Categories
Clinical General Public Health

Medical Residents: A Dream Career Can Be Yours If You “Choose Sleep”: Dr. Ilene Rosen, President of the American Academy of Sleep Medicine

Now is the time that many medical residents are considering future plans, and hopefully giving thought to a sleep medicine fellowship. The truth is, we need you. Millions of Americans suffer from chronic sleep disease, and now more than ever there is an increasing demand for sleep physicians. As awareness of sleep health increases, millions of new patients will be seeking evaluations from sleep physicians.

Sleep medicine is an intriguing field with long-term growth potential and the opportunity to have a positive effect on the health of a huge population of patients. By diagnosing and treating sleep disorders, you can directly improve patients’ health and quality of life. In addition, because sleep is still a relatively young field, many research questions still exist. These questions can lead to involvement in cutting-edge basic, translational, and clinical research.

As a new sleep medicine physician, you may have the opportunity to practice in diverse settings. Opportunities abound in teaching hospitals, community hospitals, and independent sleep centers, allowing you to cultivate a work schedule that best fits your lifestyle. In addition, you can expect a call schedule that is quite manageable, as trained technologists at an accredited sleep center monitor most overnight sleep studies, and patients often self-administer their own sleep studies at home.

Another great thing about sleep medicine is the constant collaboration. As a sleep specialist, you will work closely with physicians from other disciplines and lead sleep teams of other health care providers – including nurses, physician assistants, psychologists and technologists. You may find many opportunities to collaborate with multidisciplinary teams, treating patients in coordinated efforts using the latest technology. I think you will find these collaborations eye-opening and educational.

So, the choice is yours and the options are plentiful to pursue your dream career, just as I did. There are 83 sleep medicine fellowship training programs accredited by the Accreditation Council for Graduate Medical Education (ACGME). Learn more at www.ChooseSleep.org.

Categories
General Law Lifestyle Public Health

Keeping Abreast of Lactation Laws

Infant forced to go without milk, Mom says it’s not her fault.” This seems like the kind of terrifying headline that would be on the five O’clock news. Yet this is exactly what happens every day when the rights of women to breastfeed or express milk on the job go unprotected. One politician, Representative Carolyn Maloney (D-NY), has made it her mission to make sure that women can breastfeed without repercussions. I have to admit that when I first heard about Representative Maloney’s Supporting Working Moms Act, I was baffled to think that in the year 2017, breastfeeding in the workplace could cost a woman her livelihood. With a little research, I started to realize just how ill-informed I was on the legality of breastfeeding.

I was surprised to learn that currently, no federal legal protections exist to protect public breastfeeding. Furthermore, only 47 states have laws that legalize public breastfeeding.[1] Of those states, Michigan’s law is a mere three years young. Astonishingly, Iowa offers no legal protections for breastfeeding. Even though public breastfeeding might be legal in most states, it wasn’t until 2010 that breastfeeding in the workplace received its own set of protections. A federal breastfeeding provision called “Break Time for Nursing Mothers,” which was added as an amendment to the Affordable Care Act (ACA), makes it mandatory for companies with 50 employees or more to provide “reasonable” break time for women to express milk during the first year of their child’s life. This same provision also requires companies to provide a clean and dedicated space for breastfeeding in the workplace.[2] However, this provision only ensures the rights of “nonexempt” workers, meaning only those who earn hourly wages as opposed to salaries are protected. Even with the laws that protect the right to breastfeed in public, women can still face repercussions that range from fines to docked pay to even termination as a direct consequence of breastfeeding in the workplace . With the ACA in jeopardy of being repealed (possibly by the time this article is published), the future of breastfeeding is more vulnerable than ever. The Supporting Working Moms Act is meant to provide federal breastfeeding laws independent of the ACA, as well as expand protection to 12 million additional women, including public school teachers.[3]

