Month: September 2015

Categories
General

“The Power of Giving Hope” Chancellor Bill McRaven, 2015 Commencement Address of the UTSW Medical School

This week, Chancellor Bill McRaven’s 2015 commencement speech at UT Southwestern Medical School entitled, “The Power of Giving Hope,” debuts the Medical Commencement Archive.

Screen Shot 2015-09-25 at 9.52.28 AMBill McRaven, who recently retired as a four-star admiral after 37 years as a Navy SEAL, became Chancellor of The University of Texas System in January 2015.

McRaven also is a recognized national authority on U.S. foreign policy and has advised the President, Secretary of Defense, Secretary of State, Secretary of Homeland Security and other U.S. leaders on defense issues.

In 2012, Foreign Policy Magazine named McRaven one of the nation’s Top 10 foreign policy experts and he was later selected as one of the Top 100 Global Thinkers. He served as primary author of the President’s first National Strategy for Combatting Terrorism and also drafted the National Security Presidential Directive-12 (U.S. Hostage Policy) and the counter-terrorism policy for President George W. Bush’s National Security Strategy.

McRaven graduated from The University of Texas at Austin in 1977 with a degree in journalism and received his master’s degree from the Naval Postgraduate School in Monterey in 1991.

Chancellor McRaven begins his speech by boldly listing the very real responsibilities and expectations that graduates now have as residents and doctors in practice:

“As a patient, I want my doctor to be smarter than I am. I want them filled with knowledge and I want them to understand how to use that knowledge to confront the challenge before them… As a patient, my doctor must at all times be in command – in command of themselves, in command of people around them and in command of me.”

He continues by narrating his personal experience as a patient with Chronic Lymphocytic Leukemia and the life-altering and healing power of hope that one physician gave him:

“All because one man gave me hope.  Because one man healed me of my greatest malady: fear.

Above all else, as doctors, you must give your patients hope.  Even under the most dire of conditions, hope can heal.  Hope surpasses all our understanding.

Hope is the medicine that gives smiles to the forlorn, faith to the disenchanted and life to the dying.

Give your patients hope.”

He finishes by reminding graduates that although delivering bad news can be spiritually crushing and debilitating enough to push physicians into an emotional separation from patients, maintaining compassion and faith is a moment that patients will remember forever:

“A thousand moments to restore their faith, a thousand moments to give them hope, a thousand moments to heal their wounds and to show them the love and compassion that every great doctor must possess.
And that first moment begins right here and right now, because for now and evermore, you will be the doctor.”

Read Chancellor McRaven’s full speech here.

Categories
Clinical Opinion Public Health

It’s Time to Take Responsibility for our Unimmunized Patients

There is an old parable about a tree that falls onto an old dirt road in the forest. On the day the tree falls, the daughter of a rich king is passing through the forest in her carriage. The carriage runs over the tree, loses control, and crashes. A passing lumberjack sees the overturned carriage and carries the princess to safety. Her father, the king, throws a great celebration in honor of the lumberjack, and rewards the hero with riches.  In the next village, another tree falls on the road.  In this village, the lumberjack sees the fallen trunk and with great difficulty carries it off of the road.  The princess never crashes and she continues on her way, none the wiser.  A hero all the same, there is no celebration and no reward for this lumberjack.  This allegory wins no awards for its subtlety.  While life-saving and innovative treatments are often lauded by the general public, the praises of preventive measures often go unsung.

Vaccines are considered among the safest and most effective public health interventions. [1] There is no dispute among the scientific community, and repeated peer-reviewed studies have detailed the value of vaccines as preventive health measures. These studies collectively support the conclusion that the benefits of using vaccines to minimize illness outweigh the potential risks.  It is precisely because of the overwhelming success of immunizations that people have little or no personal experience with diseases like smallpox, or chickenpox, or polio.

