How Did I Get Here?

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By Jake Whetzel, MD

Recently our residency program has wrapped up another interview season, meeting to review our applicants (and potential future friends and colleagues) to complete our rank list to submit for the Match in March. It is nearly impossible to meet and get to know each applicant as a resident due to rotation schedules limiting your availability to participate in the interviews, or you get caught up in a conversation with one interesting applicant and might miss out on the chance to meet another. Our process allows us to revisit each application and hear from others in the program who had a chance to interact with these future physicians and hear how diverse our applicant pool was, with people coming from all parts of the country, each with different backgrounds and experiences, all ready to become a Family Physician. Being only a couple years removed from going through a similar process, I can still relate to the stress and excitement of choosing my future career. Reviewing our most recent group of applicants has caused me to reflect on my journey to Family Medicine and answer the question – How did I get here?

 

This blog has included a number of pieces last summer/fall that asked writers to answer the question – Why (not) Family Medicine? This was a slightly different version of a question that always seemed to come up during the interview process – Why Family Medicine? To me, the answer is probably the same for both. A career in medicine probably first developed in my mind around middle school, and was based on some great interactions I had with providers early on in my life. I was so impressed with their knowledge and ability to reassure us if things were fine or “fix” things if they weren’t. Initially, I remember thinking Radiology would be kinda cool. It seemed that this just involved looking at pictures and trying to solve the puzzle. As life progressed through high school and college, my thoughts shifted and started to include more about what type of lifestyle I wanted, what would give me fulfillment in life and where I wanted to live. The first and last questions were easy. I knew I wanted to live in a small town, evident within about a week of moving to the “city” of Helena, MT (population estimated just over 30,000 in July 2015) for undergrad. I also knew that I needed to be located in close proximity to mountains that I could escape to when I would need to decompress. And Montana will always be home.

 

Next came the decisions to find a career in medicine that allowed me to return home, a lifestyle so that I could enjoy it, and provide fulfillment in my life. This is where I came to Family Medicine. I would argue basic healthcare is a human right and that any small town community without a provider is underserved in this aspect, whether the next physician is only twenty miles away or one hundred. Without a local provider, chances are people just won’t go to see one until it’s an emergency. This may be due to inconvenience of travel, lack of funds or lack of trust in an outsider. The reason most of us are in primary care is to prevent these “train-wrecks” from occurring. To be truly beneficial to a community like these, I believe you have to be a local. They want someone who is a member of their community, a familiar face they can trust and turn to when they need it the most. When choosing a career, I felt that Family Medicine gave me the best chance at filling this void for a small town. I wanted to be able to take care of all the community members and develop those trusting relationships so that when a patient needs their care to be escalated, they can believe that the decision is in their best interest and consistent with their wishes.

 

One of the greatest things about Family Medicine is that no two paths are the same. Your career can lead you to urgent care, to academics, or to a hospitalist position. Family Medicine provides you with a base to mold your own choice that allows you to hopefully find that dream job that not only gives you the opportunity to make a major difference in other people’s lives, but also gives you a sense of fulfillment in your life. To the future physicians waiting for the Match, I wish you luck and hope that you are able to find that path to your own version of professional success.

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Jake Whetzel, MD is a second year Family Medicine Resident in the Department of Family & Preventive Medicine at the University of Utah School of Medicine.

Hindsight (or Advice to Myself in the Past)

By Lauren Wood, MD

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Hindsight is 20/20, right?  As the end of residency nears, and I think back on the last 2 ½ years, it has both flown by and been slow as molasses.  As the saying goes “the days are long, but the years are short”.  This definitely applies to residency!  Sometimes, things have gone smoothly, sometimes not – overall, though, residency has been a very positive experience and a time of immense, critical professional and personal growth.  There are certain challenges specific to each year of training.  While I can’t go back and do things differently, I hope that my reflections on the more challenging parts of residency can offer insight for residents in earlier years of training.

 

Intern Year

  • Don’t feel bad if you are uncomfortable calling yourself Dr. So-and-so. It’s awkward and unrealistic that we go from being medical students to full-fledged physicians in one day.  And it’s not exactly true either.  That’s what residency is for.  Practice using your title (sometimes it comes in really handy!!) but don’t feel bad if it feels weird.  By the time you graduate residency it will be second nature.
  • Expect the first week of any new rotation to include a bit of shellshock. Each month, you will change specialties, facilities and colleagues, especially in Family Medicine training.  You will go from inpatient pediatrics to labor and delivery to MICU at different hospitals with different EMRs and work alongside OB, Peds and IM residents, who have way more experience in their respective fields than you do. You will feel like you know nothing for a few days – you might curse, you might cry, but you will recover and you will finish that month with great skills and with a great evaluation to boot.
  • Lean on your co-interns, they understand what you are going through and they will be there for you.

 

Second Year

  • Our R2 year involves increasing leadership responsibilities. This is a new role for most residents and can be terrifying.  A major roles as senior resident is overseeing our inpatient service and two interns. While I was sort of excited about this role, I was also nervous that I wouldn’t be able to keep track of all the patients, know enough, be able to do enough. What if the intern asked a question I didn’t know the answer to?  In retrospect, this was all fine.  It actually went well and was fun.  Medicine is a team sport and we all learn from each other.  You will learn different and important management skills.  There may be crises or conflict that arise.  Ask your attendings or R3s for guidance.
  • There will be long shifts. Sometimes longer than 24 hours.  And you will be REALLY tired and feel like you can’t think straight.  You’ll shift from day to night shifts.  And you will be REALLY tired.  Sleep when you can, but if you can’t or if the lack of sleep is causing you to feel depressed, irritable or anxious – reach out.  It’s OK to take a sick day for this or go to bed at 7 PM. Really, it is.

