In Touch: News from The UTGSM's Department of Medicine, July 2015

1

Gene Stollerman, MD, Professor and Chair of the Department of Medicine for almost 20 years at City of Memphis Hospitals, died August 1, 2014, at the age of 93. During his lifetime, he accumulated a formidable list of accomplishments, including hundreds of textbook chapters, journal articles, books and monographs. He held dozens of prestigious editorial posts and leadership positions in national and international societies and agencies and acquired many awards for service, education, research and patient care. IfirstsawhimwhenIwasamedicalstudent,stillsloggingthrough the basic sciences. Our curriculum included a clinical correlations course, which among other activities, required my class to attend Medicine Grand Rounds. That morning, we sat in an amphitheater looking down at a very tired appearing chief resident wearing a starched white coat, an ill appearing lady lying

on a gurney, and although I did not know him at the time, Dr. Stollerman. The resident summarized the lady’s case without notes or prompts. Dr. Stollerman asked him a few questions, then he asked a few more of the patient. He then turned to the audience and spoke extemporaneously for an hour about what he thought she had and why he thought it. I left that morning, convinced that I wanted do whatever it was he had just done; to dissect a history, identify subtle physical clues, and make an irrefutable diagnosis. IpresentedmyfirstpatienttoDr.StollermanonChief’sRounds as an M3 and many more times as an intern and resident. The anxieties of measuring up did not weaken, and the feeling that one could never know enough only increased. Dr. Stollerman’s study guide consisted of two simple points. Always read about your patients and always carry a tablet or index cards

In the past year, I have noted a growing concern about the feelings of stress and discouragement voiced by many of my current and former colleagues. These feelings are being voiced more frequently than I have heard in over 35 years of clinical practice. Medical practice can be stressful and physically and emotionally demanding for physicians. So what change in recent

years is causing seasoned physicians to feel unhappy and dispirited? In my view, several factors are contributing to pessimism among physicians. The changes in the health care

system have become more frequent, intrusive and pervasive. Setting of productivity goals, performance measures, increasing bureaucracy, and hassles with payers have considerably dampened the enthusiasm for taking care of patients. This has led to a widespread feelings of lack of autonomy that is so essential to a feeling of satisfaction among physicians. The availability of computer access from home means that work is now conducted at all hours of the day. This has curtailed leisure time and time away from work so that balancing work and personal life has become extremely challenging. Currently, many physicians feel as if they are constantly rowing against the current. If this discouragement among physicians is not addressed, this could have serious consequences for health care in the future. Medicine has always been an attractive profession for high achievers and

LEARNING BY DISCOVERY by Dr. Ronald Lands

Points of View

Rajiv Dhand, MD, Chair

continued on page 3

continued on page 2

Department of Internal Medicine 2015 Group Photo

Department of meDicine

Connecting Technology, Education and Discovery with Humanism in Medicine Vol. 4 Issue 3 July 2015

2

A Reflection On My Residency by Dr. Christen Fleming

It lasts forever, but it is gone in a flash; that is the amount of time it takes to become a physician. I began school at age 5 and at age 8 declared I was “going to be a doctor.” At that time in my short life, this endeavor did not seem as monumental as it turned out to be. Throughout elementary, middle and high schools, I, like many others, had teachers guide me down the unknown roads of science, math, English and the many other subjects one must master prior to entering med school. Beginning college at the University of Tennessee, I was prepared, in my mind, to overcome the learning hurdles it would take to pass the MCAT and get into medical school to “begin” the process of becoming a doctor. Little did I know, I had already started this

