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Good job, Senators

After all the waiting and political posturing, today the U.S. senated voted no on a straight repeal of the Affordable Care Act (commonly known as Obamacare).

In the days leading up to this you heard many, including POTUS, urged the senators who had campaigned on repeal of the ACA to step up and deliver on their promise.

Today, the U.S. Senate voted not to repeal.

For those who had campaigned on the promise of repeal but decided to vote No because it hurt your constituents, I respect you.

Campaigning for something and then trying to follow through blindly despite learning how it hurts those you represent is — well to me, it isn’t doing your job at all.

The ACA isn’t perfect.

But a full repeal that would result in coverage loss for millions of Americans with no answer in sight is downright wreckless.

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July – It’s That Time of Year Again

It’s July.

It’s that time of year again.

Those involved in medical education — or just those that work at academic medical centers — know that this is the time of the year when brand new interns step into their roles as doctors.

Cue all the jokes about July being the worst time to be sick in a hospital.

During my chief resident year I was in charge of the first Journal Club session of the academic year. I assigned the residents an article about the July effect. You can find that article by here: Annals of Internal Medicine.

Jokes aside, I think the month of July is an exciting month to be involved in medical education. It’s a time of very new beginnings. As an attending physician supervising learners it is a time of heightened stress. However, I think it’s also a time of when you get to see new baby doc spread their wings for the very first time. This is the first time they are addressed as “Doctor.” These are the first orders they will write as a physician. This is the beginning of the rest of their professional careers.

The transition is defintely not always smooth-sailing. But it is definitely worth the trip.

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Academic Internal Medicine Week 2017 (AIMW)

This past week I had the opportunity to go to Baltimore, MD to attend Academic Internal Medicine Week 2017. It was put on by the Alliance of Academic Internal Medicine (AAIM), an alliance made up of five different organizations:

The last time I participated in an academic conference like this was for the 2015 APDIM Chief Resident’s Meeting. Each year, APDIM invites upcoming Chief Residents for several days of workshops and training. They provide education about the role and a sort of network for those who are interested in it.

This year I attended the CDIM meetings in my role as one of the Associate Clerkship Directors at my institution. My first impression was that I felt out of place. I looked around at people who have been in their roles for their entire careers. I saw people who have published numerous articles in the field of medical education. It was, I’ll admit, a bit intimidating.

I flew out on Saturday afternoon and arrived at nearly 11 PM at BWI. Picking up my checked bag from baggage claim took longer than I had hoped. By the time I was able to get a taxi to the Marriott in downtown Baltimore, check in, and get settled in my room it was past midnight. By the time I was in bed and trying to fall asleep it was past 2 AM. My alarm was going to go off just under 4 hours later at 6 AM.

The following morning I headed out to get find registration and pick up my ID badge. I picked up the program and a free bag — one of those bags they always give out each year. I had pre-resistered for a pre-course. Officially, AIMW would kick off later in the afternoon with an opening session in the evening. Starting at 8 AM, I would be at a pre-course designed for new clerkship directors.

One nice thing about sitting down at the new clerkship directors course was that I got to sit down with people who were new to their roles. All — at least as far as I could tell — of them seemed to be there as the Clerkship Director, though. They weren’t there as an associate clerkship director like myself. It was comforting to hear people talk about how they were feeling overwhelmed as they waded through the responsibilities of their new positions. I started to feel like I could understand a little more about how much the clerkship director had to do. I’ll admit there was some relief that I was not attending this conference as a new clerkship director. I think that role would be quite overwhelming for me at this stage of my career.

The rest of the conference was quite a blur. It was fast-paced. There were plenary sessions and workshops galore. I felt like I learned a lot. I tried to scribble or type notes as fast as I could. Hopefully some of it sticks.

I don’t know where life will lead me. I dont’ know where I will be in 10 years as far as my career goes. But I do know that going to a conference like this has the ability to fire you up about what you’re doing. It’s refereshing and re-energizing to be surrounded with people so dedicated to passing on knowledge to their learners.

Maybe one day, in the future, I’ll find myself at another one of these conferences. But instead of being the new guy on the scene, I’ll be a seasoned veteran who is excited to share and teach and help out.

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Doctor, Please Explain…

Recently I have been thinking about communication.

In my short career so far, I have realized that there is often a huge chasm between what we (physicians) think we have explained and what patients understand.

As a general rule, I try to take the time needed to talk to patients and answer all their questions. Sometimes I think I do an adequate job. And patients have voice appreciation for it before. I have been thanked for actually taking the time to explain my thought process and my plan. But I’m sure there are other times when I my question-answering leaves something to be desired.

Unfortunately, time is a luxury. Sometimes things get rushed. Sometimes there are patients who need more attention because of their condition so we spend a shorter amount of time talking to the more stable patient.

