“We are taking him to rehab,” she said. I could hear a faint sigh of relief and happiness permeating her voice, which had been distinctly absent for the last few months. I could also hear wind whooshing in the background and a distant trail of her voice, which meant they were already on the road.

“That is great!” I said without hesitation or second thought. Though “great” was an understatement. Was I looking for another term? Perhaps “life-changing” would have been better to say at the moment, but nevertheless, it undeniably was great.

Coping with the effects of a loved one suffering from alcohol use disorder is no easy feat. As medical professionals, it is sometimes innate for us to prescribe recommendations as opposed to tangible treatments. “Doctors orders.” In this instance, perhaps one might effortlessly add into a conversation “you need to cut back on your drinking” or “you need to stop drinking for your health and well-being.” We say these phrases almost instinctively, without consideration of what turned that person to the bottle in the first place. Too often, we fail to consider the support, challenges and failures that come along with a journey towards sobriety.

While no two narratives of an alcoholic are identical, most might attest to the fact that alcohol can change the user in more ways than one. Initially, alcohol was a shield to withstand harsh circumstances in the world. Then, gradually, tolerance and dependence take over and the day is left, unknowingly, with the alcoholic contemplating where the next drink would come from and how it would be obtained. Neuronal connections in the brain are rerouted and detoured around obtaining the substance. Therefore, alcohol not only destroys relationships and professional careers but takes over and creates a new reality for the drinker, beginning with the consequences and aftermath of intoxicated actions. Paradoxically, alcohol may become the repellent and deter those closest to them, something they were potentially dodging in the first place. Ultimately, this leads to a situation that has spiraled out of control, and any semblance of normalcy now appears unattainable.

“So what is the point?” you might be asking yourself. As a medical professional in-training and close observer to an alcoholic’s glass world, I challenge you to think before acting and speaking. Consider the provoking elements and aspects which might have led the person in front of you down a spiral. Stating “you need to stop drinking” to an alcoholic is akin to stating “the sky is blue.” Your patient or loved one knows very well that they need to do something to address their addiction but may be terrified of the consequences associated with a sober life. They may be afraid of disappointing those around them should they relapse or constantly reflecting on the trail of destruction that led them to the moment of putting down the bottle.

This may be where your words and actions are essential. Support. Support not only the obviously downtrodden and wounded person in front of you, suffering from the effects of alcohol and hiding their addiction, but also support those downstream from the wounded working alongside you in this battle. More often than you know, loved ones close to a sufferer of alcohol use disorder take blame for their dependency. The constant replaying of questions in their mind such as “what could I have done differently?” is often interrupted by a record scratch in the form of life’s cruel realities. Therefore, addiction has wide-reaching and crippling effects which must be considered coupled with meticulous planning and treatment in the place of often abandoned recommendations. Lending an open ear to someone’s struggles might be the ounce of courage they need in order to face their circumstances with courage.

As both a medical student and a family member of a loved one suffering the effects of alcohol, I challenge you to consider doing two things when approaching a substance abuse patient, friend or loved one: think and support. Much as you would consider the etiology of congestive heart failure, also consider that of a patient’s substance abuse. Ask the patient, the family, and yourself “how did we end up here and where do we go from here?” Then, while challenging, attempt to understand each perspective and inquire regarding what is needed from you. Another pamphlet, criticism, or empty recommendation may lead to the alcoholic building their wall of defense even higher. Often, patients want to be heard and as medical professionals, we are in a humbling and unique position to change someone’s life for better or worse. You may not consider these items to be a matter of life and death, but you can never really know.

The post Beyond the Bottle appeared first on in-Training.

In this episode, we interview Dr. Edward Barksdale. He is the newly elected American Pediatric Surgery Association President. He is also the Division Chief of Pediatric General Surgery and Thoracic Surgery at UH Rainbow Babies and Children’s Hospital.

He recently launched the Anti-Fragility Initiative, which takes a unique approach to addressing Cleveland’s teen poverty challenge and has already received over $2 million from the Governor of Ohio.

We hope you enjoy our conversation where we talk about living in the moment, committing to excellence, leading from a place of purpose, leading as an introvert and the difference between success and significance.

Questions we asked include:

If you enjoy what we’re doing at Leading the Rounds, subscribe and give us a positive rating. You can also connect with us at leadingtherounds.com and on social media.

Leading the Rounds: The Medical Leadership Podcast

As physicians, we are immediately thrust into a leadership position from the moment we finish medical school. Despite this, most medical students will obtain little formal leadership training. We seek to improve our leadership abilities as burgeoning physicians. We developed this podcast to challenge ourselves to explore ideas in leadership development and how they apply to medical training. We hope to educate and motivate others to further develop themselves as leaders in health care.

