So Much to be Proud Of

Hi everyone,

Heide and the girls drove to NYC this morning to celebrate Pride. Meanwhile, I’m spending today finishing off 42 letters of recommendation for fellowship- a record. Thankfully, these letters practically write themselves because they’re built around excerpts from MedHub evaluations. It’s a joy to write these letters, which show our residents at their best- smart, compassionate, hardworking young doctors who embody our highest ideals.

Next month, Fellowship Directors will have their chance to read about our marvelous candidates, but this morning, I want to share my favorite (anonymized) quotes, one for each resident. Our trainees are role models and inspirations. You make us proud.

Enjoy your Sunday, everyone. I’ll be working on the letters but hope to take a bike ride too. On Tuesday night, we’re leaving for a two week vacation in Japan.

Take care,

Mark

P.S. The annual noon Emergency Medicine Lecture (ELS) series officially starts tomorrow, featuring Dr. Gupta discussing Health Equity. See you there!

P.P.S: What I’m reading:

• Academic Freedom in America — In Support of Institutional Voices by Evan Mullen, Eric J. Topol, and Abraham Verghese
• Being There by Jerzy Kosinski

P.P.P.S. So much to be proud of:

• Respect: He is one of the nicest residents I've ever worked with and always treats patients, staff, and colleagues with utmost respect without exception.
• Thinking Independently: She has a precious skill; she questions the norm, the standard. She is a skeptic, smart enough to detect when the "things we do" don't click and might need to be revisited. Her curiosity and intelligence make her stand out from the herd (a very select herd btw).
• Humility: He is an incredible intern and person… He is bright and knowledgeable but brings an important humility about him. He is not afraid to ask questions or to listen to the wisdom of those around him, such as our experienced nurses or respiratory therapist. To me, this is critical to becoming a great doctor, knowing when to listen and how to tap into the human capital around you.
• Helping Juniors Shine: It was a joy to work with him again on his CICU nights rotation…I was very impressed with his dedication to teaching and selflessness to let his intern shine. One morning, I asked an ECG question that no intern has ever gotten right, so I asked him if he could help. He calmly said, "If you let him answer, he will tell you." It was obvious that he had anticipated the question, taught this intern, and then let his intern shine. Wow!
• Calm Compassion: She skillfully managed difficult family dynamics that were enough to ruffle even us attendings. She remained calm and compassionate even under stressful conditions.
• Ownership: As the float resident, she covered different patients each day but quickly identified their issues and took care of them as if they were her own, so that patients clearly benefited from her important contributions, even on the one day she cared for them.
• Meticulous: 10 out of 10 - absolutely outstanding in every way. He is a brilliant resident, one of the finest I've worked with: meticulous with details, focused, possessed with a vast fund of knowledge and sophisticated beyond his years in clinical decision-making…Truly, if I have missed any domain, it is only because there are so many good things to say about him.
• Building Community: He made an effort to get to know each patient and every member of the team as individuals and was an absolute pleasure to work with. His enthusiasm for celebrating positive patient outcomes was uplifting and rubbed off on us all.
• Teamwork: She is a stellar co-resident. She takes complete ownership of her patients and is also familiar with the cases of her sister team. In cross covering days, goes above and beyond expectations and even updates discharge summaries for patients
• Attitude: She was a fantastic senior! She always showed up with a cheerful, wholesome attitude which really helped with the number of patients who were actively dying on this rotation.
• Growth Mindset: He is eager to learn, responds well to feedback, and is proactive in identifying areas for self-improvement.
• Attention to Detail: She is hard-working, with exquisite attention to detail, knows everything about her patients, successfully manages workflow and communication with consultants and family with ease.
• Organization: It is difficult to pinpoint her best aspects because they are too many. I will say that she was super organized, kept track of all pending tasks, knew each patient in high detail, and demonstrated a lot of confidence in her medical knowledge during pre-rounds, during rounds, and when called to evaluate a patient.
• Role model: Someone recently asked me who I want to [emulate] as I'm starting to think about moving into my role as a senior and after thinking about it I immediately said her!!… She was always finding times to teach me about things and give really good real-time feedback. She cultivated an extremely emotionally/intellectually safe environment for me to ask questions, lead RRTs if I wanted to, and ultimately send me home early if it was possible.”
• Kindness: Before even knowing him, I was primed with high expectations "Your next senior [is] just the most beautiful person ever…" When you hear him talk with families and patients, he provides just the right amount of comfort, understanding, and realistic expectations that a physician is meant to provide.
