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Submitted: 27 June 2017
Three sessions: 23 August 2016, 1 September 2016, 25 October 2016
Total approximate duration: 4 hours 44 minutes
Interviewer: Tacey A. Rosolowski, Ph.D.
For supplementary materials:
Please contact, the Historical Resources Center, Research Medical Library:
Javier Garza, MSIS, firstname.lastname@example.org
About the Interview Subject:
Dr. Walter Franklin Baile [b. 2 June 1944, Jersey City, New Jersey] was recruited to MD Anderson in 1994 as a Professor in the Department of Neuro-Oncology where he also served as Chief of the Psychiatry Section. When he retired in 2016 he was a Professor in the Department of Behavioral Science and a practicing psychiatrist with a dual appointment in the Department of Psychiatry. He also served as founding Director of the Interpersonal Communication and Relationship Enhancement (I*CARE) program in the Department of Faculty and Academic Development.
Major Topics Covered:
Personal background; educational experience; professional path
History of psychiatry; the value of psychiatry to medicine
Overview of communications in medicine; communications issues for oncology patients
Sociodrama and psychodrama as teaching techniques in medical communications
Psychiatry at MD Anderson
Leadership and conflict in the Department of Psychiatry
Developing communications teaching at MD Anderson
The iCare communications program: services, institutional support for
Institutional change with shift in administration, 2011 and Ronald DePinho
About transcription and the transcript
This interview had been transcribed according to oral history best practices to preserve the conversational quality of spoken language (rather than editing it to written standards).
The interview subject has been given the opportunity to review the transcript and make changes: any substantial departures from the audio file are indicated with brackets [ ].
In addition, the Archives may have redacted portions of the transcript and audio file in compliance with HIPAA and/or interview subject requests.
The views expressed in this interview are solely the perspective of the interview subject.They are not to be interpreted as the official view of any other individual or of The University of Texas MD Anderson Cancer Center.
Interview Session One: 20 February 2014
Early Education and a Transformational Experience in Italy
Chapter 02 / Educational Path
Some Background on Psychiatry and a Fellowship
Chapter 03 / Professional Path
A Role as Psychiatric Services Liaison and Reflections on Justice and Care of the Mentally Ill
Chapter 04 / Professional Path
Chronic Pain, Working with Cancer Patients, and a Digression on Photography
Chapter 05 / Professional Path
Interview Session Two: 1 September 2016
A New Specialization in Oncology Communication Skills
Chapter 07 / The Researcher
Teaching Communications to Larger Groups
Chapter 08 / The Researcher
The iCare Program [Interpersonal Communication And Relationship Enhancement]
Chapter 09 / Building the Institution
Interview Session Three: 25 October 2016
Communication, Propaganda, and the Need for Self-Awareness
Chapter 11 / Overview
Clinicians and Communication: Challenges and Obstacles to Good Rapport
Chapter 12 / Overview
Reflections on Communications
Chapter 13 / View on Career and Accomplishments
Final Thoughts on Institutional Change and a ‘Job that Is Not My Life”
Chapter 14 / Critical Perspectives
Interview Session One: 23 August 2016 (listen/read)
interview Identifier (listen/read)
Chapter 01 (Personal Background)
A Modest Middle Class Upbringing that Stressed Education (listen/read)
In this chapter, Dr. Baile talks about growing up in a white middle class neighborhood as one of five sons. He talks about his father (Franklin), a factory worker, the origin of the name Baile, and his amazement that his father was able to provide such a comfortable life on one income. He talks about his respect for unions and his father’s view that education offered a pathway to success.
Next, he talks about his mother (Marie), raised by a very devoutly Catholic older sister. He talks about what his daughter, Danielle, is currently doing in college. He briefly discusses his own interest in photography and his plans to pursue photography once retired.
Chapter 02 (Educational Path)
Early Education and a Transformational Experience in Italy (listen/read)
Dr. Baile begins by describing the educational experiences and support he received at Catholic elementary and preparatory schools. He notes that he was a “late bloomer” and did not have the advantage of a family background of scholarship: he had to “make it on his own,” he says.
He talks about choosing to major in psychology at St. Peter's College (Jersey City, NJ; BA conferred 1966) and how, in his junior year, he met Angelo Dannizino who encouraged him to apply to medical school, which led him to the University of Pavia School of Medicine in Pavia, Italy, (MD conferred, 1972). Italy provided him with a “transformational” experience. He discusses the impact of living and studying in Italy and notes that he has sustained his friendships in Italy and travels back there to conduct workshops on communication.
Chapter 03 (Professional Path)
Some Background on Psychiatry and a Fellowship (listen/read)
Dr. Baile observes that he has always worked at the interface between psychiatry and medicine. He begins by telling how he met Rob Buckman, who wrote a book on how to break bad news. He talks about working with him to develop videos on communication for the iCARE program at MD Anderson.