many years prior. Throughout the grueling hours of attending lectures and studying individually for my college classes of honors chemistry, organic chemistry, BCMB, and others, I reflected back on the guided lessons taught in Mrs. Cox’s high school chemistry class and Mr. Ware’s biology class to prep me for these days. It was a stark realization that my 600-person UT classes lacked “hand-holding” that I had taken such advantage of in the 30-person high school classes. As college finished I began the daunting first year of medical school at my dream school, UT Health Science Center College of Medicine. During orientation they described first year education as “drinking from a fire hydrant.” And in all honesty, I did almost drown initially; through the group studying with my peers, tutoring from upper level medical students and finally third and fourth year clinical rotations with engaged interns and attendings directing my education, I made it. The countless hours of studying books in the library, making notes at home, and listening to podcasts on my afternoon walks had finally paid off: it was time to begin residency. The first months of residency were terrifying if not exhilarating. I was petrified to order acetaminophen on a patient with a fever, for fear I would put them into fulminant liver failure. Would I order a one-time dose of ibuprofen as requested by nursing for osteoarthritis? No way! I would not be the “doctor” who caused my patient to have end stage renal disease. Slowly but surely throughout the first year of residency, I gained knowledge from instruction as well as modeling after accomplished upper levels and the all-knowing attendings, with whom I was blessed to work. The hands-on experiences, the (oops!) medical errors which were committed but fortunately led to no harm, and the late nights in the ICU with tolerant attendings all led to my current destination: the ability to graduate residency. I now venture into the long sought after and finally found dreamland of “attending-hood,” the place that once meant I was “finished” with my education. Now I know that completing residency is not the final destination. I have the educational skills to research medical innovation and form opinions. I know my limitations and abilities. The 8 year old whose dream it was to become a doctor is proud. The 30 year old knows that as an attending I have a lifetime of learning ahead, which is just as thrilling as my acceptance to medical school was so many years ago.

in your clinic coat to record anything new or unusual, then read about it that night. He taught us to be curious and to enjoy the thrill of learning new things. He stressed the importance of rereading—acquiring new ideas about old material. Doctors of a certain age have found that much of what we were taught in residency is no longer relevant. New chapters about new concepts have appeared in basic texts. Hallway conversations contain phrases like polymerase chain reaction, single nucleotide polymorphisms,fluorescentinsitu hybridization—words and ideas that did not exist only a few years ago. Practicing physicians havehadtolearnnewthingsaboutthesamediseasestheydiscoveredforthefirsttimeastraineesinordertomakethetransitionfrom the recognition of phenotypes and patterns to the modern day use of molecular medicine. An aspiring young writer once asked a famous, Kentucky poet how to become better at his craft. “Discover something new every day,” he advised. That is a source of inspiration for a writer. It is path to lifelong learning for a doctor. Rest in peace, Dr. Stollerman.

continued from page 1LEARNING BY DISCOVERY

Neuromuscular diseases take a huge toll on patients and their family members. This poem expresses the grief I have experienced while serving as a caregiver to my mom, who suffersfromParkinson’sdiseaseandis in the late stages of Alzheimer’s disease. I feel that my mom’s grace during her illness has been unparalleled, and I wrote this poem as a tribute to her courage.

The DanceI saw the robin shake

and cough

Her fine plump breast she shivered off

And then her legs began to freeze

In the dark, dark forest of brittle

trees

Her fluids danced a reckless tune

And sallow face shown glowing moon

As light as feather trapped in lead

Her legs go there and here instead

This robin’s dance was not to fly

I hear her sing then watch her die

A Poem by Jane Obenour

3

Rawson Awards Clinic Star Awards

Comings And Goings

performers. Lack of enthusiasm for the profession among the current workforce will dissuade the brightest young students from embracing our profession and will surely erode the quality of physicians produced by our medical institutions. Disillusionmentamongphysicianswillalsoaffectthequalityofcareprovidedtopatients.Whilemonetarycompensationisan important consideration, it is also equally important to realize that medicine has a higher purpose, and it is imperative thatphysiciansderivesatisfactionandasenseoffulfillmentfromtheirwork.Suchcareersatisfactioncomesfromasharedsenseofpurposeandcannotbeenforcedbycommandsormonetarypolicies.Weneedasystematicapproachthatempowersphysicians and rewards them for their labors, while at the same time protecting time for leisure so that they have time to rest, relax, and enjoy their time away from the demands of patient care.

continued from page 1

Drs. Kayleigh Litton and Asha Pathak, PGY-3s, and Dr. TJ Mitchell, PGY-2, won the Rawson Award presented at the 2015 Department of Medicine Residents’ and Fellows’ Awards Dinner, which was held on Saturday, June 13, at the Ft. Loudon Yacht Club (venue provided courtesy of Dr. Rick Gibson and Dr. Bill Smith). This award is presented annually to 2nd and 3rd year residents who embody the spirit of teaching and possess excellent clinical skills.

