Category: career

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.

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.
 

Coming full circle, 15 years later

     This week, I had the pleasure of participating in an information session for my medical school Alma Mater, St. George’s University. The entire experience was a bit surreal when I realized that almost 15 years ago I was one of those faces sitting in the audience, taking notes and wondering what lies in my future.
      Like many of the students that were sitting in front of me, I had doubts. I had doubts about my prospects getting into a US medical school. I also had doubts about whether going to a foreign country for my medical education would be the right decision. Standing there in front of them, I was genuinely happy to report that it was absolutely the right decision.
      It was the right decision for many reasons. First, I came away with some incredible friends, one of whom is actually getting married in a few weeks in what will be an incredibly fun reunion in Hawaii. More importantly, despite all my initial doubts, I came away with a great education and an opportunity to pursue a truly gratifying career. My other really good friend from medical school used to quote the movie Spiderman and tell me,  “When you doubt your powers, you give power to your doubts.” My belief in myself and the support of St. George’s eliminated those doubts and allowed me to excel in my professional life.
     I told my audience at the information session that at times when I was medical student, I wondered if I was as knowledgeable as my counterparts from other schools. As a resident, I also wondered if i was up to par with residents from other schools. 15 years later, I realize the answer was and always will be a resounding yes. Not only that, in my current career path as an academic internist, I’m responsible for teaching those same students and residents that I compared myself to many years ago.
     Ultimately, doubting yourself or comparing yourself to others at any point in your career is a futile and worthless effort. The fact is, we all somehow end up in the same place, which is in front of a patient in need. Everyday I am grateful for that opportunity. And as the number of those patients in need continue to rapidly grow in our country, it’s great that St. George’s is continuing to produce a steady stream of excellent doctors that are looking to make a difference just as I did 15 years ago.
   

Learning, food and great memories

I had a few minutes so I thought I’d try and collect some of the many pictures taken at my last job that capture the spirit of learning combined with the fun and joy of eating together like a family.

At least a couple of times a month, we would hold pot lucks at our clinic while we did our Friday afternoon outpatient noon conference. They often a had a theme such as “Pi day”where we all made/bought some form of a pie.

The work we did in that clinic was often quite difficult but small events like these really made the work and learning process so wonderful!

Lot’s of great memories and I miss all of you!