Next, Dr. Baile gives a brief history of psychiatry, noting that the first generation prior to Freud were neurologists. Freud represented a paradigm shift that had particular impact in the United States, and he notes that he had three psychoanalytic supervisors. Then, in the late 70s and early 80s, the interests of the field returned to neuro-psychiatric discussions and psychoanalysis waned.
As an example of the interface between medicine and psychiatry, Dr. Baile explains that breast cancer patients who are particularly traumatized by their cancer often have trauma or abuse in their backgrounds. He talks about the “beauty of being a psychiatrist” and being able to work closely with a patient.
Next Dr. Baile discusses his fellowship period at the Laboratory of Behavioral Sciences, Gerontology Research Center, National Institute on Aging, Baltimore, where he worked with Bernard T. Engel (1976-1978). He also talks about working with the The Sexual Behavior Consultation Unit during his residency at Johns Hopkins (1973-1976).
Chapter 04 (Professional Path)
A Role as Psychiatric Services Liaison and Reflections on Justice and Care of the Mentally Ill (listen/read)
In this chapter, Dr. Baile talks about his first position as Director, Consultation/Liaison Service, Department of Psychiatry, Johns Hopkins Bayview Hospital, Baltimore (1978-1983), where he also served as Director of Psychiatric Education in the General Internal Medicine Residency Program (1980-1983). He notes the “steep learning curve” and his enthusiasm for applying what he had learned about group dynamics and systems theory as he educated the staff about the need for mental health treatment.
Next Dr. Baile talks about attitudes toward treatment of mentally ill patients (particularly those in prison) and compares general treatment practices with the excellent community treatment and support offered at that time through Bayview Hospital. He notes that the question, What is justice, “guides my heart” and approach to psychotherapy. He talks about his commitment to helping people who have been disadvantaged by their life experiences.
Chapter 05 (Professional Path)
Chronic Pain, Working with Cancer Patients, and a Digression on Photography (listen/read)
In this chapter, Dr. Baile first touches briefly on his next job (Director, Maryland Center for Pain Management at the University of Maryland Hospital in Baltimore, Maryland, 1983-1986), discussing current psychiatric theories of pain as well as his own theory that chronic pain sufferers had conversion disorder. He describes the Pain Unit and notes a publication he placed. He notes the period of depression he suffered after the Pain Unit was closed.
Dr. Baile then focuses on his next role as Chief of the Psychosocial Medicine Service at the H. Lee Moffitt Comprehensive Cancer Center and Research Institute (South Florida School of Medicine, Tampa, 1987-1994). He observes that his is “imaginative and creative” and able to take on different roles.
Dr. Baile then digresses and discusses his interest in photography, mentioning several photographs he has taken.
He then returns to the topic of his work at the Comprehensive Cancer Center. He talks about the overall, crisis theory approach to working with cancer patients, noting that the quality of interaction with patients makes the biggest difference to them. He discusses the “powerful role” that caregivers have on patients, who experience not merely grief, but extreme loss.
1 September 2016 (listen/read)
Interview Identifier (listen/read)
Chapter 07 (The Researcher)
A New Specialization in Oncology Communication Skills (listen/read)
In this chapter, Dr. Baile discusses how his career flourished from 1994 to 1998, despite administrative challenges he faced as he entered the evolving field of communication skills in oncology (i.e. teaching oncologists to communicate effectively).
He talks about how he met a team of people interested in this subject and they received a K Award from the NIH to develop workshops for oncologists, offered at retreats in Aspen, Colorado. He explains how the workshops were organized around role playing and notes the uniqueness of this model. He describes how Amy Zuckerman came from the New York Times to write an article on the program (becoming aware of it via Oncotalk videos, see http://depts.washington.edu/oncotalk/videos/) and witnessed a very poignant scene. He then explain how they wrote a grant to teach communications skills, describing how the workshops were organized.
Chapter 08 (The Researcher)
Teaching Communications to Larger Groups (listen/read)
In this chapter, Dr. Baile talks about how he spent the next seven years developing strategies to teach communications to larger groups, basing his approach on the work of Rebecca Walters and John Nolte’s use of psychodrama and sociodrama to explore communcations and emotional issues.
Dr. Baile illustrates his approach by talking about psychodrama retreats he held in Italy, in particular a workshop for forty hospice workers addressing end of life communications.
He discusses the warm up exercises needed and the way that psychodrama techniques are based on role-reversals.
Next, he describes challenges that participants confront and the opportunities for transformation that psychodrama offers –experiences that he finds very gratifying to offer to clients. Dr. Baile then talks through how psychodrama works, using the example of a nurse who was taken off a case without any explanation for why.
