Category: medical professionalism

The New Normal: Practicing Medicine Quasi-Masked and Semi-Remote

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by Melissa C. Janse

It’s 7:30 am. My husband glances over at me and queries, “Are you seriously in a med school faculty meeting right now?” I look down at my striped pajamas and pull the comforter further over my shoulders with as much dignity as I can muster and without toppling my laptop, which is open to a virtual meeting. I am propped up in bed with two pillows, sipping a ceramic mug of coffee with a picture of our 3 boys glazed on it, and petting my dog’s head, which is deeply snuggled into the crook of my leg.

“It’s not like the camera’s on,” I reply defensively. “Or the microphone. I’m paying attention. It’s…well, it’s how we do things now.” My husband glances over skeptically, finishes knotting his tie, and grabs his cell phone.

“Well, I’m heading to work. To actually see people. In person. Enjoy your meeting.”

Several hours later, prepping for my Emergency Department shift, I put on hospital monogrammed scrubs, tug up my pink striped compression socks (it’s going to be a busy one), hurriedly twist my hair in a facsimile of a bun, and take a quick minute for some minimal makeup.  I skip the lip color, as the lower part of my face will be hidden behind a mask anyway.  I also leave in my nose stud; no one’s going to see it. This mask is the final part of my uniform, which I passive aggressively delay until just before walking through the doors of the Emergency Department. With a practiced hand, I guide the elastic loops around my sore ears and pinch the light blue covering over my mouth and nose, which immediately fogs up my glasses. I emit an audible sigh which only worsens the fogging. Every. Time.

My first patient is a bright-eyed, pleasant octogenarian with dementia who was sent by her nursing home for some changes in baseline behavior. I introduce myself. She has absolutely no idea where she is or why she is here. She furrows her brow at me when I approach her stretcher. “I can’t see your face.”

“Pardon?”

“I can’t see your face,” she staunchly re-announces.

“Oh.” Sheepishly, I pull the mask down and give her my best winning smile. “We have to wear these now. Because of Covid.” She looks unconvinced. I see a flaccid, unused mask in her lap and opt not to tell her that patients are supposed to wear them, too. Later, I pull my mask down again to review her EKG, as my glasses are still intermittently fogging and instead of improving my vision, they are obscuring it. 

When I call the hospitalist to admit the patient, he initially asks me to repeat several sentences as my voice is muffled.  In frustration, I jerk the mask off so that my words can connect to him clearly, without barrier. I leave it off another few minutes to gulp down a quick cup of tepid coffee as the waiting room census mounts. 

Mid-shift, a fourth-year medical student passes through the ED and sweetly takes the time to enthusiastically greet me. I taught her during her first year of medical school. I enthusiastically greet her back although I must surreptitiously read her name badge to figure out who she is since it has been a while, and the mask is hiding the lower half of her face. I am having a hard time recognizing her without all the puzzle pieces to put together- it’s harder with just eyes and hair. I want the nose and mouth, too.

It has been over two years since the onset of the Covid pandemic. We keep waiting for things to get back to normal. But they’re not going to, are they? Ever positive, we call it the “new normal.” There have been incremental shifts in the way that we practice and teach medicine, and some of those changes seem that they are here to stay. 

One of the positive effects is the convenience of virtual meetings. I don’t have to shower, dress professionally, fix my hair or put on makeup, or even leave the comfort of my own home. I can effectively conduct business in sweatpants, sitting on my sofa, with my dog contentedly sighing in my lap. Or even while I’m on vacation in a different state. Thankfully, I’m an introvert. I’ve been preparing for this scenario my whole life. 

But these scenarios admittedly blur the lines between home and work life. Instead of being a calming respite from work, your home inexorably slides into an extension of work. Yet we know that in any healthy relationship, there need to be boundaries; we need a differentiation of self. Our getaway vacation is no longer a retreat for wellness if we spend every morning virtually dealing with work and work stressors, meeting via screen with students or giving lectures. We no longer have the uninterrupted, dedicated time to ourselves and loved ones to restore our spirit and replenish our physical and emotional needs if we are always reachable, always accessible, even if we aren’t physically in the hospital or our office…or the state. It’s on us to create healthy, personal boundaries and keep our job from becoming that needy, jealous partner who consumes all.

