Presenting Research Posters

A few months ago I presented my second poster at a medical conference. The first was at American Heart Association (AHA) 2018 Scientific Sessions in Chicago. This past one was the American College of Cardiology (ACC) 2019 Scientific Sessions. As a pre-med, standing among residents, fellows, and attendings can be nerve-wracking and intimidating. Presenting two poster does not make me an expert by any means, but I’d like to share some tips!

#1 Review, Review, Review

To present a topic, you should know the ins and outs of what you’re presenting. Know the trends of data, the specifics of procedures, and other important general ideas should be easy to recite off the top of your head.

#2 Know Imaging on Your Poster

As pre-meds, we don’t have as much experience with specific procedures. If you’re using imaging like X-rays, CTs, or ultrasounds, review the images. Many physicians at the conference will zero in on those images.

#3 Discuss Common Questions with Your Attending

Anticipate questions that are likely asked about your research. The most common one I’ve heard is “Can you tell me about your poster?” Prepare a little elevator speech summarizing your research.

#4 Be Confident!

My mentor likes to say “no one knows more about a poster than the person who wrote it.” You are the expert on your poster. Remember that when people call you into question.

I hope these tips help. Presenting posters always makes me nervous. I hope my experiences improve with time. Please feel free to share your tips. Happy presenting!

Happy Holidays, You Might Have Cancer

It was the day before Thanksgiving. The menu was planned, the shopping done. I planned on baking pies and chopping vegetables once I got home. Only a few patients to see that day, one a new patient. Usually my NP doesn’t see new patients, as initial evaluation is left to the physician.

She was flustered about seeing this patient she’s never met. Rushing into clinic to see the NP usually means something is urgent. This particular patient was highly symptomatic following a procedure by another provider. Unable to provide an explanation for her sudden shortness of breath, that provider referred her to our clinic.

The sudden onset and change in her symptoms frightened the patient and her husband. A young woman who enjoyed exercising was panting after walking less than 10 feet. Looking over the results from labwork, procedures, and imaging didn’t reveal a clear picture. She looked at us, pleading for answers with big, round eyes. She held her hand tight as her husband helped answer questions so she could catch her breath.

Imaging showed an abnormality, not explained by the most common diagnosis. The suspicion arose for cancer, though more testing would be needed. By the way her face fell, she had obviously not considered such a disastrous possibility. Her procedure was supposed to be simple and easy. From a cardiac perspective, it had been successful. Now she and her healthcare providers were forced to contemplate more malignant causes.

Despite working in a medical clinic, I’m not accustomed to seeing my patients die. We primarily see patients with atrial fibrillation, a treatable and manageable disease not likely to be the sole cause of death. The interventional team has to worry about death from heart attacks, while the heart failure team deals with high risk transplant candidates or LVAD patients. Cancer is usually handled by outside physicians specializing in other bodily systems and/or oncologists.

Right before the holidays, even the most remote possibility of cancer seemed devastating. It was difficult to hold myself together for the patient’s sake.

One of the research physicians suggested that I begin hospice volunteering. Despite all my research and reading book after book about death, I have little experience with confronting the ultimate partner to medicine. Perhaps it’s best I heed his advice.

Confronting “Bad Faith” in Medicine

 

Image result for bad faith when religious belief undermines modern medicine

This month’s reading focused on a sensitive topic – religion. When people mention religion and medicine, most people jump to abortion; however, there’s a frightening array of issues that involve religion in the setting of modern medicine. Bad Faith: When Religious Belief Undermines Modern Medicine covers these topics in depth. The preventable deaths caused by “faith healings” is the main focus of this book.

Several church groups and religious organizations shun the advancements of modern medicine on the basis of faith. Most notably, “Christian Scientists” refuse all medical treatments except those to set broken bones and a few other necessary treatments. Vaccinations, surgeries, antibiotics, and most medications are strictly forbidden by the Church. Instead, they seek “treatment” in the form of prayer.