Dr. Baile then talks about differences between teaching in Italy, where participants can come for multi-day retreats, and the more skill-based approach he takes at MD Anderson, where participants can only spend an hour or two.
Chapter 09 (Building the Institution)
The iCare Program [Interpersonal Communication And Relationship Enhancement] (listen/read)
In this chapter, Dr. Baile talks about how he developed MD Anderson’s iCare Program [Interpersonal Communication And Relationship Enhancement], serving as the founding director since 2007. He explaining how he left the position of Head of the Section of Psychiatry, a move that came just after he had applied for money from the University Cancer Foundation to make communications videos available via a website. Dr. Baile observes that there was a lot of interest in communication skills at the time and he explains that he adapted his conceptual model of teaching communications via socio- and psycho-dramatic examples.
He talks about the different audiences for communication teaching within MD Anderson and the evolution of the program. He explains that, for the last three years, he has been training medical oncology fellows by videotaping them breaking bad news and then giving feedback. He notes that he plans to retire in 2018 and hopes to offer one on one feedback sessions before that time. He explains why some doctors are reluctant to take communications training in contrast with nurses, who are more often willing to do so.
Next, Dr. Baile comments on “MD Anderson silos,” noting that a lack of collaboration can result in ineffective programs. He uses the “Language of Caring” initiative as an example. (He was not consulted, though he feels he was uniquely placed to contribute.)
Chapter 10 (Building the Institution)
Work with Faculty and Academic Development and Other Communications Projects (listen/read)
Dr. Baile then comments on his contributions to the Department of Faculty and Academic Development. He gives examples of personal leadership coaching he has done, commenting that physicians are leaders in the institution and must be nurtured. He notes that academic medical institutions tend to place untrained individuals into leadership positions.
Dr. Baile notes that i*CARE is housed within Faculty and Academic Development. He then talks about new projects he is conducting. In partnership with Diagnostic Imaging he is developing a program to connect behavior of faculty and staff with institutional core values. He also talks about a program for Surgical Oncology fellows addressing communication challenges in surgery consults.
Next, Dr. Baile comments on how his interest in communications evolved, noting that he likes the creativity of new projects and the opportunity to “give birth.”
Next segues to a conversation about a number of photos he has taken.
Interview Session Three: 25 October 2016 (listen/read)
Interview Identifier (listen/read)
Chapter 11 (Overview)
Communication, Propaganda, and the Need for Self-Awareness (listen/read)
The beginning of this interview is strongly influenced by the 2016 election season.
Following up on a question about why individuals may not communicate well, Dr. Baile starts this chapter by quickly sketching the qualities that define emotional intelligence. He then notes that personal insecurities drive people to be judgmental. He then begins to discuss propaganda and how that can play out at a national level. He comments on how to encourage people to develop rapport and trust in communicative settings. He offers comments on presidential candidate, Donald Trump.
Chapter 12 (Overview)
Clinicians and Communication: Challenges and Obstacles to Good Rapport (listen/read)
Dr. Baile begins this chapter by affirming that physicians have the ability to bring hope and comfort to people. He explains how the caregiver is defined within crisis theory. He then sketches the many challenges that get in the way of good communication so they can live up to that potential. He notes: “the beauty of medicine is that we get to know people at a time of crisis” and then discusses empathy.
Dr. Baile then critiques the resources and support that MD Anderson has so far devoted to communication issues, comparing it (unfavorably) with the Cleveland Clinic. Dr. Baile notes that he has trained the trainers at the Cleveland Clinic. He notes that MD Anderson does not prioritize interactive time spent with patients and families. He points to several markers that the institution prioritizes research. He also explains that MD Anderson is a good place to build an academic career, but the interested clinician must use his/her own time to communicate with patients.
Chapter 13 (View on Career and Accomplishments)
Reflections on Communications (listen/read)
Dr. Baile begins this chapter by listing the accomplishments he is really proud of, then sets his work on communications in the context of a changing institution. He explains that he has seen advances in research and treatment options, but not corresponding advances in the people side of medicine. He notes that leaders can serve as models to promote these advances. He then shares his own thought process as he looks at his own career, wondering “have I failed at not making this a priority?” He discusses a 2014 institutional initiative, “The Language of Caring” that failed, noting that the faculty was too busy to take part and advance it.
Chapter 14 (Critical Perspectives)
Final Thoughts on Institutional Change and a ‘Job that Is Not My Life” (listen/read)
In this chapter, Dr. Baile talks about anticipating retirement and shares some final thoughts about MD Anderson. He notes that he is now in a “letting go processes” and wonders about the fate of the iCARE program he build, given the powerful effect of shifting institutional priorities.
He notes how pleased he is that he has helped many people and has far exceeded what he believed he would do, though he does not want to continue to practice in the current institutional environment. He tells an anecdote to illustrate current culture, then offers some final words on his career at MD Anderson.