The issue of breastfeeding is close to my heart, not only as someone who hopes to one day become a mother, but also as a future physician: I know the powerful impact that breastfeeding can have on a child’s health. In their policy statement on the use of human milk, the American Academy of Pediatrics affirmed their position that infants should be breastfed exclusively for the first six months of their lives whenever possible.[4] Breastfeeding can be challenging for a number of reasons, and it is important to respect the fact that not all mothers are able to breastfeed their children. However, for those who can and choose to do so, the benefits can be profound for both the mother and the child. According to the National Institutes of Health, breastfeeding helps infants fight infection, lower their risk of Sudden Infant Death Syndrome, and could possibly serve as a protective factor against developing asthma, allergies, and even diabetes.[5] Studies show that babies who are breastfed attain better educational achievement than their non-breastfed peers by the age of five.[6] From an economic perspective, breastfeeding has been shown to lower healthcare costs by reducing disease burden in the population.[7] Even though many of us will not be pursuing careers in obstetrics, at some point in our careers, we will all establish some connection to a new mother, whether she is your patient, your partner, or yourself. Being informed about the legality of breastfeeding can help us to provide these women with support and guidance and make sure that our littlest patients have the healthy start in life that they deserve.

References:

[1] http://www.ncsl.org/research/health/breastfeeding-state-laws.aspx

[2] https://www.dol.gov/whd/nursingmothers/Sec7rFLSA_btnm.htm

[3] https://maloney.house.gov/issues/womens-issues/breastfeeding-0

[4] http://pediatrics.aappublications.org/content/129/3/e827

[5]https://www.nichd.nih.gov/health/topics/breastfeeding/conditioninfo/Pages/benefits.aspx

[6] https://ora.ox.ac.uk/objects/uuid:13bde0c7-0070-43c6-9ae3-307478e8c42c

[7] http://www.reuters.com/article/us-breastfeeding-study-idUSTRE6342ZG20100405

Photo Credit: Roberto Saltori

Categories
General

“Your Gift (and Obligation)”: Dr. Claire Pomeroy, 2017 Commencement Address of Northeast Ohio Medical University

We kick off the Commencement Archive with Dr. Claire Pomeroy’s 2017 commencement speech at Northeast Ohio Medical University titled “Your Gift (and Obligation)”.

Claire Pomeroy, M.D., M.B.A. is current president and CEO of the Albert and Mary Lasker Foundation. Under her leadership, the Foundation’s mission advanced to: “improve health by accelerating support for medical research through recognition of research excellence, public education and advocacy.” As an expert in infectious diseases, she passionately supports ongoing investment in a full range of research with special interest in health care policy and a focus on the importance of the social determinants of health.

Dr. Pomeroy has published more than 100 articles and book chapters. As a leader in her field, Dr. Pomeroy serves on the board of trustees for the Morehouse School of Medicine and the board of directors for the Sierra Health Foundation, the Foundation for Biomedical Research, iBiology, Inc. and New York Academy of Medicine. She is also a member of the board of directors for Expanesthetics, Inc. and for Becton Dickinson & Company. In 2011, Dr. Pomeroy was inducted into the National Academy of Medicine.

Dr. Pomeroy earned both her Bachelor’s and Doctor of Medicine degrees at the University of Michigan. She completed her residency and fellowship training in internal medicine and infectious diseases at the University of Minnesota. She has also earned an M.B.A. from the University of Kentucky. In 2016, Dr. Pomeroy received an honorary Doctor of Science degree from the University of Massachusetts Medical School. Dr. Pomeroy has held faculty positions at the University of Minnesota, the University of Kentucky and the University of California- Davis. At the University of Kentucky, she served as the chief of infectious diseases and associate dean for research and informatics. In 2003, Dr. Pomeroy joined University of California-Davis as executive associate dean and served as vice chancellor and dean of the School of Medicine from 2005 through 2013. She became president of the Lasker Foundation in June 2013.