• Patients First: I noted that she took the time on her first day of the rotation to individually go around to each of our 10 patient rooms to be able to understand them and their story; something I had not seen prior and will emulate as a PGY-2.
• The Things that Matter: Most of all, he is kind, thoughtful, and attentive to the little things that matter to patients. The best example of this is we had a patient on our list who we did very little for, since his indication for hospitalization was he needed transportation to radiation and his family could not care for him at home. It's very easy to not pay much attention to patients like this on your list when more active ones occupy your time and thought. But not him. On the first day of our rotation, the patient's transport forgot to get him and he missed his radiation appointment. Every single day for the rest of the block the intern called his nurses to see if his transport had come and, on days when it was running late, would call the transport office to make sure it was still arranged and on schedule.
• Knowledge: He has read a vast number of articles and frequently shares this information with us during rounds, which greatly enhances our learning.
• Setting Priorities: We had one very young woman dying of metastatic breast cancer, and he went out of his way to make sure she was discharged home to hospice (on a weekend!) so she could be with her family.
• Setting the Tone: She was one of the most supportive, caring, and nurturing residents I have worked with. She was always eager to teach, and she was always upfront about when she did not know something and where we could learn together. She checked in frequently, and followed up to make sure tasks were complete. She was always there to pitch in when necessary and helped me develop my clinical skills while making a fun, loving, and joyous work environment.
• Documentation: I was very impressed with her admission presentations and notes…She was detailed yet succinct and included only high yield and relevant information in her notes. I would have been able to safely care for the patient even if she did not give a presentation as she clearly communicated clinical reasoning and next steps in her written documentation…She also consistently wrote 'Significant Event' notes overnight to communicate changes in clinical status or plans overnight which was extremely helpful.
• Leading by Example: Takes time to teach med students, empowers his interns and is overall a great team leader. He is invested in the evidence behind why we do certain things in medicine, and I really loved his idea about starting a thread that we could share bits and pieces of knowledge with the whole team…His sign outs were great, and you could really understand what is going on with patients and why certain decisions were made.
• Caring: It is worth noting that a wife of a very ill patient, who has been in/out of the hospital many times over the last year and whose family has seen lots of residents come and go ... made a point of pulling me aside to say of all the residents she has come in contract with over the last few years, she stood out as one who really cared, took time to sit and talk with her and really listen, and helped her through the hardest decision of her life (moving to hospice for her loved one).
• Attention to Detail: Her attention to detail is among some of the best I've seen, and pushed me to focus on details, especially focusing on "non-acute" imaging findings which were buried in the description and left out of the final impression.
• Striking the Balance: She would always check in with the interns, make sure we were doing okay and check to see if we needed help with anything! She also did a really good job of being supportive, but also at the same time gave us the space to be autonomous.
• More Leading by Example: Extremely supportive of interns. Always asking about ways to improve as a senior and help out the team. Leads by example and extremely compassionate in patient care.
• Seeking Feedback: He actively sought and implemented feedback early on and throughout the rotation. I was impressed by how closely he listened and quick he was to respond to feedback. He had a mindset toward continual growth, he shared his goals for the rotation, and he also gave me suggestions on how I could be a better senior for him.
• Aspirational Care: He performed at such an incredibly high level that it would not surprise me to learn he was actually a seasoned oncology attending. On his first day on service, he astutely assessed that a patient who was scheduled for a liver biopsy to assess for [metastases] had most likely suffered shock liver and might not need a biopsy to investigate his transaminitis after all. After reviewing the patient's OSH records and discussing with his oncologist, the patient ended up being discharged home on the same day without any biopsy needed thanks to his keen clinical acumen.
• Leadership: She was an absolute blast to work with. She was an amazing senior in that she went out of her way to make sure we felt supported, but also allowed us to explore our own plans and be independent to a degree.
• Leading by Example: Always asking about ways to improve as a senior and help out the team. Leads by example and extremely compassionate in patient care.