Parental autonomy suggests that parents have the right to raise their children as they see fit.  As a result of this benign belief, however, more young parents believe that vaccination should be a choice. [2] To combat the anti-vaccination movement, health care providers have traditionally relied on their role as medical experts and discussed the scientific data, expecting patients to trust in evidence-based medicine. But the inability of overwhelming evidence to quell controversy and resolve debate has led to greater polarization—biased reasoning has made discussion counterproductive and has led to the intensification of beliefs for many of those opposed to vaccination.  As a result, there are groups of under-vaccinated children which increase the risk of an outbreak in the general population. [3]

There are patients who will continue to refuse to accept research and statistics, even when presented by a trusted family physician. These patients have fallen victim to misinformation and fear-mongering. Their concerns include side effects, immunization schedules, financial incentives, and “Big Pharma”, but more broadly represent suspicion of biomedical research and healthcare providers.  [1]

Physicians often suffer from the curse of knowledge—an inability to recall the lack of understanding that came before learning a new concept. This may play a role in the notoriously poor communication skills of doctors.  For example, watch a third year medical student discuss a clinical subject with a first year medical student and notice the difference in the use of clinical jargon.

Learning how to read a research paper, understanding how and why the study was performed, and recognizing the implications of its conclusions are skills taken for granted by those in the scientific community. These skills take years to learn, yet clinicians reference data and statistics to their patients indiscriminately.  If we want patients to trust us, we have to admit when what we are doing is not working, and be willing to change. For some patients, citing facts and figures is not an effective tactic.

It can be easy to vilify those opposed to vaccination, but new parents continue to be drawn to the movement every day. In a culture of blame, when there is an outbreak of an infectious disease, we instinctively search for someone to condemn and hold culpable. We would be better served by identifying what makes individuals skeptical and how we can change misconceptions and behaviors. The issue at hand involves trust.  Some patients will not trust what we have to say as providers. We have to consult the experts—we must refer them to their grandparents.

Grandparents can discuss the ominous nature of diseases that many of us, due to vaccination, are not frequently exposed to.  They can explain what it means to have a cousin under quarantine or a sibling living with the complications of an infectious disease.  They can express what it means to lose an infant child to a vaccine-preventable illness. Anti-vaccination parents have had the impact of their decisions mitigated due to many years of previous vaccination and herd immunity—a community’s general protection from disease because of a high proportion of immunity in its members.  It is time for us, as medical professionals, to admit that we must change our tactics.  Some patients may not understand the consequences of many of these infectious diseases, but I bet their grandparents do.

References:

  1. http://iom.nationalacademies.org/Reports/2013/The-Childhood-Immunization-Schedule-and-Safety/Report-Brief011613.aspx
  2. http://www.pewresearch.org/fact-tank/2015/02/02/young-adults-more-likely-to-say-vaccinating-kids-should-be-a-parental-choice/
  3. http://www.reuters.com/article/2015/08/27/us-usa-vaccine-exemptions-idUSKCN0QW2JY20150827
Featured image:
Clipart edited by Ilya Aylyarov
Categories
Lifestyle Opinion

Invest in Knowledge

One of the biggest lessons I learned during my first year of medical school is that there simply isn’t enough time. Not enough time to lead the same life I once did. Not enough time to study every last origin and insertion. And definitely not enough time for faculty to cover all the essential information. Some of the information that is inevitably left out is what happens after medical school.

How can we as residents and physicians manage both our newfound salary and our mounting pile of debt? What is a 401k? Roth? How do I save money for retirement without living like I am in college? These questions are incredibly important to answer sooner rather than later, because gaps in financial knowledge can have monumental consequences later in life. My suggestion to all medical students is to learn the basics of investing and budgeting now, so you won’t regret it later.

After realizing that this knowledge needed to be acquired on my own outside of medical school, I purchased a book called The White Coat Investor, which was published in 2014 and written by James Dahle, MD. This book is an easy read about financial information specific to future and current physicians. The bulleted information below has been paraphrased from Dr. Dahle’s text. All of the statements are his personal findings.

Pertaining to pre-med students

  • Be cautious when considering taking a gap year or more. Each year you take off is one year less of earning potential as a physician you may have. Take time off if it is to do something you are truly passionate about.
  • Apply to medical schools you can actually get into, and apply to many. It would be a large inconvenience to have to reapply because you did not apply to enough schools to begin with.
  • Go to the cheapest school at which you will be happy. There isn’t a huge difference in education from school to school.