Peter Dimitrion (12 Posts)

Columnist

Wayne State University School of Medicine

Peter is a second-year MD/PhD Candidate at Wayne State University School of Medicine. In 2016, he graduated with Honors from the University of Pittsburgh double majoring in chemistry and molecular biology. He then earned an M.S. in Biotechnology from Johns Hopkins in 2018. Peter currently holds a Thomas C. Rumble Fellowship and the Jerry A & Mary D Martin Memorial Scholarship from the AHEPA Educational Foundation. In his free time, he enjoys rock-climbing, cooking and hiking. After graduating from medical school, Peter would like to pursue a career in Dermatology as a physician-scientist and pursue a career as a physician-writer as well.

Leading the Rounds: The Medical Leadership Podcast

As physicians, we are immediately thrust into a leadership position from the moment we finish medical school. Despite this, most medical students will obtain little formal leadership training. We seek to improve our leadership abilities as burgeoning physicians. We developed this podcast to challenge ourselves to explore ideas in leadership development and how they apply to medical training. We hope to educate and motivate others to further develop themselves as leaders in healthcare.

The post Leading the Rounds: The Medical Leadership Podcast — “Presence, Excellence and Leading as an Introvert with Dr. Edward Barksdale” appeared first on in-Training.

I was patiently sitting in the lobby at Quest Diagnostics, waiting for the staff to slowly let people inside in adherence with the new social distancing guidelines. I waited for about ten minutes before a man in his mid-50s called my name and led me into a patient room.

“So we’re doing the drug screening?” he asked me in Spanish as I entered the doorway and confirmed. While he typed in my information in his computer, he asked me where I was from. I told him I was from Venezuela.

“Ah, Venezuela! A beautiful country! I worked in a small Venezuelan town called Maturin for a few years,” he said cheerfully. I knew Maturin; my grandmother had taken us there when we were young. She had shown us the town where she first arrived when she immigrated to Venezuela from Spain during the Spanish Civil War.

“You need the drug screen for school? What are you studying?” he asked me. When I told him I was in medical school, he told me he was a doctor himself. He had studied medicine in Cuba and practiced for years as an intensive care physician. He proudly told me that he had just gotten his degree to become a nurse. The process of revalidating a medical license in the United States is a long and expensive one. With some shame in his voice, he told me this process would have been too much for him.

A moment later, a staff member came into the room and called him away for help. He told me someone else would be collecting the urine sample from me and that they would be in shortly.

“Thank you, doctor,” I said as he walked away.

He turned around in a paralyzed fashion and looked at me. His silence and the light in his eyes are something I will never forget. How long had it been since a patient called him doctor? I could tell that he was content with his work by the liveliness and the kindness with which he treated me. However, I couldn’t help but think about his years of dedication to the study of medicine and how he was no longer able to practice his passion as a physician.

That afternoon I realized that one word had likely made this man’s day. Doctor. A word that had come with many sacrifices, enormous commitment and profound passion. A title that he would never reclaim in America.

This was not the first time I had encountered a Latino physician who was unable to practice medicine or who had to go through additional, extensive training to regain their privileges in the U.S. A few months prior at a conference, I met a Venezuelan orthopedic surgeon who had just recently relocated to the U.S. He was at the conference to network within the medical field and was considering training to become a surgical technician.

A family friend who had been a renowned orthodontist in Caracas was now working as a dental hygienist for a local dentist in Miami. An OB/Gyn physician from Maracaibo whom I met on a medical mission trip was in the process of starting his residency — for the second time — in order to be able to practice in America.

These doctors abandoned their adored countries to create safer lives for their families. They left behind memories, homes and families. They renounced their titles and with enormous humility, entered their beloved medical profession in new roles. Their passion towards the field is undoubtable and will certainly be recognized by their future patients.

To all the doctors that cannot exercise their passion because they made the brave decision to give it up in search for a better life, I want you to know that the medical community sees you. The lives you touched in your past will never forget your work, and you shouldn’t either. Although you might not regain the privilege of being a practicing physician, your role in medicine is remembered; you will always be an honored part of this community.

Thank you, Doctor.

Image credit: "Läkarutbildning till Örebro" (CC BY-NC-ND 2.0) by bjornengqvist

The post Thank You, Doctor appeared first on in-Training.

Waiting outside the anatomy lab doors just before my first cadaveric dissection, I found myself unaffected by the sense of nervousness that palpably pervaded the rest of my class. For me – a first-year medical student at the time – the anatomy lab was but a brief sojourn on my way to becoming a psychiatrist; it was an experience from which I expected to take away nothing more than an intimate knowledge of human anatomy.

When the doors were opened and we were to meet our cadavers for the first time, I went into the lab without a sense of apprehension; I intended to approach my cadaver with some distance and reserve.