In her address to the graduating class, Dr. Pomeroy is forthright. She does not embellish the career of a physician but rather illuminates the very real truths and what is expected of us as we take the lives of others into our hands. She states:

“By virtue of the credentials you now hold, people will now turn to you at their most vulnerable moments…..They will literally trust you with their lives. This trust is a gift and an honor. “

The use of the word “gift” is interesting. We often perceive physicians as the one “giving the gift”, namely providing care to the patient, but Dr. Pomeroy reframes this suggesting that it is the patient who offers trust and allows a physician to enter into a very personal domain.

Dr. Pomeroy continues on, urging the new physicians not to be content with the state of the medical field but rather to push its bounds.

“It has been said that change does not roll in on the wheels of inevitability; it comes through bold vision, continuous work, and unflagging dedication. This is what you are called upon to do. So as you accept your diploma today, you are also accepting the charge to lead us in the change our country needs.”

What was most compelling about Dr. Pomeroy’s speech was the discussion of her path to this career. After leaving a troubled childhood, only to be placed in four foster homes, Dr. Pomeroy faced the very issues physicians strive to improve in health care, issues such as “trusting the system,” and racial and social inequality. She so poignantly states:

“My first foster home was an “emergency placement” and just as I was thinking maybe I could trust them, it was time to go. From this, I learned about how hard it can be for the vulnerable and abused to trust the system, to trust even those dedicated to caring. My second placement was with an African-American family, who though not quite knowing what to do with this blond, blue-eyed white girl, opened their home with kind- ness. From them, I learned about race, equality and social justice…My final placement was with a couple who became foster parents just to take care of me and to them I will always be grateful. They saved my life. I learned that by giving ourselves, we can give life to others.”

She concludes with the following:

“In closing, I ask only that you heed Harriet Tubman’s call to action as she said, “Every great dream begins with a dreamer. Always remember you have within you the strength, the patience, and the passion to reach for the stars to change the world.”

Read the full speech in the Commencement Archive: https://www.themspress.org/journal/index.php/commencement/article/view/286/306

Categories
Emotion Empathy General Humanistic Psychology Narrative Public Health

Guter Mann

This city is so peaceful. As the bikes whiz by, I notice the absence of the cacophony and polluting fumes of traffic. I’m walking down the sidewalk in brown leather shoes and a tucked-in dress shirt while eating bougie gelato. I love gelato. I look up and notice the blue sky. It’s a deep blue and the clouds have distinct borders. I’m in Salzburg, Austria for a conference and I’m loving this city. Just as I marvel at the clean streets and begrudge the abundance of luxury vehicles, I turn the corner and see my sister on the floor asking for money. I immediately cross the street and reach in my pocket to hand her the change I received at the gelato stand. My sister is donning the flag of Islam on her head and I greet her with the anthem of Islam, a greeting of peace. She smiles and says, “Allah yijzeek al-khayr” – God reward you with the good. As I walk away, I smile at the beauty and seamlessness of our interaction.

I continue walking back to the conference hall. I review my rehearsed words as I finish my gelato. My presentation is on the data I generated regarding the controversial use of bisphosphonate anti-resorptives in the setting of chronic kidney disease mineral bone disorder. The nephrologists in the crowd won’t be too thrilled. In my head, I am considering all the different questions I could be asked, when I see another of my friends on the corner of an intersection. As I approach him, he brings his hands together and bows his head. When he raises his head again, I smile at him. I don’t have any more change so I reach into my pocket and hand him 5 euros. He has a cup in front of him, but I decide to hand him the money. I think this might make the money more of a gift than a charity. I can see hurt in his eyes as he tries to find a way to thank me. Reaching out I put my hand on his shoulder and squeeze, pointing up with my other hand, trying to tell him that I will pray for him. While my hand is on his shoulder, he turns his neck and kisses my hand. I say, “No, no!” and withdraw my hand. I feel ashamed. I know I should be the one kissing his hand for accepting my miserly gift of 5 euros while knowing full-well that I have another 10 laying comfortably in my pocket. Ten euros that I will, over the next couple hours, undoubtedly spend on a sacherwurfel from the bakery next to my fancy hotel and then on another helping of overpriced gelato.

