Enclothed Cognition

This week as we focus on Emergency Medicine I have the pleasure of interviewing the dynamic an inimitable Brandon Faza MD, MBA.  I could easily use up a few paragraphs describing Dr. Faza and all of his interests, but I'm sure you will agree it's a lot more fascinating to hear him tell his story:

I’m one of those people who  Baz Luhrmann mentions in “Wear Sunscreen” that probably won’t know yet at 40 all that I ultimately want to do in life. I've been a DJ, campus politician, body painter (GO USF BULLS!), and wannabe entrepreneur. I am known for my spiky hair, which I refuse to give back to the 90’s. I do want to serve others and to lead, and medicine is a perfect place for those. I hope someday to start or to help lead a non-profit organization that can do everlasting good for others on a large scale. I don’t endorse many things publicly but chose to write that I am outspoken wearer of Medelita lab coats because they really should be the industry standard!

What Med School did you attend?

University of Miami Miller School of Medicine.

Where is your Place of Residency?

Emergency Medicine at Tampa General Hospital. I also completed a Transitional Year at St. Mary Mercy Hospital in Livonia, Michigan.

What year of Residency are you in?

Second Year (PGY-2).

Did you have a mentor during Residency?

I have an official mentor through the residency program, and all of the ED attendings at TGH are great about frequently offering mentor-ship in general. I also maintain connections with mentors outside of medicine, including community and business leaders, which I think is important for maintaining a sense of self and a sense of membership in the greater community outside of work and residency.

Have you or do you hope to ever work in Private Practice?

There are options for non-hospital-based jobs in EM and in related fields, but I am fairly sure I will not work in private practice. A lot of factors are driving newer physicians like me away from private practice and towards hospital or system-based employment. In addition to the grueling daily patient care schedule one must keep in today’s environment just to pay the bills, spending more time after business hours to run a practice leaves little time for family and for other ventures. The countless regulatory demands required by today’s healthcare system are making it much harder to survive without the benefits of a larger employer, and make employment preferable to private practice for many young physicians.

What are the currently the biggest challenges you face professionally?

I have many professional interests and right now I need to stay the course in residency.

What decisions would you change on your path to Residency?

I would have sought a lot more advice in advance. There is a perplexing culture in medical school and in medicine in which seeking advice or help in general is frequently seen negatively. Some peers will view asking for help in general as a sign that one “hasn't done their homework,” is under prepared, or is even incompetent. It can be discouraging for students who are assimilating that culture. However, the truth is that we are all human, nobody has all the answers, and we all need as much help and advice as we can get. I also believe that this culture is changing with time. My medical school was wonderful about making a wealth of resources available, but I should have asked more questions. Now that I am more confident in my membership in the profession, I am much more willing to ask for help. To the students entering residency after me; know that we all need help and advice all throughout our journey, and that nobody should ever be discouraged from pursuing it.

What advice would you give a Med Student about to graduate and go into their Residency?

Don’t spend your first paycheck all in one place! Party hard, vacation, and visit family in the months between Match and start of residency; we don’t get many breaks along the road and it is important to take advantage of the time when we have it. Practice what you preach. You wouldn't go to a dentist who has bad teeth. You must tend to your own health before you can serve others. Diet, exercise, sleep hygiene, and personal health go a LONG way towards supporting or detracting from your education. Start thinking about insurances and financial planning. Even though we don’t make enough money to make a dent in that educational debt, foresight is invaluable and you won’t get much training for those types of real-life decisions in medicine. Take residency seriously, but not so seriously that you lose your sense of self and membership in the greater community. Physicians are in a great position to be involved for the betterment of others in every community, and getting lost in your studies and your endless work hours can make habits easy to carry over once you’re done with residency. We have spent years learning how to help others, and that spirit is needed outside the hospital walls too. Along those lines, don’t forget to develop and fiercely maintain hobbies and interests outside of medicine. It’s our job to help people, and to help them we must understand them. It’s hard to understand others if you’ve spent years completely lost in books and have difficulty relating to the average person. Remember, Medicine is a service industry. Think about that - service. But instead of preparing products, selling wares, or providing entertainment, we are offering the most important service of all: to help others to live and be healthy. Medicine is the ultimate service industry. It should be patient-centered and people-centered. Sometimes our long hours and difficult journey can make this hard to remember, but it makes all the difference to the people we serve daily. Patients tend to have no idea how smart you are, how much you’ve studied, or how accomplished your skills are. They assume you’re great at all of those things because you’re a doctor. We are judged on our bedside manner and our ability to help people understand what is happening to them and their loved ones. They depend on us to help them make life-changing decisions. It is as important, if not more so than knowing the medicine and giving the right treatment. It may be hard to fully understand how much a little extra time and patience is appreciated until you or someone in your family goes through the same thing. We have the power to help people through some of the most difficult times of their lives, especially in residency when we may see the most high-acuity and critical conditions. Remember that. Live it. Own it even if those around you don’t, and it will set you apart and set an example for others.