However, upon encountering this lifeless body for the first time, I was instead confronted with a morally imposing demand: treat her as if she were still a person, as if she were still alive. I realized that the body, despite the absence of an inner agent, was still a reflection of personhood. The traces of identity in the cadaver that continued to reside in her body even after death, from her polished nails to her golden tooth, were representations of a person who once was. Over the course of the dissections, I would reconstruct who this person may have been using these final artifacts of her existence.

Learning about each section of my cadaver’s body felt like a story that did not unfold by the standard flow of time from past to present; instead, the story was already revealed in its fullness from the very beginning. The timeline of this story was laid out before me in her body, and I could relive any part of it as if I were recalling a memory of her life. When I dissected the muscles of her legs, I pictured the athlete she may have been in her youth. When I discovered her golden tooth, I imagined the slow decay of her body in her old age. With each dissection, I felt as if I jumped back and forth between such moments, guided by the cadaver as an emissary of her own past. Throughout the course of my time with her, I often found myself excited to return to the anatomy lab so that I could again reach back in time to relive stories of old.

In those mere hours I spent with the cadaver, I felt like I had observed the passing of a lifetime. I felt as if I had witnessed moments of her life, but I was unable to experience them with her. I suffered a sense of loss from being deprived of having a place in her story.

Against this sorrow, I considered other moments in my life when I experienced similar dilations of time and subsequent feelings of loss. For example, reunions with old friends and family members were tinged with sadness, for we had separate paths to travel. Revisiting places where I lived long ago stirred a sense of nostalgia that was painful, as I realized that the world I once knew no longer existed. In these dilations of time, I discovered that life has moved on in my absence. I discovered that family, friends, and places have changed — or perhaps even that I have changed.

This feeling of loss and subsequent reflection revealed to me something fundamental about how I experience time in my own life. As I depart the anatomy lab, I stand on the shores of time’s river and gaze into the clear water’s surface. In it, I see a reflection of growth and of internal transformation — a reflection not of who I was but of who I have become. I emerge not only learned in anatomy but also with insight into the impact that individuals can have on one another.

Relationships have the power to carve riverbeds into our inner selves, transforming us as they flow in and out of our lives. The anatomy lab demonstrated that human relationships can be entwined not only in life but even after death. This experience from which I expected to find little meaning was instead spiritually seismic. I had changed dramatically ever since the day I met my cadaver, and, as a result, I came out of the anatomy lab as someone different from the person who entered it.

Image credit: “Time” (CC BY-SA 2.0) by mirandiki

The post A Meditation on the Anatomy Lab appeared first on in-Training.

On the first day of medical school, I turned to my roommate as we walked to campus from our apartment and said, “I just want to be an M3.”

A part of me could not help but feel anxious. We had worked hard to receive acceptance letters into medical school with hopes of working with patients, understanding complex disease processes and making a difference in the lives of others. Walking into my first lecture as an M1, Molecular Cellular Biology, those hopes seemed like a far cry from our reality.

As I began the many long days yet seemingly short weeks that followed, it became apparent just how premature my statement was. I knew nothing about what being a third-year medical student on clinical rotations entailed. I also had no idea, at the start of M1 year, how grueling but equally rewarding the preclinical years would be for me. Despite the informational overload, the summation of knowledge at the end of each unit gave me the confidence to continue; I finally realized that medical education is a long marathon — not a quick sprint.

When the start of M3 year came along, I was ready: ready to put my First Aid book to rest, ready to be involved with patient care, ready to observe physicians in their realm of expertise and ready to find my place in the broad field of medicine. Now, halfway through the twelve months of clerkships, I ask myself, was it all I imagined it would be as an inexperienced first-year student?

I failed to realize before starting this year that one of the hardest aspects of clerkships is experiencing “the first day on the job” feeling every few weeks — even weekly in some rotations. Contacting the clinic to ask what time you should arrive, getting lost in the hospital trying to find an obscure room (likely without a room number), and greeting new physicians as they speed walk to their next patients (thank goodness for the physician headshots on Creighton’s website) are all moments that M3s know all too well.

Coupled with the frequency of “first days,” the limited amount of time that M3s spend on specific medical teams makes it challenging to feel completely comfortable or competent. As an example, it was not until the last day of surgery that the scrub nurse informed me of something I was doing wrong and the surgeon remarked that I hold scissors “like a kindergartener.” There have been plenty of days that I’ve left the hospital thinking I couldn’t do anything right.

After a few months of interacting with healthcare staff, it became apparent to me that they expect you to make mistakes, ask a million questions, and appear out of your comfort zone. It all comes with the territory of being a first-year clinical student. But feeling incompetent is something that us medical students aren’t used to. Still, if there ever was a time to learn from mistakes, it is during M3 year.

A positive feature of this year is the bond between medical students and interns. At first glance, interns appear to be just another person with that coveted “Dr.” printed on their ID badges but, in fact, they are so much more. They are the ultimate rock stars having survived all the hoops and loops of medical education, still standing on the other side. Unlike their superiors, interns still identify with students, as they were one just a few months ago; they truly see us when we feel invisible, educate us when the confusion sets in and look out for our best interests.

