Month: September 2015

Talking Medicine

There’s something very gratifying about talking medicine with trainees. Regardless of their level of expertise, there’s always some wisdom to be shared.  1st year medical students are completely a blank slate and any  simple clinical discussion greatly augments their expertise.  Clinical discussions with 3rd year medical students are also extremely enriching considering how their heads are usually buried in textbooks for almost 2 years. The conversations about diagnosing and treating actual patients are both challenging and invigorating.  As interns and residents in internal medicine, the conversations about patients start to get deeper. It’s no longer just about diagnosis and treatment, but understanding and applying clinical evidence towards the best course of action in patients they are completely responsible for. This is also the time where we as medical educators who spent countless hours “talking medicine” with our trainees need to start talking about the most difficult questions facing healthcare today.

These difficult questions are aren’t about arcane diseases or curious physical exam maneuvers. We are beginning to ask about how our patients function within our broken healthcare system  For example, instead of simply talking about the different treatment options for a ganglion cyst, we challenge our trainees to ask and think about why a mother would take her daughter to the ER for that same ganglion cyst; a routine outpatient problem. We delve deeper into a patient’s day-to-day existence by trying to understand the myriad of medical and psycho-social reasons behind an elderly lady’s 3 hospital admissions within 2 months in order to identify solutions that will reduce health care expenditures and protect her from the dangers of hospitalization. Instead of simply prescribing medicines that lower blood sugars, we also talk about the cultural basis of an individual’s diet to better tackle the nutritional aspects of diabetes.

These types of issues which have no obvious answer are unfortunately the exact types of questions our trainees are least prepared to tackle. We’ve created a medical education system that emphasizes building knowledge and understanding of healthcare in terms of multiple choice questions and the absoluteness that comes with selecting a one true answer. Part of my goal as a medical educator is to deconstruct this black or white approach to thinking by asking the difficult questions and exposing how truly grey the world of healthcare is. From there, I hope some are inspired to reject the status quo and pursue careers that aim to provide great patient care, while also tackling the most complex systems issues in healthcare. This is just one of the many gratifying and important aspects of talking medicine today.



Now that we’re fully moved to WordPress, just wanted to take this opportunity to welcome you all!

If you’ve found your way here from my Blogger site, I appreciate you taking the second to explore further by coming here.

This blog is a lot of different things. It’s about medicine at its core and my life as a primary care physician.

It’s about my past experiences that shaped who I am in medicine today.

It’s about the the world of medicine today ; the good , the bad the ugly.

It’s about the future of medicine.

I hope you enjoy your visit here and please do not hesitate to leave comments or contact me!

-Shabbir Hossain MD FACP


      Around 1991, as a 7th grader, my fascination with science far exceeded my prepubescent fascination with girls. For that year’s science project, I decided to explore the world of energy by exploring traditional sources (i.e. fossil fuels) and looking at potential future sources (solar, nuclear etc.). I did a comprehensive report, doing most of my research at libraries (you know those buildings that housed books!). I also did a lot of reading in encyclopedia Britannica (RIP!). In addition to a comprehensive 15 page written report, my teacher suggested everyone bring something in class that could demonstrate what we had learned.
       I was impressed with what I had discovered about nuclear energy and decided to bring an orange to class to demonstrate the processes of nuclear fission and fusion. Standing in front of a class of 30 snickering and giggly teenagers, I explained how the orange was an atom and splitting it (fission) would create juice i.e. nuclear energy. Conversely, smashing together the separated pieces would also result in a citrus shower i.e. nuclear fusion. And with that explanation, I put on one of our science aprons, a pair of our chemistry goggles and aggressively smashed my orange down the middle using a knife I brought from home. 
      Those early teenage years were hard enough as it was. But I fondly remember this because it reminds me of my love for science and one of the early examples of how I overcame shyness and insecurity to stand in front of an audience. I wouldn’t have recalled this moment were it not for the story of a young Muslim teenager and science tinkerer from Irving, Texas who was arrested like a common criminal for bringing a homemade clock to school. 
    I am frightened to think what would’ve happened today if I tried to do a science demonstration by bringing a knife to class. I probably wouldn’t even had made it through the school doors because of metal detectors. The mere sight of young Muslim male with paper thin arms, wielding a butter knife would’ve resulted in a SWAT team descending upon my school to whisk me away in handcuffs. My parents and sister would be intensely interrogated and humiliated. With the rampant bigotry and xenophobia going around today, maybe my parents would think seriously about going back to Bangladesh. Or if we stayed with the stain of being a suspected criminal, would I have the courage to continue to pursue my passions or just settle into a life of acceptance of the old (and now reborn?) American reality that perhaps all men are not created equal. 
   But something terrible did happen to me on that fateful day in 1991 where I brought a knife to class. I got a “B” on my mediocre report which drew the intense ire of my parents. It was probably one of those sentinel moments that are emotionally magnified as a teenager which led me to work harder in pursuit of my goals. But what happened to Ahmed is far worse than a bad grade on a science project. I hope with the same intelligence that he uses to create, tinker and build, he is able to realize that it’s not his fault he was born in the post 9/11 world. And that regardless of how the world may view him and try to bring him down, this is still a great country where someone bright and hardworking like him will have the opportunity to become successful, make a difference and change many hearts and minds.