Pertaining to med students

  • Choose a specialty wisely. Consider income and lifestyle, while still keeping yourself happy with the work you want to do (i.e. if Emergency Medicine and OB/GYN both make you happy, but Emergency has a better lifestyle and pay, go with that choice).
  • “Be a poor medical student.” Dr. Dahle states it’s a lot easier to be poor when all your friends are too. This will pay off later.

Pertaining to residents

  • Try not to buy a house. Likely you don’t have the down payment and it takes about three years to break even on this investment. Once you are at the end of residency or a physician, chances are you will want a different house (i.e. space for an incoming family).
  • Invest in a Roth 401(k) or traditional 401(k) if the Roth isn’t available, and do this up to the match by your employer. (Roth 401(k): You contribute money to this fund after taxes have been taken out and your employer will match the amount you put in, up to a set amount. This money accrues interest and can be taken out during retirement post age 55 ½ with no penalty. Dr. Dahle explains the Roth option is the way to go during residency because you are in a lower tax bracket than what you will be in the future. Traditional 401(k): You contribute pretax money to the account and your employer matches up to a predetermined amount. When you withdraw the money in retirement, you pay taxes then on the money. This is still a great option if the Roth isn’t available, because your employer is basically giving you free money).
  • Establish an emergency fund for up to 3-6 months of living cost.
  • Purchase disability, life, and liability insurance.
  • Pay down high interest debt (i.e. credit cards) and student loan debt.

Pertaining to physicians

  • Live like you are on a resident’s income (for three to five years, or as long as you can manage).
  • Live somewhere affordable, unless your dream is to live in California. Understand that higher living costs don’t necessarily correlate with higher wages.
  • Educate your family and make sure they are on the same page as you financially.
  • Don’t buy a house that has a price tag more than double your gross income. Try to put 20% down on the house.
  • A few things to consider if you want to hire a financial advisor: make sure they are fee-only, have gray hair, don’t mix insurance and investing, and offer physician specific help.
  • The biggest risk to your financial wellness is divorce. Spend time with your significant other and consider a prenuptial agreement.
  • The book contains much more on investing in stocks and real estate, plus additional info on protecting assets, taxes and how to make sure money goes to the right people in the event of your death.
If any of this information confuses (or empowers) you, be sure to read The White Coat Investor. Dr. Dahle does an excellent job of explaining financial material in an understandable way. He backs up all of his recommendations with solid arguments and life experience.
The advice given to medical students consists of common sense factoids, like “try not to rack up credit card debt and try to spend loan money wisely.” When we begin to earn an income in residency, the advice becomes more tangible, hence the difference in the amount of advice under medical students vs. residents in the bulleted list above. There isn’t a ton we can do right now while we are in medical school to be financially savvy, but we can invest. Not money (yet!), of course. Rather, we can invest in our own future by putting time and effort into learning the foundation of the financial world.
Featured image:
Tom Gores: Investing by Tom Gores
Categories
General

“Where There Are Challenges, There Is Huge Opportunity” Dr. Paul Klotman, 2015 Commencement Address of the Baylor College of Medicine

This week, Dr. Paul Klotman’s 2015 Commencement Speech at the Baylor College of Medicine entitled, “Where There Are Challenges, There Is Huge Opportunity” debuts via the Medical Student Press.
Dr. Paul Klotman began serving as President and CEO of Baylor College of Medicine in 2010. He
received his Bachelor’s degree in 1972 from the University of Michigan and his M.D. from Indiana University in 1976. He completed his medicine and nephrology training at Duke University Medical Center. In 2001, he was selected to be the Chair of the Samuel Bronfman Department of Medicine of the Mount Sinai School of Medicine. The BCM Board of Trustees named him as the school’s new President in July of 2010.

Dr. Klotman’s research has been a blend of both basic and clinical research in molecular virology and AIDS pathogenesis. He developed the first small animal model of HIV-associated nephropathy using transgenic techniques. He is on the editorial boards of journals in both the United States and in Europe and he has served on and chaired numerous study sections including those from the NIH, the American Heart Association, the National Kidney Foundation, and the VA research service.