Whether it’s moving their shoulders out of the way in the OR to make sure you have a good view or quickly telling you the answer to the most pimped question the attendings like to ask, they go out of their way to help students learn and succeed. Their knowledge and partnership help propel us to continue studying, and I have found myself looking up to many of the interns I have worked with, in awe of their journey, wanting more than anything to be like them.

While our hopes may have originally been to work with patients, understand complex disease processes and make a difference in the lives of others, reaching the halfway point of M3 clerkships has made me realize new aspirations: working on my own patience and allowing others to make a difference in my life.

I have to take a step back and look at the bigger picture with ease, knowing that I’m exactly where I’m supposed to be. I have found that I can achieve the right state of mind by taking a deep breath and remembering all the hard work I’ve put in, appreciating all of the small but meaningful milestones that I have crossed thus far. I need to embrace all of the new experiences and perspectives that are flooding me with the hope that one day, not too far in the future, it will make me a stronger, more confident doctor.

M3 year may be halfway over, but it feels more like halfway from the start. It has been a blur of confusion and understanding, exhaustion and exhilaration, defeat and triumph. It isn’t exactly as graceful as I had imagined it to be, but it has also shown me a world of medicine that no book, blog, or best friend could have prepared me for – and for that, I wouldn’t change anything.

The post Halfway appeared first on in-Training.

As a child, I viewed healthcare as a utopia. All who entered the career sought only to help others;  providers were always compassionate and prioritized the patient above all else. As with most ideologies of childhood, I learned this is not always the case. The system is more complicated than that. Systemic racism, xenophobia, prejudice, biases and stereotypes plague healthcare.

To overcome these faults in our healthcare system, I believe communication is paramount, particularly in language-discordant patient-physician relationships. The art of speaking with others and learning their stories allows for understanding and compassion between patient and physician. This is especially true of patients from different backgrounds and cultures. While it is often assumed that healthcare professionals use quality communication practices, my experiences demonstrate otherwise — specifically in regards to language barriers. In one week of my obstetrics and gynecology clinical rotation, I came to witness three failures in healthcare from such barriers. I will hereby refer to the patients as the days of the week for the sake of maintaining confidentiality.

Patient Monday is a 21-year-old woman in labor for the very first time. She came from Guatemala with her husband who stands by her side. Neither of them speaks English. I walk in excitedly alongside the midwife and a family medicine resident who will be managing the birth of the baby while I manage the birth of the placenta. I am the only one of us who speaks Spanish, so I introduce the team, ask how the mommy- and daddy-to-be are doing and ask them if they have any questions regarding the vaginal delivery they are about to go through. Dad perks up quickly and asks if mom is ready to give birth because he is “sensitive to blood;” he asks if it would be okay for him to step out should he start to feel dizzy. I chuckle and explain in Spanish, “Of course, we don’t want you to be a patient here too!” Mom and dad laugh. We are ready to go.

The nurse walks in to assist and exclaims, “Oh, thank God you speak Spanish!” I translate the entire experience for the mom. I tell her when to push. I count down each time. I explain how the epidural she had been given minimizes her sensation of the contractions, but we can see them through a monitor. I share with her when we see a lock of the baby’s hair beginning to gleam through. I check in on dad as he becomes diaphoretic with sympathetic overdrive. About an hour in, more nurses arrive not to assist but to discuss what they are ordering for lunch. Salad, tacos, soup. All in English. This goes on for almost an hour — I counted.

Mom and dad stare anxiously at the excessive number of people chatting in the corner in a foreign language, wondering if there is something wrong with the baby. Why else would so many other people be crowding their room? Thank God I speak Spanish. I become frustrated by their obliviousness to the patient’s concerns. I explain to the young parents to please not worry; the baby is doing well. I tell myself to not pay attention to them; focus on my counting. “Hasta diez y con mucha esfuerza,” I encourage the laboring mother. She pushes on. Imagine.

Patient Tuesday is a 34-year-old mother of three and roughly 35 weeks pregnant with new-onset hypertension. She is originally from Honduras, lived in Mexico for two years, arrived two weeks ago, spent one week in a detention facility and was released on the same day as President Biden’s inauguration. One week out from detention, she goes to a local community clinic to establish prenatal care. At the clinic, she has elevated blood pressure and is sent to the hospital for monitoring and work-up of suspected preeclampsia. As the medical student on the floor, it is my job to get the full history from the patient for her admission to the hospital. I introduce myself in Spanish and, knowing only part of her story, begin interviewing her.