 

Third Year

  • This blog post is three weeks late currently. I’m teaching a didactic session in two days and I have nothing prepared.  I need to email someone back from a few weeks ago.  I haven’t read the journal article for journal club tomorrow.  I have three notes from clinic yesterday that I need to finish. I probably shouldn’t be freely admitting these things, but I have found this to be my biggest challenge in third year.  In addition to usual clinical duties, typically 8-6ish M-F plus occasional weekends, evenings and early mornings, there are many assignments. This is partly a challenge for me, because when I’m not at work, I’m on mom duty.  But, children or no, all residents have friends, families, hobbies that can make it hard to stay on top of all these tasks.  I can’t speak for anyone else, but when I have time off I want to ski, hike, travel and hang out with my family and friends – not do more work.  But, this is still residency, so I try to start early and set aside specific time to get things done.  You can get a lot done in one hour if you put your mind to it.
  • Your job search will be stressful, but it will be okay. Getting the CV up to par, dusting off the suit you haven’t worn since residency interviews and remembering a time when you worked with a team and things went well can feel overwhelming.  You’re a nice person and a good doctor and someone will be really lucky to hire you.  And someone will hire you.

 

If I had to sum this up in a few sentences, it would be these:

  • Residency is hard, it makes you tired and stressed but it is an instrumental part of your development as an independent physician. You will look back on it fondly, although the thought of doing it over again will make you shudder.
  • It will be okay, even when it feels like it won’t. ALL residents in all specialties have days, weeks and months when they feel like quitting residency.  If you ask a co-resident, I bet they have thought it too and knowing that can be helpful.
  • Reach out if you need help. Try to get exercise.  Prioritize your health and your important relationships.  Make a to-do list and focus on one thing at a time. Hang in there, learn and enjoy!

 

Check – blog post complete.  Now off to read the journal club article for tomorrow!

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Lauren Wood, MD is a Chief Resident in the Family Medicine Residency Program at the University of Utah School of Medicine

 

On the Edge of the Future: Imperatives to Succeed in Health care’s Grand Transformation

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By Paul Grundy, MD, MPH, FACOEM, FACPM

Making health care smarter

The current health system transformation has been referred to as health care’s “moon shot” – that defining moment when a grand vision is fulfilled and the world changes.  Cognitive computing systems play a major role in achieving this moon shot.

Cognitive computing systems learn and interact naturally with people to extend what neither humans nor machines could do on their own. They enhance humans’ ability to make decisions by penetrating the complexity of Big Data.

Traditional computers, while powerful, are limited by their programming. They are programmed to review every possible answer or action needed to perform a function or set of tasks. They can only do what they have previously been told to do.

Cognitive computing systems, by contrast, are “trained” using artificial intelligence and machine learning algorithms. They mine the world’s data, make correlations, identify patterns and present actionable, patient-specific information and recommendations to physicians at the point of care. This enables physicians to focus on the diagnosis and the patient relationship when the patient is in front of them rather than spending that time on research. In this sense, cognitive computing is the X-ray of diagnosis: It reveals hidden details of the patient’s condition to enable more informed and accurate decisions.

Consider this example of how cognitive computing will contribute to a patient’s long-term health as well as the healing relationship of trust between the doctor and patient.

A patient with chronic heart failure (CHF) visits his primary care physician seeking a plan of treatment. After the patient meets with his physician he is handed off to the office’s care manager, who calls up the patient’s record and is provided with a personalized plan of care based on a multitude of factors, including the patient’s current health status, family history, genetic predisposition, socio-economic factors and other information. The patient is encouraged by the care manager to download an app for his smartphone that will let his provider track his progress against the plan.

Each day, the app collects information such as the patient’s weight and the answers to his questions about common symptoms. If he has questions about some aspect of his health, his plan of care or his medications, the app either answers the question, or escalates the question to an e-visit with a care manager. In addition, persistent health reminders encourage patients to adopt the right behaviors and develop healthy habits that lead to better health and lower costs.

Based on that patient’s history and current remote data, as well as population health data for thousands of other CHF patients and information from the clinical literature, the app may spontaneously send an alert recommending that the patient consult his doctor.  In that case, it offers to set up an appointment via integration with the office’s scheduling system.

As you can see from this scenario, population health management supported by cognitive computing lets health care organizations identify the right type and scope of care to treat patients in a minimally-invasive fashion and in the most cost-effective setting.

 

 

Outlook for the future

It is not difficult to imagine what health care will look like in the future, because we have already made great strides toward achieving a transformed health care system. The fabric of the care team will continue to advance. New technologies and new structures will drive more efficiency and accountability across healthcare, and give us the confidence that we are making a meaningful difference in patients’ lives.

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Paul Grundy, MD, MPH, FACOEM, FACPM, is the Chief Medical Officer and Global Director of Healthcare Transformation for IBM Healthcare and Life Sciences. He is also a founder of the Patient-Centered Primary Care Collaborative (https://pcpcc.org/), and is an Adjunct Professor in the Department of Family and Preventive Medicine at the University of Utah School of Medicine.