What advice would you give a student considering Med School?

Truly seek to understand what you might be getting into. It’s never too late to change careers, but it’s a lot harder if you discover that you chose the wrong path once you've committed a decade to an education and get into sizable debt. Consider the extreme commitment of money, time, effort, and personal sacrifice. Seek resident physicians and attending physicians to ask them about these things. Consider whether the things you will want out of life are compatible with the realities of a career as a physician. Make sure you at least consider other professions of similar service if you feel a calling, such as PA and ARNP. For example, many mid-level practitioners are able to handle a large proportion of the everyday cases that physicians do, and there are meaningful differences in the length of training, risk of litigation, and relative pay. There are people who go into Medicine because their parents pushed them into it, or because everyone in their family went into Medicine, or because someday you can make a good living. There are a lot of bitter, regretful 30-somethings in Medicine who are watching life go by while they do something they come to realize they weren’t meant for, but by the time they discover it, there’s no way to turn around. In the end, you’d only be fooling and cheating yourself if you choose Medicine and it’s not right for you. Make sure you REALLY want it before you saddle yourself with decades of debt. I’m over $500,000 in debt, and a changing healthcare system may not guarantee my ability to pay that back any time soon. I’ll be 32 before I am an attending, having never bought new things, and that is the age when families begin and costs go up. A lot of us work ourselves into mountains of debt while our friends in other fields are already buying houses, boats, and socking away money for retirement. If it’s truly your calling, and worth everything I've mentioned and more, then dive in head first. I have, and I made the right decision. But we all work around people every day who don’t give the best care because they made the wrong career choice. Just like for the med students; don’t forget to develop and fiercely maintain hobbies and interests outside of medicine. Take lots of classes outside of medicine. It’s our job to help people, and to help them we must understand them. It’s hard to understand others if you've spent years completely lost in books and have difficulty relating to the average person. There’s nothing worse than a stuffy physician that nobody can get along with because every joke you crack is lost on them and they can’t relate to you (remember – this is a people industry). Don’t stress about where you get into med school. MD, DO, school rank, etc is all overblown. We all learn mostly the same stuff, take the same exams, and make the same paycheck someday. Most patients never know where you went to med school, or even if you’re an MD or a DO. Truly, your residency is where the bulk of your true training is, and that’s the time to be the most selective. Don’t be one of those people in med school who say they don’t study but secretly study constantly. Own your nerdiness, and quit giving the rest of us a bad rep for being gunners with all talk and no game! If you are a physician who is interested in sharing advice on their area of practice, please contact us via email.

Our Pathway to PA series is back as we interview Diane D. Abercrombie, PA-C, PhD.  When we started this series we were looking for inspirational stories that would inspire people interested in a career in medicine; Dr. Abercrombie's story is certainly inspirational. Diane D. Abercrombie, PA-C, PhD was born the eldest of four children to a single mother. She grew up in rural Alabama with her maternal grandparents and learned at an early age that the only way she could help her mother and others who lived in rural and medically under-served areas was to obtain an education.    She is currently the Program Director and Chair of the Department of Physician Assistant Studies, University of South Alabama, Mobile, AL.  Here is her story:

What was your education route and how you decided on your schools?

