Haunting

Beep….beep….beep….beep….

“Are you listening to me?”

Beep….beep….beep….beep….

“Hey pay attention to me”

Beep….beep….beep….beep….

“Did you call x about y?”

Beep….beep….beep….beep….

“Why hasn’t this been done?”

Beep….beep….beep….beep….

“Did you finish that note?”

Beep….beep….beep….beep….

“Why are you so quiet?”

Beep….beep….beep….beep….

Beep….beep….beep….beep….

Beep….beep….beep….beep….

Her screams echoed through the unit

Beep….beep….beep….beep….

Beep….beep….beep….beep….

“Sumit?”

Beep….beep….beep….beep….

Beep….beep….beep….beep….

Her screams are the only sounds I hear

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#WeWrite

Writing is an important way that I communicate with the world. I spent my childhood reading a lot of books, and I developed a desire to put my own thoughts into words and share them at a young age. It started in grade school and junior high with keeping personal journals. Photography was my primary creative outlet in high school and college but as I moved forward with my education, writing became such an integral part of my learning that I turned back to it. Today, as a training physician, writing is a large part of how I take the experiences I have and process them and share them with the world. 

I am starting a new project and I welcome any and all to join me. The rules are simple. 

1. If you’re a human being, you can participate. As a physician myself, much of my writing and inspiration come from my work in the hospital. As such this project may be more appreciated by others in the medical profession such as nurses, techs, prehospital providers, etc. There is no qualification here. We are all together in this. We are all here for each other regardless of title. 

2.  Once a week, each Tuesday morning, I’ll be posting a writing prompt on my site.

3. Participants can take the prompt and write a response however they prefer – their website, email to me at sspatel@em.umaryland.edu to post on my site, a link on Twitter, or even in your own personal journal. I’ll share any submissions that are sent to me with the world, with the permission of the authors.

4. The idea is to communicate through writing & create a community of people who are trying to support each other.   

With that, here is the first #WeWrite prompt:

“When is the last time you were extremely frustrated or overwhelmed at work? What were the circumstances? What would you do differently if you could go back in time? How would you change the situation to improve it?”

I’m back!

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Many of those who interact with me on social media picked up on my brief hiatus from Twitter. I am now back and thought I would get back into the swing of blogging by discussing what happened and why I decided to take a break.

As a resident, my brain is constantly swimming with details about work, whether it be me wondering how a patient I admitted or discharged is doing today, or a dose of a medication, or whether I will pass my USMLE step 3 exam I’m taking tomorrow, or about my personal life, such as how I will spend time with my wife and pup on my next day off or how I will pay for my medical licenses, required training courses, and DEA number before I graduate residency. In between all of that, I ponder my own mortality and health, and try to maintain relationships with family, friends, and colleagues.

Social media has been a huge source of support for me ever since I started to participate and engage. I have met some truly remarkable people, most virtually and a few in person too, through my activity on Twitter. After the 2016 presidential election, and during it, social media was ablaze with political discourse. Some of it was productive and healthy debate but a lot of it was cruel, intolerant, and upsetting to witness.

I was finding that I was using my Twitter more to vent my anger and frustration at current affairs than for engaging with others to better myself, both from a medical standpoint and as a contributing member of society at large. It all came to a head when I realized that I was posting only political rants and I was not growing from my investment in social media. So, I realized it was time for a break. I shut down my Twitter for a while.

At first, I did feel the urge to check. I had gotten so used to checking my phone in between conversations, activities, and whenever I had some down time. Truthfully I was glued to my phone a little too much, but no one’s perfect, right? Then as I settled in, I found new and different ways to get news and information. I used to rely on the Twitter moments a lot when I was heavily active on Twitter. I started to look up articles on specific news sites. I used other news applications available such as Apple News and others. I discussed articles with my wife. I asked her for recommendations and sent her articles I read myself.