Suddenly, a nurse walks from behind the curtain in the triage room; the patient is startled. She looks to me and asks who this woman is as this is not the same nurse she had previously seen. The nurse goes straight to the computer next to the patient. No greeting, no acknowledgement of the woman on the stretcher. “Last name?” the nurse asks. I explain to the patient that this is the new nursel the shifts must have just switched. The nurse becomes impatient and sternly repeats, “Last name?” I give the last name to the nurse and explain to the patient that she is just trying to look up her information in the computer. I wrap up my interview, in Spanish, with the patient and tell her that I will be back with the doctor in a few minutes. I ask the nurse if she needs help with anything like translating. I assumed her repeated questions in English (even though our conversation had taken place in Spanish) meant that she did not know the language. She said it was fine.

Ten minutes later, a call reaches the front desk where I sit with the resident and attending physician working on documenting the encounter: “The patient is trying to leave. Someone come here to talk to her.” The resident and I rush over. The nurse is seen holding the tocometer in one hand and the fetal heart tracer in the other. She was trying to place them around this woman’s pregnant belly to monitor for contractions and the baby’s heartbeat as she does with all her patients.  Upon arriving at the room, we learn that the nurse continued trying to speak to this patient in English despite the patient’s evident inability to speak the language. Following her half-hearted attempt at “patient education,” she proceeded to lift the patient’s gown and attempts to strap on the monitors. As a result, the woman is frightened by her nurse because she is unaware of what this foreign nurse is doing to her and her unborn child. One week out from detention. She is scared. Imagine.

Patient Wednesday is an 18-year-old first-time mom who had just undergone a vaginal delivery of a baby boy. The resident and I walk through the hallway when we catch a glimpse of some new mother’s baby being transported in what could be best described as a baby spaceship. A tiny, newborn lying in a plastic encasement adorned by monitors; a massive binder with an exuberant amount of paperwork for this young life sits atop his temporary home. We look past and enter the patient’s room. This is the first time that we meet this patient and the father of her child.

The resident and I note that the new mom has a flat affect. We begin to wonder what is going on. Is it an issue with the partner? Is it postpartum blues? We ask the usual set of questions to the mom and are met with one- to two-word responses. Next, we ask about the baby, only to realize the baby is not laying in the incubator as expected with both parents in the room. Where is the baby? As it turns out, her baby was the same one we had seen in the baby spaceship earlier in the hallway. He had thrombocytopenia and was being transferred to a different hospital with a NICU for further evaluation and more appropriate monitoring.

I ask the parents if they know what is going on. They say no. The team who came to transfer the baby explained everything in English, a language neither of them knew. I assure the new parents that I would get them the information right away. I ask the transporters if anyone was going to explain to the parents what is going on and where they are taking the child. They tell me the hospital name but that they would get someone to translate for them. None of them spoke Spanish. The baby was already out of the room and ready to be sent off. I wonder what would have happened if no one had spoken up.

A woman arrives a few minutes later and, in a broken Spanglish, explains the situation. I proceed to take notes for the family. She gives them a folder with some documents so they can call the hospital for information about their newborn and eventually visit him. I confirm my notes with the woman and thank her for helping. I ask the dad if I can see the folder he had just been given so that we can review it together. The documents, the ones that were to guide the new parents to their newborn son, were in English — again, a language they did not know. We look at one another frustrated and I tell them not to worry, I will translate it for them and make sure they have all the information they need to see their child.

I take the documents and scurry off to my usual corner of the nurses’ station. I spend the next twenty minutes translating the instructions for them. I return to the room; they tearfully thank me for doing this for them. I come to learn that the mom had crossed the border illegally from Guatemala with her father. He was an alcoholic who abandoned her just over a year ago. She was alone with no family and did not know the language: an “illegal” immigrant. She eventually met her partner and the father of her child who has helped to support her and give her the family for which she was looking. She became pregnant and finally felt like things were looking up. The baby was born and she was so happy, she explains. Then, something happened and he was gone. Imagine.

Imagine being any of these patients. Imagine enduring a grueling journey to arrive at the so-called “Land of the Free,” requiring medical care in this foreign place for the sake of your child and having no idea what is going on. Imagine the gut-wrenching fear, the emotional anguish forced upon you. I have never been as disappointed by the field of medicine as I was on these days. The field that brings about so much hope and support to those who need it the most failed each one of these women.

We failed to provide them the adequate care they needed and deserved. We failed to provide them compassion, basic human decency and respect. We failed to do our job as educators and provide them with information and autonomy over their family’s care. Something so easily rectifiable with a simple phone call to translator services. Maybe “Land of the Free” only applies if you speak the language. Imagine.

Image credit: “Labor” (CC BY 2.0) by bradleygee

The post Imagine appeared first on in-Training.

“Unlock, press down on the green button and wait 10 seconds.” I read the instructions for the subcutaneous injection over and over again for what seemed like hours. With clammy hands, I finally took a deep breath, positioned the injector, and heard a loud “click.” That “click” would turn my whole life upside down, but in the best way possible.