Twitter Grand Rounds

I’m currently into my 2nd week of life here at UTSW with most of my time committed to orientation related things. But today, I was able to resume one of my favorite activities as an academic internist which is attend departmental grand rounds. It’s great because the numerous disciplines in internal medicine all gather in one place to hear a respected colleague discuss important research, clinical and non clinical topics in medicine. Today’s grand rounds was especially noteworthy because it was given by someone within my own division (general internal med) on the unique topic of secondary cancers in adult survivors of pediatric cancers. As always, it was informative and captured my full attention.
But grand rounds wasn’t always as exciting for me. As a junior faculty in my prior institution I would find myself sitting there at 8 AM, staring at power point slides desperately trying to keep focused or even stay awake. Despite interesting topics and engaging noteworthy speakers, I didn’t get much out of it. That was until I entered the world of Twitter and became fully engaged in grand rounds by live tweeting. From that moment, grand rounds became an active fun event instead of a passive attempt at learning (an experience far too familiar from my days in medical school). Twitter became my platform for self learning and engagement as well as an opportunity to share important medical advances and concepts with the world at large. I looked forward to learning and the challenge of feverishly tweeting key facts and themes. Soon, other faculty members, house-staff and medical students became involved as we developed a virtual back channel conversation each morning of grand rounds.
Now after having left my prior institution for several months I’ve resumed my live tweeting of grand rounds, having learned several interesting things about pediatric cancer survivors and their heightened risks of adult cancer. In that process, I’m confident, a few others out there in the Twitterverse have a learned a few things as well.  And like most things in social media, the connections we make are a two way street. There are many others out there, doing what I’m doing, sharing their knowledge via social media in an effort to connect our minds and expertise for the purposes of improving medicine.

Twitter account run by former colleagues with tweets from grand rounds, noon conferences and much more!

Free open access medical education hashtag.

Medical Education hashtag

A generic hashtag of all kinds of grand rounds across the world.

My twitter account

Sir William Osler conducting Grand Rounds
(courtesy of the medical archives at Johns Hopkins University)

Faces of the J Train

It’s been about 10 months since I left New York ; the city, the state, the place of my birth. And on the eve of celebrating the 1st birthday of my daughter back where it all started, I’m thinking about all the experiences here that made me who I am, When it comes to medicine, my career in primary care started on the New York City Subways and the J train.
    One of the few largely above ground subways, The J train continues to click, clack, roll and tumble through a myriad of diverse neighborhoods in Queens, Brooklyn and Manhattan. From 1992 to 1999 (high school and college) I made the daily sojourn into Manhattan, using the hour of time to catch up on sleep, spanish homework, chapters of Homer’s Odyssey or complete assignments for organic chemistry. What I enjoyed most of this experience was simply sitting back with my AIWA walkman (Discman later) and observing the faces of the crowd. In a city so large, the faces and the stories were rarely the same.
    My trip started in a rapidly evolving middle class neighborhood in Queens. The area was in the midst of a “white flight” as caucasians slowly moved to parts further east as south asians and west indians moved in to begin their immigrant lives, struggling to fulfill their american dreams. As the train rolled west and into Brooklyn, tree lined streets gave way to boarded up apartment buildings, police sirens and general urban decay. This was East New York, a place defined by poverty, drugs and violence. The faces from here looked like any other, but they hid struggles unique to this neighborhood . Further west, the J train passed through Orthodox Jewish neighborhoods where the modern world clashed daily with religious and cultural traditions. And finally before crossing over to Manhattan, the train would pass through Williamsburg where the struggle to survive gentrification was only just beginning.
    I no longer live in NY and ride the subways. But as a physician each day continues to feel like a subway rides except now I am the conductor that’s picking up patients, helping them get to their destination.  And just like back in the day, I try to read their faces, understand their struggles by listening to their story. But as a primary care physician I recognize their struggle isn’t simply about what part of their body hurts or what disease currently plagues them. There struggles are a composite of their illness, their life stories, their backgrounds and the streets and people in their neighborhood that helped forge their identity. And healing isn’t simply about mending a broken bone, stitching up a wound or completing a course of antibiotics. Healing is about helping the patient cross the Williamsburg bridge, into Manhattan so that they can live to carry on for another day.