my drinking was heavily influencing my personal life back then too. It’s tough to suss that out. Even today, to suss what the theology degree has done, or the recovery process has done, but I do know that I am far more compassionate than I have been in the past. Far more forgiving, not only with others, but with myself. I find myself far more patient. I find myself being able to communicate at levels that I was not able to communicate in the past such as being vulnerable in intimate levels with people I know that I am not used to.

I hope that I am a little bit of a better guy, you know? A little bit better guy than 20 years ago. I have had much more rewarding relationships today than I ever did 20 years ago. I think that is part theology, and I think it is part recovery.

20. You mentioned communication. How important is communication to recovery? Being able to communicate, for instance, those that come into a situation and realize, “Okay, I have a serious problem.” But they cannot even articulate to others that they care about that it’s a problem.

Communication isn’t necessary in the rooms, in the 12-step rooms. Everyone know what’s going on. So, you don’t need to communicate that. There’s something. They mention something. And you go, I know exactly what you’re talking about. The 12-step community is a place where I learned to start to learn to communicate. I learned things in AA that I should’ve learned in kindergarten. How to share, how to be nice, how to be kind, how to communicate, how to tell people how I feel, I learned all of that in AA.

So, I think communication with the other people outside of the rooms took me much longer because I had to learn those skills in AA before I could take it into my relationship with my wife and my kids. Of course, there is the process in AA about making reconciliation and amends, and all of these others things they call on.

Eventually, recovery demands that you communicate with your loved ones to reconcile. There are a lot of people that are abstinent, but not in recovery. Abstinent does not mean a person is in recovery. That is a whole different ball game.

It does not mean it happens right away. Communication is critical at some point, but it does not mean that it has to happen right away.

21. Two things come to mind from that. First, in the period leading up to your going into detox, entering your Masters in theology, you lost your family…

…Yes…

22. …And you lost your work. And you mentioned reconciliation, and you mentioned family, what this brings to mind for me is how did things reconcile for you – if they did?

They did. It’s taken a long, long time because I devastated my family. I abandoned the family. When I left the family, there were a lot of reasons that I used to justify what I did that made no sense. I blamed my wife, my job, etc.

Only in hindsight after I got sober did I realize that I was chasing my addiction. It was too difficult to juggle family, and work, and addiction. So, the family usually gets discarded. Most addicts discard the family. Because you need to keep the job to pay for the addiction. So, I got into recovery. Like I said, I devastated my family. I broke my daughter’s heart, and I broke my ex-wife’s heart. The two boys, I got three kids. I have an older daughter and two sons. The two boys. They’re men, right? They’re much less complicated. They are like, “It’s okay, dad. We still love you.” We’re guys. It’s okay. That was quickly resolved. The reconciliation, but my daughter took me years to move past the pain and the hurt that I caused her.

She was heavily aligned with my wife and my wife’s pain. So, the two of them were allies with the pain that I caused. Their pain was covered up with anger. So, whenever I approached them, there was always anger.

My daughter was really important for me to reconcile with – so I made this huge effort. I sent her cards, and emails, and little messages, and you name it. I tried everything. Gifts. Send her trips and stuff. Nothing, no thank yous, no phone calls, no nothing. I was with my sponsor. He said, “Be diligent, be diligent, be patient, be patient.” Until finally, I said, “Forget it. Screw that. Enough of this bullshit. I can’t handle it. I’ve done everything I possibly can. It’s in her lap.” And I got angry at her, which made me feel bad that I was getting angry at my daughter for the terrible things I did to her and she didn’t want to forgive me, like, where does that logic come from?

Somehow, I began developing a relationship with my ex-wife over this because we talked about the kids, and there was this softness that began to develop. I was sending her Mother’s Day cards and thanking her for taking the kids while I was gone. I made my amends to her. Matter of fact, I made amends to my ex-wife 3 or 4 times as I remembered things. So, that relationship got softer. And then Father’s Day, which was a big event in my day, because I was waiting around the house waiting for the kids to call.

My boys would call. They’d say, “Hey dad, called to wish you a Happy Father’s Day.”

(Click)

They were done. They’re men. One sentence or less.