We’ve all heard the cliché sayings about medical school: “it’s like drinking from a fire hose” or “it’s a roller coaster ride that won’t let you off.” Although I can relate to these to some degree, my medical school career was complicated by more than just complex cardiac physiology or biochemical pathways. Little did I know that at the end of my second year I would go from knocking on a patient’s door during a clinical session, to sitting in an exam room myself, waiting to be officially diagnosed with psoriatic arthritis.

For two years, I spent almost every day in pain. I would physically struggle to get out of bed most mornings. I strategically planned to leave my apartment at a certain time, knowing how long it could take me to walk through the hospital, past the library and to the classroom.

I was able to hide my symptoms for the most part — the skin lesions on my face with makeup, my limp by walking slowly, my knee pain by avoiding the stairs. It was surreal to see images in textbooks and read the specific medical terminology used to describe my chronic condition, while comparing it to how I actually felt. The buzzwords that were supposed to serve as learning tools only seemed to reduce me down to labels. I did not look at my skin and think “silver scale,” I did not look at my joints and think “pencil-in-cup deformity,” and I did not view psoriatic arthritis as simply a “seronegative arthropathy.”

I began immunosuppressive treatment just weeks before the pandemic hit the United States. While still processing my diagnosis and adjusting to new medication, I was now at a higher risk of getting infected. After being pulled out of my first clinical rotation after only three weeks, I felt conflicted. I wanted to be able to help care for patients and the community at large, but also knew that I needed to take extra precautions to take care of myself.

These experiences throughout the past year have shaped who I am as a medical student, future physician and person. I have spent a lot of time thinking about how having a chronic condition and being on an immunosuppressant could impact my career in medicine. Although there have been and will be challenges, I also see the benefit of the unique perspective I gained.

I learned to never take anything for granted; biologic therapy has truly transformed my life. I am thankful for my physician for helping me weigh the pros and cons of going on biologic therapy, and my support system of family and friends for offering their unconditional support when I was struggling to decide if I would go on this medication. Since starting, I feel more like myself both physically and mentally. I am now able to exercise and stay active. Before biologic therapy, I would have never imagined being able to stand for nine consecutive hours during my surgery rotation or running up and down multiple flights of stairs during my medicine consult rotation. 

I also recognized that it is okay to ask for help. Everyone needs support, and I am thankful to have patient and understanding colleagues, senior residents and attendings who always took the time to check on me. I strive to pay forward the kindness I have received to my future medical students. I plan to continually actively seek a network of healthcare workers with chronic illness, because there is comfort in knowing you are not alone.

Lastly, I realized that I do not want to hide anymore. I want to share my experiences with my future patients. I understand firsthand what it means to have chronic pain. I also understand what it’s like to feel reluctant about trying new medications. I believe I can use my vulnerabilities to better connect and empathize with patients enduring a similar struggle.

As I look forward to a career in internal medicine, I strive to study not only the complexities of the illnesses my patients may have, but the complexities of their lives. I want to truly learn about who my patients are, and not just focus on the buzzwords associated with them. I am humbled and grateful for each day I have in medicine and am excited for what lies ahead.

The post Doctor/Patient Patel appeared first on in-Training.

In this episode we interview Dr. Tait Shanafelt. Dr. Shanafelt is a Jeanie and Stewart Ritchie Professor of Medicine, Chief Wellness Officer, and associate dean at Stanford University School of Medicine. He is the co-author, with one of our former guests Steven Swenson, of “Mayo Clinic Strategies to Reduce Burnout”. He is credited for bringing physician-burnout to the forefront of healthcare discussion. He is a leader in the field of physician wellness and healthcare team efficiency. He has published numerous works on well being and his studies in this area have been cited by CNN, USA Today, and The New York Times.

We hope you enjoy this episode where we talk about his book, why wellness initiatives often fall flat, and how we can build a positive work environment.

Welcome to leading the rounds

Questions we asked:

• How has the pandemic changed the ideas you wrote into “Mayo Clinic Strategies to Reduce Burnout”?
• What systemic issues in healthcare wellbeing has the pandemic shined a light on?
• What were some of the processes that your team at Stanford implemented to fight the pandemic?
• Are financial constraints a valid argument for not prioritizing healthcare wellness?
• What makes a good wellness initiative?
• What would you say to a medical leader who is making excuses for not prioritizing physician wellness?