I had hoped to make more profound changes in how I interacted with people digitally and how I sought information and news. I made some changes, for sure. In the end, what I really gained from my break was a chance to reflect on what I wanted to gain from my social media presence. What did I want to say? What did I want to think about and converse about with others? What did I personally gain from my tweeting and blogging?

This and more I pondered for a couple of months, all the while intermittently logging into and deactivating my Twitter to keep it alive in the shadows. I’ll probably delve into all of this more in the coming months and years, as there’s much to share, but it’s good to be back.

Why do you use social media? What are your reasons for blogging, vlogging, tweeting, instagramming, or snapchatting?

We Need More Men Like Dr. Paul Kalinithi

The clouds are fluffy and the purest white. I have a window seat on the left, just a few rows in front of one of the pair of powerful jet engines, propelling us onwards and upwards. Beside me, my wife reads. An eighties hits playlist helps to fill the low drone of the turbines. I have just finished Paul Kalinithi’s When Breath Becomes Air.

As a physician myself, I have never read any one piece of literature that could get to the heart of my very existence better than Dr. Kalinithi’s masterpiece. Since the day I sat and met with my high school guidance counselor for the first time at the age of 14, and declared my decision to become a physician, I have never had this level of clarity. I never met Dr. Kalinithi, but his words echo throughout my soul, and I have internalized them as the wisdom of an older brother.

In the medical field, we joke amongst ourselves that the most important characteristics that go into a great physician cannot be taught – not in grade school, college, medical school, residency, or even fellowships. We must learn the lessons, develop the communication skills, and find the strength and love to provide compassionate medical care on our own, individual journeys. In his memoir, Dr. Kalinithi shares his own journey, from an inquisitive young man who showed the signs of future brilliance, to an exceptional neurosurgeon and neuroscientist, and finally, to a loving, fulfilled, and complete father to his daughter, Cady.

I myself have wondered about my purpose in this world a great deal. I spent many late nights, especially as a troubled teenager, trying to wrap my head around existence, and what it all meant to me. I have studied philosophy, literature, the scriptures, and the sciences in my quest to find meaning. Even as I near the end of my residency training in Emergency Medicine, thankful to have married my high school crush and celebrated our first anniversary this past September, with our future stretched out before us, I had felt this sense that I wasn’t anywhere closer to the understanding of my purpose and place in the world as I was in high school. 

However, in Dr. Kalinithi’s words, and in his and his family’s experiences, I have found that which has eluded me in my almost three decades of life. Never before have I encountered such a complete and honest treatment of what it means to be a physician, a patient, or the relationship between the two. Furthermore, as a young husband myself, I have yet to read words which have touched on the challenges that physicians and their partners face in relation to the training and work that we do. Reading When Breath Becomes Air has felt, in more ways than one, like coming home. 

I will explain it in this way. Last year, I read the wonderful Being Mortal by Dr. Atul Gawande. A gifted surgeon and writer, he addresses end of life care in this work, discussing the story of end of life care as it is, or is not, delivered in America today. He uses the stories of specific individuals, including the challenges his own father faced battling a terminal condition. However, Dr. Kalinithi’s When Breath Becomes Air has that total commitment to the mission that only he could achieve, by nature of his own challenges and how he rose to face them with his family.


The world needs more men like Paul Kalinithi.
The world needs thoughtful, hard working, and loving individuals who care about the people around them and dedicate themselves and their lives to the understanding of the human condition and the pursuit of meaning through meaningful work. Dr. Kalinithi inspires me to plan for the future while living with total attention to the present, to strive toward perfection knowing it may not be attainable, and to forever seek ways to better myself and the people around me.

Healthcare Professionals & Politics

I dedicate this post to all the men, women, and children who showed the world that Donald Trump is a man, and that he does not speak for us all. I dedicate this to all those who participated in the Women’s March, all over the world. I dedicate this to the leaders at FemInEM, PolicyRX, at my own University of Maryland Department of Emergency Medicine, and others, for inspiring me in my own career to engage.