Religious belief is a touchy subject. Many providers have difficulty understanding why people would refuse life-saving care in favor of prayer. There is little debate in how adults can choose to treat themselves. If a Jehovah’s Witness refuses a much-needed blood transfusion, that is their choice to make. This is the same for any patient, whether or not they choose this for religious reasons. Legal adults of sound mind are able to sign AMA (against medical advice) forms.

The greater problem lies in the children of these “faith-healers.” On the basis of their religious belief, parents deny their children medical care – which lawmakers refer to as “medical neglect. In the state of Arizona, there are multiple religious protections in place, including protections to avoid vaccinating school-age children. Although anti-vaxxers (religious or otherwise) have been refuted repeatedly due to overwhelming evidence in support of vaccinations, many continue to refuse to vaccinate their children against potentially deadly diseases.

It is my strong opinion that every adult person should be able to dictate their care. They have the right to refuse medical treatment and care. That belief, however, should not automatically apply to their children. An infant or a child cannot consent to medical care. In the medical community, we rely on the patient’s parents or guardians to provide that consent. The issue is that children cannot refuse medical care either, which unfortunately falls to the responsibility of the parents. The default practice should be, then, to provide care when children are sick and in emergencies, regardless of parental consent. The type of care provided may be subject to religious relief (such as avoiding blood transfusions), but parents should not be able to refuse care completely. Naturally that creates the issue of where the boundary lies. Providers and medical staff often end up court-ordering care for pediatric patients, which depends on the decision of a judge.

“Faith healers” can specifically refer to Christian Scientist “practitioners” who provide “care” in the form of prayers. The quotations are there because these people in no way provide actual medical care. Under Arizona law, these people are exempt from medical licensing. They can provide “care” yet they are not liable for the outcome of their “patients,” nor are they regulated in any way. This lack of accountability is something a physician would never dream of, a point made in Paul Offit’s book.

Doctors can be part of the problem as well. Per Arizona law, doctors and medical personnel can refuse to provide services based on their religious beliefs. This means refusing to prescribe birth control, perform abortions, collect umbilical cord blood (for stem cells), and end-of-life care. Notice that most of these cases are related to women’s health. (If you have the time, read Justice Ruth Bader Ginsburg’s scathing dissent of the Hobby Lobby ruling and the importance of reproductive rights). One pharmacist made headlines for refusing to provide a patient with abortion-inducing medication (even though the fetus had already died inside her.) Physicians and other healthcare providers should be required to perform and provide the services needed of them.

In the same way that providers would have to respect a patient’s religious belief, providers should respect their lack of religious belief.  Jehovah’s Witnesses do not believe in blood transfusions. I disagree with this, but I would respect that adult patient’s wishes. By the same logic, a patient requesting an abortion (for any reason) should be able to receive that procedure safely from a doctor, regardless of whether the doctor personally objects. A doctor’s personal conflicts, political leanings, or religious beliefs have no place in patient care. The physician is not a god, is not a judge of people’s moral actions. The physician’s duty is to provide the care needed.

I don’t have anything against religion in particular. In fact, Mr Offit’s book makes several points about the importance of faith. He even uses the New Testament and Jesus’ treatment of children to support medical care and protection for children. I would also like to note that some of the cases mentioned in the book involved religions and religious leaders who explicitly recommended medical care for the sick and dying, which individuals chose to ignore. The issue isn’t religion, but how religious belief becomes warped and causes harm in the realm of medicine.

AHA 2018 Poster Presentation

I have finally returned from my adventures in Chicago! This past Sunday I presented my very first research poster at the 2018 American Heart Association Scientific Sessions. Despite some hiccups in obtaining data, I stood in front of my poster during my designated presentation time – one of the only pre-meds presenting. Though the AHA is primarily focused on interventional cardiology (rather than the specialty I work in), I had some interesting questions and feel like I held my own.