Lost in my thoughts of embarrassment, I begin to walk away, and as I do, he yells in German, “Guter mann!” – good man. Halfway across the street, I think to myself, I may not be a good man, but I have the opportunity to try, and so I turn back around.

Ten euros was all the money that I had left on me. But 10 euros was all it cost to earn the respect and love of a man I had only met minutes ago. Excitedly, the man begins to talk to me in German. His name is Damien. (We spend a good 5 minutes on my name. I would say, ‘Mo-ham-mad’, and he would then repeat after me, ‘No-han-nam’). Damien is a father of 3 kids. He was doing well for his family until his wife lost her vision. He said, “Now my heart is still good, but children’s stomachs are empty, so my hand is outstretched.”

I notice the tears in my eyes. I had never heard German spoken before, and I shouldn’t know what he’s saying to me, but I understood every word. Home is where the heart is, and this man is my neighbor. As I leave Damien for the second time, I point up again and then turn my palms up to the Heavens in prayer. He says, “Allah.” And I repeat, “Allah.”

On my second day in Salzburg, I take the long way to the conference center, hoping to run into my friend Damien. I turn the corner and there he is, sitting at the end of the block. My stride lengthens and my steps quicken. As I approach him, I see him leaning left and right, squinting his eyes; he’s trying to see if it’s me. He leaves his corner and yells, “Nohannam!!” while jogging towards me and we embrace each other as brothers and lifelong friends. And as my neighbor and friend embraces me, I realize I may not be a good man, but Damien is willing to show me how to become one.

Photo Credit: Sam Rodgers

Categories
Emotion Empathy General Humanistic Psychology Narrative Patient-Centered Care Psychology Reflection

Immigrant’s Suitcase: Ordinary people with the will to do extraordinary things

A mother separated from her missing husband flees a war-torn country, her homeland, to provide a brighter future for her children. She’s a dentist by training and practiced dentistry back home; but here, here she’s cleaning homes for a living. Why? When she left her home with her four children by her side, headed to a safer place, to America, what was in her suitcase? Alongside the picture of her missing husband and the few possessions that remained after the destruction of her home, in her suitcase, she has hopes and dreams, fears and doubts. She looks to her children for strength, but she’s terrified every time she looks them in their eyes. She is not optimistic, but she is hopeful; she looks the odds straight in the face and proceeds anyway. Because hope is not logical, it is powerful.

She’s cleaning the home of a happy family; the father is an engineer and the mother is a doctor and the children play piano. Their life, their hopes, goals and dreams are dependent on the stability of their country, but they cannot see it. The same hands that used to place crowns to relieve the pain of the suffering are now scrubbing the floor of another woman’s bathroom. But hope is powerful, and she lives through the dreams of her children. Two of her daughters want to be doctors. Her third daughter wants to be an artist. Her son is eight and he loves math. In her suitcase, she brought with her the dream of a better education for her children. “In Syria, we ate grass. In Egypt, we didn’t have food. In Indiana, I love school.” These are the words of her eight-year-old son.

A man runs to catch the bus. He can’t miss the interview; he really needs this job. It is his third interview in as many days. His last job got him enough money to get his family off the streets for a couple weeks. But motels are more expensive than he ever imagined. He’s homeless. His family is homeless. This wasn’t a possibility he considered when he graduated with his MBA. He had a great job, but the hurricane took everything away. And he hasn’t been able to get back on his feet. He catches the bus and pays the $1.75 in quarters. He checks the email that he printed; the interview is in room 4015. He runs up the stairs; he really hates being late. As he enters his interviewer’s room, a bead of sweat runs down his forehead. What’s in that bead of sweat? Desperation and nervousness, humiliation and self-pity, purpose and resilience.