I attended the University of Alabama at Birmingham (UAB) and obtained a B.S. degree in Biology in 1985 and a M.A. degree in Education in 1988. My original plan was to attend the School of Public Health at UAB and obtain a doctorate in epidemiology. However, I was diagnosed with SLE at the age of 19 and suffered numerous medical illnesses. I was forced to cease my education as I recuperated from heart surgery. During my convalescence, a very good friend told me about the Physician Assistant profession. He thought it would be perfect for me because he was keenly aware of my passion to provide health promotion and disease prevention messages to vulnerable populations. I decided to apply to Emory University and was accepted in 1992. I knew this was the right path for me. My interview was on Good Friday, 1992 and I felt as though God was giving me a new beginning, a re-birth. He had placed purpose in my life. In 2009 I obtained a PhD in Education to enhance my opportunities to serve the “under-served.”

How long have you been a PA?

I have been a PA since December 1994. I am so proud to be in this profession. It has given me so much and I hope I am returning on Emory’s investment in me. I have spent my life dedicated to working with rural and medically underserved patients. Currently I am working in conjunction with colleagues at my program to increase the numbers of underrepresented minorities (URMs) and veterans in the PA profession. There is a major shortage of URMs in the professional workforce. In working toward this goal, I have uncovered an even greater problem. Those who come from underserved backgrounds and attend institutions of higher learning are declining. Many of these students are not prepared to bridge the gap between high school and college. They need mentors and experience a number of barriers. I hope to have a positive impact in the Mobile area in helping these young individuals realize their dreams. I believe education is a “right,” not a priviledge.

Did you ever consider becoming an MD or another career in medicine?

I came from a very small rural high school. The only professions I knew about were doctor and nurse. It was only when I attended UAB that I became aware of the public health arena. I am still contemplating a Masters in Public Health. I want to have all the requisite skill sets to provide effective intervention and prevention messages to the underserved.

Did you have a mentor?

I have been blessed to have several mentors during life’s travels. The mentor depended upon the stage of my life. If I have to choose one however, it would have to be my grandparents. They taught me that I could do anything and that God gave everyone at least one talent. They encouraged me to determine what that talent was and use it to edify others and not myself. They taught me never to let my circumstances become my story in life. I am grateful to my later grandmother Minnie, and my 100 year old grandfather Rev. George P. Kornegay for showing me the way.

What are your biggest professional challenges?

My biggest professional challenge is having the funding to develop so many needed programs for young kids who come from high schools that are unable to adequately prepare them for college. Our kids need summer enrichment programs, peer mentors, and others to help them navigate the world of higher education. If you are the only person in your family to attend college, it can be very scary. There is so much I want to accomplish.

If you could change any decisions you made along the way what would they be?

In retrospect, I would not change any decisions I've made along the way because the culmination of the positive and oftentimes very negative consequences of those decisions is what shapes the Diane D. Abercrombie today. I am a product of my good decisions and bad decisions. I like the caring, compassionate person God has evolved in me.

What advice would you give a pre-med student or anyone trying to choose between being a PA and another medical profession?

For any young person who is seeking a medical profession it is important to match your skills sets to the profession.  It is important to be in a career field that mirrors your personality where you can have the greatest impact. Many young people are focused on money, and yes, having a good salary is important, but money truly does not buy happiness. It is true that you have found your purpose when you would do your job for free. I understand what that message means. I don’t think it means, “Free” in the literal sense; but that you don’t worry about counting the hours, minutes, and seconds you work towards your purpose. You are willing to go above and beyond and do whatever it takes. Young people need a plan for how to get from point A to point B. Life doesn’t just happen. You need a plan, you need to work your plan, and you need to be willing to adjust the plan if need be.  I could go on, but finally, be your own best cheerleader. Have internal motivation and be willing to work hard. Don’t count on someone else to do for you what you should do for yourself.   If you are a PA and would like to be interviewed for our Pathway to PA series, please email us here. email us here.

What Medical School did you attend?

Where was your Place of Residency?

When did you do your Residency?

1997-2000

Did you have a mentor during Residency?

What is your specialty or area of practice?

What particular skill set is necessary to work in your specialty?

What are the currently the biggest challenges your face professionally?

Our H.E.R.O. Award -Honoring Excellent Resident Observations - was launched to highlight the personal sacrifices and educational commitment during a medical resident’s professional adult life.  We realize, considering the fast moving changes in healthcare,  how courageous medical residents are to embark upon a career in medicine with such an uncertain future.  This award is our way of recognizing that courage.

