The Physician, The Leader!

Lately I have been exposed like never before to the diversity of roles available in a medical team  in a developed country like the United States and this has made me wonder even more about the role of the Physicians as the "Head of the medical team" and leaders in the medical sector and the responsibilities that come with such leadership positions that most physicians have to imbibe rather than learn.

As Physicians, do we have to master all, to lead all?

I came across this interesting article on the "proper way for physicians to be leaders" by a Pathology resident one KevinMD.com, one of my favorite medical blogs and I thought i should share 

via Kevinmd.com, by Benjamin Mazer MD, MBA

In medical school, you learn very quickly that you can’t know everything. By the end of your first-year anatomy course, you’ll probably give up on learning the names of every part of the body, let alone the intricacies of how they function. As physicians, we must grow comfortable with our limitations. We seek help from our colleagues and try not to let our egos get in the way of patient care. We accept that no physician will ever master the entirety of his or her discipline.

But are physicians now expected to master other disciplines, such as software engineering and social work? If you read the popular press and even academic journals you may think so. I like to call this phenomenon, this growing body of subjects doctors “should” master, “Hippocratic capture.”

I was reminded of this new pressure most recently while reading this article in a New York Times blog. The author makes some excellent points. Medical curricula are relatively stagnant while our world rapidly changes. The best medicine will incorporate modern technology and respect for the socioeconomic factors that influence patients’ health. The author also complains that he sometimes feels as if he has only one tool in his toolbox: the biomedical framework. For many health problems, this feels like simply not enough.

It’s hard to imagine any physician not empathizing with this struggle. But is the solution for medical students to take design courses from a fine arts school, as the new Dell Medical School is planning (according to the NY Times blog)? Should doctors also become designers?

Doctors face the paradox of being among the most visible and respected members of the health care field. While this authority provides many rewards, it also places an enormous expectation on us as leaders of health care. Doctors are expected to heal the sick (and we want to). If socioeconomic struggles are leading to sickness, doctors are expected to fix that. If technology provides the opportunity to democratize health care, then doctors are expected to lead the charge. We’re even supposed to design better hospital gowns according to Dell Medical School’s example of its innovative new curriculum.

But to point out the obvious: We can’t do it all! Doctors have already come to terms with our inability to master the entirety of biomedical knowledge, and we need to come to terms with our inability to personally fix every social determinant of health or poorly-designed health system. In fact, we can better provide these influencers of health the respect they deserve by allowing the true experts to take charge.

There are millions of social workers, public health professionals, software engineers, designers, and others who have the ability and desire to improve people’s health through their respective disciplines. The solution isn’t for physicians to master yet another subject; it’s to build powerful interdisciplinary teams that can address these aspects of health care in an egalitarian manner by including many kinds of experts. Doctors and other providers can no longer be the only ones responsible to the public for creating the best possible health care system. This physician-dominant model is regressive and inefficient.

I am not suggesting that doctors should ignore problems outside of the biomedical framework. I personally attended business school in addition to medical school because I was excited by the opportunity to improve patients’ health through innovative health care delivery. But I went to business school precisely because I didn’t expect the intricacies of management and economics to be taught in medical school. I don’t expect all physicians to master this part of medicine.

I am suggesting that if doctors are expected to master the multitudinous disciplines that are relevant to health then eventually the biomedical aspect of medicine will suffer. After all, despite the need to address the social determinants of health, you still need someone who knows how to take out an appendix. In forward-thinking health circles, the “biomedical framework” has become an epithet. It represents the myopia of past physicians, who thought scientists in a lab would cure every disease, ignoring issues of poverty, education, and behavior. But biomedicine is still a vital part of good care delivery and should remain at the center of medical education.

While many types of professionals can address health care policy, good design, and innovative technology, only physicians have the duty to provide medical care under the biomedical framework. When someone requires a surgery or drug for their illness, it is doctors who are responsible for ensuring the proper selection and delivery of that type of care. We can dilute our education, but we cannot dilute that responsibility.

Doctors should have some familiarity with the many disciplines that affect health. This isn’t a new idea, despite what the popular press would lead you to believe. I attended the University of Rochester’s medical school, which since the 1970’s has been home to the “biopsychosocial model” of medicine. I greatly value the broad experiences I received from learning under this medical model. Even in this environment, however, I spent plenty of time learning the pathophysiology and technical skills that are traditional parts of medical education.