• Equanimity: His positive attitude was a standout aspect, contributing significantly to a pleasant and productive work environment, even under pressure. Notably, on extremely busy days, such as when we faced four late admissions within an hour, his positivity and proactive approach were instrumental in effectively managing these challenging situations, greatly aiding in the completion of tasks, and maintaining team morale.
• Respect and Honesty: I greatly appreciated his goals of care conversations with family members of a critically ill patient nearing the end of her life for whom family was having a very difficult time working through goals of care conversations. He spoke to the patient's family respectfully and honestly.
• Commitment: His attention to detail is unparalleled and I never had to worry about tasks been done…He is deeply committed to patient care; he used to update patients in the afternoon before he left to go home without even me asking.
• Thoughtfulness: He led meaningful goals of care conversations with families. I admire his thoughtfulness which was always patient-centered/including the patients desires and values into the care plan.
• Responsibility: She is a pleasure to be around, very empathetic toward both patients and peers. She was always kind, thoughtful, and considerate to her team members…Even though she was rotating through as float, she took complete ownership of patients and took the time to learn them thoroughly, get to know the patients and their families, and advanced their care.
• Joy: Her joyfulness always brightened up the room and had a profoundly positive impact on our team's interns and medical students who were at the start of their year and still learning how to function.
• Teaching: He had amazing teaching sessions about various topics, including different cancer types, running codes, and palliative care… He would always provide great teaching during rounds, and provided feedback in the middle of the rotation and throughout. It was truly a privilege to be able to work with him. He embodies the qualities that I aspire to carry out as a senior in the future.
• Professionalism: She consistently treated all residents, nurses and staff with the utmost kindness, respect, and professionalism. Even when managing up to 7-8 admissions/transfers per night (Donaldson and Peters combined) and setting each patient up with a detailed plan to address their most acute problems, she never failed to consider how to work up and manage the non-urgent/chronic medical issues affecting them too…She was an exceptional role model who helped shape my own practice of medicine in meaningful ways.
• Encouragement: She also pushed me to give presentations to the team and gave thoughtful and encouraging feedback. I also really appreciated that went through an H&P very carefully with me, giving specific suggestions that I can utilize to improve my notes in the future.
• Advocacy: She was extremely detail-oriented and thorough in addressing each medical problem, while equally considering her patients' social contexts, which were sometimes quite challenging. She always communicated in a professional and empathetic way with patients, families, and staff. She provided frequent updates to nursing, and frequently returned to patients' bedsides throughout the day. Very diligent and hardworking, cared a lot about her patients and consistently advocated for them.
• Approachability: She is also patient and approachable as a cross-cover senior. Even when a patient was technically not on her team for the day, I always felt comfortable asking her for help if my senior was not available and she knew all the patients very well. On the days when my senior was not there she would also check in on me frequently and support me.
• Vulnerability: We had an unfortunate outcome wherein a sick patient unexpectedly decompensated and died. This was extremely hard on the entire team. We met after as a team to process the event which is a very raw and vulnerable time. I can only say how much more I came to respect her. Her compassion and openness to learning from the event were not only admirable, but showed me what a truly caring and thoughtful physician she is, even at a time of vulnerability. I respect her immensely and would choose to have her on my team any time!
• Mentorship: She is the type of senior I will eventually try to become. She always respected my opinion, was there for me when I doubted and worked every second to bring the best of me. Completely open to discussing any concerns I may have and I always felt she had my back in every situation. She let me take the lead but corrected me when appropriate. I know that someone as strong as her could go anywhere for fellowship, but I really hope she stays at Yale and continue to be part of this institution.
• Setting the Standard: She represents the best of Yale internal medicine. On this rotation in particular, I watched how she seamlessly picked up an entire day of work for her intern to have the day off when he wasn't feeling well - she flawlessly presented an interesting case for professor rounds without complaint or need for preparation. She always inspires me because she goes the extra mile for her patients - whether it is calling families and talking to them at length or checking with pharmacies to make sure her patient's medications are delivered. She leaves no stone unturned. She provides holistic, compassionate, and detail- oriented care for all.