And there’s something else missing, too. I think it’s that human-to-human connection and communication. Even if we are seeing a patient or colleague, resident, or student, in person and not through a screen, the physical barrier of the mask on our face is inhibiting. You miss subtle facial expressions and non-verbal messages playing around the nose and mouth:  irritable nasal flaring; a corner of a lip raised in irony or sardonic amusement; the mouth twisted in contemplation; a broad, unguarded smile of joy; or pinched lips of pain and distress.

The post-pandemic changes, with their requisite benefits and detriments, are continuing to evolve, and we are continuing to adapt. But in the interim, patient care must come first (always) and continue. So, I keep working my shifts. But now when I go into patients’ rooms to introduce myself, I quickly lift my mask to give them a glimpse of my face in its entirety as well as a warm smile of greeting before pinching it back onto my nose. And fogging up my glasses. Again.

Melissa C. Janse, MD is an Emergency Medicine physician at Prisma Health-Upstate. She is also a clinical associate professor who teaches first-year medical students and serves as a career counselor at the University of South Carolina School of Medicine Greenville.

Unmatched, now what? The Hazy Path of the Qualified Medical Residency Candidate 

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by Jessica Obi, MD

On March 15, 2021, I found out I didn’t match. Needless to say, I felt alone, disappointed, and uncertain of my next step(s). “Dr. Obi!” is what family and friends would call me. The next question I would hear and would still feel uncomfortable answering was, “Which hospital do you work in?” or “What residency program did you match to?” My reply would always leave them asking, “It’s not automatic to match into a program?” followed by “I thought there weren’t enough physicians?” Then my favorite question, “So what are you to do now?” Although these questions are asked from a sincere place and valid, I could not, and still sometimes can’t help but question my worth, intelligence or if I made the right decision to pursue a medical degree. I feel the medical educational system is broken in that it lacks support for candidates like myself – support that includes mentors for such situations and jobs that would allow our degrees to still be useful. Instead, unmatched candidates are left to scramble for positions and other areas of work to repay student loans. The worst part of not matching is not having a sure direction to follow that would guarantee matching during the Supplemental Offer and Acceptance Program (SOAP) or the next  cycle. 

As any unmatched candidate would do, I began searching for mentorship and guidance. I happened to join Twitter to network and follow physicians, and by chance stumbled upon a few accounts dedicated to helping the unmatched. I was able to learn of zoom webinars dedicated to guiding unmatched applicants down this tricky road in terms of personal statements, letters of recommendation, curriculum vitae, and networking.1-2 Of  course, my family, friends, and medical school have been supportive; however, to my utmost surprise, social media, particularly Twitter’s @Inside_TheMatch and @unlikelymds, has provided the most useful support. I have met and networked with awesome physicians and mentors via social media, and I have also found a peer support group  with the same goal of matching. This has undoubtedly powered my strength to persevere. 

The recent match cycle left many unmatched with unanswered questions. There were 42,508 active applicants and roughly 6,254 candidates that went unmatched. Yet, we are forced to forge a unique path to residency. As I reflect on this, I find myself finally at peace to have had this experience. I can use my struggle to gain empathy and experience that will help my patients navigate their struggles e.g., decreasing blood sugar or losing weight. My struggle to achieve residency is analogous to a patient’s struggle to achieve healthy outcomes, and in both cases, it is crucial to have proper guidance and strategy. My attributes of resilience and perseverance developed over this period, will fuel my passion and strength. 

I believe every path, albeit hazy, is unique to the individual whether one is a patient, student, resident, or a physician. Some practices I’ve adopted to cope include remembering my why and my faith, mentorship, networking with other qualified candidates, and following the stories of others   who have previously tread this path and are now residents. Currently, I’m also working on a few  projects that I’m hopeful will be ready for the next match cycle. 

Creating a path to reach this goal is not easy. I find on this journey that I’m developing resilience, endurance and relationships. I’m essentially creating a story, my story, that just may provide enough hope for that competent unmatched candidate – who may be on the verge of quitting – to not give up. 

To all the qualified unmatched reapplicants, you’re not alone. There is a virtual community of faculty, residents, physicians, your peers, that are supportive and are willing to aid as you carve your unique path to matching. 

There is hope. Keep going. 

