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!

 

 

Advocacy

Our nation is struggling to provide basic healthcare for all of its citizens for a variety of reasons. One of the simple reasons is that we’ve created a medical education system that simply is not producing enough primary care doctors for a population that grows older and more complex. Fortunately, at my current institution, we’ve set upon a path to try to help with this, through the development of a primary care track  in our Internal Medicine residency program. It’s exciting to help build something from scratch that will hopefully inspire some young physicians to pursue general internal medicine and provide excellent clinical care while tackling some of the biggest issues in healthcare today.

Advocacy is one of these themes that I hope will be a hallmark of our program. As generalists, we advocate on many levels. We advocate for our patients when they face terrible illnesses and uncertainty. When the healthcare system lets our patient down, we advocate for them to help overcome road blocks. We advocate for those that the political world far too often marginalizes such as immigrants, elderly, children and women. We also advocate for our own physician and healthcare colleagues against the powers that be that preclude our efforts to take care of our patients.

Advocacy is a common ideal amongst the intrepid medical student that too often gets lost as a result of accumulating student debt, burnout, lack of mentorship and the general rigors of residency. I’m hoping with our primary care track, we can reinvigorate these ideals and empower the next generation of physicians to keep advocacy an integral part of their career.

I never had any specific training with advocacy. I’m learning this on the fly. But the modern world has made this much easier for busy clinicians like myself. This blog, though it’s reach is small is a personal quest to advocate for issues I care about. Social media is a powerful tool that brings the world immensely close together. I can directly communicate with people who can help me make a difference. In fact today, I tweeted our local congressman @REPEBJ to hopefully ignite a relationship with legislators who can advocate and enact change at the government level.

I also found a tremendous amount of resources at Society of General Internal Medicine Advocacy to help bring this theme to our primary care track.

If anyone reading this has other ideas, please let me know! This is an exciting and important endeavor for us a program and the people of Texas!

 

 

Denying Healthcare

It seems like whenever I listen to politicians, it’s all about denying people something. Denying refugees a chance at life has been a big point of emphasis recently for many of these would be leaders.

In healthcare too, politicians and other influential groups continue to use their clout and biased selfish ideals to deny people a chance to be healthy and take care of their bodies. Recent iterations of our healthcare “System” promoted a for-profit scheme that emphasized quantity instead of quality of care, while denying access to care those who need it the most and are at greatest risk ; immigrants, elderly, children, minorities, the poor and women.

The adoption of the Affordable Care Act (ACA), though not a perfect solution, is finally pushing the needle towards a model of care that’s inclusive, focusing on quality and giving access to those at greatest risk.

Despite signs of early success, the ACA continues to take fire from bellicose politicians who want to tear it down for their own political gain. Other critical forms of healthcare access, like Planned Parenthood continue to be targets of both politicians and terrorists. It’s a national shame that women are being denied access to healthcare  by both the edge of a sword and the edge of a pen held by male dominated leadership.

As someone in general medicine, every day I see the tremendous importance of providing access to comprehensive healthcare. It is a place people come for the pure purpose of wanting to be a healthier contributor to society, devoid of politics, judgment, racial, religious or gender bias. I’m proud to be able to provide that. I urge all of our politicians to recognize how important this is and become leaders that focus on giving to their constituents rather than denying them healthcare.

 

 

 

 

 

Keep them out?

My blog was never intended to be about political discourse. It still is about me, medicine and my personal journey here. But this journey would not have been possible if 40 years ago the political climate on immigration was as toxic as it is today.

After the bloody civil war that gave birth to my native country of Bangladesh, a young educated Muslim man who escaped extermination, seized an opportunity to escape famine, post-genocide  political upheaval of his mother country to chase the American dream. It’s as genuinely American as any other immigrant story. With a few dollars in his pocket and a can-do attitude, my father came to New York and established a legacy as the Christopher Columbus of our entire extended family.

It’s that American idea of hard work and self reliance that led him to become a successful engineer in New York City’s department of transportation. He was responsible for the roads and bridges that people of all faiths, colors and ideals traverse daily in New York City. It’s the same roads and bridges that certain business men used daily on their way to becoming national political candidates. It’s that same infrastructure that came under attack on 9/11, just a few blocks away from his office. Covered in debris, he escaped the fallout, walking  for hours, side by side with people from all over the world. Once again, he found himself in a war zone, attacked by his fellow Muslims.

Through the  years, despite these experiences he remained a devout, pragmatic and moderate Muslim. It is a perspective that influenced my sister and myself but also the numerous family members he helped support and immigrate over the past 40 years. It is a family tree, entering it’s 3rd generation, littered with remarkable success stories defined partly by the fact that we are all Muslim, but just as importantly, as Americans dedicated to honor, community and service.

When we reflect on our family’s journey to this moment in time, we rarely contemplated the “what if” he had never immigrated. But now we do wonder with the myriad of immigration proposals being suggested that target specific people like Muslims. What if he had been kept out? America certainly would not be safer for it. America would have only lost a small but vital part of its soul.

 

 

IOS, Android and the battle for my #mhealth soul

The preamble story to this discussion is as follows.

My 3 year old son is quite adept at using my Iphone. He was more interested in my phone than the Macy’s Thanksgiving day parade. He was so engrossed in it, I had to physically carry him to the bathroom to take care of business. In that process, he accidently dropped it in the toilet. My phone was toast. I shrieked and cried (on the inside) while I had a  massive digital heart attack.

Now it’s decision time.

My initial instincts were to stick with what I knew and the Apple ecosystem that was flourishing in my home for the past 7 years. My wife has one. My kids use a 2nd generation IPAD  for their activities. I also use a 3rd generation IPAD mini for work and day to day activities. We even have our old Iphone 4’s in our kid’s bedrooms that play music and function as a sound machine for their sleep. We also have Apple TV’s for entertainment purposes. My wife and I also share a Mac desktop. This ecosystem has been working well, but admittedly has given me Apple tunnel vision and a general fear of  trying Android devices.

In addition, my interest in the concept of #mhealth has been growing recently. Specifically I’m appreciating  how remarkable smartphones are and their potential to  be a game changing element in healthcare.

In medical education, mobile devices like a smartphone gives trainees and veteran clinician’s access to real time evidence based information. Social media is a ubiquitous platform for networking, advocacy and expanding medical knowledge. There is a growing capability of technology to collect numerous forms of patient data with the smartphone being the fulcrum that processes that information and connects patients to their clinicians. #Mhealth is and can be so many different things. We are just scratching the surface of its immense potential.

With that in mind,  I’ve started a #mhealth interest group within the Society of General Internal Medicine. We will be meeting for the first time this spring and I look forward to collaborating with people want to explore this area further.

SGIM 2016 Annual Meeting

But it took my precocious son’s butter fingers to make me realize I’m only experiencing  half of the #mhealth world by avoiding Android devices. So with much trepidation but in an effort to be a more complete digital physician, I’m going to jump ship from Apple temporarily. I hope by the time the SGIM meeting rolls around, I’ll have a better perspective on the smartphone #mhealth world.

I’m already noticing a difference. I have so many different phones to chose from…

And what’s KitKat, Jellybean and Lollipop???

🙂