There was just something about hospitalized patients and the folks who cared for them that drew the attention of Monal Shah, MD. Midway through residency, he decided that the best word for it was respect. For the doctors and the people they treated—respect.
“I also liked that [the hospitalists] had a depth of knowledge outside of clinical care that was still important in managing patients: e.g. what insurance pays for what service, how to facilitate outpatient follow-up appointments, the importance of social factors in preventing a patient from returning to the hospital, etc.,” Dr. Shah says. “Even though we weren’t in an outpatient setting, I really appreciated that holistic approach and knowledge base required to care for inpatients.”
That was more than a decade ago at the University of Texas Health Science Center in San Antonio. In the intervening years, Dr. Shah has become involved in clinical informatics and works with a nonprofit company developing prediction models and surveillance analytics for healthcare systems. He also serves as a physician advisor for Parkland Health and Hospital System in Dallas.
Question: I have your CV, but tell me a little more about your training in medical school and residency. What did you like most [and] dislike during the process? Was there a single moment you knew “I can do this”?
Answer: I really enjoyed the camaraderie of residency, especially when I was on an inpatient service and worked with a team [residents, interns, students, and attending]. I was fortunate to have an amazing group of people who inspired me to become a better clinician. I liked clinic the least. I still have days when I’m not sure if “I can do this.”
Q: What’s the biggest change you would like to see in hospital medicine?
A: With information overload, I feel like it’s pretty easy to figure out how to clinically care for a patient. For example, knowing which antibiotic to give for a certain infection is pretty easy to figure out. But knowing which IV antibiotics can/should be given in a nursing facility or at home is more nuanced and forces providers to address and think about the financial and social implications of healthcare. I think that it’s helpful for all specialties to have understanding about this, so the earlier that this type of training occurs (i.e., medical school), the better.
Q: Clinical informatics is clearly a growing area of interest for many. What about it appeals to you? How would you like to apply that knowledge to HM?
A: I found the EHR [electronic health record] to be very valuable, and it’s become difficult to imagine what it was like practicing in the pre-electronic era, but, with it, there definitely is information overload. Specifically, there is lots of duplicative/repetitive information coupled with new information (e.g. labs, vitals, imaging, notes) continuously being generated. Unless you’re sitting at the EMR [electronic medical record] or being notified every time something new appears, it’s almost impossible to know what is going on with the patient in real time. Clinical informatics has the ability to look for the most salient pieces of information—for instance, specific labs or radiology findings or specific words a clinician/nurse might use through natural language processing, etc. [We can] synthesize that information in real time to identify patients with certain diseases—like sepsis, where treatment with antibiotics is time-sensitive, or those who are at risk for adverse events. [We can identify,] for example, those patients at risk for cardiopulmonary arrest, readmission, etc.
Q: You’ve talked about access to data. How do you access the technology? How often? What about it works best for you? Is it something you wish older docs used more?
A: There is so much information ... that is constantly being generated [that] it makes it almost impossible to stay up to date on everything. Rather than even attempt to memorize every single treatment, I make an effort to know where to look for standard of care treatment regimens (e.g. ACCP [American College of Chest Physicians] anticoagulation guidelines, IDSA [Infectious Diseases Society of America] guidelines, ACC/AHA [American College of Cardiology/American Heart Association] peri-operative guidelines). I use technology daily, probably looking up something on at least half of the patients I’m taking care of [on] a given day.
Q: What is your biggest professional challenge?
A: Being able to say no.
Q: What is your biggest professional reward?
A: Students and residents that I’ve worked with who choose a career in HM.
Q: What aspect of patient care is most rewarding?
A: Seeing a patient get well enough to be discharged home or to a lower level of care.
Q: What’s the best advice you ever received?
A: Say yes to anyone asking for help in managing a patient.
Q: What’s the worst advice you ever received?
A: Say yes to every job opportunity.
Q: Did you have a mentor during training or early career? If so, who was the mentor and what were the most important lessons you learned from him/her?
A: My division chief, although he probably didn’t know it. He was firm and had a clear direction for the division/program; however, he was very affable and had a delicate touch when dealing with the other physicians.
Richard Quinn is a freelance writer in New Jersey.