Quotes:

• ”The culture of our organizations is the foundation of wellbeing and professional fulfillment.”
• “It’s about organizational change, systems change, and culture change, not tips and tricks for personal resilience.”
• ”Our goal is to fix a broken work environment, not teach and train physicians to tolerate a broken work environment.”
• Ask your team, ”What do you need from your leaders that you’re not currently getting? What have your leaders done that has been effective?”
• ”Probably the most important thing we can do [is] listening.”
• ”When organizational wellness efforts are either lip service, or manifest as yoga and granola and learn how to practice mindfulness… they will fall flat.”
• ”Physicians have higher resilience than the general population.”
• ”Even physicians with the highest scores on resiliency… have high levels of burnout.”
• ”Our efforts are focused on improving the work environment.”
• ”The purpose of the leader is to accomplish the mission and attend to the welfare of the soldiers.”

Book suggestions:

• Humble Inquiry: The Gentle Art of Asking Instead of Telling by Edgar Schein
• Good to Great by Jim Collins
• Tribal Leadership by Dave Logan

If you enjoy what we’re doing at Leading the Rounds, subscribe and give us a positive rating. You can also connect with us at leadingtherounds.com and on social media.

Leading the Rounds: The Medical Leadership Podcast

As physicians, we are immediately thrust into a leadership position from the moment we finish medical school. Despite this, most medical students will obtain little formal leadership training. We seek to improve our leadership abilities as burgeoning physicians. We developed this podcast to challenge ourselves to explore ideas in leadership development and how they apply to medical training. We hope to educate and motivate others to further develop themselves as leaders in health care.

Peter Dimitrion (14 Posts)

Columnist

Wayne State University School of Medicine

Peter is a second-year MD/PhD Candidate at Wayne State University School of Medicine. In 2016, he graduated with Honors from the University of Pittsburgh double majoring in chemistry and molecular biology. He then earned an M.S. in Biotechnology from Johns Hopkins in 2018. Peter currently holds a Thomas C. Rumble Fellowship and the Jerry A & Mary D Martin Memorial Scholarship from the AHEPA Educational Foundation. In his free time, he enjoys rock-climbing, cooking and hiking. After graduating from medical school, Peter would like to pursue a career in Dermatology as a physician-scientist and pursue a career as a physician-writer as well.

Leading the Rounds: The Medical Leadership Podcast

As physicians, we are immediately thrust into a leadership position from the moment we finish medical school. Despite this, most medical students will obtain little formal leadership training. We seek to improve our leadership abilities as burgeoning physicians. We developed this podcast to challenge ourselves to explore ideas in leadership development and how they apply to medical training. We hope to educate and motivate others to further develop themselves as leaders in healthcare.

The post Wellness is NOT Yoga and Granola with Dr. Tait Shanafelt appeared first on in-Training.

The first thing I notice are his boots. He’s still in his street clothes, having just been admitted. He looks thin, emaciated — his clothes hang off him, shirt collar drooping down from his neck like peeling paint. His boots, however, seem to fit him properly. They look warm, well-worn but sturdy, like they have weathered a hundred bitter winters and could withstand a hundred more. For some reason, this comforts me.

I sit down next to him and start taking a history, just as we are taught to do. He tells me his story mechanically, with little emotion. He has metastatic cancer and has been plagued by multiple complications. He was just hospitalized a few weeks ago and a few weeks before that — he’s used to this now. Most of this I already know, having reviewed his chart extensively, but I am still jolted by the way he speaks those words out loud. I say something comforting in response, but the words sound far away, as if spoken by someone else.

On rounds, I like presenting his case. His medical history is interesting. His problem list requires frequent additions and rearrangements; new complications often provoke extended discussions.

“…Presenting with ascites s/p paracentesis,” I say, “his SAAG is consistent with malignancy.”

“For his thrombocytopenia, I calculated his 4-T score which suggests low risk for HIT.”

I am excited whenever the attending agrees — grateful to feel included, to be a part of the well-oiled machine that moves his care forward.

But in the room with him, my confidence wavers. He is kind and patient with us, but it is clear that he is suffering. His pain is worsening and our interventions have not touched it. He can no longer tolerate solid food. He feels lonely, isolated and the pandemic has prevented us from allowing him visitors.

Over the course of his stay, however, we find little ways to cheer him up. He likes the strawberry Ensure shakes, a rare commodity at the VA hospital, and we go out of our way to find them for him. We encourage phone calls with his partner; when they are speaking, we do not interrupt. Perhaps those calls can do more for him than we can. Often in the afternoons I return to chat with him. He tells me about his life, his family, his future plans. I am surprised how the time passes; I forget I am working and not just a bystander who was fortunate enough to be privy to this man’s stories.

When the day comes, the first thing I notice are his boots. They are not there, in their usual spot in the corner of the room. They are not there, because he is not there. I know before I check the chart and see that our list is one name shorter, before I see the word “deceased” beside his name. It happened overnight; the residents will already know. His death is not unexpected, but still I feel breathless.

The response is respectful, but brief. We share a moment of silence, and then continue with rounds. We continue because we have to — there are always more patients to see, more tasks to complete. A collective deep breath, a moment to reflect — that is all we can spare.