I personally look forward to addressing the business side of health care in addition to providing good medical care under the biomedical framework. When I do work on issues outside of this framework, however, I expect to succeed not by knowing everything there is to know about health care delivery, but by engaging administrators, engineers, and others through interdisciplinary teamwork. If physicians are expected to be leaders of the health care system, then this is the proper way to lead. Hippocrates, after all, didn’t need an MBA or MSW to be a good doctor.

Benjamin Mazer is a pathology resident and can be reached on Twitter at @BenMazeror at his self-titled site, Benjamin Mazer, MD, MBA.

Medic-ALL 2016

Medical Jobs in Saudi Arabia

Medic-ALL @ One !!!: MedJobs:

Medic-ALL ( 08: 03;2015) Jobs for Doctors in Saudi Arabia  There are great opportunities for doctors to work in the Kingdom of...

LIFE AFTER MED SCHOOL Episode II

Choosing A Medical Specialty

Some medical students know exactly what kind of doctor they want to be long before applying or resuming medical school. For others, it takes years of lectures, coursework and clinical rotations for them to decide on what specialty they fancy the most. Even so, many more still have a hard time making up their minds long after graduation.

This decision could prove to be a task for many medical graduates! Asking one's self certain questions (starting with the questions in a first episode of the sequel ; "What You Must Know Before Leaving Med School") could help narrow down the choices.

The very first question to consider at this point involves your Personality.

1. What kind of Person am I?

Are you a people person? Do you genuinely enjoy listening to people? Are you interested in having a lot of patient contact? Or do you prefer as little as possible patient contact? Certain specialties such as Family Medicine, Psychiatry and aspects of Internal Medicine offer a lot of patient contact while others like Radiology and Pathology offer less patient contact. You may also want to consider your personality type in terms of your love for routine or for variety as the case may be. You don't want to be bored in your choice of specialty! SO IT BASICALLY STARTS WITH KNOWING YOURSELF!

The next 2 really important questions you want to consider have do with your Time.

2. How much Time do I want to have for myself and my family down the years? & How many years would I like to put into training?

These are really crucial questions that may well determine how happy you would be in your choice of specialty. Even though you would love to be the "Benjamin Carson" of your generation, the time it will take you to go through a Neurosurgical residency in any part of the world and practice as a Neurosurgeon is worth considering, especially if raising a family with a working wife (perhaps an equally ambitious medical  graduate also considering a surgical residency!) is important to you. You definitely have to be clear on how much time you want to give to the profession. COUNT THE COSTS!..

Along the same line as the previous 2 points involves considering the sort of lifestyle you wish to have outside the hospital doors!

3.  What type of lifestyle do I want?
After the long hours of work and  "crazy" calls, there is nothing wrong with wanting some kind of life outside of the hospital walls. If this is important to you, you want to narrow your focus in the direction of specialties that are less time intensive. Even within specialties certain sub-specialties consume less of the doctors time than others. So it's basically a question of how much free time you wish to have to yourself on the long run. This one is more important to some than others.

4. Do you love Emergencies?
Are you one of those that live for the "energy-drive and adrenaline-rush"  of the emergency room or are you allergic to stress? It is important to know if you are someone who does well under pressure as you consider a choice of specialty. Certain aspects of medicine are filled with life-threatening situations in which you are regularly involved in high pressure,  life or death situations in your patients. You want to sure of what you can handle before getting into a specialty. ARE YOU HARDCORE?

5. Does the Paycheck matter to you?
This is one, I was almost not going to talk about, not because it's not important , but largely because I personally have my reservations when it comes to practicing medicine with remuneration in mind. This is obviously a key factor in "Choosing a Medical Specialty" for many. However, there are many parts of the world where doctors employed by the government earn similar salaries irrespective of specialty or call hours, while in other countries there are differences in the paychecks of practitioners across specialties. Hence, those who are going to decide based on the paycheck will nurture the idea of practicing in another environment. This leads to the next question

6. Where do I want to Train/Practice?
The increasing trend of medical students trained in developing countries pursuing residency training notably in the United States, United Kingdom, Canada, and Australia has largely been due to the desire to get the "best" training possible as well as better appreciation and a "better life" worthy of the sacrifices of the medical profession. Other reasons include a lack of availability of adequate training facilities for certain sub-specialties such as Neurosurgery, Cardiothoracic  , Vascular Surgery, Interventional Cardiology and Intervention Radiology most commonly. Hence, answering the question of where you would want to train or practice could indeed open up more options of specialties that may necessarily not be "marketable" in your home country.  See What You Must Know Before Leaving Med School"Episode 1.