The three day session has a huge variety of events. Admission includes large lectures and sessions by the world’s leading cardiologists, discussions of new and future research, presentations on current research, small session tips on networking and career choices, demonstrations of new technology and medications, as well as outside events.

After waiting for about an hour to get my badge, I headed to a “Main Event” lecture entitled “Hey Doc, My Watch Says I Have AF, What Now?”. I was surprised that I was able to understand the information being presented. I was disappointed that only one lecture pertained to EKG monitoring with the Apple Watch and similar devices. I stayed for the majority of the 2 hour lectures. Using the AHA Conference App, I participated in polls and asked questions. I appreciated how smooth it was, though many presenters did not have time to answer more than one question.

I explored the Science and Technology Hall, where reps from pharmaceutical and medical device companies showed off their new toys. I watched an automatic device deliver chest compressions, played an iPhone game where I could stent patients, and scanned over research and textbooks for sale. There’s an EKG learning program that I’m very interested in purchasing, but didn’t want to buy anything until I talked to my attending.

I didn’t spend all day at the conference, especially because Boyfriend came with me. I didn’t want to bore him any longer. We came back the next morning for my presentation. Thousands of posters are presented each day. I stood next to residents, fellows, and foreign doctors. We asked each other questions more than anything else and chatted about the conference. Many doctors I spoke to were not familiar with catheter ablation of A fib, so I felt more like an “expert.”

Here are some tips if you’re going to your first research conference for a poster presentation!

1) Buy your ticket early.

It’s quite expensive for non-members to attend events like these. However, students are usually offered a lower price. In addition, buying tickets earlier can mean cheaper prices.

2) Use your hospital and/or school’s printing services.

I paid $115 to have AHA print and deliver my poster to the conference. I was unaware that my hospital had a library with a printing service. I could have easily had them print it for free, then hand-carry it to the conference. Next year I’ll know to save me some money.

3) Consider where you’ll stay.

Conferences like these usually make deals with local hotels. Don’t be fooled, the hotels are still horrendously expensive! Fortunately, my hotel was paid for by my very generous attending physician. Others may not be so lucky. The main convenience with staying at an AHA hotel is that the buses at the hotel can take you directly to the conference. You are not required to stay at one of those hotels.

Let me know if you have any questions about my experience or my research!

American Heart Association Scientific Sessions

I’ll be in Chicago this weekend for the AHA Scientific Sessions. You can contact me on Instagram at futuredoctorfoodie. If you’ll be in attendance, I’ll be presenting my research on a poster on Sunday around 10:30 AM!

For those of you who are unable to attend, I’ll be posting about it once I get back!

Protecting Patients from Sexual Abuse

An orthopedic surgeon and his wife recently made headlines for drugging and raping women. The NPR article makes no mention of revoking his physician’s license, though if he serves the maximum sentence (of only 30 years for possibly thousands of women!!!) it is unlikely he would be able to continue practicing. The article does make a reference to his position as a physician establishing a sense of trust in his victims.

After 2 years, prosecutors were finally able to convict Dr. Shafeeq Sheikh of raping a heavily sedated patient while she was hospitalized. He was fired from the hospital and his license was suspended. He served no jail time. Unfortunately, Texas does not require permanent revocation unless a doctor agrees or when a doctor permanently surrenders his or her license in lieu of further investigation. He could potentially re-apply in a year.

These headlines are unfortunately not uncommon. Sexual assault and rape are hot-button issues in the US right now, particularly sparking outrage when rapists and sexual predators receive little to no punishment for their actions. There should be even greater outrage against physicians who take advantage of their position and their patient’s vulnerabilities.

There are watchdog organizations focused specifically on appropriate legislation and punishment of physician-offenders. Per one website, Arizona only scored 66%, but ties Massachusetts and Ohio at number 10 best patient protection states in the country. Mississippi is the worst, and Delaware is the best.