His interviewer gives him the job offer. He smiles and shakes his head. A tear runs down his face. He can’t take the job; he can’t manage the branch that makes most of its revenue through alcohol sales. Another day and another interview, but his family remains homeless. He needs the job, but rejecting the offer was an easy decision. He believes that although alcohol may have small benefits to people and society, the harm it causes is much larger than its benefits, and wants to play no part in its distribution; he will not be a co-creator in the intoxication of his neighbor’s mind.

A young woman sinks into herself on the examination table. Her husband is holding, squeezing her hand. The doctor is still talking. He looks very sympathetic. The young woman just learned that she has a cancer growing inside of her lungs, an aggressive cancer. The doctor thinks ‘we can fight it.’ The young woman’s mind is overwhelmed into quietness. All she can think about is her daughter’s play after school that she doesn’t want to miss, even for this. The doctor brings her back, ‘Do you feel comfortable about our next step? I think that’s the best place for us to start.’ The young woman shrugs. What is in that shrug? Fear and uncertainty, peace and tranquility, ambivalence, a need for normalcy, a desire for time to make meaning.

The young woman is herself a physician, trained and licensed as a radiologist. She knows enough about cancer and the late stage non-small cell lung cancer she has been diagnosed with to know that the longevity of her future has been called into question. And yet this is not the topic of discussion with the doctor. Instead, he discusses treatment options, which is fancy talk for a long list of big words in different orders and combinations. When asked about the next step, she shrugged. She shrugged because there didn’t seem to be room for her in that room. (Insert young woman with terminal cancer here). Although it is more comfortable for the doctor to rattle off treatment options, the patient wants to take time to acknowledge the inexorability of our life cycle. To the doctor, it was the end of a beginning, and they were, together, supposed to begin a new chapter of strength and resilience. While he rattled off treatment options, she just wanted to catch her daughter’s play after school, and she was running late.

In the words of HL Menken, ‘For every human problem, there is a solution that is simple, neat, and wrong.’  Without taking a moment to explore what’s inside the immigrant’s suitcase, the homeless man’s bead of sweat, the sick young woman’s shrug, we stand a sorry chance to witness, help, and learn from ordinary people with the will to do extraordinary things. This is the power of narratives; the power of listening. I call myself to look inside the suitcase, to investigate the bead of sweat, and to ask about the shrug; I call myself to listen.

I find myself in an imperfect world, full of injustice and oppression. I find myself an imperfect man perfectly given the ability to alleviate suffering, on a personal level with a smile or a hug, and on a larger scale by fighting injustice and refusing to stand idly in the face of oppression. Poverty belongs in a history museum. And hunger…we have enough food in the world for every member of the human family to eat a balanced 3000 calorie meal. When we eliminate poverty and hunger, there will be many other injustices for us to face. I want to make facing these injustices my mission. My mission is to be ‘human’ as best I can; to work to establish justice in any capacity that I can, from a generously given smile to an honest political campaign.

Photo Credit: Robot Brainz

Categories
General

A Rude Awakening: Addressing iatrogenic sleep disruption in the inpatient setting

The first thing I learned on my very first rotation was to never wake a sleeping patient. The first thing I learned on my most recent rotation was to never be afraid to wake a sleeping patient. With two completely opposite opinions on the same practice, the former from a psychiatric service and the latter from internal medicine, I started to wonder if there could be some sort of happy medium, rather than a one-size-fits-all rule about sleep in the hospital setting. As medical students, we all know the importance of a good night’s sleep – even though it’s a luxury our schedules so rarely afford us. How is it, then, that while we get trained on numerous medications and interventions, we often overlook sleep as one of the most crucial aspects of health?

