Posts

On the interview trail, one question seems to come up in every interview—the wording might be different but the information they are trying to collect is the same. How do you handle negative feedback? How do you approach a team member that is not pulling their weight? What would you do if a fellow resident showed up to work drunk? It all boils down to the same thing: how do you treat others?

I think the programs are trying to gather what I call the tone of my character. What tone do I set in these circumstances? What made me adapt that particular tone?

Here’s a glimpse at my answer: My parents come from humble beginnings, dad a farmer, mom the eldest of 4 siblings in a single income home. They fought for themselves, for us, for a better life. They moved across the country, worked many odd jobs, and now, they have provided an excellent life for me and my sister. Because of how they grew up though, they instilled a few lessons in me.

1. You are not better than anyone else. You may come from a bigger house and have a car, but you are a human being, and so is the homeless person on the street. Treat them with respect.
2. Work hard. Hard work pays off. (They are a prime example of this one)
3. Follow through. “You made a commitment. You will honor that.”

Through this answer, I hope my interviewers can gather that I offer respect to everyone I interact with and therefore, demand respect from those around me. I even had one interviewer ask, “Well, doesn’t respect have to be earned?” My response, “I think respect should be a given, unless betrayed and thus lost on one another.” I hope they gather that I treat everyone equally regardless of our differences. I hope they understand that I will finish what I start and give my best effort always. Below is a screenshot of positive evaluations from my sub-internship this year. It seems that my hard work Is paying off.

In last year’s portfolio assignment, I started a list of vow’s that I plan to honor, my own sort of Hippocratic oath. The three promises I began with are listed below, followed by a few more I’ve added since then.

1. I will not tolerate discrimination of any kind from anyone, and I will speak up against it.
2. I will also not tolerate intimidation for intimidations sake, especially in the OR. I think it cultivates a poor learning environment.
3. I will buy snacks for my team at least once a month- again, cultivating a good team environment.
4. I will dedicate my time to teaching the next generation of doctors.
5. I will work on improving myself as a person and a surgeon for as long as I shall live.
6. I will remember to incorporate perspective into my life, to focus on the bigger picture.
7. I will help those struggling with compassion and understanding rather than judgement and punishment.
8. I will ask for help before I am drowning.
9. I will continue to add to this list as I grow and learn.

Recently, I have been reading a book called Unaccountable by Mark Makary. I stumbled upon this book when I was in search of some answers. Working in a hospital makes a person privy to all of the unethical acts that occur within its walls. I realized quickly that although hospitals helped save lives, many of the systems in place hindered quality care. I wanted to find a book that discussed these issues, informed me on how I could best react and respond to unethical care or decision making. One particular aspect of medicine that bothered me was the lack of transparency. When a lay person goes to a hospital it is often impossible for them to know which hospitals are better at treating which conditions, which physicians offer the best surgical care, and even which unit has the most highly qualified nursing teams to help with recovery. I kept thinking about how my mother has recently suffered some health issues—she asked me which surgeons were qualified. I wondered, who is advising the other 99% of the population on these decisions? Maybe a trusted PCP if available, but in most circumstances, patient’s usually just go to their closest hospital and trust the first doctor that walks in the room.

An excerpt of the book goes as follows:

‘The doctors who operated on Ronald angered me. I was bothered by the fact that they didn’t just refer him to someone who could have done a safer and better operation. I shared my frustration with my fellow resident [and he said], “Just keep your head down, Mart. We’re not going to be helping anyone if we kicked out of the residency program.”’

This excerpt was in response to a surgeon who only offered open surgery as opposed to laparoscopic. The patient suffered complications of wound breakdown, which are much more common in open surgery and therefore, he spent months in the hospital as opposed to the few days expected with laparoscopic surgery.

I wonder what I would have done. Would I have called in another surgeon that was not on call to offer the laparoscopic approach? That is not common practice in the medical community. Would I have said nothing, like this resident, to protect my career, and vow to offer all of the options to my own patients in the future?

As a result of reading Unaccountable, I vowed to speak up whenever I could to protect quality care and patient safety. The hierarchy of medical teams can be intimidating, but I wasn’t going to let that intimidation injure a patient.

Sometime after I made the decision to speak up, I was spending the day in an OR learning about robotic surgery. I was bedside assisting the robotic for a hernia operation. The surgeon was closing the primary hernia defect with suture, when I noticed he had grabbed a nerve in his first bite of the tissue. I got nervous and started to sweat as I said, “Excuse me. Maybe I’m not seeing this correctly, but is that long white thing  a nerve?” The surgeon promptly removed his last bite, and corrected his trajectory to avoid the nerve. Below is a surgical robotic video of that exact moment.