I have moved forward, and continue moving forward, through the rest of my third-year rotations. But he has stuck with me and I think about him often. I think about his life, and the impact that he made, as a veteran, as a part of his family and as an individual. I think about his death as well — was there any more that we could’ve done? Was he at peace when he passed? I did not know him long, nor was he my first experience with loss, but he left an impression. His life held meaning, and I am grateful to have shared in it, if only briefly. I hope that in return I made some positive impact, however small, in the final weeks of his life.

Image Credit: “Army boots” (CC BY-SA 2.0) by liftarn

The post A Moment to Reflect appeared first on in-Training.

A classmate of mine committed suicide a few weeks ago. Though I’ve heard the harrowing statistics about physician and trainee suicide rates, to be honest, I never expected to personally encounter such a tragedy. The small classes at my medical school allow for a strong sense of community in which we all know each other, celebrate important life milestones, and happily reconnect when we’re together after clinical rotations scatter us throughout the hospital.

In some ways, I can’t help but wonder if the inevitable dispersion during rotations played a role in his distress. We spend much of our preclinical time leaning on our classmates as we collectively attempt to master the intricacies of medicine; oftentimes, they are the first to offer words of encouragement after exams don’t go our way, kindly explain concepts that weren’t clear the first time around, or simply provide companionship over an afternoon cup of coffee. However, during rotations, the medical school experience becomes much more isolating — joining teams often as the lone medical student, left to your own devices to navigate not only clinical challenges, but also the awkward and complicated hierarchies universally found in medical training. When considering the additional isolation that comes with social distancing due to the current pandemic, I can only begin to imagine the suffering my classmate must have been experiencing.

In the weeks since his passing, I’ve found it challenging to grieve. No tears have been shed, nor have I been able to reminisce over the warm memories of his kindness and joviality as we tackled cadaver dissection together. Instead, I’ve found myself wondering about the medical minutiae of his “case” — a word that, despite its omnipresence in our medical lexicon, takes on a cold, reductionist tone as it attempts to distill the life of a friend down to a history of present illness, physical exam, set of lab values, and assessment and plan. How long did it take for someone to find him? Was recovery even a possibility? Were his organs eligible for donation? Did his care team know he was one of their own?

When my thoughts of medicine abate, I’m left with more troubling questions about myself. Why can’t I ignore the medicine and simply grieve his loss? Has my ability to grieve morphed into a numb, medicalized replacement? Is this how I’ll “grieve” the losses of my family or other friends too?

In retrospect, these feelings shouldn’t come as a surprise. In medicine, we’re unconsciously taught to medicalize losses of all kinds as we care for patients. In the trauma bay, for example, I observed “a traumatic aortic injury with unsuccessful repair,” as opposed to a tragic car accident leaving behind a young widow with small children. The octogenarian I met on hospital service was no longer known as the life of the party at Bridge Club; instead, she was the frail elderly woman admitted for a change in mental status who would require skilled nursing placement at discharge and would have to miss her granddaughter’s birthday party. The disheveled gentleman I met in the acute care psychiatric unit wasn’t seen as the neighbor who shoveled snow off everyone else’s driveway, but rather the man with decompensated schizophrenia admitted under civil commitment for stabilization and medication optimization. In none of these instances was the impact of loss a component of the conversation; instead, we focused on the medicine.

To be clear, it is necessary that we view our patients through the lens of medicine; it is our job to address the medical issues that bring them to our doorsteps. However, when we overly medicalize our patients as they experience loss, we create an unnecessary distance, shielding ourselves from some of their grief. Based on my experience, I suspect we suffer from that distance as much as they do. I personally felt out of touch with grief because despite the losses occurring around me throughout my rotations, we seldom took time to acknowledge the elephant in the room. Grief is a normal human emotion, so why are we trying so hard to avoid it? What might hospital rounds or office visits look like if we took the time to discuss the losses our patients experience, not just with them but with each other too? How might that change the learning environment, or, more importantly, patient care?

Perhaps my feelings — or lack thereof — are simply a product of my training level that will fade as I become more comfortable with my clinical skills. Instead of worrying about interpreting lab data or performing physical exam maneuvers correctly, I hope someday to work through the medical aspects of care more efficiently, allowing me more time to sit with my patients, experience the weight of their sadness, walk through the pros and cons of difficult choices with them, and extend my condolences to loved ones. In the meantime, I can challenge myself to bring to light the grief experienced by the patients we encounter on rounds or in our outpatient clinics and encourage my peers and preceptors to pause in reverence of this emotion.

I hope as I encounter future losses, my fears about medicalizing grief are never realized, but I suspect that if I continue to acknowledge the presence of grief around me, I can safeguard myself from future hard-heartedness. I hope the same for others too.

The post Medicalizing My Grief appeared first on in-Training.