hart, MD

Med school and more. Happy to share my wisdom on navigating the road to physician-ship. Current stage: MS4 at UT Southwestern. Explore my pages and some common tags.

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No union is more profound than marriage, for it embodies the highest ideals of love, fidelity, devotion, sacrifice, and family. In forming a marital union, two people become something greater than once they were. As some of the petitioners in these cases demonstrate, marriage embodies a love that may endure even past death. It would misunderstand these men and women to say they disrespect the idea of marriage. Their plea is that they do respect it, respect it so deeply that they seek to find its fulfillment for themselves. Their hope is not to be condemned to live in loneliness, excluded from one of civilization’s oldest institutions. They ask for equal dignity in the eyes of the law. The Constitution grants them that right.

Justice Anthony Kennedy, Obergefell v. Hodges

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I am opposed to heart attacks and cancer the way one is opposed to sin.

Mary Lasker

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A fundamental tenet of all medical care is the acceptance of patients as they are, for who they are, with respect and without prejudice or personal agendas.

In Support of Same-Sex Marriage

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Impressions of Brazil

A few thoughts about medicine in Brazil, after spending 8 days at HFSE in Rio de Janeiro:

All the doctors were amazing! This is a wonderful Brazilian culture and these are wonderful people. For not even doing a legitimate rotation, I sure never expected to receive the level of personal attention that I did. From day 1 and to the very last minute people were legitimately concerned with my learning and my experience.

I spent most of my time on infectious disease services or on ID clinics, about half of which was just HIV. I enjoyed it quite a bit. The biggest surprise was the wide prevalence of syphilis (40%?).

Generally speaking, the culture of medicine here is way more relaxed. To give you an idea, Monday after Easter I showed up around 8:30; about 3 hours too early! Clinics themselves do tend to get going around 9-9:30, but it's not at all a problem if you're a fellow rolling in at 11 AM! Even on inpatient residents don't arrive until about 8 AM (say what?) And they all lunch except one. Crazy!

On the downside, doctors are quite poorly reimbursed. Medicine as a career is just not as well respected or protected as in the United States, or even in Peru. One resident suggested that this is why more men don't go into medicine (see below)? Residents and starting out physicians end up doing a lot of “plantão” to make ends meet - basically moonlighting, only per hour it pays about 10 times more than the public employment rate. It may include 24 hour call once a week, which made the interns shudder! Another indicator that quality of life is a really big deal.

An internist, or primary care in general, is not a feasible career. You really only do internal medicine so you can specialize later.

 Interestingly, pediatrics just barely became a three year residency (from 2). Internal medicine is only two years.

There is no HIPAA here. I think that kind of concept is not really so important here.

The médicos in Brazil are about to be replaced whole scale by the médicas. At first I thought it was just because I was on pediatrics, but then the interns (5th-6th year med students) told me their class was 75% female.

I heard the comment “Mas ele fala bem!” (he speaks well) about a dozen times. This showed me both that they were impressed with my Portuguese and that it in fact wasn't that great. Why else keep talking about it? This is quite close to the truth I’m sure.

Lastly, and this needs to be the subject of another post, but residents and faculty alike were all quite curious: why did I come to their hospital in Brazil? On a superficial level it's easy to relate my personal history, but what is it that brings me here? What am I meaning to accomplish in my career and personal life? These are questions worth pondering.

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Awesome note from the mother of a very unfortunate little girl who got sick while visiting Brasil.

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Post Match Advice for Med/Peds

A few pieces of advice for sharing at the post match panel.

Before you make your list, try to find out what is important to you, both in terms of location and quality of program. I, for example, I wanted to live in a larger city with an active population and good access to the outdoors. In terms of the program, I felt that working at a large pediatric hospital would best cater to my interest in inpatient medicine.

Along the same lines, the most highly rated programs may not nearly be your own best programs. I do regret not applying to one program that matched a lot of what I wanted just because I was talked out of it for being a “poor” program.

Med/peds was apparently very competitive this year, different than years past. It also continues to have a low number of spots at each program (most are 4 or 6). This greatly increases the odds of not only missing your first choice, but of also falling significantly further down your list.

On the trail don’t trust a single thing any of them tell you! They may truly love you and think you’d be a great resident at their program, but that doesn’t mean there aren’t 50 other applicants they actually think are better.

Don’t set your heart on anything. It may have just been a bad year at UTSW, but I personally know relatively few classmates who actually matched to their first choice.