Throughout my time on inpatient medicine over the past several months, I have noticed a certain asymmetry to the workday. Mornings are usually hectic and full of activity. We get to the hospital early, read up on our patients, examine them, and then go through morning rounds as a group. By the time lunch is over, the day takes on a more leisurely pace as we finish our notes, await new admissions, and tackle any breakthrough issues with our patients. Our patients are often subjected to the “morning shuffle” which means that the medical team often causes sleep disturbance in the name of obtaining an early morning physical exam, sometimes for our own convenience. I think of this as an iatrogenic sleep disruption, meaning that it’s a problem caused by the medical team, not by the patient’s disease process.

In academic hospitals, many of our patients get examined multiple times by attending, residents, interns, and, last but not least, the lowly medical student. Often, these examinations are taking place early in the morning when some of our patients would barely be taking their first sips of coffee at home, let alone being poked and prodded by strangers. The multiple rounds of examinations and questioning are often in addition to being woken several times at night by the nursing staff. A 2013 study in JAMA Internal Medicine found that waking patients from sleep unnecessarily actually increased the patient’s odds of returning to the hospital, increasing what is sometimes referred to as the “bounce back” rate.[1] This study hypothesizes that the Modified Early Warning Score (MEWS) can be used to assess which patients will still receive quality care with fewer interventions. Another perk of respecting hospitalized patients’ sleep was identified by a 2010 study in the Journal of Hospital Medicine, which found that fewer sleep interruptions were linked to a lower rate of sedative use by patients.[2] Furthermore, a 2006 study identifies sleep disturbances as being a leading contributing factor to two of the most common hospital complications: falls and delirium.[3] As professionals in the medical field, we are relatively acclimated to performing sophisticated tasks early in the morning, but we have to realize that many of our patients have completely different schedules and may not be used to rising with the sun. While I feel relieved to know I’m not the only one who’s puzzled over the how little regard the medical profession has for sleep in the inpatient setting, there’s obviously still more that needs to be done in recognizing iatrogenic sleep disruption as a true health detriment.

In an effort to recognize sleep as crucial to the healing process, I have, at times, chosen to defer early morning physical exams on my patients until after morning rounds. For me to feel comfortable deferring an exam until later in the day, a patient has to meet three criteria: I must be familiar with them (i.e., already examined them during the admission), they must have stable vital signs, and I must feel reasonably sure that physical exam findings won’t grossly alter my plan of care. Although some attending physicians have been mildly irritated that I didn’t initiate a patient examination before our morning rounds (one of them saying, “The hospital is not for sleeping.”), many have actually responded favorably when I explained that I chose not to wake our patients. As a bonus, prioritizing the delivery of care amongst several patients on a busy service acts as another way for me to hone my clinical judgment skills. For patients for whom an early morning exam is unavoidable, I make it a priority to revisit them in the afternoon when they are more alert and able to participate in discussions about their care. After all, of all the sacrifices we ask our patients to make in the name of health, sleep no more shouldn’t be one of them.

 

References:

[1] A Prospective Study of Nighttime Vital Sign Monitoring Frequency and Risk of Clinical Deterioration: https://www.ncbi.nlm.nih.gov/pubmed/23817602

[2] Decrease in as-needed sedative use by limiting nighttime sleep disruptions from hospital staff: http://www.journalofhospitalmedicine.com/jhospmed/article/127000/sleep-disruptions-and-sedative-use

[3] Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem: http://docs.wind-watch.org/Sleep-Disorders-Sleep-Deprivation.pdf

 

Photo credit:

@berkshirecat

Categories
General

Call for Submissions: The MSPress Journal

The MSPress Journal is now open for submissions. Submit your theses excerpts, scientific research papers, research essays, interviews, medical ethics essays, creative writing pieces, sound pieces, and visual art pieces for review by August 1st. Guidelines for submissions can be found here. For any questions, feel free to contact The MSPress Journal Associate Editor, Eileen Nguyen at journal@themspress.org.

Categories
Clinical General Lifestyle Narrative Opinion

In the Business of Medicine, Be Your Own Boss

As medical students, we exist between two worlds. On the one hand, we’re tasked with learning as much as we can about the practice of medicine from our preceptors, many of whom have decades of experience. On the other hand, we’re always thinking about our place in the future of medicine and fantasizing about what our unique style of practice will look like. While I feel indebted to the seasoned physicians who graciously give of their time to teach us, a recent interaction reminded me that I am the boss of my own practice of medicine.

