Month: January 2018

Professionalism: Personal Priorities and Growth from Flaws

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One of the reasons I went into medicine is because I am largely motivated by feeling helpful and useful to other people. I almost always prioritize tasks that help someone in some kind of need.

In undergrad, a good portion of my free time went to tutoring classmates, helping talk people through tough situations, and in general learning to solve problems people had. It didn’t matter if it was the day before an exam or if I had a project due the next day. If someone had a need they expressed to me, I would address it. I’ve stayed up through the night multiple times before my own exams and projects to help someone study for their tests.

I thought that by going into medicine, I would be guaranteed to be able to perform my work as every task is related to someone’s needs, so I continued to prioritize tasks the way I believed was right in medical school. My own academic deadlines didn’t matter. I would stay up before exams, projects and other deadlines to write articles for LSIpedia, help my friends with research, or tutor acquaintances. I even stayed up a few times to talk to a friend I knew from my undergraduate years who was feeling depressed, and ended up staying up twice during exams to make sure they didn’t hurt themselves when they expressed some concern to me. In general, people acknowledged these efforts, and made me feel validated.

Unfortunately, as it turns out, blindly prioritizing other people’s needs isn’t conducive to good medical practice. In modern medicine, there are a myriad of bookkeeping tasks that are not directly related to anyone’s needs that must be performed with equal zeal in order to prevent future complications. I learned this very quickly during medical school. Previously, in my undergraduate years, I treated auxiliary tasks (such as reflections, timekeeping forms, and I’m ashamed to admit- documentation) as non-essential, and finished them when someone asked me specifically for them. Within my first two years I learned that “when someone asked me for them” was too late in the field of medicine. Medical school also had reflections, sign-ins to required events, and required documentation. In an effort to make sure we didn’t have trouble with these auxiliary tasks by the time we were actual doctors, OSU directly grades us on these in a “Professionalism” category, and at the time I was an M1 and M2, a single late assignment meant you failed the Professionalism category for a certain academic block. Despite my best efforts to develop habits to finish things on time, I still submitted an auxiliary assignment late for several academic blocks, as I was unused to keeping organizational habits.

It was harrowing. I hadn’t expected to find something unrelated to the direct work of medicine that I would have so much trouble with.

My motivation, as I’ve stated, is to feel useful to other people, and I hadn’t previously kept a checklist or calendar and maintained myself on it. In my undergraduate years, there were few enough tasks that I could prioritize them all in my head, so I had simply hopped from one task to the next based on what felt most useful. I feel like people trying to help me are frequently perplexed by this, as it is so incompatible with the typical pre-medical path that most people take to get into medical school. One of the first meetings I had to discuss with faculty why I had not submitted one of my evaluations on time, after I explained the circumstances regarding that particular late assignment, one of the faculty mentors  asked me “Why would you, on the week before a test, the day before several assignments are due, go off to print study material for other people?”

I didn’t know what to say to that. I can see why it seems foolish, but the reason I would go off to do that is literally the reason I entered medicine. I am here because I am willing to sacrifice my time to be helpful to others.

But the lesson I took from that meeting was not “if I want to be a doctor, I can’t prioritize other people’s needs directly.” It was “If I want to prioritize other people’s needs, I need to be more organized.” And so even if I failed a few times, I persevered. I learned to keep a checklist, I learned to keep a calendar. I learned to use technology to make these things available to me in all situations. Most importantly, I developed the habits to check and maintain these things regularly, and the habits to maintain redundancy in these so that even if one method fails, I have a backup. And this worked. I gradually made myself more organized and got to a point where I no longer missed auxiliary tasks. I didn’t have to give up my penchant for addressing other people’s needs to do it. I still do many of the things I used to do that made me feel helpful and fulfilled. I still occasionally tutor friends and family online. I still act as a support sounding board for depressed friends and acquaintances who use me as such. I still generate study material, and I still write computer programs for friends who find them useful. However I don’t miss any time-sensitive auxiliary tasks to do it.

I think that this has been one of my greatest successes in medical school, the development of personal organizational skills. I think that by going through the process, I’ve refined these skills to the point where they are above average, where I started well below average. I’ve been able to keep myself much more productive than I imagined I could be as a result, even for auxiliary personal tasks that I want to accomplish for myself. Over the course of my second and third year of medical school, I’ve learned new instruments (some basic guitar and basic violin), gone through flight ground school (in the middle of my IM rotation), learned some Spanish and Russian, and built devices that I’ve wanted to build (an endoscope). Thanks to the organizational ability I’ve developed, I’ve done all of this without sacrificing the things I want to do for other people, or sacrificing any part of my medical training.