The UT Internal Medicine Center was delighted to present Clinic Star awards throughout this academic year.  The recipients were Drs. Neena Agrawal, Aimee Wehber, Kendra Black, Christen Fleming, Andy Streicher, and Kristen McFarland. The Clinic Star of the Year award was presented to Dr. Christen Fleming at the graduation dinner on June 13th.  We wish to congratulate her on receiving this well-deserved award for her hard work and excellent interpersonal skills at the clinic.

COMINGSInternal Medicine PGY-1 Class Starting July 2015 • Azaria Ehlers, St. George’s University, Island of Grenada• Jonathan Angotti, University of Tennessee Health Science Center,

College of Medicine, Memphis, TN• Adam Price, East Tennessee State University, James H. Quillen College

of Medicine, Johnson City, TN• Spencer Pugh, University of Tennessee Health Science Center, College of

Medicine, Memphis, TN• Vimal Patel, Lincoln Memorial University, DeBusk College of

Osteopathic Medicine, Harrogate, TN• DennisLester,MarshallUniversity,SchoolofMedicine,Huntington,WV• Matthew Boulos , Edward Via Virginia School of Osteopathic Medicine,

Blacksburg, VA• Vamsee Lakkakula, St. George’s University, Island of Grenada• Lesley Jackson, Indiana University School of Medicine, Indianapolis, IN• Avi Das, St. George’s University, Island of Grenada• Jonathan Dewald, Ross University School of Medicine, Dominica• Amber Sholl, Edward Via Virginia College of Osteopathic Medicine,

Blacksburg, VA

Transitional Year PGY-1 Class Starting July 2015 • Charles Gaston, University of South Alabama, Mobile, Alabama• Laura Pruitt, Brody School of Medicine, East Carolina University,

Greenville, NC• Trevor Rosenlof, Tulane University School of Medicine, New Orleans, LA• Nathaniel Slater, University of North Carolina School of Medicine,

Chapel Hill, NC• Nicholas Sutton, Ohio State University College of Medicine, Columbus, OH• Jarred Tanksley, Vanderbilt University, School of Medicine, Nashville, TN

GOINGSInternal Medicine Residents• Andrew Christie is returning to Alabama to a hospitalist practice.• Christen Fleming is joining UT Internists at UTMCK.• Laura Green is starting an allergy fellowship at the Medical College of

Georgia.• Sarah Latif is going to practicing with her father, Dr. Muhammad Ismail,

in Anniston AL.

• Kayleigh Litton is staying at UTMCK to do a cardiology fellowship.• Mehul Patel will move to Chattanooga to be a hospitalist at Erlanger.• Asha Pathak will start an endocrinology fellowship at the University of Washington,Seattle.

• Harsha Ranganath has accepted a position as chief resident at Scripps Mercy Hospital in San Diego, CA.

• Molly Van Petten will return home to a hospitalist position in Atchison, Kansas.

Internal Medicine Class of 2015

Pulmonary Fellows:• Dr. Farhan Khan will start a Critical Care Fellowship at Orlando Health.• Dr. Dipaben Modi joins Pulmonary, Critical Care and Sleep Medicine at

Baylor College of Medicine.

Cardiology:• Dr. Harry South joined Hamilton Cardiology Associates, Hamilton, NJ.• Dr. Umang Shah starts an Interventional Cardiology Fellowship at

Hackensack University Medical Center/Rutgers, The State University of New Jersey.

Points of View

Pictured in front row from left to right: Drs. Asha Pathak, Harsha Ranganath, Kayleigh Litton, Sarah Latif, Mehul Patel, Laura Green Molly Van Petten,

Christen Fleming, and Andrew Christie Standing: J. Turner, MD, Rajiv Dhand, MD, Mark Rasnake, MD, Daphne

Norwood, MD, Juli Williams, MD

Kayleigh Litton Asha Pathak

4

In Touch Volume 4, Issue 3: July 2015

Publishers James Neutens, PhD, DeanRajiv Dhand, MD, Chair,Department of Medicine andAssociate Dean

Editor Ronald Lands, MD

Administrative Director SusanBurchfield,CAP-OM

Contributors SusanBurchfield Rajiv Dhand, MD Christen Fleming, MD Kandi Hodges Ronald Lands, MD Jane Obenour

Design J Squared GraphicsIn Touch is produced by the University of Tennessee Graduate School of Medicine Department of Medicine. The mission of the newsletter is to build pride in the Department of Medicine by communicating the accessible, collaborative and human aspects of the department while highlighting pertinent achievements and activities.