It was seven years, seven years, and then my daughter called on Father’s Day. It was really awkward, obviously. “I just wanted to wish you a Happy Father’s Day.” I probably said I loved her, she did not respond, and then I thought, “Wow, we’re making some headway.” After, I started thinking, “Why did she start thinking to pick up the phone and make this darn call?” I think what happened was that I was repairing the damage done between me and my ex-wife, and that allowed her to make some space to come closer to me. I think she thought if she created a relationship with me, she would have felt that she would be betraying her mom because they were locked in their own pain. Their own grief. I had it backwards. I should have always been trying to work with my wife and reconciling with her, and that would have allowed my daughter to come closer.

That opened the door, and it’s got better, and better, and better, and better, and better. In April, I am going to be staying at my daughter’s house. She’s invited me to stay in her house.

Now, I’ve been sober for 21 years.

(Laugh)

And, you know, it took seven years before I got the first phone call. I still don’t like the relationship I have with my daughter, but that’s because I’ve got this idealized relationship picture that probably can’t happen because there’s so much time that’s gone by. I don’t know my daughter the way I should know her. Because there are huge gaps of time when I wasn’t around and didn’t see her grow and experience. And I am hoping at the end of the day, that she’s going to, you know, ten years after I die, she’s going to sit around at the dinner table with my two sons and they’ll be exchanging stories about dad and she’s going to say, “Hey –

[Long pause]

[Zierten Crying]

“…He was a good man. He’s alright, you know?” And I’m sad that I didn’t know them better. But if that conversation occurs, then it will make life worthwhile. So yes, reconciliation takes a long time, man. But at the end of the day, it is the relationships you have with your loved ones and how do you make them the best you possibly can. And by the way, the onus is on my side of the street, not theirs. If they want to play along, that’s wonderful, but if they don’t want to play along I still have that role I have to play.

23. It’s okay. We can take the time. If you need time, it’s okay.

Okay.

[Pause]

24. You mentioned something else about someone being abstinent, but not necessarily in recovery. So, what does abstinence mean in this context? And what does recovery mean in this context? Therefore, how can one be abstinent and not in recovery?

The answer to this is maintaining a sobriety from all form of mood altering substances: alcohol, cannabis, cocaine – whatever the drugs of choice are. So that you’re not always defaulting back into an old behemoth. And living sober. Recovery is about becoming a better human being as a result of this freedom you’ve gained from not having to use anymore. To me, if you don’t get recovery, you’re going to go back to using because you just can’t live with the terrible angst. Those issues have not been solved yet. The negative consequences may have stopped. That’s fine. That’s probably good, but you still haven’t solved the inner issues. To me, recovery is about resolving the inner issues. The reconciliation, establishing the relationships, righteous living, just being a better guy one day at a time. That usually requires community support, therapy, education, all of the things that make you a better person.  That’s the difference.

25. Now, some of the things talked about before with respect to the content and purpose of the MA had to do with it simply being a way in which to better think independently about certain subject matter – to “play around with ideas.”

That seemed to fit your anti-collective, or independence of, mind that you had, which was both grounded in that American, Milwaukee experience. In addition to, possibly, going away from the collective of your father, who was likely Roman Catholic, in addition to the Roman Catholic system, which is, in general, to do with authority, especially to do with Mass and cathedral attendance with the priest wearing a robe.

The authority based on apostolic succession from Saint Peter. You have the boys in the white robe coming down the pews. You lean down with the cushion pullouts from the back of the seat behind you, and do prayers, but it is all guided for you. It is all interpreted for you, preliminarily. Therefore, your thoughts are guided, and therefore your decisions, for you in advance with regards to the ultimate nature of the world from theological disciplines.

What I am getting a sense of is both this spiritual experience of ‘getting alcohol out of my life!’, ‘I’m going to enter detox’, ‘I interpret that as a miracle from personal perspective’, and ‘that was an act of God’. The act of God, the quitting, the entering detox, and then going into the MA of theology, which has to do with a large independence of mind there, and the self-driven and the self-discipline. Now, the self-driven was more there at 16, but the self-discipline was more developed during the second Masters degree. One thing that was not necessarily talked about was the content and purpose of the MA.

