Month: January 2016

The Imitation Game of Medicine

I love good movies and marvel at Hollywood, their creativity and the ability to capture people’s imaginations. But I also love medicine. I especially find it amusing when I see a movie that parallels my perspectives on medicine.

Recently, my wife and I watched the Imitation Game with Benedict Cumberbatch.

Quad_BC_AW_[26237] Imitation Game, The

It was terrific.

Briefly, it’s about Alan Turing; a brilliant mathematician and father of modern computing who decoded the impossibly complex Nazi Enigma machine, helped the Allies win WWII, all while battling persecution and oppression as a homosexual in Great Britain.

The basic premise of his challenge was that he had 18 hours each day to manually decipher Nazi military messages from combinations of letters and numbers that exceeded hundreds of millions. It was an impossible daily task for even the most brilliant minds. But he overcame this by designing a machine that could break parts of the code faster than the human mind thereby augmenting his team’s ability to decipher each critical message.

Though not fractionally as brilliant as Alan Turning, my life as Internist has parallels to this story.

Patients are each like their own enigma machine. Underneath, they are an amalgamation of billions of processes (some detrimental) sending out signals that we have to manually decipher in a myriad of ways. Instead of an 18 hour clock, the clock is variable with each patient. And unfortunately despite all our best genuine efforts and available technology  we sometimes fail to capture and decrypt enough of the messages to make an even greater difference.

Essentially, medicine is still waiting for its Alan Turing moment. Right now, researchers, entrepreneurs and others are trying to find the best way to capture all the signals. Wearable technology, mobile phones, genomics, advanced blood and radiologic testing and other modalities are on a crash course towards creating a monumental repository of real-time “Big Data” on each patient. And just like Turning, despite how adept we may seem as physicians, we will need the raw power of digital computing to crack these codes

Once we do this, medicine will be completely different and physicians will be empowered with a revolutionary perspective on how we view disease and manage life.

 

Prescribing Hope

As doctors, we’re usually pretty good at recommending treatments for different illnesses. But we definitely struggle to help patients manage these illnesses. That’s because our mindset from the start of our education is to think about the disease and the correct scientifically validated answer. We rarely explore or think about the very unscientific unpredictable element of disease; everyday life.

Recently, I had the privilege of seeing a patient with one of our bright house staff that illustrated the above point. Briefly, it was a young patient with poorly controlled Type 1 diabetes with repeated hospital admissions from inconsistently managing her complex medical illness. The patient blamed her inability to manage her diabetes to difficult living circumstances related to her parents and her boyfriend

After telling me this very complex medical story, I asked the resident what we should recommend to her. Right on cue, I got the technical answers I needed to hear in an academic setting. We talked about checking blood sugars frequently, increasing her insulin, improving her diet, carb counting and stressing the outcomes associated with diabetes ravaging a body.

I then asked him, how would we going to get her to do these things when it had appeared this advice had already been rendered to her several times before. Not surprisingly, I got a bit of a blank stare.

The first thing we did was recognize she had poor health literacy. With that in mind, our goal was to explain the disease in simple terms, advocating for consistency with just a few recommendations that would ensure she has more insight into her disease while allowing her achieve some semblance of success.

The bigger question was, how do we get her to manage this complex disease successfully long term? But before we figured this out, I asked the resident what made him spend so many hours studying and working so hard as a resident. He told me, it was his hope to have a successful gratifying career while being able to share in a happy and healthy life with his family and friends. With that answer in mind, the both of us went to see the patient.

After spending a few minutes discussing diabetes, I posed a similar question to our patient. I asked her, as a young woman with her entire life ahead of her, what was she looking forward to that could help motivate her to manager her diabetes more aggressively. She kind of smiled, looked down and the floor and couldn’t give me an answer. I pressed her for an answer again, and she told me,

I dunno, just waitin.” 

She wasn’t waiting for anything in particular, but just for anything good to happen.

With that, it became painfully obvious that she was also afflicted with hopelessness. Though there isn’t a diagnostic code for that, its a chronic illness, that persistent grey cloud and lack of hope that we also need to manage in chronic illness in the poor and downtrodden.

 

 

 

 

 

 

Happy New Year

2015, was a transitional year for me. After making the big move from New York to Texas, my family and I are finally feeling settled, unabashedly happy with our big decision. It wasn’t easy from a personal and professional standpoint to leave family, friends, colleagues, patients, medical students and residents. But after a year of getting acclimated, we can now look ahead to 2016 with a sense of comfort and excitement that we made the right decision and the future is very bright.

Here are the 5 things I’m looking forward to, professionally for 2016.

5: Getting back to Twitter. For many reasons, I drifted away from being active on Twitter. But I’ve started to miss the conversations with people from all over planet who have unique forward thinking perspectives on healthcare and medical education. I also miss the energy that comes from advocating for issues that I’m particularly passionate about such as modernizing healthcare, improving access to healthcare, medical education and voicing my political opinion against bigotry, xenophobia and politicians who want to divide this country. @shabbirhossain

4: Inspiring medical students and residents. I feel part of my job as a medical educator is to show and emphasize to our future doctors that our healthcare system is a mess. We need them to be excellent doctors, but also vocal advocates for improving the system. It’s simply not enough anymore to be a good doctor and work hard. The problems in our healthcare system demand more.

3: Thinking innovatively. I’m going to keep trying to look for small (and perhaps big) ways to practice medicine more innovatively. Medicine, for many reasons has evolved at a much slower pace than most other industries. I believe the system rewards dogma, tradition and self-preservation too much to allow people to think outside the box. It’s a daily struggle not to fall into the grind of simply doing things the way they’ve always been done. But I’m hopeful in 2016, I can get my mind back to thinking more about the future of medicine.

2: Reading. As physicians, we’re always reading. Journals, news articles, blogs etc. But I want to get back to reading more non-medical stuff. I regret not taking more advantage of my liberal arts education in college. The perspectives offered in non-medical literature are critical for a physician to understand people as well the world that exists outside the human body. For example, I’ve been wanting to finish reading Money ball. My hope was to understand Saber Metrics to get an idea of how statistics can be used to understand trends and reinventing “the game.”

1: The Patients: In my short time here, I’ve already been lucky to meet and take care of some incredible patients. This is the best part of being a primary care physician. I get to be a part of the lives of patients from so many different back grounds, each with their own unique story to tell. Young, old, men, women, healthy or sick. I get to see it all, do it all and it’s an incredible privilege.

Happy New Year to everyone and hope 2016 brings good health, peace and prosperity!