I’ve also had nurses tell me that they care for patients who ask them all sorts of questions about their medical care but when the physician comes in to see them, the patient either forgets or chooses not to pose the question to the physician. Sometimes they get overwhelmed. Sometimes they are intimidated. Nurses tell me that sometimes after the doctor leaves the room, the patients will ask their questions to the nurses.
Most of my work caring for patients involves residents/interns and medical students. I try to emphasize the need for clear and accurate information each time I work with a new group. Nevertheless, miscommunication happens. We aren’t perfect. We operate in a flawed and broken system that expects perfection and efficiency from medical providers.

If you’re reading this post, I’d love to hear about your experience as a patient. Are there still things that confuse you about that experience? Are there things that you wish your doctor had taken more time to explain? Are their topics or diseases that they sped through while talking to you? Do you wish they’d have slowed down and spoken in plain English? I want to know what the confusing topics are! I want to know where we, as a profession, fall short!

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Parenthood Thus Far

It’s now December. I went back to work in mid October after approximately 6 weeks without a shift. During those six weeks I had the occasional meeting to attend and other administrative responsibilities. But I had no 12 hour shift to fulfill. After feeling like I’ve been going non-stop throughout medical school and residency, it felt weird not to have any clinical duties for so long. At the same time, however, it wasn’t a vacation.

Prior to my 6 weeks off, I thought I would be able to stay at home, take care of the baby, and take time to read. I had hoped to have this time to catch up on much-needed reading. I soon learned that a newborn takes a lot of time. Despite both me and the wife being off work, we frequently found ourselves getting behind on things we had to do because, well, we were trying to keep this new creature alive.

During residency I had my share of on-call shifts that lasted over 24 hours. The newborn period soon came to feel like a prolonged call shift lasting days. Our nights were split into shifts where we would take turns taking the baby and making sure she was clean, dry, and fed.

We were lucky that Faith, our baby, was quick to take the breast or bottle. She wasn’t fussy and she didn’t need much coaxing to eat. But let me tell you, this little one can go from 0 to ‘hangry’ in no time at all. It’s as if she finally has the realization that, “Oh, I actually AM hungry.” This is usually followed by immediate wailing and crying.

They say that parenthood changes you. They say that having a child shifts your own priorities. I wonder how she shifts mine. I suppose only time will tell.

Oh well. It’s December. It’s baby’s first Christmas. And I will try to enjoy it while it lasts. In a few days the baby turns 4 months. I can’t believe it’s been 4 months already. It’s been crazy watching her grow so much in such a short period of time.

 

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Back To Work

I go back to work this week. It’s the first time I have been on a shift since mid August. My wife and I recently celebrated the birth of our first child, a baby girl. I was fortunate to be able to arrange my schedule in order to accomodate this time off.

It’s odd going back to work after a long time. Part of me welcomes going back. Part of me wants to hang out with this brand new, little human being.

They say that having children changes your priorities and perspectives.

Personally, I think its’ too early for me to say what, if anything, has changed.

Sure, I wish I could spend a ton of time with the little one. But I also have gotten antsy and wanted to get out of the house.

If it were an option or possiblity, I wonder how I would do being a stay-at-home dad/husband. I would probably have to be intentional about being active and doing things out in the community with the baby. Needless to say, I’ve got tons of respect for men and women who are full-time caregivers with their children at home.

We’ll see how it goes.

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Are you there?

A longtime reader (and by longtime reader, I mean my mother) of this blog recently commented to me that I haven’t been writing here very much as of late.

As a blogger, I suppose it is good to know that your absence is missed — even if that absence is noted by your mother.

My last post was published prior to this academic year ending. I was wrapping up my year as a Chief Resident. It truly was a good year. I felt that I learned a lot and developed not only as a clinician but an educator and (dare I say it) administrator too.

Am I still here? Do I still exist? Well the answer is yes, obviously. I have been left in the post residency… afterglow? Is it even appropriate to call it that?

Though I did round as the attending physician during my chief residency, those stints were scattered here and there. Now, however, that is life. I’m no longer involved in the inner workings of residency administration. And that’s ok. It’s time to move on. The new chiefs have taken over that baton beautifully.

But it does sort of force you to redefine your life. Because for so long life has been about training and learning and education and answering to a program director.

Sure, I still have a boss and a department chair. But there is a much more autonomous feel to it now.

I’ve taken up some leadership positions. I’m trying to get involved with our institution in ways I feel I can contribute positively. I’m working with residents and medical students. Overall, though, I feel that the path is now less defined and it’s up to myself to figue out where I’m going to point this ship.

That’s an exciting, scary, and daunting idea.

But this journey goes on.