Dr. Jessica Obi is a 2020 medical graduate of Ross University School of Medicine, from Los Angeles California, and learned in 2022 that she matched in Internal Medicine. She is passionate about health equity and medical education, and outside of Medicine, Dr. Obi enjoys spending time with her family, traveling and fashion and hopes to positively impact the medical field. 

References
1. van de Ridder, J.M.M. [@MvdRidder]. (2021, April 28). INVITATION Zoom network meeting for UNMATCHED STUDENTS, organized by UNMATCHED students. Please register in advance. Please RT.[Tweet]. Twitter. 
 
 2. Stulak, J. [@JohnStulakMD]. (2021, April 19). As promised, for those who went unmatched in #MatchDay2021, feel free to sign up for an informal webinar in which we give our insights and your answer questions No matter who or where you are, we are happy to help and be a resource [Image attached]. [Tweet]. Twitter. 

Acknowledgements 
I would like to thank Kyle Swearingen, MD, Emmy Abraham, MD, and Monica van de Ridder, PhD for their support and feedback on the earlier drafts of my reflection. 
 

Speaking of Addiction…

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By Meaghan P. Ruddy

When we speak of addiction, there is a lot we can say. We can talk about stigmatization, how stigma is a mark, a signifier of something often associated with shame and disgrace, which in turn are responses to things deemed problematic by dominant cultural narratives. We could focus on historical usages of stigmatizing practices, how we come to know disgrace and feel shame by observing how others, particularly those who are in helper roles, respond to our marks, and how all of this negatively impacts healthcare. And we could, as we often do, speak about it from the safe, professional distance of the theoretical.

But there is a simpler truth here.

It is the truth expressed by the civil rights movement, the equity in marriage movement, and women’s suffrage. It is the truth that fuels both political correctness and the fight against it. It is the truth that language matters.

Think about it. If it didn’t matter, we would never take offense, never laugh at a joke, never tear up at a well-delivered line in a film or speech. No one would bristle at terms with historically racist or fascist overtones.

Yet, we do.

Healthcare has made some progress but our work is far from over. The person-first language movement has done a lot of good; even the CDC-recommended terms of use for people with disabilities. Even the word healthcare is a relatively new and welcome reframing away from the silos implied by medical care, rehabilitation, nursing care, etc. The harsh terminology that was once part and parcel of “clinical-speak,” handicapped, gomer, diabetic, depressive, has largely been abated or is at least on the way out. There has been wide-spread recognition that these are people first, conditions second.

Except. Except for one challenging, and unfortunately swiftly growing population.

Addict.

Drug-seeker.

Yeah, but c’mon, someone might say. They are seeking drugs. They’re a huge problem! They should know better.Read More »

“The Homeless Situation” – Reflections of a Neighbor and Doctor

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by Suzanne Minor, MD, FAAP

The subject of the email read “MDC Commissioners Meeting to Address the Homeless,” the body asking me to attend the Commissioners Meeting to describe my challenges in dealing with the “homeless situation in our area” in order to force the Homeless Trust to allocate dollars to target the Miami homeless populations.  Common scenes in the nearby downtown Miami waterfront public park included all manner of dogs and owners frolicking in their respective packs, designer-clad joggers and boot campers, tourists snapping photos, parents hovering near toddlers, and men and women rolling out blankets or spreading out cardboard for the night.  This email started me to seriously reflect on the homeless living in the park.

I’ve lived in this area for 10 years now.  There are more homeless now than when we moved in, displaced to the local park by museum construction.  At first, it was awkward as the pristine park felt overrun with this new population.  For a time, I even avoided the park in the evenings, not wanting to be reminded of the poor after working to provide healthcare for them in the face of great obstacles in my professional life throughout the day.  Looking at the homeless in the park was painful, bringing up feelings of helplessness, hopelessness, failure – providing health care for the poor of Miami was so difficult.  For any patients in the county safety net system, subspecialty appointments might take 6-12 months patients and if homeless, those patients might not get the appointment notification at the shelter address they gave until after the appointment was actually scheduled.  Just to see me as a walk-in patient required them to spend hours in the waiting room to be fit in to the day’s census.  Work was like constantly climbing a steep hill without the necessary gear or support.  And seeing those patients at night reminded me of this defeat and wore at my reserves.Read More »

The Power is Yours: An Exhortation from an Undocumented Medical Student

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By Sumbul Siddiqui

My parents immigrated to the United States when I was 4 years old, hoping to give their children a better life. I was raised in Georgia with my three younger siblings, two of whom were born here. Georgia has a policy called 287(g), in which some counties are proud to work together with ICE agents to detain immigrants.