Although seemingly a small save, I was proud of myself. It’s definitely not easy to speak up to a much more expert faculty about a possible mistake you witnessed. However, I felt like I had made the choice to protect the patient first. I respected my vow. In the future I plan to even get an MBA or MPH to further study how I can continue to protect patients.

I wrote my last interpersonal communications post about the phone call that is made to family members when a patient needs an emergent, live-saving surgery. You know, the one where we ask if we should operate or let the patient die. Here is an excerpt of the phone call made by the intern to the family of a woman that needed a second lifesaving surgery despite the fact that she would never wake up from her coma.

I’ve spent a lot of time trying to reconcile this situation, come up with a better way to ask this impossible question of families. My answer to this quest was to take a palliative care elective rotation; I knew that I wouldn’t get any more specific training on how to have difficult conversations before I became an intern, so I planned the palliative care rotation to learn what to say in difficult situations. That is exactly what I thought the doctors would do—take all of the medical information together and advise patients on what is best. For example, if the patient had been brain dead for months, the palliative team could help the family understand that the patient would not be waking up and walking out of the hospital.

Man, was I wrong. As doctors, it is our Achilles heel to spew information. It is not surprising, then, that when we have no more medical options for treatment, that we spew about everything we have done for the patient. We vomit statistics about prognosis and ramble on as if we have everything to say, when in reality, we just can’t bear to be silent. We can’t handle standing in front of a patient, telling them we are out of options, and then letting it be quiet.

On my 3^rd week of the palliative care rotation, I was given a map of communication and asked to follow my attending’s path as she navigated a tough conversation. The techniques ranged from dealing with emotion to deciphering what the patient wants to providing information. In the 15 minute conversation we had with a family about withdrawal of care, not once did she “provide information.” I was astonished! First off, it only took 15 minutes for this seemingly difficult conversation to come to a family consensus to ultimately withdrawal care, and not once did the doctor spew information at the family.

I was happily shadowing doctors as they navigated through these tough conversations, when at the end of week three, an attending said to me, “Kendyl, why don’t you try leading one of these discussions tomorrow?” I was shocked. I truly thought that the board certified palliative doctors were the only experts qualified to be having these conversations, to be privy to helping patients decide to live or die. However, I was taking this elective to learn how to communicate, so I said sure!

The next day came, and before I knew it, the conversation was over. I focused on determining what it was that made life worth living to the patient and really, the rest fell into place. It’s as if the decision had already been made, rather the family needed to hear themselves say it out loud. As a result, I received the following evaluation at the end of the rotation.

I think any general surgeon would gawk at the follow conclusion. My palliative care rotation was thus far, including my subI, the most valuable rotation of 4^th year of medical school in terms of preparing me for intern year. I will take those tenants of communication with me for the rest of my career. Next year, if I am stuck with the task of calling a family about an emergent surgery, I will be slightly more prepared than I would have been without this experience.

Prior to fourth year of medical school, all of the research I performed was in basic science or translational labs. Because of a brief stint in undergrad, I viewed clinical research as busy work entering data, sitting behind a screen all day. Consequentially, I found myself in the basic science arena performing animal experiments with long hours and little evidence to show for it. I also think that many academic mentors of mine viewed basic science research as superior to other forms, so begrudgingly, I did it for my resume.  I was unhappy, burned out, and lacked inspiration. Lucky for me, that was about to change.

In fourth year of medical school I was required to do a quality improvement project. Like many of the other requirements, I was skeptical going into the project. It felt like one more obstacle to graduation. I would have to work with a group, which can be challenging, and coordinate meetings among medical professionals, all the while interviewing for residency. I have to say, I couldn’t have been more wrong. I was inspired from the very beginning when our team was simply analyzing our personal experiences for ways to improve the hospital system. Rather than spending time injecting cells with some new drug therapy, I was talking to patients, staff, and administrators about how to directly improve healthcare. In each conversation, I could feel our team getting closer to a plan that could impact patient lives, lessen length of stay, decrease hospital associated illnesses, and more. It may sound hokey, but I really felt like I had stumbled upon a passion of my own.

Quality improvement project intervention- laminated checklist to be filled out and reviewed daily with patient’s care team

This project became much more than just a requirement. Quality improvement became a focus of many of my residency interviews. I asked every program about the QI initiatives being developed and carried out in their respective departments. I inquired about resident involvement in quality improvement and what my role would be if I were to match at their program.

In the future, I hope to take my passion for quality improvement to the next level even with hopes to hold a leadership role as a quality champion within the hospital. I want to teach other medical professionals about the importance of policy change and speaking up about the problems they see within the current system.

