Medicine – on the differential

Since second year when I shadowed Dr. P at DHMC, I have liked the idea of hospital medicine. You get to romp around the hospital, changing orders, negotiate with specialists, communicate plans, counsel and even break bad news to patients. Its more continuity than the ER but not the agonizing length and commitment of outpatient medicine which I think I simply do not have the patience for as important as it is. Add to that the versatility of seeing both routine “social visit” patients and very complex acute care patients and hospital medicine seems like a good choice.

The patient I am seeing now is a case in point. This guy is a noncompliant 65 yo patient with full blown AIDS and a CD4 count of 18 and a viral load of 176k who is here with 12lb weight loss, fever and chills likely due to an opportunistic infection exacerbating some possible hypogonadism (fancy word for your endocrine system not working well anymore and causing your metabolism to be out of whack). I like stabilizing the patient and then taking symptoms, tests and thinking and looking up literature about what could be causing this guy’s problems then going back, discussing it and coming up with a diagnosis or plan that is not only the state of art care for the patient but is also the result of my creative and diligent researching. I like explaining these things to my patients, educating them, treating them and then discharging them when they get better.

I guess the only drawback is the acuity of care, there is still a difference between surgical and medical patients in the sense that surgery is really still the last line of defense when medical options have failed and carries with it the gravity (and also the rewards) of being responsible for the life or death of a patient. I wrote to Dr. B at the end of my trauma experience thanking him for teaching me how to save lives. As cliche as that might sound, I really meant it because the satisfaction of seeing my kickboxer patient who was literally dead weeks before sitting up in bed and talking to him knowing that myself and my team played an important role in saving his life was probably one of the most meaningful experiences in my life.

The ability to inspire . . .

I just watched Barack Obama’s 2004 Democratic Convention speech and realized something. Leadership, true leadership is rooted in the ability to inspire. Its not just being the smartest person in the room or the tallest, best looking person with the deepest voice. It is about finding that inner truth about oneself and being confident and human enough to share it with everyone that defines the true meaning of leadership. Somewhere in transit, that inner confidence strikes a chord in another person, another person, and yet another person and inspiration happens. Leadership happens because no matter what you say, that connection, trust and bond you have just created will allow others to stop and listen to what you have to say and give you the benefit of doubt that your vision is consistent with their values. And so leadership happens.

I think Barack really understands on a human level this connection that can happen in a big crowd or with one person, one at a time. Its this ability, this quality of inspiring others even when he is criticized (including by myself several times in conversation) that he is too abstract or too dreamy that will attract those around him to believe in his vision and put in the work to achieve that vision. Having seen the fruits of leadership in several institutions now, the leader not only sets the vision, but creates a culture within their organization within which the work of achieving that vision happens. Whether its in a residency program who attracts the right kinds of residents and lets them be their friendly, caring selves or a business that attracts the brightest but also most competitive individuals that do not like to work together, it is ultimately the leadership who sets the cultural tone for the organization and inspires others to either work for the common good or work for themselves. I believe that I’ve underestimated this quality, this ability to inspire the best in others that Barack possesses which is so vital to leadership. I’ve become so mired in memorizing molecular minutia in medical school that perhaps I’ve lost the perspective that its seeing the big picture that may matter most in the end. Vote for Barack Obama in November!

Best Peking Duck in the bay area

Great China = best peking duck in Cali! Crispy skin, deboned tender meat, thin wrappers, green onions and sweet plum sauce makes this just amazing. One piece of advice, don’t go there for dinner on a Sat night w/o a reservation. Its a small place and it gets packed! Jane and I ordered take out and ate it in the car. $26 bucks for half a duck but its definitely worth it!

2115 Kittredge St. Berkeley, CA
5108437996

A reminder about residency

Just got off the phone with my old boss from J&J who reminded me once again 1) of how much fun I had at J&J and 2) of how important it will be for me to become a real physician. He told me about a story of how he walked through the ER and was able to pick out a young guy who was having a heart attack just because “he didn’t look right” and I also shared with him my story about the kickboxer I took care of who had severe rhabdomyolysis and multi-organ dysfunction who we saved on surgery. He told me how important it was in organizations where people are too scared to make decisions to have the skill of making the right decisions with insufficient data, the skill that physicians put into practice on a daily, if not hourly basis. And for the rest of my day at least, I will be feeling pretty good about where I am and where I am going.

From Alice

I heard something today from one of my patients that I really have to write down . . . she told me “Please, be a good doctor . . . or else don’t do it because its going to be a lot of hard work”

That pretty much sums up my decision.