My first encounter with ICE officers was probably when I was 14 years old, just about to enter the 9th grade. I remember this moment very well, because the night before I had watched this scary movie called Saw. So, I was terrified that someone was going to kidnap me. I checked my closet and slept with the lights on that night. No one came for me, but my mom was taken. Two ICE officers entered our home that morning. I only heard bits and pieces because my mom had closed my bedroom door and told me to go back to sleep. Eavesdropping, I heard them tell my mom to go with them, and she would return back to her family soon. That took 3 months. She was taken to the Atlanta Detention Center, and then transferred to an Alabama detention center.

I don’t remember much of what happened during that time, but I do remember visiting my mom in the Atlanta Detention Center. We were only allowed to see her for a brief moment. She was wearing an orange jumpsuit – crying. Her handcuffs were taken off so she could talk to us through the glass window. I told her that everything was going to be okay even though I had no idea what was going on – or really, a clue about our immigration system. When my mom returned, I started high school, and I didn’t think much about immigration again.

Fast forward to my sophomore year in college. They come for my dad. Within just a few months, they come for my brother. My dad was gone for 2 years, and my brother was gone for 7 months. They were both in two different detention centers. Sometimes, I had to figure out who to visit – whether I would drive an hour up from Atlanta to see my father or 3 hours down to see my brother.Read More »

No Smoking This Side of Room: Reflecting on things that aren’t there any more after 42 years as a student and a teacher in a medical school

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By Michael Dauzvardis

In The Beginning

It was June of 1977 and I had just begun my graduate career in anatomy.  Little did I know that I would be taking all my major classes with the medical students.  A lifelong journey in accompanying medical students in various ways had begun.

The Lecture Hall

A typical day in anatomy class began with 130 or so medical students, shuffling sleepy eyed into their small seats with swing out mini desk tops. They came bearing newspapers, coffee mugs, 3 course breakfasts, adorned in hair too long and shorts too short.  Bell bottoms, blue jeans, and baseball caps ruled the day.  I quickly assimilated by wearing my new Levi overalls. On the right side of the room (while facing the podium) was a sign affixed to the wall which declared “No Smoking This Side of Room.”  Now I must say that on the opposite side of the room I did not observe a lot of smoking but on more than one occasion I observed a student chewing tobacco and spitting into a large plastic cup during lecture.  The class of 122 consisted of 90 men, and 32 women– with a racial and ethnic composition of 1 black person, 3 Latinos, 7 Asian-Americans, and 111 Caucasians.  Forty-six of the men had mustaches, with the majority of those also sporting beards.  It was the prime of the disco period and it showed.

A portion of a newspaper containing the daily crossword puzzle would be passed around for each student to contribute. The instructors drew on a thing called a chalk board while some students tried to keep up on their yellow pads of legal paper. Audiovisuals consisted of carousels of 35 mm slides projected onto a pull down screen in the front of the room. On more than one occasion I observed a professor drop his entire tray of slides before lecture.  The slides would fly in all directions. Students and staff, eager to be helpful, would assist in reloading the carousel, but since slides needed to be placed upside down and reversed in order to be projected correctly, this usually resulted in much confusion and sore necks during the lecture.  These slide carousals also provided for the mischievous opportunity of inserting bogus slides into the lecture.  If a lecturer wanted to show a “film strip” he had to notify the AV department in advance so they could bring in a reel-to-reel projector, whose sound never worked and which often melted the film.

There were no computers or cell phones (two payphones were mounted outside the lecture halls).  Pocket calculators were the rage–and I even saw an occasional slide rule.  Virtually all students participated for 15 dollars in a co-op note club.  Each student would be assigned a lecture at which he or she would take detailed notes.  These were typed out, mimeographed and distributed to the entire class.

The lecture hall had a center aisle, but no side aisle.  As a result, students had to climb over each other to get to and from the end seats.  Furthermore, the floor slanted at almost 45 degrees toward the front such that a dropped pencil or spilled cup of coffee made it all the way down to the lecturer.  The lecture hall spanned two floors with the upper half flanked by the outer windows in a manner leaving a precarious eight-foot drop hidden by curtains– which on more than one occasion gobbled up a medical student like a bug in a Venus flytrap.