Now for post-match.

Alas, we don’t get everything we want. After the match, I’ve found it best to admit that, despite my ideas, I don’t really know what’s best for me. For example, working at a small pediatric hospital likely means it is “resident-driven” as opposed to “fellow-driven,” which could translate to more autonomy.

Be grateful for matching in your chosen residency! When it comes down to it we’ll all be doing the same job no matter where we train. Some of us don’t get to do what we want, and others don’t even have a job.

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A few pics of my 2 week visit to a hospital in Rio de Janeiro, primarily to the infectious disease department. I'll try to share some thoughts later.

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My Personal Statement for Residency

Just a few years ago I found myself at a major crossroads with regard to my faith as I finished my undergraduate degree at Brigham Young University. I grew up in a hard-working family in rural Idaho, one of seven kids. The Church of Jesus Christ of Latter-day Saints, also known as the Mormon church, was central to our lives, and I was raised to be a devout believer. The culmination of my Mormon experience came during the two years I spent as a missionary walking the streets of São Paulo, Brazil. Sharing my beliefs in a new language and in a foreign country was terrifying at times, but I quickly grew to love the Brazilian people and culture. I found great satisfaction in teaching and mentoring the new members, and many of them became good friends. I sincerely believed that helping them adopt the Mormon religion was the best way to serve them. Upon returning to my studies I certainly never intended to abandon my religion. Life is unpredictable, though, and over the next few years my faith began to fade. My last year at BYU was quite difficult, spent largely in isolation, since I felt unable to confide in my faithful family and friends. Soon enough I made the long drive to Dallas all alone. I didn't know it then, but in just a few short months I was about to leave my religion behind for good.

I arrived in Dallas a few months before medical school began to teach an intensive, “boot-camp” MCAT preparatory class. My students were all members of the Joint Admission Medical Program (JAMP) which meant they came from economically disadvantaged backgrounds and from underrepresented minorities in medicine. For five full weeks we did nothing but MCAT. We taught classes in the morning, held private tutoring sessions in the afternoon and evening, and at night we prepared our lessons for the next day. The work was quite draining, but it was one of the most meaningful experiences of my life. I loved getting to know each of my students. They came from difficult personal situations, but nonetheless demonstrated an impressive determination to succeed. Investing in these students was a cause that I believed in. It had been a long time, not since my mission in fact, that I had been motivated and impassioned in such a way. After the struggles of the preceding years, my JAMP experience was like a breath of fresh air. I realized then that I wanted and needed to be involved with mentoring and teaching throughout my life and medical career.

Working with the JAMP students was a wonderful experience, particularly because it came at an especially vital time for me. Teaching and mentoring gave me a higher cause to invest in which helped to partially fill the void left by my broken beliefs. I made it a priority to embrace this cause while moving forward through medical school. I was an instructor of MCAT, biochemistry, and English (ESL) classes. I mentored another batch of JAMP students as well as a high school junior. When I began my clinical years I learned that each of my patients was also a student. I had some of my most memorable, uplifting experiences as I sat in counseling with them. Teaching is at the heart of effective medical care, and heartfelt concern for the student – or the patient – is at the heart of effective teaching. For me, there is nothing more gratifying than investing in the growth and well-being of another. I am very grateful for my teaching opportunities. I look forward to pursuing my medical career in a medical specialty where patient education is of prime importance, as well as in an academic environment where teaching opportunities and mentoring relationships are encouraged and supported.

Teaching was only part of the answer, however, as I tried to make sense of my life after Mormonism. Losing my religion was the most disorienting experience of my life. The past few years have been quite challenging, but now I can appreciate how the hard times have helped me to grow and mature. As I have struggled to form my own identity, I have learned to not shy away from my past, but rather embrace the strengths of my upbringing even as I forge my own future. I have become much more comfortable with myself and confident in my abilities. I have lost much of my sense of ethnocentricity; I am much more curious about and appreciative of the wide variety of cultures and religions in the world. I have learned that my faith is not really dead; it has simply shifted loyalty to a more universal belief in the value of building up and serving humanity. As I have shared my story with others, I have realized that my silent personal struggle was really not that unique. Understanding this has made me much more sensitive to the suffering of my friends or colleagues. I know how important it is to find kind, nonjudgmental support. That was key for me. I have learned to value emotional and mental health just as much as physical health. All of these lessons have come at a personal price, but I am grateful for them. I am a better person than I was before. These lessons will help me become a more effective and empathetic physician. I feel content for the road I have traveled and am excited to dedicate my career to being an excellent teacher, mentor, and clinician.