Over the past few years, I’ve had a great experiencing exploring social media as a physician trainee and medical student. Before starting my Twitter, I had sworn off all forms of social media. I mostly wrote and journaled privately. However, using social media as a medical professional has been a vital source of inspiration & collaboration with people all over the world. Twitter as well as other online outlets have become go to places for me to engage in discussion & learn about current events. For those of us who work ridiculous schedules & hours, online communities work well for getting and sharing information. In a very basic sense, having a platform to let the world know how I feel has also been quite cathartic. 

However, in the past year, especially in the current state of affairs in the United States & around the world, I have become much more vocal about my views on politics and healthcare policy. I have been scorned by medical professionals who keep their online social media and other presences apolitical and purely clinical in nature. I don’t dispute that this is a good idea for many. After all, as with anything in life, we all have our reasons. 

What irks me, though, is judgment cast against those of us who DO share our opinions on current events & who DO take stances on various issues. If you don’t agree with me on this, there’s a simple solution – unfollow me, and move on. Don’t judge me though. Don’t think you’re somehow better. And most definitely don’t think you’re right and I’m wrong. 

Being a physician required me to take the Hippocratic Oath. Medical professionals dedicate themselves to caring for their fellow human beings. Yes, the majority of how I help the world occurs during my shifts in an Emergency Department, where I remain 100% apolitical and without judgment. I treat each and every single patient with the same compassion and work ethic as if they were my own family. 

I give medical advice and provide treatment and support to the very best of my ability, regardless of who you are, where you come from, or what your beliefs are. In fact, I have myself been judged by patients and other medical professionals. I have had racial slurs hurled in my direction when I made a clinical decision that patients did not agree with. I’ve been called a “sand nigg**” because I didn’t want to give my intoxicated patient opiates for his muscle ache. It wasn’t medically indicated and I told him so. Despite his slurs toward me, I gave him the benefit of the doubt and had to do breathing exercises the entire 10 minutes he stood by me, with nurses, doctors, staff, and other patients right there, as he insulted me, to remain under control.

I know I have a duty to care for my fellow men and women without casting any judgment on them or their choices. This is NOT the same as keeping your social media presence apolitical or purely clinical. I believe, in my heart, that it is my responsibility to use my education and my passion to create positive change for all, and to that goal, I use my social media presence to advocate on issues I think are important. 
I have posted about:

  1. Donald Trump & his presidential “campaign”
  2. Abortion
  3. Planned Parenthood
  4. The Affordable Care Act
  5. Women’s Equality
  6. Mental Health Issues for healthcare professionals 
  7. Health policy
  8. LGBTQ Rights & Disparities

In many instances I took a stance and tried to articulate my beliefs & reasoning.

What I hope is that we can create discourse and discussion that leads to positive change. You can’t achieve anything unless you’re at the table. And I believe, truly, that most medical professionals are not at the table. 

Many of us are simply too burnt out or exhausted to even participate. People have this notion that a doctor simply exists to try and diagnose conditions and write prescriptions. But that’s not even the half of it. There’s so much more to our work, and this applies to all types of medical professionals – RNs, NPs, PAs, techs, prehospital professionals, all types of therapists, and the list goes on and on. Yes we are expected to deliver clinical care but I didn’t sign up to simply be a cog in the medical industrial machine. 

I signed up to create change. 

Change requires dialogue, and for that to happen, you’ve got to share your voice.

I can’t force you to use your social media presence to engage in political discussion. I can’t force you to tell me what you think about the potential repeal of the Affordable Care Act or why anti-vaccination is dangerous for us all, but I want you to stop judging me and my colleagues who are willing to sit at the table. 

Star with MDCalc

For those of us who work clinically in an Emergency Department, Intensive Care Unit, prehospital, or other acute care setting, we know that our resources are limited and finite. Most of all, our time is limited. In our line of work, our demand is skyrocketing while we are expected to do a lot more with a lot less. This is where technology can be a tremendous help.

Over my 18 months in residency training so far, I have had the chance to try out many different tools and technologies to increase my productivity and aid in me in delivering quality, timely care. With the dramatic increase in volume of technology tools over the past years, it is hard to sort out what resources are valuable and which ones are white noise.