It started out as a morning just like any other. I needed to finish rounding on my patients before a noontime meeting where I was slated to give a small presentation. The last patient on my roster had been particularly troublesome for our service. She had been admitted for worsening congestive heart failure and although she was relatively young, and had a very supportive family, she did not seem willing to make any of the lifestyle changes that would improve and possibly prolong her quality of life. Nurses, doctors, and respiratory therapists had been trying to get her to wear her CPAP mask during this hospitalization, but for reasons that we didn’t completely understand, she had been refusing to wear it for the past two months.

After a quick exam and what seemed like a futile imploration to try her CPAP again that night, she started telling me a bit about her life prior to becoming ill. I knew the time was coming closer and closer to my meeting, but I couldn’t leave while she in the middle of divulging such personal information. Our conversation dwindled, and I stepped toward the door, when she tearfully mentioned that her dog had recently died. Again, my thoughts drifted toward the upcoming meeting, but I also wanted to be sensitive to this very meaningful event in my patient’s life. Trying to be polite, I asked when her dog had died.

“Oh, about two months ago,” she replied.

I paused. “Is that about the time when you stopped wearing your CPAP mask at home,” I asked.

She stopped to think. “Yes, I think it was exactly around that time.”

Thinking that the timing of her dog’s death coinciding with when she stopped using CPAP might be more than coincidental, I offered my condolences for her loss, and assured her that I wanted to come back later in the day to talk more about her dearly departed pet. I felt relieved to see that I had only run a minute late, so I hightailed it to the meeting. As I stopped to pick up the materials for my presentation, I heard my attending calling my name from the hallway. I couldn’t wait to tell him that I had stumbled upon a very useful piece of information to help us understand why she stopped using her CPAP machine.

“I know I’m a minute late-I got stuck with our patient,” I explained. “I couldn’t just couldn’t leave when she started talking about her dog who recently died, but I may have a clue as to why she won’t wear her sleep mask.”

He looked dismayed. “You have to figure out how to get out of those conversations,” he told me curtly. “That’s just the business that we’re in.”

His last words “the business that we’re in” struck me so profoundly that I can still replay them in my head as clearly as if he was standing right across from me. I have not had a temper tantrum since childhood, and yet, in that moment, everything inside me wanted to shake my head and bang my fists in passionate disagreement. I understood immediately that whatever business this physician is in is not the same business I’m planning to go into. As a student, I still have a lot to learn, but one thing I know for certain is that patients should always take precedence over meetings. After all, without fostering the relationships we have with our patients, medicine would be a business in bankruptcy.

Medicine has a rich history of being passed down from generation to generation, but like anything else, aspects of medical practice may become antiquated. As the next generation of physicians, it’s up to us to hone our judgment and decide whether we will accept the status quo or make a new path forward. We get to decide what the business of medicine means to us. Whether we work for a large corporation or go into private practice, each one of us is a boss-in-training of our own future practice. It took some not so sage advice from a preceptor to remind me that meaningful and collaborative relationships with my patients are the cornerstones of my business of medicine.

 

Photo credit: Christophe BENOIT

Categories
General MSPress Announcements

The Medical Student Press Journal is live!