I think sometimes having a flaw we are aware of teaches us how to improve much better than just believing we have some “natural ability” for certain things. At least, it certainly feels that way for me with organizing myself.

Thank you for reading about my journey of personal growth!

Medical Knowledge: New Technology in Medicine

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I’ve always been a fan of using technology to make work easier. Medicine is full of areas of workflow that can be improved by technology.

I realize that for many people (myself included, surprisingly) it sends a stab of fear into their heart to hear the words “workflow improvement.” That’s why I try to be at  least partially responsible for all the changes in workflow involving me. I also try to contribute what knowledge of technology and programming I have to improve the quality of life of other people who have similar workflows. To me, being involved in the workflow I’m trying to improve means I’m much less likely to unintentionally sabotage it.

I’ve done this in a few areas.

When I first arrived at OSU I discovered this wonderful student-led initiative called LSIpedia. It is a wiki page like wikipedia that students can edit and put their notes up on so that others can read them (our curriculum is called the “Lead, Serve, Inspire” curriculum- hence the LSI). It’s password protected so that we can discuss OSU specific lectures without accidentally releasing information that is supposed to be private. Very few students were involved in generating content for it, but I was one of them. I spent a great deal of time compiling my lecture notes and creating LSIpedia pages for more complex topics, like complement factors in the bloodstream. About half-way into my first year we also started using the site to generate practice questions and practice tests for peers. There was great interest in this and many people wanted to write questions, but wiki markup is not necessarily easy for writing things with complex formatting like exam questions, even to the initiated. So I called upon my programming background and wrote a little java program (it looks like this) into which you can type your question, possible answer choices, and explanation; and it will generate wiki markup which can be copied and pasted into LSIpedia or any other wiki to generate a nicely formatted exam question (which looks like this).

I identified a need, collaborated with my peers to teach each other, and offered one of my strengths to make the entire process easier.

I’m a big fan of filling in gaps in workflows before trying to improve existing ones; that is: providing something that the people who are doing the work actually want. It’s a fundamental principle of quality improvement- to make sure that people buy into changes you make, but sometimes implementing new technology seems to bypass this step. People will create solutions and implement them without getting feedback. For new technology outside of quality improvement, people just ignore technology that isn’t useful. However to maximize the usefulness of technology, you should go through the process of revising the technology with feedback from the intended user. I certainly went through a few iterations of the LSIpedia question writing program before I got it to a point where it was useful to everyone.

There was another case several years ago where I wrote a program for a friend and mentor of mine who was doing a retrospective research project. He was hoping to tabulate the results of transcranial dopplers from several hundred patients, and was trying to do it by manually reading the report and filling out an excel file. He specifically asked me if it would be possible for me to help with a program of any kind. Now I had previously written programs that went from plain-english text to numbers and sentence fragments or vice-versa (the LSIpedia program is an example), so within an hour I sent him a proof of concept program that you could copy-paste a transcranial doppler report into and get a list of numbers out. He was thrilled, of course, and sent me an example of his excel file and asked if there was also a way to specifically get an excel table out. I looked it up and found a way to use a table that could be again simply copy-pasted into excel, and made my program keep adding a new row every time you pasted in new patient data. His several hundred patients went by very quickly. Again- there was a feedback process to ensure that the technology was useful to the person using it. If I had just given him a list of numbers back, there wouldn’t be much improvement to the workflow, since he would still have to individually copy-paste each number into the corresponding cell in his excel sheet. But this way he just had to copy paste the patient reports into the program and it did all the work for him, greatly speeding up the process.

More recently I had the opportunity to begin to write a phone app to help consolidate several resources in one place for residents. It’s still in development, but it’s also based on filling holes in workflow rather than changing it. The app is meant to address the fact that there are multiple websites for different things for residents- calendars, contact information, and resources. The app puts them all in one easy searchable location, and is also convenient for quick access during clinical situations. I am still developing it, but I have already gone through several cycles of getting user feedback and rebuilding it accordingly.

Technology in medicine IS ultimately used for quality improvement, and so should be developed in a similar way. Thanks for letting me show off a few ways that I’ve done this!