Finally, it is important that you choose a specialty that you love! You want to enjoy doing what you do, asides from being able to settle you bills, having time for your family and going on exotic vacations. For the sake of the patients you are going to care for and the younger colleagues who look up to you and are eager to learn from you, YOU NEED TO LOVE WHAT YOU DO. You therefore should consider this last question!

7. What Makes Your Day!
This may involve thinking back to your medical school days or internship years and  recalling the events of your clinical rotations or particular patient encounters. There are days you felt happy to be a medical student, call hours that you weren't in a hurry to disappear from, those rotations that stood out in your clinical years, all simply because you enjoyed yourself! Perhaps your "innate" area of expertise and dream specialty choice is embedded in those memories.

Having giving so much into this course of study and practice, the least we owe ourselves is to be Happy Doctors, Giving our All on a daily basis, simply because we are Passionate about what we do.

CLICK HERE FOR EPISODE 1 OF THE SERIES; What you must know before leaving Med School

Medic-ALL inc 2015! Anniversary Week Special

LIFE AFTER MED SCHOOL: WHAT YOU NEED TO KNOW BEFORE LEAVING MEDICAL SCHOOL

 EPISODE 1 

How ironic is it that after spending nearly a decade in the fore walls of medical school, medical graduates leave school and yet remain bereft of information that are crucial to them succeeding in the real world.

The truth remains that there are as many reasons people enter into medical school to study medicine as there are to choose whether or not to practice the profession following graduation. It is common to hear medical students give "passion for helping people or desire to save lives" as their reason for choosing to study medicine after secondary (high) school, and many indeed confess to have found themselves in medical school as a result of parental influences and pressures, while others just loved having the "Dr" title before their names. 

Continue READING HERE

The Reason Future Doctors are choosing Medicine have Changed

Medic-ALL (16:12:2014)

By an Anonymous American Medical Student

Why would anyone want to become a doctor?  Seriously.  Think about it, because this is a very important question for the future of healthcare in our country.

The future of medicine is somewhat unclear in this age of healthcare reform, but we do know a few things. Physician compensation is currently falling while lawsuits and malpractice premiums are rising.  Doctors must see many more patients in a day to maintain their salary, all while dealing with more paperwork in their limited time.  The hours are often long and the training is challenging.  Students must attend four years of medical school after college plus an extra three to seven years of residency depending on their chosen specialty.  So, why on earth would the best and the brightest young minds want to pursue a career in medicine, especially when they’ll be expected to pay in upwards of $200,000 for their education?

As a second year medical student I’m proud to report that the reasons our future doctors are choosing medicine have changed.  The decision is no longer made because of prestige or money, as it commonly was in the past.  Some of our nation’s best students are choosing medicine primarily because they care about others.   I’m not saying that older physicians don’t care about others, but they entered medicine under much different circumstances than what we face today.  Ask any pre-med student who’s shadowed a doctor and the majority will tell you that they were encouraged to choose a different career path.  There are plenty of kind and compassionate doctors out there, but there are also many who went into medicine for the money and recognition.  Personally, I was told that I should become a plumber, “because it pays better and medicine isn’t what it used to be.”

Yet, according to the American Association of Medical Colleges, the number of applicants to medical school has been steadily increasing for the past ten years, and students are choosing medicine despite all the challenges.  They see the challenges that our healthcare system faces and they’re excited to start working on solutions.  As of 2010, there were over 47,000 medical student members of the American Medical Association (AMA), showing their interest in shaping the future of healthcare policy.

So what does all this mean for the future of healthcare?  Overall, we’re going to see more and more doctors who are compassionate and who chose medicine for the right reasons.  These doctors will understand the challenges that are facing them and they will be prepared to fight for the interests of their patients, whether their opponent is an insurance company or a congressman.  That is why I’m optimistic about the future of healthcare.

Courtesy: Kevinmd

Sadly, Doctor loses Ebola Battle, Dies in Omaha

Medic-ALL (17:11:2014) Courtesy New York Times 

WASHINGTON — This time, the challenge of Ebola was much steeper for the doctors and nurses at Nebraska Medical Center, one of a handful of hospitals specially designated to handle cases of the deadly virus in the United States.