We wanted to take a moment to introduce you to our nominees individually:

Sarah Bryczkowski,MD

Rutgers – New Jersey Medical School/Newark, NJ

Sarah graduated from Robert Wood Johnson Medical School in 2010.  The person who nominated her said "the one thing that I will always remember about her, was her ability to smile and remain calm under pressure." All medical students make personal sacrifices while earning their M.D./D.O. Like others, Sarah had to put her personal life on hold to make time for her studies. When I asked her this question, she modestly said that

 “I didn't make any sacrifices that every other medical student didn't also do.”

Sarah has a goal to be an academic surgeon. She often talks about her excitement participating in educational research and continues on her path of excellence to make her family proud. She comes from an average blue-collar family and she is the first in her family to graduate college and medical school. During medical school Sarah’s father became seriously ill and passed away following infectious complications of a peripherally inserted central catheter. During this time period, Sarah received mentorship and continued support from the surgery team she was working with at the time. Sarah still speaks fondly of Dr. Dennis Hoelzer, a pediatric surgeon at Cooper University Hospital. She had a unique experience where she learned about the compassionate, empathetic characters that surgeons have. Sarah continues to be committed to improving patient care and advancing medicine. She took time during the middle of her residency to do research in improving patient outcomes in the intensive care unit. Her team is trying to find a way to prevent delirium in critically ill patients. In addition, Sarah is involved in a curriculum development program to teach residents the skills necessary to break bad news following severe traumatic injury. Vote for Sarah here. If you know a resident that deserves to be recognized, please nominate them here.  

Our H.E.R.O. Award -Honoring Excellent Resident Observations - was launched to highlight the personal sacrifices and educational commitment during a medical resident’s professional adult life.  We realize, considering the fast moving changes in healthcare,  how courageous medical residents are to embark upon a career in medicine with such an uncertain future.  This award is our way of recognizing that courage.

We wanted to take a moment to introduce you to our nominees individually:

 

John Purakal

Graduating 4th Year Medical Student- Wayne State University School of Medicine – Detroit, MI

John will be most remembered at Wayne State University School of Medicine for Raising Our Community’s Knowledge, the public health organization he formed during his first year of medical school. John conducted quite a bit of research, in Detroit and internationally, and found many people with chronic illnesses did not understand basic concepts regarding their afflictions, which led to poor compliance and health behaviors. John wanted to create a lasting impact in the community that would address these gaps in knowledge. He began creating lectures and discussions related to the most prevalent healthcare issues in the community, such as hypertension, diabetes, obesity, etc. After recruiting 2 fellow to students to be directors of the group, they recruited student volunteers to give the talks to various venues around the city of Detroit, ranging in age from middle school to senior living centers. Since starting the group, ROCK has had over 50 different student volunteers give lectures to nearly 4,000 Detroit residents. Churches, high schools, community centers and markets in the area have all hosted ROCK events, and the organization won the Arthur L. Johnson Community Leadership Award from main campus at Wayne state University in 2013. John is pursuing a career in Emergency Medicine, which is a unique choice considering his interests in public health and clinical research. However, he would be the first one to tell you that Emergency Medicine is a field that needs leaders in public health and research as the healthcare landscape changes in the years to come.  The following describes how John became inspired:

John and two friends were leaving school after a late musical practice, when his musical director, Fr. Torina, suddenly began gasping for air. He was an elderly priest, who was wheelchair bound due to his multiple ailments. John called the police, and when he returned he found Fr. Torina leaning on the handlebars of his electric wheelchair, quickly decompensating. He has said that the moments of helplessness he felt waiting for the EMS, and the days that followed, exposed him to the unique individual struggles associated with disease and its treatment: loved ones distraught at the thought of loss, hoping medicine will prevail; physicians collaborating in efforts to properly diagnose and treat their ailing patients; the patient’s feeling of betrayal towards his own body. Although it took a strenuous week-long battle against advanced sarcoidosis and lung failure before his teacher’s body gave up, the fragility of human life had been exposed to him in a matter of mere seconds. It was that night that truly catalyzed the transition of his career interests to an affirmed passion.

We will need physicians, scientists, policy-makers, and hybrids thereof to lead a concerted effort to eliminate health disparities and initiate change through research, while providing the best available treatment for our patients. John embodies the leader you need in an emergency setting, ready to take action at a moment’s notice and utilize other’s skill sets to achieve the best result for the patient. John will be a great fit in the emergency room, and down the line, as an advocate for patients’ best interests in the realm of health policy. Vote for John here. If you know a resident that deserves to be recognized, please nominate them here.