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The Match

The Match caught me by surprise, but after letting the news sink in for a day I’m happy to share that I’ll be completing my med/peds residency at Rush University in Chicago!

A few things about Rush I’m excited about:

It’s a beautiful new hospital, with gorgeous views of the Chicago skyline!

It’s all in one campus. That will make life in a big city much more simple.

My fellow residents, the program director, the faculty and the staff are all lovely people. I had a very pleasant visit with them there.

I’ve had some reticence about the small size of the pediatric population served there, but the flip side of that is that there are not many fellows around so residents ought to end up with a lot more autonomy. 

Perhaps most importantly, I know that I am wanted there.

A few things about Chicago I’m excited about:

It’s Chicago! What an awesome city.

This may sound really odd, but I can likely live without a car! I’ve always wanted to have that kind of living arrangement. It looks like public transportation will cost around $100 monthly.

The seasons! I will have to buy a LOT of warmer clothes though.

It’s a very active city generally. I’m sure I’ll enjoy more than a few bike rides down the lake shore!

All of a sudden I have a lot of friends spread throughout the residency programs there in the city!

I can’t say that the match went exactly as I had dreamed about (dreaming is dangerous btw), and I have a leading theory about that, but regardless it’s impossible to know whether what I thought I wanted is actually what is best for me. 

Two days ago I finished my PICU rotation watching a beautiful baby boy finally get extubated. We all smiled when at last he was able to be held by his thrilled parents. It was a beautiful moment as he began to re-stretch those vocal cords and start to whimper. 

When it comes down to it, as long as I am able to continue to have those kinds of experiences the rest doesn't really matter. As long as I can invest both in my patients as well as in my own personal development I can’t ask for anything more. Rush in Chicago will be a wonderful place to continue on this path. See you soon Chicago!

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I was taught an excellent lesson today given by a seasoned clinician on mechanical ventilation. More than just learning the proper management of restrictive versus obstructive pathology, however, I learned the bigger lesson of how a thorough understanding of the underlying physiology and actively thinking about those principles is essential to helping -- and to prevent harming -- your patient. That is a sign of a master clinician.

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The ABIM is not what it was. Its original mission was to make sure doctors provide patients with the best care. When condominiums and lavish salaries and free trips and making money off of physicians failing tests became a priority, the evidence suggests the organization lost its way. But that may not matter soon. In January 2014, when the ABIM issued a series of new requirements for maintaining certification—that would have generated all new fees—Teirstein and his colleagues declared “enough.” They recently formed a new recertification organization called the “National Board of Physicians and Surgeons.” It will only consider doctors for recertification who have passed the initial certification exam that has been required for decades. Doctors must also log a set number of hours with programs that qualify under guidelines as continuing medical education. The group’s fees are much, much lower than those charged by the ABIM. And its board and management—all top names in medicine—work for free. This new board is not just about breaking the ABIM monopoly, Teirstein says, but is also part of an effort to put the right people in charge of the profession’s future. Medicine has been “controlled by individuals who are not involved with the day to day care of patients,” he says. “It is time for practicing physicians to take back the leadership.”

The Ugly Civil War in American Medicine

The article does seem pretty biased, but the ideas emphasized at the end are very appealing. It will be interesting to see how this plays out.

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Helped out with hepatitis screening today for Korean and other Asian communities here in DFW. This was my lunch reward.

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T-minus two weeks until match day! Who's going to get lucky??

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My favorite souvenir from Peru: moto taxi. Rides cost about 30 cents. The model cost me around $3.

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We got to tour the new Parkland today. This mammoth of a public hospital is 2.1 million square feet (compared to 1.2 million for the old one) and cost just over 1 billion dollars and over 4 years to build. Gone are the shared, curtained rooms. In are about 860 handsome, technologically advanced private suites. When coupled with the brand new Clements University Hospital (not to mention the beautiful Children's Medical Center) the new Parkland guarantees beautiful facilities will be a legacy of UTSW residencies for years to come.

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A few pics from my month of pediatrics at UPCH in Peru. It was a great experience, thanks to all the residents, interns, and faculty!

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Celebrating cultures at UTSW for the last time. Good job class of 2015!