Contact Us In Touch University of Tennessee Graduate School of MedicineDepartment of Medicine1924AlcoaHighway,U-114Knoxville, TN 37920

Telephone:865-305-9340

E-mail: [email protected]

Web:http://gsm.utmck.edu/internalmed/main.cfm

The University of Tennessee is an EEO/AA/Title VI/Title IX/Section 504/ADA/ADEA institution in the provision of its education and employment programs and services.

Department of Medicine faculty, residents, and fellows share their knowledge and experience by publishing and presenting across the world. For a list of our most recent accomplishments, visit http://gsm.utmck.edu/internalmed/scholars.cfm.

Presentations, Publications, Awards

Thank You For Your SupportFor information about philanthropic giving to the UT Graduate School of Medicine, Department of Medicine, please contact the Development Office at 865-305-6611 or [email protected]. If you would like more information about any of the topics in this issue of In Touch, please contact the Department of Medicine at 865-305-9340 or visit http://gsm.utmck.edu/internalmed/main.cfm. We look forward to your input. Thank you.

Stay In Touch!Alumni, please update your contact information by completing the simple form at

http://gsm.utmck.edu/internalmed/alumni.cfm or by calling the Department of Medicine at

865-305-9340. Thank you!

CME Highlights and Future Opportunities

Welcome Dr. J. Francis Turner

The Third Annual Medicine CME Conference “Practice Updates and Skills Development for the Primary Care Physician” was held April 17-18, 2015, at theHolidayInnWorld’sFairPark.Thisyear’sconference included presentations on a variety of interesting topics, including management of the perioperative patient, congestive heart failure, and travel medicine. The internal medicine residents did an excellent job presenting interesting cases. Novel additions to this year’s conference were the workshops on joint injections, EKG interpretations, dermatology for primary care, and ordering CT scans and MRIs. The attendees enjoyed the

opportunitytogainhands-onexperience.Wearepleased that the conference has gained recognition over the years, as there were attendees from across the nation. The Heart, Lung, Vascular Update will be held October2-3,2015,attheUTConferenceCenter,Knoxville, TN. This conference is provided jointly by the UT Graduate School of Medicine and the UT Medical Center Heart, Lung, Vascular Institute. Please join us, as well, for our weekly Cardiology Conferences, and our Medicine Grand Rounds, which are generally held on the 2nd and 4th Tuesdays of each month for 1.00 hour CME credit.

J. Francis Turner, Jr., MD, assumed the role of Vice Chairman of the Department of Medicine in April 2015. He brings a wealth of clinical expertise inpulmonaryandcriticalcaremedicineandspecialexpertiseinthefieldofinterventional pulmonology. He has worked in university settings, in the Army system, and he served as DirectorofInterventionalPulmonologyandDirectorofCardio-PulmonaryServices at the Cancer Treatment Centers of America in Goodyear, AZ. He is the recipientofseveralawards,includingtheHarrisW.KnudsonAward:Excellencein Teaching twice at the University of Nevada School of Medicine, Internal MedicineResidencyProgram,theDepartmentofVeteransAffairsService

Award for Ten Years of Dedicated Service, and a Recognition Award for Distinguished Service for his ChairmanshipoftheAmericanCollegeofChestPhysicians(ACCP)e-AdvisoryNetwork. HewasmoderatoroftheLungCancerSymposiumatthe18thWorldCongressforBronchology&InterventionalPulmonologyandWorldCongressforBronchoesophagologyinKyoto,Japan,in2014.He was invited to serve as moderator of Symposium I: Detecting and Diagnosing Pulmonary Nodules at the Navigational Bronchoscopy Summit: Targeted Diagnostics and Targeted Therapeutics in June in Las Vegas, NV. Hehasservedasco-editorofthetextbookFlexible Bronchoscopy and currently is the Deputy Editor of the Annals of Occupational and Pulmonary Medicine. His research interests include early lung cancer detection and the mechanism to screen for lung cancer.