This week our Pathway to PA series continues as we interview Travis Sherer, PA-C, AAHIVS.  We met Travis on Twitter where we were immediately drawn to his outgoing personality (yes, you can see that even through Twitter). Here is his story:

Introducing Travis Sherer, PA-C, AAHIVS

I grew up in a small Iowa farm town. After high school, I attended Arizona State University and then later finished at New York University where I received a B.A in Psychology. During that time, I volunteered at an HIV/AIDS clinic in West Africa which had a big impact on me. I saw people suffer needlessly, either due to a lack of medications or care, or due to discrimination and stigma in their communities. I realized that I wanted to do something that helped others, especially the underserved and marginalized. Today I’m the Program Manager at the Lenox Hill Hospital Retroviral Disease Center, and I have also served on the board of directors of the Gay and Lesbian Medical Association for the past 5 years. I can be found on twitter @PAtravis and on LinkedIn.

 What was your education route and how did you decide on what schools to attend?

The physician at the HIV clinic in West Africa where I volunteered had some experience with PAs and suggested I look into it. As soon as I found out about the profession, I knew it was a perfect match. I literally stepped off a plane from Africa and interviewed for PA school at Pace University in New York City. I chose Pace because their program is incredibly well rounded, which was important to me. I also knew that global health would be an important driver for me in the future, and I loved that Pace encouraged an international elective.  During school, I did an infectious disease rotation in Mumbai, India.

How long have you been a PA?

I have been a PA for 6 years. I’m currently working in HIV medicine at the Lenox Hill Hospital Retroviral Disease Center.

Did you ever consider becoming an MD or another career in medicine?

I did briefly, but I felt that becoming a PA would be a better match for me in terms of time, money, etc. I also thought about NP school, and was accepted to a program, but ultimately the PA program at Pace, and the profession itself, won me over.

Did you have a mentor? If so, please provide some details.

I had many mentors!  I was so fortunate to be surrounded by talented and incredibly smart faculty, PAs, classmates and colleagues that I don’t know what I would have done without them. Two people in particular, Susan Cappelmann and Kathleen Roche, took me under their wing and nurtured me all throughout school, and they continue to inspire and motivate me today. My supervising physician, Dr. Ladan Ahmadi, is also a daily mentor for me. From the moment I met her at my graduation, I was determined to work with her.  Her passion for patients is infectious and I am in awe of the amount of knowledge she has. I don’t think a day goes by that I don’t learn something new from her. Ironically, I met Dr. Ahmadi at my graduation and I got up the courage to walk over to her and ask her about job opportunities. She didn’t brush me off, but she made it clear that I needed to get some experience first. Having had another career before becoming a PA, I wasn’t used to being told I needed experience! But I buckled down, did just that, and today I am working for her!

What are your biggest professional challenges?

Professionally, it can be challenging at times to explain what a PA is or to gain the respect of others if they are apprehensive about mid-level providers. I have learned that if you do great work, the work will speak for itself and the respect will come. From a patient perspective, the biggest challenges I face are getting my patients the care and services they need, particularly if they are uninsured or underinsured, and the ever increasing amount of paperwork that goes along with it.

If you could change any decisions you made along the way what would they be?

I honestly don’t think I would change a thing.

What advice would you give a Pre Med student or anyone trying to choose between being a PA and another medical profession?

Many people will tell you to have some fun before you start med school or PA school, because once you start, your life will be pretty much devoted to your studies.  While there is a lot of truth to that, do take time to have a bit of fun here and there and get to know your fellow students, faculty, and preceptors. Just as importantly, be open and let them get to know you.  That small bit of effort to develop solid relationships will pay many dividends in the future.

Our H.E.R.O. Award -Honoring Excellent Resident Observations – was launched to highlight the personal sacrifices and educational commitment during a medical resident’s professional adult life.  We realize, considering the fast moving changes in healthcare,  how courageous medical residents are to embark upon a career in medicine with such an uncertain future.  This award is our way of recognizing that courage.