With the astronomical quantities of important data out there, it’s a huge challenge we face when we work clinically to not only remember which tools we need to use, but then the specifics – when the tools apply, what the evidence behind them are, what the caveats and quirks may be, and why they were devised and researched to begin with.


Enter MDCalc.

 

This site is a one-stop shop for all kinds of calculators and mathematical tools that are useful if not essential to my daily work. They are a physician founded and operated company with a simple mission – equip medical professionals of all types in all settings with the tools they need to deliver quality, evidence based despite the chaotic environments we work in today. All you need to use their services is an internet connection, and their application and website are 100% free. You can read more about their story here. Trust me, it is always great to see a company made for medical professionals that is extremely successful but remains humble and true to their mission.

There are a lot of great features packed into the MDCalc website and Apple Store application, which are both easily accessed once you set up a free account. Creating an account allows you to “favorite” any calculators or tools you use frequently or want to follow up on at a later time so they are quickly within reach. I have used the application and the website in the department and either way the website has a simple, user friendly interface which makes it easy to find what you are looking for and get to the point.

MDCalc has always been an integral tool since I discovered it in 2015, but recently, the makers released an updated product. The most significant update they’ve made is a new, improved, and patent pending search feature which actually allows you to search for calculators and tools based on a clinical scenario, chief complaint, and a variety of other qualifiers. The first of its kind, it enables you to combine elements to discover new tools. For example, if you are working a patient up for pulmonary embolism, you could combine “pulmonary embolism” and “diagnosis.” Later, if you are trying to understand how to counsel the patient and their family, you could combine “pulmonary embolism” and “prognosis.”

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This is a gamechanger in the area of free open access medical education and medical calculators. With this new feature, it is extremely easy to simply put in a clinical scenario or chief complaint, and the site will show you any of the tools in its database which may apply. Before, you had to know generally which tool you were looking for in order to make the best use of MDCalc. However, now the makers have allowed users to not only find tools they already know about and need a refresher on, but also find new and unused tools!

This is definitely a huge tool for me. It is so difficult to find time to study and learn about the latest and greatest in research and evidence based medicine. Though this does not replace reading the primary literature and other forms of continuing education, it is a really pragmatic way for us all, regardless of our field or practice setting, to quickly look up accurate evidenced based information to help deliver the best care possible.

Outside of this bombshell of a feature, the MDCalc product also has a wide range of attributes which I love:

  • Information about the researchers and creators who designed each tool in the first place, so you can read about the background of their work and get insight into their thought process and credentials
  • Tools organized in multiple ways, including by specialty and by system, making it super easy and convenient to find exactly what you’re looking for or discover something new
  • A continuously updated database of tools and calculators which ensures you are finding out about the newest and greatest, along with the tried and true, in terms of risk stratification tools and medical calculators

I attached screenshots of the beautiful mobile application showing how the calculators are listed, and using an example, we’re looking at the Modified Geneva Score for pulmonary embolism. As you can see, all tools are organized in the same consistent fashion, making it easy to learn and know where to look for information. You will see information about how the tool can be used, what the specific parts are, a calculator which interprets your score for you and then shows you the next steps, and background information on the minds behind the tool and references for further reading.

Doing what we do

Diabetogenic

This morning, I sat in a restaurant in New Orleans with three of my favourite people and diabetes advocates. If anyone could bottle the tenacity, passion, determination, guts and cheekiness of these three women, they would make a fortune and be able to solve all the problems of the world.

I listened to Anna, Christel and Melissa – who I am lucky enough to call friends – talk about their work and we discussed the US health system which made me shake my head in disbelief and confusion. I don’t understand this it; I doubt I ever will. But these three not only navigate the system themselves, they are doing it for others as well as they trying to improve things.

All week I have been around people who are involved in important and life-changing work in diabetes care. From those who are developing smarter devices, using data better, improving access and doing reseach…

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