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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 and 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.

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The End Is Coming

The end is near.

As I type this we are speeding through the month of June.

On June 30, my year as one of the Internal Medicine Chief Residents will come to a close.

Before this year began, I remember hearing a former chief resident fondly look back on his own time as chief resident years ago. He told me that was the best year of his career.

I don’t know if that nostalgic statement was supposed to be encouraging. It probably was.

Right now I hope that this year will not go down as the best year of my career.

I’ve had fun. I’ve had headaches. I’ve learned a lot — both clinically and in other professional areas as well.

But, like I said above, I sure hope that this year isn’t the best of my career and it’s all down from here!

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Thanks For Nothing, Thanks For Everything

Thanks.

It’s can be a powerful sentiment — as in gratitude for the ultimate gift or a heavy sacrifice.

But it can also be empty — as in a “thanks for nothing.”

I remember taking care of a patient midway through my residency. We had tried many different things, but eventually he succumbed to the disease and passed away in the hospital. I don’t remember what the patient looked like. I don’t remember his name. I don’t remember the disease.

What I do remember was that we tried. We tried to make him better, but in the end we did not meet this goal. As the futility of our efforts became clear to us and to the family, we decided to focus on comfort.

The patient passed away.

The memory that has haunted me to this day is walking into the room and having the patient’s brother walk up to me. As he drew closer he pulled me into an embrace and thanked me. He actually thanked me.

In dealing with death and dying it has not been uncommon for me to hear a thank you from the loved ones of a patient who has passed. But this was the first time I experienced this. And maybe that’s this memory has stuck with me since then.

Thanks. It jarred me to hear that sentiment from this grieving man. In that instance I could not do much more than return his embrace. I had no words but to say, “I’m sorry.”

To me, my words felt empty. They felt inconsequential. But it was all I could muster.

I felt like I was being thanked for nothing. I felt like I was being thanked for failing. Because that’s the lens through which I viewed the situation.

Now, I realize that I should be grateful for their appreciation. I marvel at how some people, in their moments of grief, can still take time to express their gratitude — even if it is “just” for compassion and care instead of the cure for which they had pleaded and prayed.

Medicine is a profession most of us go into because we want to fix problems and make people better. Too often it is easy to view death as a failure of what we set out to do. The danger in allowing us to view death this way is that we may feel that we have provided nothing to our patients and their families.

But sometimes patients and their families don’t need a savior. Sometimes they just need someone to be with them through the journey’s end. And to them, you have given way more than “nothing.” You have given everything.