Unlike the two Ebola patients they had successfully treated earlier this year at the hospital’s biocontainment unit in Omaha, the man who arrived from Sierra Leoneon Saturday, Dr. Martin Salia, was in extremely critical condition. Dr. Salia, a legal permanent resident of the United States who had been working as a surgeon in Sierra Leone, died early Monday morning, barely into his second day of treatment, but almost two weeks into his illness.

The Late Dr Martin Saila

“Even the most modern techniques that we have at our disposal are not enough to help these patients once they reach a critical threshold,” said Dr. Jeffrey P. Gold, chancellor of the University of the Nebraska Medical Center, the hospital’s academic partner.

Dr. Philip Smith, the medical director of the biocontainment unit, said that Dr. Salia, 44, had initially been tested for Ebola in Freetown, the capital of Sierra Leone, on Nov. 7, but that the test came back negative. He was retested there on Nov. 10, at which point the results were positive. Dr. Smith said such false negatives were not uncommon early in the illness.

Dr. Daniel W. Johnson, a critical care specialist at Nebraska Medical Center, said that Dr. Salia’s kidneys had stopped functioning and that he was laboring to breathe when he arrived at the hospital late Saturday afternoon after a 15-hour flight. Doctors quickly tried two treatments they had used on their other Ebola patients: an experimental antiviral drug and a plasma transfusion from theblood of an Ebola survivor, which researchers believe may provideantibodies against the virus.

But Dr. Salia was already so ill that within hours of his arrival at the hospital, he needed continuous dialysis to replace his kidney function. By the pre-dawn hours of Sunday, he was in respiratory failure and needed a ventilator, Dr. Johnson said on Monday. Around the same time, he added, Dr. Salia’s blood pressure plummeted.

“He progressed to the point of cardiac arrest, and we weren’t able to get him through this,” Dr. Johnson said at a news conference in Omaha. “We really, really gave it everything we could.”

Dr. Smith said he did not know how Dr. Salia had contracted the virus. “He worked in an area where there was a lot of Ebola disease, much of it probably unrecognized,” Dr. Smith said, “and there were many opportunities for him to have contracted it.”

In the frenetic neighborhood of Kissy, on the eastern end of Freetown, an eerie quiet hung over the United Methodist Hospital on Monday as news spread that Dr. Salia had died. He was the chief medical officer and the only surgeon at United Methodist Kissy Hospital, according to United Methodist News Service.

Leonard Gbloh, the administrator of the hospital, said he did not think Dr. Salia could have contracted Ebola there.

“We have not been taking Ebola patients here” he said. “And we had stringent control measures in place to prevent it entering.”

The hospital even stopped all surgical work several months ago as a precaution, Mr. Gbloh said. Now, the hospital is being decontaminated and several staff members who came into contact with Dr. Salia after he fell ill are in quarantine there.

U.S free of Ebola case as New York Doctor is Cleared!

Washington Post (10:11:2014) by Mark Berman

The doctor who contracted Ebola in West Africa before returning to New York City has been declared free of the virus, hospital officials announced Monday. This news means that 41 days after the first Ebola diagnosis in the United States, there are no known cases of the virus in the country.

Craig Spencer, 33, who had been treating Ebola patients in Guinea, was diagnosed with Ebola on Oct. 23. Bellevue Hospital Center in New York City, where Spencer was being treated, confirmed in a statement Monday that he “has been declared free of the virus.” Spencer will be discharged on Tuesday, according to the hospital. (News of his release was first reported Monday by theNew York Times.)

Spencer’s diagnosis created concerns in New York, as the news of his illness was followed by the revelation that he visited a popular restaurant and coffee shop, rode multiple subway lines and went to a bowling alley and bar in Brooklyn. As city officials preached caution and calm,“disease detectives” fanned out to visit the places Spencer had gone and visit the people with whom he had interacted.

After returning to New York, Spencer had been self-monitoring and taking his temperature. He reported a fever of 100.3 degrees on Oct. 23, two days after he began feeling sluggish, and was taken to the hospital and isolated. He was the fourth person diagnosed with Ebola in the United States and the only one of this group to contract the disease after treating patients overseas. (Other people responding to the epidemic in West Africa have been diagnosed and brought back to the country for treatment.)