The purpose was to continue education, but I do not know what was in it, in terms of interpretation of scripture, reading, and so on.

I didn’t take credit for stuff. In my recovery, it is so easy. It so comes to me so naturally. You’re probably right. It’s self-driven, but I don’t feel that it’s self-driven. I don’t know how to explain.

If it isn’t, I will put the brakes on the statement about being “self-driven.”

I don’t know how to explain it. But going back to the content, why did I join and go back to university to get a theology degree? It was just curiosity. I had no expectation of getting anything out of it. Really, a Masters in theology. You do not make money with a Masters degree in theology, unless you’re going to be pastoring a church, which I had no intention of doing. It was totally out of curiosity.

A lot of it was around, what is the purpose of Christianity? Let’s talk about the purpose of God, Jesus Christ figure, and it’s a philosophy of God. A philosophy of Jesus Christ. That’s what most of the studies were about, and from a literal perspective to a cosmic-spiritual perspective of the Lord. It is interesting.

26. You called it the “Jesus myth” before.

Yea! I didn’t have the courage to call it the “Jesus myth” in seminary. I was afraid I’d get excommunicated or kicked out or something like that.

(Laugh)

I challenged the actual – the literalism, but I never challenged the truth of the story. So, that kept me in good grace with a bunch of folks.

(Laugh)

(Laugh)

I could elaborate on the resurrection. I could elaborate on the faith. I could elaborate on the belief system and the importance of being a good person, which is, basically, Christian thinking. Love your neighbour, love God, and love yourself. That’s the Bible in three sentences. I never strayed from that.

26. You get these principles out of Matthew 7:12, which says, “So in everything, do to others what you would have them do to you, for this sums up the Law and the Prophets.”[5] That is a general principle. There are generally three forms of the Golden Rule: an affirmative found in Matthew, a negative form, and a passive form. You can find this throughout Confucius’ Analects, Islam, Judaism, Buddhism, and so on. I believe you can even find it in The Church of Jesus Christ of Latter-Day Saints and Scientology.

For the Mormons, where the Garden of Eden was in Jackson County, Missouri, this is based on their cosmology and philosophy – and purported history, or that the Native Americans, across groups, were a lost tribe of Israel. To them, you die, go to heaven, hell, or purgatory, and then are reborn with a perfect body, and then, based on works in the world are given placement in the Telestial, Celestial, or Terrestrial realms in this after-earth life with a perfect body.

Or for the Scientologists, the perspective of the galactic overlord Xenu from trillions of years ago, and the inhabitation of human beings with Thetans with the cure being in Dianetics. You have these principles of “Love your neighbour, love God, and love yourself.” These are the valuable things that you got out of the Catholic upbringing.

I always had it. I always had it because I was brought up in the Catholic tradition. It was the epitome of Love your neighbour, love God, and love yourself. It was the literalism that I escaped from when I left after high school, but I never left the basic concept or premise of the Bible.

Appendix I: Footnotes

[1] Program Coordinator, Edgewood Health Clinics; Ex-National Executive Director, Edgewood Health Clinics Network.

[2] Individual Publication Date: April 8, 2017 at http://www.in-sightjournal.com/an-interview-with-patrick-zierten-emba-ma-part-two; Full Issue Publication Date: May 1, 2017 at https://in-sightjournal.com/insight-issues/.

[3] MA (1997-2002), Theology, The University of British Columbia; EMBA (1990-1991), Queen’s University.

[4] Photograph courtesy of Patrick Zierten, EMBA, MA.

[5] The Bible: New International Version. (2017). Matthew 7:12. Retrieved from https://www.biblegateway.com/passage/?search=Matthew+7%3A12.

Bibliography

Edgewood Health Network Inc. (2016). Edgewood Health Network Inc. Retrieved from http://edgewoodhealthnetwork.com/#.

Jack Hirose & Associates, Inc. (2016). Patrick Zierten, EMBA, M.A.. Retrieved from http://www.jackhirose.com/speaker/patrick-zierten-emba-m-a/.

LinkedIn. (2016). patrick zierten. Retrieved from https://ca.linkedin.com/in/patrick-zierten-8022637.

