Professionalism and Ethics CEO 6.1 [T]he graduate must consistently demonstrate compassion, respect, honesty, integrity, accountability, altruism, prudence, social justice, and commitment to excellence in all professional and personal responsibilities. The graduate is expected to apply these behaviors in all of the [above] competencies.
Snowmageddon. That’s what they called it on February 21st, 2015. Columbus had received 6-7 inches of snow over the last day, on top of previous snows. It was a cold, early Saturday, and I put on my boots, scrubs, and coat and headed off to Meiling Hall for the 1st Annual Ultrafest. In making it there despite the inclement conditions, I showed integrity, accountability, and my commitment to excellence in my personal responsibilities. The back of my head can just be seen in Dr. Blakenship’s excellent lecture on ultrasound in a military environment (Figure 1). I, however, was not simply there on that blustery day to learn. I was there as a trained simulated ultrasound patient (TSUP), demonstrating altruism by spending my whole Saturday being scanned so that students from around the Midwest could learn, when I could have attended as a learner or competitor instead. Some medical schools do not have the ultrasound curriculum that OSU does, and by serving as a model so students from other schools could learn, I was helping address education disparities so that we could all be physicians of the future in a few short years.
https://www.youtube.com/watch?v=4adonhIM_ug&feature=youtu.be
Figure 1: Ultrasound in a Military Environment – Dr. Blankenship – OSU Ultrafest 2015.
I approach patients with compassion, respect, honesty, integrity, accountability, altruism, prudence, social justice, and commitment to excellence in all professional responsibilities. For example, on my third year cardiology rotation on the acute coronary syndrome unit, one of my patients had congestive heart failure related to a congenital valve defect. She had just suffered a STEMI, but the attending did not think she was a good candidate for a heart cath, as she had diffuse disease in multiple vessels. Every day, I made a point to spend time talking to her and getting to know her concerns. Something that came out of my history taking was that, while she wasn’t sure quite how much she drank, it was more than perhaps the team had suspected. She explained that she mainly drank to help herself sleep, but she also mentioned that she had Pepsi with her rum at night. Her sleep habits weren’t directly related to her cardiac status, but it is important to treat patients as whole people, rather than a problem on a list in the Electronic Medical Record. So I talked to her about how caffeine intake before bed can cause poorer sleep and advised her to only have caffeine intake in the morning. She hadn’t thought about but thought it made sense. I also took time to explain how alcohol can fragment sleep, which makes alcohol not the best choice as a sleep aid. Armed with new information, she realized that she had been sleeping well in the hospital without alcohol and resolved to try melatonin at home. She also expressed an interest in following up with sleep medicine after discharge, so I made sure that my attending and residents knew, so they could place the referral. After all, too much alcohol can be cardiotoxic, and everyone needs good quality sleep to heal. Cardiothoracic surgery decided she was an appropriate candidate for a three-vessel CABG, and she was transferred to their service, but I made a point of seeing her post-op to make sure she was doing well. As it turned out, she had a bad reaction to the anesthesia and hallucinated post-op about rappers and Hell, a frightening experience for anyone. She said that she was glad that I came to see her, and I was happy that I could help. We talked about her goals for life when she returned home and hugged. Several weeks later, she must have looked me up in the phone book, because she sent a touching card (Figure 2) that I will always treasure. I was sorry to hear she had an infection, but it was great to learn that she was doing better and on the path to recovery.
Figure 2: Card.
On my 4th year otolaryngology rotation, I strove to be the professional that attendings would want as their resident, that other residents would want to have on their service, that other staff would find a good team member, and, most of all, that would do right by patients. As a first step, to ensure I was always on time, I set not one but two timers on different cabinets, and my plan worked. I worked with the other medical student on the service to make sure that we would always have the patient list ready for the residents when they arrived in the morning so that rounds could be as smooth as possible. I talked to a student who had already done the rotation, so that the first day, I knew how to stock my bag with supplies. As we changed dressings in the morning, I was prepared to assist my residents. Whenever they needed a more obscure dressing I didn’t have stocked, I would promptly fetch it from the JIT room. Having all the supplies readily available meant that patients had quick dressing changes and could then go about their mornings, instead of having to endure protracted dressing changes due to lack of supplies. Efficient rounds meant that the residents, the other student, and I made it to the OR on time in the morning to help with setup. If the OR was missing its shaver, then I’d politely go door to door at the other ORs asking to borrow their shaver, and I always made sure to return it. I read ahead on each case and would e-mail the attending ahead of time, so the attending would know a medical student would be joining the case. When I encountered questions to which I did not know the answer, I acknowledged it was a good question, said I’d look up the answer, and followed through. When a patient had new abdominal distention late at night, after the case finished, I drew my resident’s attention to the problem, who notified the attending. I went with the patient to CT. As he recovered, he developed loose stools. My residents feared C. diff. I suggested his loose stool was likely related to his history of pancreatectomy; he lacked the enzymes to completely digest food, which my residents thought was a great catch. They were able to add guar gum to his feeds to thicken them to slow gut transit time. In the clinic, I stayed with a patient who had just been told he had cancer when, coming in, he had thought he only had an infection. The speech language pathologist comforted him, as well, and I studied how she conveyed her compassion to use those techniques going forward. At Nationwide, I came in overnight to see a patient in the emergency department. She was a small child who had aspirated a cheese puff. I helped her parents navigate back to the lobby to gather their other relatives. I took de-identified photographs in the operating room for the fellow to use in his case conference. Whatever I could do to be useful, I did do. My residents seems to appreciate my commitment and taught me a secret about the hospital Cheryl’s Cookies: pick out any two cookies, and Cheryl’s Cookie will put ice cream in the middle to make a custom sandwich. My evaluation report, in Figure 3, was even sweeter, stating that I had, “Outstanding bedside manner” and that I was, “Professional, always on time and reliable.”
Figure 3: Portal Evaluation Report Otolaryngology.