Friday, August 11, 2017

Looking forward...

I want to write this now -- before I actually begin my work at UB. This way, I can look back at it and if I lose my way, or if I discover a different path.

Why did I leave the Clinic? What is it that I want to do?

Here it is:

  1. Improved patient care: I would love to have more time to think about my patients' symptoms, diagnoses and treatment. Sometimes, while working at the Clinic, I felt that the 20 minutes I had in my schedule was just not enough to fully understand what was wrong, or how to treat it. In a perfect world, it would be great to be able to pull up my patient's notes, their labs, imaging and consults and think. The thinking would be active -- consulting the literature, discussing the case with colleagues, even going back to the basics -- their biochemistry, physiology, anatomy. Then, I would come up with a map of diagnosis and treatment and implement that in the short visits, interpreting the outcomes in the light of the plan I had made. I delight in seeing complicated patients: the diagnostic dilemmas, or the patient with that rare condition for which not much literature exists (certainly nothing like a guidelines statement from a professional society). I would love to build a practice of such patients.
  2. Healthcare revolution: I make no secret of it: I am not happy with the direction healthcare is taking. Who's driving the bus? Who agreed to this? I would love to see medicine focus on a longitudinal relationship with the patient and make healthcare more than about prescribing drugs and procedures. I would want to 'push back' against the diluting of healthcare provider qualifications and credentials to provide care. In chagrin I ask, "how little education and training does it take to allow someone to provide care to a patient?" The bar seems to be getting lower and lower -- less years of training. I would seek to write nationally about matters like this. I would like to push back against turning healthcare into widget-making and business. 
  3. Teaching: My desire to teach is borne from the first two points above. It is a tradition in medicine for medical students and residents to learn in a kind of apprenticeship from practicing physicians. While teaching the procedural skills and the knowledge of medicine, I want to teach attitude, committment and respect for the patient. I think it was Osler that said, "The secret of patient care is caring for the patient." I hear a lot about work-life balance and physician and resident wellness. That's great but what about patient wellness? This is medicine! Disease and illness doesn't come from 9 to 5 on Mondays through Friday's and skips weekends and holidays. To me, this is not a job. It is a committment to patient wellbeing and care, combined with empathy that drives me to want to go the extra mile -- not cut out the inconvenient hours or long days or mental stress. If I can 'infect' the next generation to carry out this tradition that has been what makes the best doctors, then I would have succeeded. 
  4. Research: To be a good steward of the gifts and training I have, I am committed to doing research. This will take the form of basic science work -- my passion is bacteriophage and their potential as anti microbial agents. However, to stay grounded in the real world, I want to lead residents and students in research projects that will impact delivery of better care. Studying the problems my patients face and trying to improve their care.
  5. Writing: from childhood, I have enjoyed writing. I still do. As I grow older, I would like to write on healthcare. I might also enjoying doing more creative writing -- short stories, novels and plays. Medical Missions: While I like to have one foot in the 21st century, with research and cutting edge patient management, my heart still aches for most of the world that live in poverty with curable and treatable diseases. I would love to help develop healthcare delivery systems that bring basic healthcare to populations that do not have it. I would be willing to roll up my sleeves and be in the front lines in African, Latin America, India, wherever I can make a difference. I would rather commit to a place, giving its 3-4 weeks every year, than go to different places. Unless, I can do something that births a program in one place and then go to another place and do it again. 

Because the Marshfield Clinic has to compete in a healthcare market and is not a university sustained and supported by outside funds, I did not feel it was fair or practical to be able to do these things there. Although, I did mini-versions of these there and am proud that the Clinic does arguably more than some universities.

However, given the academic bent of my interests, I felt the correct place to try to do this is a university.

So here we go...

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