Center to Improve Veteran Involvement in Care (CIVIC)
Investigator Story: Jennifer Barton, MD, MCR
Written by Noah Jacobson
Producing the next great American novel doesn’t come easily. That was a realization Dr. Jennifer Barton made after graduating from college with an English degree. Little did she know at the time that she would eventually achieve author status in the world of medicine and more, bridging the gap between research and clinical interventions.
Initially, Dr. Barton did not stray far from literature, taking an unpaid editorial internship at Harper’s Magazine and eventually becoming a full-time assistant editor. While the world of writing was both “exciting and intimidating,” Dr. Barton felt her contributions lacked purpose. Reconsidering her career, a memorable social justice lecture by a physician-writer during college provided a spark. So, she pursued her medical degree first through pre-medical classes at Columbia University, followed by medical school at SUNY Stony Brook.
For Dr. Barton, the skills of a journalist translated seamlessly to medicine. “I view my role as eliciting histories and facts and then weaving them together to create a narrative,” she explained. During her fellowship at University of California, San Francisco, she saw patients every week at a rheumatoid arthritis (RA) clinic at the San Francisco General Hospital. Two-thirds of her patients spoke either Spanish or Cantonese, with the remaining third speaking Vietnamese, Russian, Tagalog or English. With such a diverse patient population, disparities research seemed like a logical starting point to utilize her communication skills. Simply put, “intervening at the point of care with tools to have better conversations could potentially reduce disparities for our patients” recounts Dr. Barton. RA interventions that facilitate shared decision making became a focus of Dr Barton’s research.
Researching communication and shared decision making in rheumatology is not unlike writing a detective novel for Dr. Barton. The two main characters, patients, and clinicians, each have flaws and strengths that she must uncover, address, and balance. “There are many demands on patients and clinicians, and it is difficult to enter that space and ask both parties to do just a little bit more or change their behavior. The system does not always allow for flexibility. I learned to ask questions, and to listen. And then to write in ways that could be understood,” she continued. For instance, Dr. Barton, with input from CIVIC’s Veteran Engagement Group, led the development of a low literacy medication summary guide and decision aid tool for vulnerable populations with RA with input from patients.
Since coming to CIVIC nearly eight years ago, Dr Barton’s roles and accomplishments have grown. She currently serves as Rheumatology Section Chief at VA Portland and is an Associate Professor of Medicine at Oregon Health & Science University, where she was awarded a National Institutes of Health K23 award to study patient-clinician concordance around goals for treatment of rheumatoid arthritis.
Currently, Dr. Barton and her team will start enrolling VA patients across three sites (Portland, San Francisco, and Philadelphia) for her VA Merit study (IIR 20-162 “Implementation of shared decision making in rheumatoid arthritis: a stepped wedge, cluster-randomized trial”). The project manager, Rachel Matsumoto, and research assistant, Chris Larsen, work with the other sites’ research staff to ensure fidelity across survey sites, recruit and enroll participants, and generate online content. “They’re both indispensable,” exclaimed Dr. Barton. Dr. Barton’s goal is to pursue a broader implementation and dissemination study nationally across VA rheumatology clinics to facilitate shared decision making and improve communication and outcomes for patients with RA both in VA and beyond.
Dr. Barton’s early editorial work reached Harper’s Magazine’s 600,000 readers but her career as a physician impacts communities on a greater scale. “I can see patients, teach fellows, conduct research, and oversee policy as section chief” with plenty of “opportunities for creativity,” remarked Dr. Barton. From literature as an undergraduate to medicine today, Dr. Barton continues to explore, and now more importantly improve, the human condition through thoughtful communication.
