What's the biggest barrier to practicing medicine today? "Open-access medical records," said Kanani Titchen, MD, a pediatric resident at Thomas Jefferson University Hospital in Philadelphia, and Alfred I. duPont Hospital for Children in Wilmington, Del., in response to one of the 10 questions MedPage Today has been asking healthcare leaders.
1. What's the biggest barrier to practicing medicine today?
Open-access medical records. Increasingly, I find that parents approach me in the hospital after tracking their child's lab results online. Sometimes they see the results before I do, since I might have an urgent issue, an emergency, or simply the routine care of many other patients.
Parents are fearful and sensitive to every "abnormal" lab that is highlighted, and I usually end up spending half an hour explaining each result and reassuring parents.
Results that fall outside of a certain range are automatically highlighted by a computer program but frequently are fine. (Some that aren't highlighted can be abnormal, too!)
The fact is that physicians spend many years in training to learn to interpret labs in the context of disease and the patient's clinical appearance.
I'm all for transparency in medicine, but we need to keep in mind the potential patient and parent anxiety, as well as the multiple demands on physician time, and subsequent wasting of medical resources as parents and patients (now frequently viewed as customers) demand unnecessary follow-up tests.
2. What is your most vivid memory involving a patient who could not afford to pay for healthcare (or meds, tests, etc.), and how did you respond?
Just recently, I was involved in the care of a U.S. child whose parents were from a [developing nation]. The parents had been searching for a reason for their child's progressive deterioration for 6 years in multiple countries.
Finally, this mother had carried her pre-pubescent child on her back and taken multiple buses across the U.S. to get to our hospital, because, she said, she knew her child would get the best medical care here.
After 2 weeks, we -- a team of 14 different specialists ... with considerable help from our social work team to find funding -- were able to make a diagnosis. Sadly, the child's disease is a fatal genetic condition, but mom found peace in knowing that there is nothing she could have done to prevent his demise.
3. What do you most often wish you could say to patients, but don't?
We're on the same team. Primary care physicians do not make hundreds of thousands of dollars; we work long hours, and we do what we do because we care about you and your family.
Patient gratitude goes a long way. When you're waiting for us in the waiting room or exam room, we're likely reviewing your file, dealing with an emergency, or fighting to get a medication or needed services for you or another patient.
4. If you could change or eliminate something about the healthcare system, what would it be?
5. What is the most important piece of advice for students or clinicians just starting out today?
In every job, there will be aspects you despise. In medicine, these are likely to be an endless amount of paper/computer work, constantly [having to justify] yourself to insurance companies, parents/patients who read "X" on the Web or heard "X" on television, and a relentless scrutiny of your performance.
Focus instead on the aspects you enjoy, such as uplifting moments with patients, the wealth of intellect and altruism in your colleagues, and the joy of discovery.
6. What is your "elevator" pitch to persuade someone to pursue a career in medicine?
Oh, gosh, I don't have one. Do something else first. Then, if science, art, and serving others is your thing, think about medicine.
7. What is the most rewarding aspect of being a clinician?
I get jazzed seeing a patient recover, and choose really living over merely existing.
8. What is the most memorable research published since you became a clinician and why?
An article from Pediatrics in 2012 by Jack P. Shonkoff, MD, et al., highlighted the implications for the role of toxic stress in lifelong disease.
This topic involves multiple disciplines -- neuroscience, psychology, sociology, socioeconomics, genetics, pediatrics, and adolescent medicine, among others.
I'm interested in toxic stress and its role in adolescent development, and I'm interested in identifying the mitigating factors that foster resilience.
9. Do you have a favorite medical-themed book, movie, or TV show?
I avoid most medical shows, but I'm a sucker for "Scrubs." As far as books, I could read Aldous Huxley's "Brave New World" over and over for its insights about the relationship between science, medicine, and social order. A favorite medical movie is "The Doctor" with William Hurt.
10. What is your advice to other clinicians on how to avoid burnout?
Words of my Grandma Mac, whose words -- with 88 years of life and experience behind them -- carried considerable weight: "Life is long. Take it easy, kid."