We wanted to take a moment to introduce you to our nominees individually:

Jeffrey Cooney

University of North Carolina at Chapel Hill Neurology Residency Program – Chapel Hill, NC

Dr. Jeffrey Cooney's  enthusiastic nominator described him thusly:

Dr. Cooney is able to appraise all the available evidence, synthesize it in a current fashion and apply it to the most challenging of clinical situations. He is also able to make it “fit ” to teach the medical students and undergraduates under his supervision, while ensuring that it all actually happens for the patients. Jeffery is able to explain the “fit ” of his plan to patients from all backgrounds, with equal ease, to the families who are concerned and often devastated by the news of a neurological diagnosis. There is no doubt that Dr. Cooney is the right fit for Neurology and Medicine . He would be the Right fit for your program, because he is exemplary of everything we want out of our doctors, our students and our peers. Dr, Cooney is motivated to help those with neurological disorders improve their symptoms and quality of life. Watching a patient with devastating tremor be “turned on” with their Deep Brain Stimulator has motivated Dr. Cooney to do the same for other patients. 

Vote for Jeffery here. If you know a resident that deserves to be recognized, please nominate them here.

Almas Zane

Richmond University Medical Center, Staten Island – staten island, NY

Almas  Zane M.D.  graduated medical school in India and began her residency in 2012 here in the US. Almas is incredibly dedicated and hardworking, and  her attitude embodies the true spirit of what a resident should be. She sacrifices her time with her family to take care of her patients, and demonstrates true compassion and patience even at the most trying of times. In addition to all she does, Almas manages to stay up to date with the most current medical information. She is incredibly bright and works diligently, and should be recognized for her skills and strong work ethic. Vote for Almas here. If you know a resident that deserves to be recognized, please nominate them here.

If you follow us you'll know that advancements in technology that impact medicine get us excited, and we are huge proponents of encouraging kids to get involved in science, technology, engineering and math.  That's why we donated our lab coats for this event in South Jordan, Utah, where middle and high school students were shown how exciting STEM is. A few months ago Keila Valdz Mower, a Girl Scout leader in Utah, wrote a compelling email to Medelita requesting a donation of lab coats to support a STEM Education program. Medelita enthusiastically said YES! We are very excited to take a journey with the troop in support of their mission to educate young ladies about the career possibilities in the Science, Technology, Engineering and Math fields (STEM). We will be posting pictures of their adventures as they meet with different STEM professionals. Kiela and assistant leader Kathy Steen Spahr shared the following experience about their first STEM trip. “I wanted to share a sweet/positive story today. As part of our STEM Education program, our girls meet with Dermatologist Dr Kimberly Peppit and Registered Dietitian Jaime Saunders from The University of Utah Health Center in Daybreak. The girls learned all about skin care, nutrition and the role of STEM Education in their lives. What made this experience perfect, was the fact that the girls were wearing Lab Coats with their names embroiled in and ID badges… Medelita made it possible for girls to have a visual idea of what their future may look like.” Here is the video: Additional information on the Girl Scouts of America STEM program: http://www.girlscoutsgcnwi.org/stem If your organization is planning an event to encourage kids to get involved in STEM, please let us know so that we can help get the word out.

Erik Domingues,MD

University of Massachusetts Medical School, Worcester, MA – Worcester, MA

Dr. Domingues graduated from the University of Massachusetts Medical School in 2010.  From day one he was a hard worker who persisted in doing his best so that he could take the best care of his patients. He served as a student volunteer coordinator at a local free clinic that helped provide care for refugees and other Portuguese speaking patients and used his knowledge of the Portuguese language and culture to prevent mis-communication from becoming a barrier in taking care of his patients. Dr. Domingues was the first person in his family to attend college and ultimately, medical school. His parents immigrated from Portugal and worked in factories to help support the family and Erik made the most of his opportunity to become a physician; he turned his family’s struggle into his own success. Erik's versatility complements his specialty, Dermatology, given his interests in medical dermatology, pediatric dermatology, surgical, laser, and cosmetic dermatology. At the age of 18 Erik began shadowing and working with Dermatologists to gain exposure to his specialty. Although he entered medical school with an open mind and enjoyed every branch of medicine, Dermatology remained his passion. Attending UMass Medical School, Erik knew that the Dermatology residency program there was the right fit for him. The excellent support, clinical experience, and faculty have helped Dr. Domingues achieve his goals of becoming a Dermatologist. Vote for Erik here. If you know a resident that deserves to be recognized, please nominate your candidate  here.