A very valuable skill that doctors learn to possess is adaptability. The field of medicine is ever-changing from a health care perspective to a basic science perspective. Likewise, medical school demands that students change and evolve. Learning to study and prepare for different phases of medical school is no exception. I know that it is imperative to continue practicing adaptability in my future career as I learn to become a general surgeon. I am committed to learning the best ways to adapt as time goes on. Below is a poem I wrote to depict how I have had to adapt my studying and preparation to meet the expectations of each phase of my life.

High School- wake up. School. homework in study hall. School is over. Soccer. Finish homework. Test in a week? Study a few hours for a few days. Ace the test.

College- wake up. Class. Study in between class. Netflix break. Work out break. More class. Review notes for 2 hours after class. Sleep. Test in a week? Study several hours for several days. Ace the test.

Medical school years 1-2- wake up. Review material before class. Class. Review material for hours after class. Much shorter Netflix break. Review material in a group. Realize how little you know compared to classmates. Go home and panic before reviewing more. Test in a month? Review material in almost every waking moment leaving enough time to relax to avoid burnout. Maybe beat the average on the test.

Medical school Year 3- wake up. Practice questions. All the questions. Rush to work. Break? More practice questions. Break over. See patients. Look up relevant medical knowledge. Go home. Even more practice questions. Test in 3 months? Make sure to do all of the questions 3 times. Test in a week? Practice tests. All the practice tests. Average on the test.

Decision to become a surgeon- Study? No. Review notes? No. Look up knot tying videos. Fumble through self-taught knot tying. Attend knot tying class. Realize you forgot your self-taught tying. Ask friend for help. Relearn knot tying. Repeat X5.

First Surgery- Case complete. Resident closing skin. Question from resident, “medical student, can you knot tie?” Me- yes. My doubt- I think. My hands- grabs the two strands of suture, forms finger guns. My doubt- shoot. What’s next? My hands- somehow instinctively move to form some semblance of a knot. Resident- good job. Keep practicing.

Practicing- Suture tied to every coffee mug in the house. Suture tied to my backpack. Suture tied to my scrub pant strings. Suture tied to the coffee table. Roommates annoyed that there is suture tied to everything.

Intern year- to be discovered.

I came into medical school confident about my “patient care” skills. I had two years of working as a patient care technician under my belt, that’s two years of strict patient care: toileting, bathing, transporting, comforting, the list goes on. As I began talking to patients in OSCE’s and performing basic physical exams, I do think my background as a PCT was helpful. What I didn’t expect though, was that as I became more knowledgeable about medicine and comfortable during history taking, that patients would put all of their trust in me. They would confide in me about very personal matters that were seemingly affecting their health. They would cry tears of sadness sometimes and shed tears of joy others. I wasn’t ready to hold the weight of their trust, so at the beginning of medical school I learned to shrug it off. Whenever a patient would express trust in my decision making I would say, “Oh I am just a medical student! Your actual doctor will be in soon to give you their thoughts and recommendations.” And I would think to myself, phew, crisis averted.

Flash forward to 4^th year of medical school, I am taking a history with a patient who has had many episodes of Cdiff diarrhea. She says to me, “now doctor (she insisted on calling me doctor), explain to me why I keep getting this infection, I want to know how best to avoid it.” Without even thinking I explain her risk factors for Cdiff, most prominent being status post renal transplant, on immunosuppressive medications. She understands completely and thanks me again as she says, “ Thanks doctor. You know you’ll be a great doctor.” I walk out of the room, shut the door behind me and just stand there for a minute. It felt like only a week ago I put on my white coat for the first time and awkwardly walked into O’Charley’s room. O Charley is what I nicknamed my first patient on rotations 3^rd year. Below is an excerpt of a previous post about him.

Portfolio post titled “O’Charley” about meeting my first patient on my first day of clinical rotations third year.

Now, here I was standing outside a patient room. I didn’t deflect decision making to “the actual doctor.” I didn’t shrug off the trust that was so kindly gifted to me. Without even thinking, I cared for the patient from “Hi my name is Kendyl, I am a medical student”, to “You know you’ll be a great doctor.” I responded to patient concerns and answered questions like a medical professional. Almost in awe, I stood outside that door for maybe a total of 20 seconds. I gave myself a mental pat on the back and vowed to continue improving on patient care. I vowed that as I enter residency I will make an effort to continue accepting trust from patients and honoring that trust with human connection and patient care.

Welcome to u.osu.edu. This is your first post. Edit or delete it, then start writing!