The Pub

There was a long, often leaky, run-down hallway that connected the medical school and hospital with the dental school, a dark tiny basketball court, an old theater, and the beloved pub. The pub served pizza and sandwiches and soft drinks for lunch during the week.  But, at 2:55 pm on Fridays, students, staff, and faculty could be seen with their tongues attached to the outside of the pub Read More »

“Pobrecito” – The Fine Line between Compassion and Infantilization

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By Fabiana Juan Martinuzzi

“Pobrecito”– she said as we discussed the patient’s pneumonia course before entering his room.

“Pobrecito” – she repeated as we donned our gloves.

“Pobrecito”- she mouthed to us in front of our patient.

“Pobrecito”- she whispered in my ear as we left the room.

That day, “pobrecito” became a word I eliminated from my vocabulary. In Spanish “Pobrecito” translates roughly to “poor thing” or “poor baby” and it is an appropriate word to use to show empathy with an endearing connotation. However, when one of the healthcare providers in the team used it incessantly to show pity in front of my 60 year old patient with cerebral palsy and dementia I began to cringe every time I heard her say it.Read More »

My Pediatrician

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By Puja Nayak

“Doctor,” I say, my voice fading. I hear footsteps running and my eyes shut.

Hours later, I have a wire in me. I try and pull it out but my doctor stops me.

“No, don’t do that sweetie.”

I give her a look. I don’t understand why I’m here. My head is hot, I am sweating, and many students surround me, taking notes. Are they talking about me?

“Honey, you have something called Kawasaki.”

I raise my eyebrows.

“Your body and I are fighting it, so you will be okay.” She hands me a juicebox and leaves the room with my parents.Read More »

Sharing at the Free Clinic

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By Megan Masten

I recently had the opportunity to spend a month at a free health-care clinic in Flint, Michigan as part of my third year Internal Medicine clerkship.

I am in an underserved medicine program and I have a deep interest in working with people who have characteristically been left out of healthcare.  I loved working with the population who receive their healthcare services at the free clinic – I have mostly been impressed with patient’s willingness to feel vulnerable.  I have spent my third year of medical school in a variety of medical settings, and my favorite type of patient interactions are the ones where patients are willing to be completely honest with me and share things about their life that they might be ashamed of or have complicated feelings about.  I feel like I am doing what I’m called to do when I get to have difficult discussions with people about medical and non-medical issues that affect their lives, and my ability to have these discussions has been strengthened by my time at the clinic.

I spent time with a patient at the Free Clinic who opened up to me about his mental health issues.  He was recently started on a new antidepressant medication for depression and anxiety, and he was open and honest about his challenging feelings.  He shared with me that he was feeling really depressed and had frequent suicidal ideations – and he was quick to say, “I’m sure you don’t struggle with depression, I’m sure your life is really good.”  It was such an important and unexpected conversation to be had; although I don’t personally struggle with depression at this point in my life, I can’t say that I never will, and I can’t say that I don’t understand how he feels.  I shared this with him, and I shared with him the fact that I have family members with depression and bipolar disorder who have been suicidal in the past.Read More »

The Past Today: A Southern Physician Visits the Mississippi Civil Rights Museum

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By Suzanne Minor

At this year’s Southern Group on Educational Affairs conference, the University of Mississippi hosted an outing at the Two Mississippi Museums, consisting of the Museum of Mississippi History and the Mississippi Civil Rights Museum.

I focused my visit on the Mississippi Civil Rights Museum.  It was exhausting, difficult, heart-wrenching, and, in the end, hopeful.  Growing up in rural Georgia and Jacksonville, Florida, I witnessed legalized segregation through small private schools and experienced rampant racism as the norm. Thankfully, college and medical school broadened my perspective, particularly gross anatomy.  Once without skin, all of those black and white cadavers looked so similar.  Not better than or less than, but equal in skinless death.  I dove into former slave narratives, reading Frederick Douglas and trying to reconcile the message from my upbringing – that I was better than because I was white – with my new learning in gross anatomy and in my direct experience with people who looked different than me.  I was learning that we were all just human, no better and no worse than each other.  My professional career has been dedicated to attending to the medical and holistic needs of the underserved communities of Miami, Florida, a diverse area in which I’m in the minority.

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