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The Mentalist


 

Kelly Cunningham, MD, acknowledges she followed a “pretty traditional” path into medicine. She can’t point to one role model or a single experience that sparked her interest in the field. Rather, she felt medical school would be the ideal way to combine her love for biological sciences, her passion for helping others, and her desire to make a difference.

But Dr. Cunningham didn’t have to wait long for career inspiration. “When I was doing my initial clinical rotations, I had very good hospitalist mentors,” she says. “I started thinking, ‘I really like your job, and I can see myself wanting to be like you.’ ”

Those mentors developed Dr. Cunningham’s interest in quality improvement (QI) and patient safety, which tied in well with hospitalists’ evolving role and complemented her interest in caring for medically complex patients. “I’m a thinker, so I realized early on internal medicine was a good fit for me,” says Dr. Cunningham, an assistant professor of medicine at Vanderbilt University in Nashville, Tenn., and an attending physician at Vanderbilt University Hospital and the Veterans Affairs Medical Center in Nashville. “It became clear I wasn’t going to be a surgeon. I don’t like to fix things using my hands. I like to fix things using my mind.”

Studies show it’s not uncommon for patients to not know the name of their treating physician in a hospital or to not know their diagnosis or to not know why they’re taking a certain medication. It comes down to taking the time to talk to patients and empower them to take an active part in their medical care.

Question: How do you balance your academic appointment with your clinical responsibilities?

Answer: That’s the biggest challenge for me. I went into hospital medicine first and foremost because I enjoy taking care of patients. But I really like teaching. I’m very interested in working with residents and students. I’m at the point now where I’m starting to have to say no to things and prioritize a bit just to maintain my sanity.

Q: Does one aspect of your career complement the other?

A: Absolutely. You can’t do clinical activities or academic activities in a vacuum. In order to be a good clinician, you need to have the perspective of being able to ask research questions or understand how to teach and be able to tie QI activities into your daily work. On the other hand, I don’t think you can be involved with a residency program without having the knowledge of what it’s like to be on the front line of patient care.

Q: What do you find rewarding about working at the VA?

A: The physicians who are working in the VAs very much appreciate veterans’ service. They enjoy sitting down with them and hearing their stories and seeing them as people. In turn, the veterans are very grateful for the care they receive. Most veterans only receive care within the VA system, so it’s kind of like its own community, and I really like that.

Q: You are passionate about improving the quality of care transitions. What sparked that interest?

A: When I was a resident at Emory University, much of my clinical work was at Grady Hospital in Atlanta. The patient population tends to be underinsured and doesn’t have great access to healthcare. On the day of discharge, we’d give them the right instructions and the right prescriptions, and we’d schedule a follow-up appointment. Two weeks later, they were readmitted. We’d find out they didn’t understand the instructions, couldn’t afford the prescriptions, or didn’t go to the follow-up appointment. It made me realize how important the transition is between hospital and home, and what a vulnerable time it is for patients.

Q: How can hospitalists help improve those transitions?

A: It’s about doing the right thing and providing good customer service. Studies show it’s not uncommon for patients to not know the name of their treating physician in a hospital or to not know their diagnosis or to not know why they’re taking a certain medication. It comes down to taking the time to talk to patients and empower them to take an active part in their medical care.

Q: How do you respond to someone who says there’s not enough time?

A: It’s critical to being a good physician. Sometimes when I’m taking care of 15 or 20 patients, it’s easy to think about cutting corners. But this is one area where it’s not worth it to cut corners.

Q: What is your biggest professional reward?

A: Working with so many trainees and being able to help shape their career path or interest. At the end of a rotation, if they tell me they learned something from me—not necessarily facts but something that they feel will make them a better doctor—that truly is the most rewarding thing.

Q: What advice are you giving to the next generation of hospitalists?

A: It’s important for them to realize that residency is not always completely representative of the real world.

Q: How so?

A: Since the Accreditation Council for Graduate Medical Education is becoming more strict with work hours and workload, the doctors who are graduating from residency now may not have as much clinical experience when they’re coming out of residency and transitioning into their role as an attending physician or practicing hospitalist. … When I was a resident, I was taking care of 12 or 15 patients. As a hospitalist, I’m sometimes taking care of 20 or 25 patients. Being aware of the workload and how to balance work with the rest of your life is something I didn’t have a great perspective into when I started.

Q: How will the ACGME duty-hour changes affect HM?

A: Interns can only work 16-hour shifts. Who is going to take care of patients when interns have to take a nap or go off shift? Who will pick up all of the resident duties? A lot of it is going to fall on the hospitalists. We can increase our workload, but at what cost? We still need to maintain job satisfaction and have a career that is sustainable and desirable.

Q: Do you see any other solution?

A: Doctors spend a lot of time doing activities that don’t require a medical degree. I think a lot of case managers, midlevel providers, and ancillary support will help us improve our efficiency and workload to help our resident teams while still helping us maintain our sanity.

Q: What’s next for you professionally?

A: I’m finally at the point where I’m starting to define my niche academically. On the clinical side, I really enjoy the variety of the work I do. I’d like to get involved more with handovers within the hospital and also medication reconciliation. Those are two things I’m involved in on a small scale, but they are priorities for the medical center.

Beyond that, I want to try to balance everything and be more selective when choosing opportunities that come my way and be thoughtful about how they fit with my work before just saying yes. TH

Mark Leiser is a freelance writer based in New Jersey.

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