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At Baylor College of Medicine, he oversees the only private health science university in the Greater Southwest, with research funding of nearly $400 million. The medical school is ranked as one of the top 20 for research by U.S. News & World Report and first among all Texas colleges, universities and medical schools in federal funding for research and development.

 

Dr. Klotman begins his address by jumping right into the topic of ethical consequences when medical expenses influences treatment options:

“How do we measure it and how do we make sure we do the right thing even if it costs more? …All this sounds good but unless we deal with the costs of intervention and the costs of end of life care, we will struggle to bend the cost curve significantly.”

He further discusses the continued issue of the uninsured poor, despite government and local changes, and the graduates’ role in being catalysts of improving the opportunities that the underserved have in attaining medical care:

“But where there are challenges, there is huge opportunity. And the opportunities in health care have never been greater. Whether it’s new approaches to the discovery of drugs, transformational technologies to expand access to or delivery of care, or novel ways to approach the health of populations, the opportunity to innovate and transform has never been more apparent.”

Click here to read Dr. Klotman’s full speech.

Categories
Emotion Reflection

The Power Of Crying

Last week, we started a class called “Death and Dying” (doesn’t it sound fun?).  Jokes aside, this class is a valuable component of the medical school curriculum. Physicians deal with death on a regular basis—some every day, and others every hour. During one of our discussions about a patient, a small tear rolled down my cheek. I quickly wiped it away in embarrassment, pinched myself to “get my act together,” and hoped no one had seen. Later that day, I wondered what would have happened if another student had seen me almost cry? Would their opinion of me change?

I am a “crier.” Not when I am faced with my own struggles, but when those I love go through happy or sad times, that’s when the waterworks kick in. This has me worried. I know that crying is seen as a sign of weakness. Some would even call it unprofessional, and I can’t blame them. Our profession teaches us to set personal and emotional problems aside. But what happens when our profession is the cause of these emotions?

A recent discussion we had in class answered my questions. It turns out that crying is okay. Of course, this does not mean we should break down every time a patient has to spend an extra day in the ED, but it does mean we can be vulnerable in a highly professional setting. One of the pediatric oncologists shared a special patient experience with us. She had always shied away from crying in front of her patients. However, one day after a family had received especially disheartening news, she unintentionally teared up in the clinic room. This was well received by the patient’s family—the patient’s mother told her, “It let me know you cared.” From that point on, the physician’s relationship with the family was altered—an unbreakable, unspeakable bond was formed.

This alleviated a few of my fears concerning the display of raw emotion. We are in a profession where humans care for other humans. It is natural to cry. In fact, we become physicians because we deeply care and love others. Showing this empathy is not a sign of weakness—it is a sign of power.

Yet, there are some important points to remember about crying. Though releasing a few tears is okay, you cannot become a mascara-stained mess.

  1. Your tears have to come naturally. These tears are symbols of your love and devotion. They signify your raw, genuine emotion. Don’t cry to make yourself closer to a family.
  2. You still need to be strong for your patients and their families. You want to be able to process and deliver information to them in a calm, collected way.
  3. You do not want to cry and then have your patients feel they have to comfort you. You are their robust pillar of support! They should be leaning on you for guidance and comfort—not the other way around.
All in all, I am happy to have realized that watery eyes in the clinic will not make me a pariah. Crying, like all aspects of medicine, has to be motivated by your candid empathy. Only then can it be powerful.
Featured image:
A Single Tear by Lauren C
Categories
General Mentorship MSPress Announcements

“Going Forth with Compassion” Dr. Ruth Lawrence, 2015 Commencement Address of the University of Rochester School of Medicine

This week, Dr. Ruth Lawrence’s 2015 commencement speech at the University of Rochester School of Medicine and Dentistry entitled, “Going Forth with Compassion,” debuts the Medical Commencement Archive. This address was a personal favorite to read and a great reminder for those of us still studying in our medical school caves, as well as those starting their life in residency.

