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Decisions, Decisions


 

When Weijen William Chang, MD, entered college, he pursued a path he believed would allow him to do the most public good: He majored in journalism.

Before long, he was frustrated.

“I’d gather all of this information and disseminate it and realize the general public could take that information and do something with it, or maybe it wouldn’t,” Dr. Chang says.

Inspired by his father—a family medicine practitioner in Bakersfield, Calif.—he began to consider becoming a physician. Upon graduating from Johns Hopkins University in Baltimore, he opted for medical school over journalism, and later matched to Duke University’s combined medicine-pediatrics residency program.

Dr. Chang (right) chats with a colleague at Rady Children’s Hospital in San Diego.

Dr. Chang (right) chats with a colleague at Rady Children’s Hospital in San Diego.

“On the plus side, I knew what I was getting into,” says Dr. Chang, an adult hospitalist at the University of California at San Diego Medical Center and pediatric hospitalist across town at Rady Children’s Hospital. “Having watched my father, I knew how difficult medicine was as a lifestyle. Beyond that, I felt by pursuing medicine, I was able not only to acquire information, but also to use it in an effective way for the benefit of at least a small portion of the public.”

Question: What lesson did you learn from your father that made you a better physician?

Answer: His idea that a physician’s priority is the patient sitting in front of him or her. He has a very single-minded emphasis on doing everything a patient needs—and advocating for that patient’s needs—regardless of their ability to pay. He’s one of those people who will drive to the hospital in the middle of the night to see a patient in the emergency room. That devotion really set an example for me.

Q: How did he influence your career path?

A: I really wanted to model myself after my father to some extent. I wanted to be able to treat people of all ages like he does. The things he did were mostly general medicine and pediatrics. That’s what drove me into that residency program. I think both fields complement each other very well.

I think most hospitalists are interested in fixing processes that are not working so well. I have a friend who is a nonmedical person who once told me, “Oh, you’re a hospitalist. Does that mean you fix hospitals?” He was joking, but in some ways, we’re not just treating patients, we’re treating the systems that support those patients.

Q: What led you into HM?

A: I worked in a community health center in a Boston suburb for many years after residency. I found I had the ability to change the health of my patients, but in terms of effectively changing the health of a large number of people, it’s a lot more difficult than it sounds when you interface with community leaders. It required a lot more politics than I preferred to undertake.

Also, the pace of it is not really my style. I think HM is the perfect blend. It’s a fast-paced environment in which I get to see the fruits of my labor almost immediately. From a quality-improvement standpoint, it allows you to directly change the health of the population going into your hospital, which can be a fairly large population.

Q: Do you take a different approach when you’re treating children than when you’re caring for adult patients?

A: You definitely have to have a different approach. In adult medicine, we take a much broader picture of things. In pediatrics, there is a much higher attention to the very fine details of a patient’s case. Very small changes can result in drastic differences in patient outcomes.

Q: How does that affect the physician?

A: On a very basic level, there is a much higher level of anxiety about your decisions. Every decision you make in medicine is important, but the decisions are more important in pediatrics in some ways, because any mistake you might make is multiplied by many more decades of someone’s life. I think that anxiety probably is appropriate. The population is so fragile, and there’s much more to be lost if things go wrong.

Q: Why don’t more physicians do both?

A: A lot of med-peds residents feel like it’s impossible to do both. Once they come to the conclusion they want to become a hospitalist, they almost feel forced to go one way or another. Certainly, it is more difficult to be a hospitalist in both fields, but on some levels I think it’s more rewarding to do both. You’re able to see the best of both fields and cross-pollinate two departments in terms of practices and QI efforts.

Q: You have an impressive list of QI projects and major committee assignments. What motivates you to be so involved in those aspects of your programs?

A: I think most hospitalists are interested in fixing processes that are not working so well. I have a friend who is a nonmedical person who once told me, “Oh, you’re a hospitalist. Does that mean you fix hospitals?” He was joking, but in some ways, we’re not just treating patients, we’re treating the systems that support those patients. Treating the individual patient remains the highest priority. But improving the system we’re in is, if not as important, at least the next most important thing to make sure we do the best job we can.

Q: You practiced at Massachusetts General Hospital for seven years, and you ran the Boston Marathon while you were there. How did that come about?

A: The chief of HM had developed a fellowship in international refugee medicine called the Durant Fellowship, and they were begging for any person to join the marathon team so they could raise money. I figured, it’s now or never, so I said, “Heck, I’ll do it.”

Q: Are you glad you did?

A: It probably was one of the most memorable and inspiring things I’ve ever done. All of the charity runners run together. Many of them are cancer survivors. When you see them running next to you, and you know they finished their chemotherapy treatments just a couple months ago, it pushes you to finish. It inspires you to see how much determination they have.

Q: You also took part in a two-week medical mission to Honduras. What was that like?

A: It was a great experience, not just medically, but personally. It was eye-opening to see the general conditions that large portions of Hondurans live in and how basic their needs are.

Q: Did it change your professional perspective?

A: It makes you realize how lucky we are in the U.S. in terms of our healthcare system, and it makes you realize how fragile in general civilization is. It gives you some perspective into just how basic the needs are of many people and how important it is to try to contribute any time you might have to volunteer work.

Q: What’s next for you professionally?

A: Probably continuing to do what I do right now. When you’re in an academic institution, sometimes you feel like a small cog in a giant machine. That can sometimes make you feel small. In other ways, it is liberating, because you don’t necessarily have to deal with all the administrative problems you have to deal with in a smaller program. That frees me up to do QI projects I’m interested in. TH

Mark Leiser is a freelance writer based in New Jersey.

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