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Rationing Tests?

March 25, 2020 by Leave a Comment

Rationing tests? In the U.S.A.? It may sound strange to hear that in the land of plenty we are rationing tests. But here we are, ill prepared for a global pandemic.

One of the most difficult things to say to patients who are having symptoms of cough and/or fever during this pandemic is that they need to stay home and act as if they had COVID-19. Testing, for the most part, is being reserved for the patients sick enough to require a hospital admission. I don’t think it helps that many people keep seeing things in the news touting how people can get tested without fully explaining the limitations we have. Or maybe my region of the country is the abnormality?

Ideally we could swab anyone who had symptoms. But since we cannot, maybe this will help:

  • With a limited supply of testing supplies, we should only test those in which testing will change the management or treatment.
  • It is accepted that there is a spectrum of presentation of COVID-19. Some patients may have zero symptoms. Some patients may have mild symptoms. Some patients will need extra support that requires treatment in a hospital (like supplemental oxygen, mechanical ventilation, etc.)
  • If patients are stable enough that they are breathing comfortably, they should stay home and act like they have COVID-19. They should treat symptoms and self quarantine to avoid spreading it others who might develop more severe disease.
  • Patients who have symptoms that include shortness of breath or trouble breathing should go to the Emergency Department to be evaluated. They may be hypoxic (have low oxygen saturation) and need additional support. These patients who are sick enough that they require care in a hospital should be tested.

Again, it isn’t a perfect system. We don’t have an infinite number of testing kits/supplies. We don’t even have enough test everyone we suspect of having COVID-19. But this is why testing is being limited.

Needless to say, this post is not intended to be medical advice. If you have questions about your particular case, please contact your primary care physician.

Filed Under: After Residency, My Life Tagged With: , , , ,
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Pandemic!

March 25, 2020 by Leave a Comment

It is painful to watch the amount of distrust or disbelief amongst the public – even among those who are in healthcare. Last week I saw an article about young people still going on about their usual life, not willing to put things on hold. One of the people interviewed was a nurse.

I saw another article from this week that beaches remain open in Florida for spring break. Parties were just told that they must keep their groups to 10 or less. However, the article also showed a picture taken on a Florida beach in Clearwater that showed pretty crowded situations (the picture was taken on 3/27/2020).

Sometimes I just want to face palm.

Filed Under: After Residency, My Life, News, Opinion Tagged With: , , ,
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Obesity Week 2019

December 6, 2019 by Leave a Comment

I had the chance to attend Obesity Week 2019 in Las Vegas from November 3-7. Obesity is not really a topic or area that I had much exposure to during training. But in the past few years I have wished that I knew more about it. After residency I worked exclusively in the inpatient setting as a hospitalist. For those of you unfamiliar with this term, it means that I only worked in the hospital treating patients who were sick enough to be admitted in the hospital. During this time I would frequently encounter patients with chronic medical conditions, many of which would improve with significant weight loss. But the extent of my intervention was to advise the patient about the importance of lifestyle changes and to follow up with their primary care physician. Because for the hospitalist, the physician-patient relationship ends when the patient is discharged from the hospital.

A few years ago I asked around our division why our outpatient Internal Medicine clinics did not have an obesity clinic. After all, I thought, this should be well within the scope of practice for an internist. This is not to say that no one at my institution was treating obesity. In fact, we had a medical weight loss program as well as a bariatric surgery program. But Internal Medicine did not have a dedicated clinic for obesity. Instead, internists had to address obesity along with any other medical conditions during a patient visit.

Fortunately, while I was asking around and looking into obesity treatment, I discovered that one could become board certified in obesity medicine by the American Board of Obesity Medicine. And, through asking around, I learned about the annual Obesity Week meetings held by The Obesity Society (TOS) and the American Society for Metabolic and Bariatric Surgery (ASMBS).

Over the last year I have transitioned out of inpatient medicine. Currently I see patients in the Internal Medicine clinic at my institution as a primary care physician. But I am also starting a new learning/educational journey with the obesity medicine. I am not sure where this journey will take me. But as with the journey thus far, I’ll continue to try and write and reflect on it here.

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Back To Writing

November 6, 2019 by Leave a Comment

Over the last few years my activity on this blog has definitely decreased. I suspect that it is a combination of a lack of time and a sense of not having an audience. The blogosphere has changed over the last few years. This is the age of the social media influencer. I see a lot of activity on Twitter and Instagram now. When I started my blog I was an undergraduate student trying to apply to medical school. That seems like a lifetime ago. And in a digital/technology world, that is several lifetimes ago.

But I have to remind myself that when I started blogging, it wasn’t for the audience. It was for me. At the root of it all, writing was cathartic. And I need to get back to writing for me. And if there are friends who want to follow the journey, then that is a bonus.

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Aging

May 1, 2019 by Leave a Comment

I’m not talking about the aging of my patients.

I’m talking about my own aging.

I looked at the medical students rounding with me last week and realized that these “kids” have only ever known an Electronic Medical Record.

I recalled to them my experience as a medical student when I would handwrite orders for the team on triplicate forms and then turn the orders in to the unit secretary to be faxed off to the pharmacy and/or distributed to the nurses.

Their faces clearly showed their shock and disbelief.

The idea was totally foreign.

I think I felt an ache in my back at that moment.

Filed Under: After Residency, Education, Medical School, My Life Tagged With: , , , , ,
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July – It’s That Time of Year Again

July 11, 2017 by Leave a Comment

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)

March 27, 2017 by Leave a Comment

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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