Dr. LawrenceDr. Ruth A. Lawrence, MD, is a graduate of Antioch College and the University of Rochester School of Medicine and Dentistry. She is a pediatrician, clinical toxicologist and neonatologist. She is Professor of Pediatrics and Obstetrics and Gynecology at the University of Rochester School of Medicine and Medical Director of both the Ruth A. Lawrence Poison and Drug Information Center and of the Breastfeeding and Human Lactation Study Center. She became the Director of the Poison Center at the University of Rochester in 1958 and wrote on the management of household poisonings with Dr. Robert Haggerty, Chair of the Department of Pediatrics and former Director of the Boston Poison Center. She has been a member of the New York State Association of Poison Centers since its founding and has served as its President twice. In 2002, Dr. Lawrence received the Life Time Achievement Award from the American Academy of Clinical Toxicology.

Dr. Lawrence begins her speech with the almost-intimidating reality of graduating from medical school:

“You are about to embark on the most challenging year ever.  Medical school pales by comparison because before you were the student, you were there to learn but it was someone else’s responsibility.  In a few weeks, you will be the doctor of record, what you do may save a life, solve a problem, or change the course of an illness.”

She reminds the class that despite the advances in technology, treatment plans and hospital protocols, and despite the efficiency of a quick reference to “Google,” nothing will ever replace the significance of simply listening to your patient and being compassionate.

“The key to being a good doctor is to really care about your patient.  The science will come and go, but the best doctors understand people, REAL people, and are good communicators. Listen when patients talk, listen completely.”

Dr. Lawrence concluded by reciting a short quote:

The purpose in life is not to be happy, it is to matter

To be productive and responsible

To be honorable

To be dedicated to goals higher than self

To have it make some difference that you lived at all.

Click here to enjoy Dr. Lawrence’s full address.

Categories
General Opinion

You don’t belong here; are you even a real doctor?

Disclaimer: This is written with the sole purpose of increasing awareness.

Rare things are valuable.  They stand out.  They generate intrigue.  However, they can also make people apprehensive.

There is a misconception that naturopathic doctors are quacks who couldn’t get into “real” medical school, and don’t know what they’re talking about. But there is a big difference between naturopaths (online certification) and naturopathic doctors (four years at an accredited institution). At age 23 I had been to nearly 20 different MDs and was ingesting 10 different medications each day until I saw a naturopathic doctor (ND) who turned everything around. Not only did my health change, my career choice did as well.

Naturopathic Medicine is a distinct primary health care profession that combines natural healing techniques with modern science.  It is a whole-person approach tailored to each patient and focuses on finding the root cause of the health issue. NDs are well versed in treating chronic illnesses and emphasize preventative medicine, but can also aid in acute care. By combining natural healing methods with modern scientific principles and technology, naturopathic medicine genuinely embodies modern integrated health care.

There is a time and place for everything. NDs are trained to know when referral or higher intervention is needed. It is time to erase the battle lines because the “us versus them” mindset is not beneficial to patients. Furthermore, MDs and NDs are more similar than it may seem.

We all have the same ability to heal and treat our patients. Although the manner in which we go about treating our patients may be different, we are all trained in basic and clinical sciences, including biochemistry, anatomy, physiology, pharmacology, and even minor surgery. NDs have additional training in nutrition, botanical medicine, and counseling, while MDs have added training in pharmacology and more clerkship hours. Both cohorts complete clinical training and take board examinations in order to become licensed professionals.

We have similar struggles. We sit through hours of classes only to go home and study until we fall asleep. We sacrifice our social lives for our scrubs. We are more up to date on the latest neuroanatomy YouTube videos than we are on episodes of Game of Thrones. We go home at the end of the day smelling like dead bodies and bodily fluids.

But aside from these things, we have the same end goal. We are all detectives, trained to combine history, lab tests, imaging and physical examinations to understand the patient. While NDs typically don’t advocate drugs at the first sign of trouble, we are still trained to prescribe them.

There is an underlying assumption that only pharmaceuticals are “real” medicine, while nutrition, exercise, and lifestyle interventions are “fake” medicine. In actuality, real medicine is whatever works, and the most important aspects of patient care are things that cannot be quantified or measured, but can instead be conveyed and experienced.

Partnerships require a lot of work. Nonetheless, patients need and deserve the services of both MDs and NDs.  Therefore, we should work to understand and respect each other’s profession.  Our skills complement each other and by working together our patients will receive the greatest benefit.

Featured image:
Apple for Health – Apple with Stethoscope by Wellness GM