Media Awareness Project. (2016). Drug Forum A Success. Retrieved from http://www.mapinc.org/drugnews/v05/n1697/a05.html?1818.

Mirus Rehabilitation Care Centre. (2016). Meet the North York Team. Retrieved from http://www.mirusrehabcare.com/about-our-addiction-treatment-center.html.

The Bible: New International Version. (2017). Matthew 7:12. Retrieved from https://www.biblegateway.com/passage/?search=Matthew+7%3A12.

The Globe and Mail. (2013, September 24). John Cleese explains why he loves Canada. Retrieved from https://search.yahoo.com/yhs/search?p=john+cleese+on+canada&ei=UTF-8&hspart=mozilla&hsimp=yhs-003.

The Rave. (2005, November 11). CN BC: Community Discussion Focuses On Drug-Use Prevention. Retrieved from http://www.rave.ca/en/news_info/28877/all/.

Zierten, P. (2012). EDGEWOOD Alumni INSITE in Vancouver. Retrieved from http://docplayer.net/5470680-For-those-seeking-help-for-addiction-access-to-more-professional.html.

Zierten, P. (2011, September 1). Motivated to Change but Not Ready for Residential Inpatient. Retrieved from http://www.edgewood.ca/assets/uploads/enews_summerfall2011_155.pdf.

Appendix II: Citation Style Listing

American Medical Association (AMA): Jacobsen S. An Interview with Patrick Zierten, EMBA, MA (Part Two) [Online].April 2017; 13(A). Available from: http://www.in-sightjournal.com/an-interview-with-patrick-zierten-emba-ma-part-two.

American Psychological Association (APA, 6th Edition, 2010): Jacobsen, S.D. (2017, April 8). An Interview with Patrick Zierten, EMBA, MA (Part Two)Retrieved from http://www.in-sightjournal.com/an-interview-with-patrick-zierten-emba-ma-part-two.

Brazilian National Standards (ABNT): JACOBSEN, S. An Interview with Patrick Zierten, EMBA, MA (Part Two). In-Sight: Independent Interview-Based Journal. 13.A, April. 2017. <http://www.in-sightjournal.com/an-interview-with-patrick-zierten-emba-ma-part-two>.

Chicago/Turabian, Author-Date (16th Edition): Jacobsen, Scott. 2017. “An Interview with Patrick Zierten, EMBA, MA (Part Two).” In-Sight: Independent Interview-Based Journal. 13.A. http://www.in-sightjournal.com/an-interview-with-patrick-zierten-emba-ma-part-two.

Chicago/Turabian, Humanities (16th Edition): Jacobsen, Scott “An Interview with Patrick Zierten, EMBA, MA (Part Two).” In-Sight: Independent Interview-Based Journal. 13.A (April 2017). http://www.in-sightjournal.com/an-interview-with-patrick-zierten-emba-ma-part-two.

Harvard: Jacobsen, S. 2017, ‘An Interview with Patrick Zierten, EMBA, MA (Part Two)In-Sight: Independent Interview-Based Journal, vol. 13.A. Available from: <http://www.in-sightjournal.com/an-interview-with-patrick-zierten-emba-ma-part-two>.

Harvard, Australian: Jacobsen, S. 2017, ‘An Interview with Patrick Zierten, EMBA, MA (Part Two)In-Sight: Independent Interview-Based Journal, vol. 13.A., http://www.in-sightjournal.com/an-interview-with-patrick-zierten-emba-ma-part-two.

Modern Language Association (MLA, 7th Edition, 2009): Scott D. Jacobsen. “An Interview with Patrick Zierten, EMBA, MA (Part Two).” In-Sight: Independent Interview-Based Journal 13.A (2017):April. 2017. Web. <http://www.in-sightjournal.com/an-interview-with-patrick-zierten-emba-ma-part-two>.

Vancouver/ICMJE: Jacobsen S. An Interview with Patrick Zierten, EMBA, MA (Part Two) [Internet]. (2017, April; 13(A). Available from: http://www.in-sightjournal.com/an-interview-with-patrick-zierten-emba-ma-part-two.

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