In Delaware:

  • Duty-to-report laws require any healthcare worker aware of an offense to report the physician within 30 days, or else pay hefty fines.
  • Physicians who have committed felony sexual offenses have their licenses permanently revoked.
  • Doctors must undergo background checks with fingerprinting, updated every 6 months.

In Arizona:

  •  Incidents reported by other hospital or clinic staff do not need to be made within a specific time period, and there is no requirement to report these offenses to the medical board.
  • State law does not require revocation for any type of sexual misconduct or convictions.
  • The medical board cannot refuse to issue a license based on previous criminal acts.

In Mississippi:

  • There are no criminal laws specific to sexual misconduct for physicians.
  • State law does not require physicians to report possible violations by fellow doctors.
  • Doctors whose licenses are revoked can reapply at “reasonable intervals.”
  • State law doesn’t require revocation for any type of sexual misconduct or convictions.

Physicians are with patients at their best in worth. They establish trust with a patient, and that patient trusts their physician to provide the best care possible without taking advantage of their vulnerabilities. When a physician rapes or assaults a patient, they violate that trust and the trust future patients would have given. Those physicians guilty of such crimes have violated the fundamental vow of doctors- “Do no harm.” I cannot fathom how a felony sex offender, a rapist, would in good conscious be allowed to continue practicing.

The laws need to change. We need to make hospitals responsible for the behavior of the physicians they hire. Physicians, patients, and staff should be able to anonymously and quickly report inappropriate and unacceptable behavior. The physicians responsible for these heinous acts should be punished severely, including the loss of their right to practice medicine.

Does anyone have any suggestions on how to get Arizona laws regarding license revocation altered?

Shadowing: MS Clinic

I’ve probably only spent 6-9 hours scribing for the neurology clinic. The provider I worked with is older than the average physician. His expertise lies in the treatment of multiple sclerosis (MS). MS is an auto-immune disease in which the body attacks the myelinating sheaths over the nerves of the nervous system. It can be diagnosed with lesions apparent on brain imaging, but symptoms vary. Usually there is some component of chronic pain, disability due to lack of coordination or difficulty with motor movement, and fatigue.

MS is often confused with fibromyalgia (which is a clinical diagnosis not based on brain imaging). Patients with chronic pain are often over-diagnosed with MS. Though the reasoning may be unclear, it may be a last-ditch effort to diagnose a patient with something, anything that could lead to a treatment plan. Extensive work by Dr. Andrew Solomon has explored how often MS is incorrectly attributed to patients and how to improve diagnosis (as well as how to address the misdiagnosis with patients).

Chronic pain patients get a bad reputation. Some of the negative labels attributed to them are “crazy,” “attention-seeking,” or even “drug-seeking.” I have an aversion to treating chronic pain, which I suspect many pre-meds may have as well. Chronic pain is difficult to attribute to a diagnosis, difficult to treat, and nearly impossible to cure. I’m sure this aversion will resolve with more extensive shadowing and understanding of the physical factors at play.

The provider I worked with is one of the greatest people I’ve ever met, especially as a physician. There are very few people who can make such a strong, empathetic connection with patients. Clinic with him is not like a doctor’s visit, but an engaging conversation in which he and the patient discuss health and treatment options. He is first and foremost a teacher, to patients and staff.

He does not flinch in the face of complicated medical histories, patient pain and emotional struggles, or patient non-compliance. He and his patient come to a truly mutual decision regarding their health and treatment.  He does not shame patients for refusing a certain medication or procedure. The patient only has to explain their reasoning. Whatever it is, he will accept it, as long as they are willing to explain their refusal. The patient feels like they are the one deciding, not the doctor.

I wish I could properly convey the experience of his clinic. He openly admitted to treating me like a resident. In exchange for scribing, he felt he should offer me an opportunity for education. He asked questions and encouraged me to ask questions. All my fear about the lack of neurology knowledge went away. I left more confident and energized. My only disappointment is that I haven’t been able to return for more shadowing.

Have you shadowed in neurology clinic? How was your experience?