His diagnosis also sparked a panic among authorities, as the governors of New York and New Jersey hurriedly announced that they would quarantine any medical workers returning from West Africa, a highly-criticized move that went against the advice of public-health officials. This drama spilled up the East Coast, as a nurse who had treated patients in West Africa (and had no symptoms of Ebola) was quarantined in New Jersey and had a prolonged confrontation with authorities in Maine over her treatment.

The first person diagnosed in this country, Thomas Duncan, was a Liberian man who contracted it before flying to Texas in September; two nurses who treated Duncan were infected during his hospitalization. Duncan died eight days after he was diagnosed, becoming the only person to die from Ebola in the United States, while the Texas nurses who contracted Ebola were both treated and declared safe. The news that Spencer was cleared came three days after the last person being monitored for Ebola in Texas was also cleared, ending the Ebola saga there.

More than 350 people were being actively monitored by the New York City health department for Ebola as of last week, the department said in a statement. Most of these people had traveled to New York City from Liberia, Guinea or the Sierra Leone, but that number also included Bellevue staff members treating Spencer and lab workers who took his blood.

Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said Monday that people should be reassured by the fact that tried-and-true approaches, such as contact-tracing and active monitoring, have helped to prevent broader transmission of the disease in the United States.

“In fact, it has worked,” he said, noting that contacts of patients in Dallas have all been cleared and that people who interacted with Spencer so far appear healthy.

“That doesn’t mean we are not going to see another case; it’s possible we will,” he said. “[But] I think we are pretty well prepared.”

Medic-ALL.Inc.2014

IMGs: Acing Your U.S Residency Interview

Medic-ALL (19:09:2014)

Matching into a desired residency program in the United States is the dream of every International medical graduate (IMG) who has devoted "unquantifiable" effort towards achieving the status of ECFMG certification (successfully passing the USMLE Step 1, 2Ck and 2CS examinations). After applying for the residency matching via ERAS , the next step is attending interviews.

While a successful interview can make the difference in your obtaining that prestigious residency slot, skillfully fielding all the interviewer’s questions can prove to be a difficult task. Program directors can ask difficult questions; it’s your responsibility to come to the interview with all of your answers –even to the stickiest questions! –at the ready.

To help you navigate these tricky waters, we’ve prepared a list of some of the more challenging questions that an interviewer may pose –along with IMGPrep’s recommended responses. We hope that these tips help you obtain the residency of your dreams!

Learn More HERE

DOCTORS' STRIKE: Will the NMA be banned?

Day 30 : NMA Nationwide Strike Continues

As sad as it is to comprehend , the truth remains that doctors in government Hospitals across Nigeria under the aegis of Nigerian Medical Association (NMA) have been on nationwide strike for the past one month over irreconcilable differences and alleged breach of trade union agreement.

Series of talks between government representatives and officials of federal government have so far failed to result in concrete agreement and hence the strike continues to linger as it enters it's second month , to the detriment of a large populace who cannot afford the cost of healthcare offered by the private hospitals.

IS THIS TRUE?

There are purported reports in some section of the media suggesting that the Federal Government plans to take drastic steps towards ending the 30-day old strike. This may include  banning the NMA, followed by the privatisation of  public health institutions. The no work, no pay principle will then be enforced, and doctors who are interested will be protected to resume duties while new ones will be employed to take the place of those who are not.

In my opinion, if these plans are indeed true , it only goes to show how ignorant the Government is when it comes to the organisation of multi-tier health services for a country.

MIND BUGGING...

What happens to the laws that established tertiary institutions? What happens to the training of medical students and residents when the Teaching hospitals become privatised? Will the Laws of the Federal Republic be changed so that the "now" Private hospitals will serve the primary functions (mainly training and research) as defined in the Acts that established the hospitals as opposed to making profits.

MORE Questions.....

Where will the Ministry of Health find the doctors to replace the present crop? Will retired doctors be recalled in addition to unemployed doctors, and perhaps some who are practising abroad in countries where doctors receive ideal incentives who agree to return home. Will the Ministry of Health reconstitute the entire health sector and import foriegn doctors keeping in mind that there are presently a meagre 30,000 or so Nigerian doctors in practice.

I guess we just have to wait to see what "great" plans the Government comes up with to salvage the state of an already inadequate health sector. TIME WILL TELL!