The Medical Student Press Journal team is delighted to announce that Volume 4 Number 1 is now live! You can access the journal here: https://goo.gl/4JuY6g

 

ORIGINAL RESEARCH

Lance-Adams Syndrome: A Case Report, Alec Rezigh, Kayla Riggs

 

ESSAYS

Celebrating the 200th Anniversary of the Stethoscope with a Song, Geoffrey D Huntley

Learning Together: How Interprofessional Education Can Strengthen Health Care Professional Relationships and Improve Patient Care, Braydon Dymm

Improper Statistical Analysis: A Cause of Poor Translation of New Biomarkers into Clinical Practice, Justin Barnes

The Curation of Creative Hospitals, Shella Kirin Raja, Lilah Raja
CREATIVE WRITING
DIG FAST, Puneet Sharma

Young Patient X, Logan William Thomas

The Watchman, Daniel Wang

The Longest Journey, Lauren DeDecker

 

VISUAL ARTS/DIGITAL ARTIFACTS
The Teaching Dead, Alexandra Wood

Categories
Clinical Emotion Empathy General Patient-Centered Care

Opinions Aren’t Facts

I wanted to discuss an experience I had in the newborn nursery. I was assigned to Baby K—a small baby girl who was delivered by emergent cesarean section because her mother abused cocaine during her pregnancy. Looking through Baby K’s chart, an unsettling feeling came over me. This was one of the first times I directly saw how a mother’s behavior impacted her child. Before this, all my clerkships had dealt with adults who were responsible for their own health. Seeing an innocent newborn enter this world with a disadvantage because of her mother’s actions was disheartening.

With this in mind, I went to talk to Mother K the next morning. The chart stated Baby K was going to be given to her great-grandmother, and I needed to confirm this information. I could immediately tell that Mother K was upset when I asked her to confirm. She said, “Yes, she’s going to her great-grandma, but I’m still going be involved! I’m NOT giving up on her!” I realized that just asking the question caused her emotional pain. Especially since the social worker, the nurse, and probably several others, had also asked this question. She again assured me that she loved Baby K, but that she just needed to get her life together before she could care of her. After talking more to Mother K, I realized she was trying her best.

This experience opened my eyes to my perception of patients. After browsing Mother K’s chart and reading that she continued to abuse cocaine while pregnant and was planning on giving Baby K to another caretaker, I may have made the assumption that she didn’t want anything to do with Baby K at all. This assumption may have been reflected in the way I asked her questions, leading her to become distraught. Many patients, especially those who suffer from substance abuse, have lost complete control over their actions. Their mind is controlled by an addiction, and they need help before they can take care of others. After talking more with her, I learned that Mother K actually planned to enroll herself in a treatment center that has housing. After getting better, she yearned to resume care of Baby K. These are details that were never mentioned in any notes, but if they had been mentioned, may have altered my first impression of Mother K before I met her. I also learned that Mother K continued to use cocaine during her pregnancy because she didn’t realize its impact on Baby K. She used cocaine during her prior pregnancy with her older son, and he remained “normal and healthy.” Even though we, as medical professionals, can understand how abusing cocaine during pregnancy is directly detrimental to the fetus, many individuals may not understand this basic concept of maternal-fetal physiology. We thought Mother K’s use of cocaine was due to her lack of care for Baby K, when in reality it was fueled by her lack of knowledge.

The most important lesson I learned was not to judge patients based on chart review alone. I know this seems like “common sense,” but it can be easy to jump to certain perceptions after reading the tone of some of the notes in a patient’s chart. My goal in the future is to enter every patient’s room with a blank slate. Our duty has always been to provide the same quality of care for all patients, regardless of their actions or beliefs, but sometimes we let our feelings get in the way of this duty. I have struggled with this in pediatrics more than I have in any other specialty. When I talk to parents who are willing to move mountains for the health of their children, I feel endearment towards them. There is nothing stronger or more special than a parent’s love. In contrast, with parents like Mother K, it is easy to become frustrated. After examining Baby K, I kept thinking about her fragile little arms and small shrunken head. Baby K may grow up to have health consequences that could have easily been prevented. All I can do is allow this experience to shape future patient encounters. I’m going to try to place myself in each parent’s situation and ask myself: what information or advice would I find the most helpful right now? At the end of my time with Mother K, I gave her a tight hug—I’m rooting for her. I hope she is able to complete her treatment and be reunited with Baby K soon.

 

Photo credit: Weird Beard